Dr. Robert Weissfeld
Credit to Drs. Craig Buhler, Spence Williams & illustrator Morgan Williams
Background: Musculoskeletal problems are by far the most costly and prevalent group of maladies we face in the U.S. and weakness of individual muscles — clinically revealed through manual muscle testing — can probably be found in every condition. Muscle weakness is listed as a factor in most named problems — e.g. plantar fascitiis, whiplash, tennis elbow. It is also routinely found in 'non-specific' or unexplained problems, most notably low back pain. Weak muscles can also be found in non-symptomatic areas. Diagnostically known as muscle inhibition, it is nonetheless missing from the 70,000 codes of the International Classification of Diseases. While several mechanisms that may describe the onset of inhibition are well accepted, research fails to present a mechanism for the ongoing persistence of the condition, which is known to outlast even 'successful' healing by decades. Resistant to even aggressive physical therapy and targeted exercise, muscle inhibition is essentially a permanent condition.
Hypothesis: Muscle inhibition is sustained by maladaptive learning. Specifically, previous incidents have inculcated (unconscious) beliefs that use of particular muscles will lead to bad outcomes, creating automatic avoidance of use of those muscles.
Method: We experimentally attempt to treat muscle inhibition by applying a psychotherapeutic technique theorised to erase maladaptive learning by blocking ‘memory reconsolidation’ -the re-storage of memories rendered unstable following recall. Saccadic eye movement (as used in Eye Movement Desensitisation and Reprocessing (EMDR), an accepted therapy for post traumatic stress) is performed by subjects immediately after testing each weak muscle. Experienced muscle testers applied the method on 136 randomly selected weak muscles in 8 subjects.
Results: Eye movements immediately strengthened 91% of muscles, with 84% remaining strong 15 days later. Just over half those muscles 'spontaneously' recovered, assumedly a vicarious effect from the treatment of preceding muscles. In a control group of 42 weak muscles, 88% remained weak over similar time period.
Case history: A case history applying this experimental method as the primary therapy adds practical understanding.
Conclusion: This experiment suggests a novel model of muscular PTSD (mPTSD), in which memories of stress and trauma become associated with the use of certain muscles (or specific vectors of movement) leading to chronic avoidance of use of those muscles. Erasing the information from the brain that led to that avoidance is the putative mechanism of cure. A simple treatment for inhibition (mPTSD), if broadly accepted, will be a disruptive innovation in musculoskeletal care, which has been ignoring muscle inhibition in both its studies and treatments for over a century.
Indexing Terms: Muscle inhibition, PTSD, chiropractic, theory, hypothesis.
Cite: Weissfeld R. Mind, trauma & muscle inhibition Part I: Experiment and case history yield novel theory of muscular PTSD [Hypothesis]. Asia-Pac Chiropr J. 2021;1.3.
Academia Summary of this paper
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The hypothesis we are putting forth is that chronic weakness of individually tested muscles, more technically known as 'muscle inhibition', is sustained by maladaptive memories, making it similar to some descriptions of post traumatic stress disorder (PTSD). Therefore, adding 'm' for muscle, we will refer to this entity as the mPTSD model.
Muscle Weakness, An Egregiously Ignored Issue
In addition to the arthrogenic reflex, pain, (Falla et al., 2004Hodges & Tucker, 2011;Le Pera et al., 2001;Mense, 2008;Muceli et al., 2014) psychological stress, (Hudes, 2011;Stone et al., 2010;Van der Ploeg & Oosterhuis, 1991) and biochemical or organ stress, (Gangemi, 2006;Hoffman & Mendel, 1977;Schmitt & Yanuck, 1999;Walther, 2000, p. 14) have all been said to promote at least acute weakness of individual muscles. Muscle weakness without atrophy is also thought by some to result from the presence of trigger points in muscles. (Mense, 2008, p. 18) Regardless of the initial cause however, inhibition can become chronic, affecting any voluntary muscle in the body.
Beyond Muscle Inhibition, A Second Ak Treatment Paradigm
The mPTSD hypothesis being presented grew out of observations that ensued from my investigation of a new way to treat inhibited muscles that began in about 1993, an early attempt that would develop over several decades. The mechanisms of this method are unknown however, meaning that it is not evidence that can be used to substantiate the hypothesis, so we will only offer a superDicial description here. Nonetheless, the results I observed from working in this way show what is possible in the treatment of muscle inhibition.
Treating Muscle Weakness As (Mal)Adaptation
These treatments routinely reverse weakness in many muscles at once, bulk erasure of inhibition, we might say. There seems to be little relationship between the severity of symptoms, the number of muscles that are weak, the chronicity of the problem, and the treatments that are required. The muscles in a chronic case with severe symptoms may require a similar, seemingly trivial or random treatment as an acute, symptomatically mild condition.
A New Understanding Of Memory Allows For Unlearning
If muscle inhibition were a learned phenomenon, a logical speculation would be that testing of an inhibited muscle would activate the memory that is sustaining that inhibition. That memory, according to the reconsolidation model, would then be destabilised. With the memory destabilised, the application of some agent that could block reconsolidation would cause the memory to be lost.
The test is isometric, with the force of the examiner and subject equally matched such that in a normally facilitated or 'strong' test, the limb remains stationary throughout. Performed on neurologically healthy individuals, the SMB test has been demonstrated to produce a binary result; either the muscle is found to lock in place from the outset of the test or it does not, beginning to give way immediately upon testing. (Caruso & Leisman, 2000Conable & Rosner, 2011) (We analyse the use of muscle testing to determine inhibition in Part III of this series.)
