Those of us who have used muscle testing outcomes as a basis for determining proper therapeutic intervention had unwittingly become restricted by the very same therapeutic methodology we had so fervently adopted. Muscles, Testing and Function by Kendall, Kendall and Wadsworth is considered a classic text describing muscle testing technique and parameters. These authors declare in the 1971 edition that muscle testing is an integral part of physical examination. It provides information, not obtained by other procedures, that is useful in differential diagnosis, prognosis, and treatment of neuromuscular and musculoskeletal disorders. Accurate muscle testing, as described in the book, was focused on determining the site and extent of nerve lesions. The concept of muscular strain and stretch lesions is also included.
Even though the previously mentioned book is an excellent resource, we found ourselves obliged to develop novel muscle testing procedures at the time many of us are clamoring for more standardized classical testing methods. While standardized or classical testing are essential, they are also limiting and should truly only be used as a starting point in our quest to become congruent with the unique needs of the case we are treating at that moment.
The need for novel testing procedures was a result of an increase in understanding acquired as we investigated the particularities of neuromuscular dysfunction. Initially, we continued to test muscles in the classical fashion until such time as we began to understand its inherent limitations.
The new understanding that we have come to, during the several years necessary to develops this work, has shown to us that proprioception, in all its forms, and also the way the central nervous system processes that proprioceptive information, is paramount in determining neuromuscular responses throughout the body. Motor function is not determined just by the motor system. Any form of proprioception can be the decisive modifier of motor function. Undoubtedly this reflects the complex interactions of the spinal interneuron pools and more central interactions.
Once we understood that we were only using a small part of the proprioceptive receptor fields available to us to determined our interventions we broadened our investigations to include other proprioceptive fields. Heat, cold, pressure, light touch, joint position sense, vibration, pain, and others all have their place and any one of these may be decisive in the outcome of a therapeutic intervention. We now have greatly expanded therapeutic options.
Most of the neuromuscular dysfunction we are trying to correct in consultation is not the result of some lesion or aberrant function inherent to the muscle under consideration. The real problem is that the central nervous system has come to a bad solution based on the proprioceptive information it has received. If we can find a way to demonstrate to the central nervous system the nature of its error, the central nervous system will instantly modify the neuromuscular responses. This is the beauty of P-DTR.
Jose Palomar