A Mechanism For Muscle Inhibition
In the experience of practitioners who rely on muscle testing, most inhibited muscles test as a 4 (on the 0 through 5 scale). Though they break away immediately, measurable resistance is still occurring. (Caruso & Leisman, 2000;Conable & Rosner, 2011) Further though, the clinical experience in which patients unconsciously avoid positions that would rely on those muscles is more proof of prior knowledge of inhibition in the MCS.
Explaining The Results Of Immediate Treatment Following Injury
Whatever mechanisms initially led to the inhibition of a muscle -the arthrogenic reflex, pain, emotional or organ stress -the resulting avoidance is logically only the Dirst stage muscle inhibition. In the second stage, new muscle synergies must be created which substitute other muscles for the ones that are now considered unreliable.
Ak Protocol And Trauma Learning
If this is in fact the mechanism underlying muscle inhibition, the AK protocols, which also offer ongoing resolution of muscle inhibition, must, it seems, also be erasing the memories that have resulted in chronic muscle weakness. (This includes both the basic AK protocol and AMIT ® , the advanced version of Beardall's protocol, which addressed 300 muscles bilaterally and was perfected by Buhler working with NBA players.) There is no obvious answer as to how this might be occurring, but we can speculate several possibilities.
The Remainder Of This Series
In Part III, we examine muscle testing when done for the purposes of discovering muscle inhibition. We will conclude that the type of testing outlined for the above experiment may be superior even to 'objective' tests that are now applied in studies for determining whether a muscle is inhibited or not.
Part I of this series experimentally validated a hypothesis that muscle inhibition (the ongoing weakness of individual muscles clinically revealed through manual muscle testing) is sustained by trauma-induced maladaptive learning; a muscular form of PTSD (mPTSD). It demonstrated that about 90% of inhibited muscles would immediately strengthen, and 80% would remain strong over a period of weeks, when treated only with side-to-side eye movements, a part of EMDR, an accepted intervention for PTSD. This therapy has been theorised to gain its effects by interrupting reconsolidation (re-storage) of activated (recalled) and therefore destabilised memories.
Currently, muscle inhibition is ignored and considered untreatable in most musculoskeletal specialties. The chiropractic subspecialty of Applied Kinesiology, however, has been reversing muscle weakness for over 50 years, but because of a dearth of reporting and studies of the treatment, it has gone unnoticed in most muscle inhibition literature. A 20 plus-year demonstration of correction of muscle inhibition in the NBA has left statistical and other evidence suggesting what is possible when the condition is routinely treated. Particularly striking is the finding that when treated immediately, mild to moderate sprain-strain injuries can recover in minutes, not weeks, putting into question universal assumptions we hold about the nature of tissue damage in injuries.
Muscle inhibition, PTSD, chiropractic, theory, NBA, Applied Kinesiology.
Because pain itself may be a contributor to the development of muscle inhibition, and inhibited muscles may remain that way inde6initely, muscle inhibition is ubiquitous, certain to be present either as a cause or result of pain. Its resolution should therefore be a central goal of musculoskeletal research but instead the condition languishes in almost complete obscurity: the weakness of individual muscles is not among the 70,000-plus codes in the International Classi6ication of Diseases, an attempt to exhaustively list all human maladies. (Weissfeld, 2021) Here, in Part II of this series, we will look at a treatment protocol for muscle inhibition that has been around since the 1960s known as Applied Kinesiology (AK).
Half A Century Of Treatment Of Muscle Weakness
This original protocol evaluates individual muscles one at a time, a well-accepted use of MMT in orthopedic and neurological contexts. This is different from what has been called 'muscle response testing' (MRT), in which a single muscle known as an 'indicator muscle' is tested repeatedly to determine responses to sequentially presented stimuli. (Jensen, 2018) MRT is has been shown in several studies to be both reliable and valid.
Expanding The Number Of Testable Muscles
From his experience treating the same small group of top athletes before and after games over years, Buhler concluded that if the entire protocol, which takes about 10 minutes to complete for each muscle, is not followed, that the muscle corrections might not hold. From conversations with AK practitioners, it appears that many do not utilise the full protocol, only the aforementioned origin-insertion treatment, and many may not utilise testing of the expanded set of muscles. As we discuss the results attained by Buhler with the Utah Jazz players, it is with the understanding that this full protocol was being administered on the full set of muscles.
Treatment Of Muscle Inhibition In The NBA
He states that in addition to resetting the alignment of the bones of the ankle, he treated several divisions of Stockton's peroneus muscle, known to be negatively affected by ankle inversion sprains. (Palmieri-Smith et al., 2009) Buhler also believes, as he implies in the video, that because of his previous treatment of Stockton, his tissues were more resilient and 6lexible, unrestricted by the usual defensive tension that occurs when the brain adapts to the instability caused by muscle inhibition. According to the logic of the re6lex treatments, inhibited muscles have reduced circulation, meaning less resources reaching them.
In Part III of this series we will take a new look at the phenomenology of muscle testing, and how that plays into the evaluation of muscle inhibition. In Part IV, we will look into the psychoneurophysiology of mPTSD, evaluating potential mechanisms for the ongoing weakness of individually tested muscles.