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From the Townsend Letter
January 2015

Correlation of Manual Muscle Tests and Salivary Hormone Tests in Adrenal Stress Disorder: a Retrospective Case Series Report
by Scott Cuthbert, DC; Anthony Rosner, PhD, LLD[Hon], LLC; Trevor Chetcuti, DC, DIBAK; and Steve Gangemi, DC, DIBAK
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As in the Jacobs and Moncayo studies mentioned previously, the interaction between thyroid dysfunction, nutritional support, and muscle strength is indicated in a study by Leaf. 92 Participants participating in the study answered a survey containing thirty symptoms relating with either hypo- or hyperthyroidism. The study was done to determine the effect on a weak teres minor muscle of putting nutritional substances on the skin or in the mouth. Four nutritional substances – niacinamide, vitamin E, inositol, and thyroid extract – were placed on the skin, and the teres minor muscle was retested for strengthening. The substances were then put in the mouth, and the teres minor was again tested for strengthening. Placement of the nutrition on the skin produced a random response. This study suggests a selectivity of chewed nutrition affecting an apparently associated muscle.

Naturally, the alterations found both symptomatically and in steroid metabolism as measured with the ASI or the AK MMT in this report are unlikely to be the only route to a complex state such as stress syndromes, but perhaps describe a distinct and identifiable subset of vulnerable individuals.

This notion has some predictive implications. It might be possible, perhaps early in life, to identify individuals with reduced glucocorticoid metabolism who are at increased risk of stress-related illness and related disorders on exposure to trauma later in life. To test this, it will be helpful prospectively to follow cohorts such as the offspring of women who had significant ASD during their pregnancy. It also implies that use of adrenal gland nutritional support during the early phase of development of symptoms may aid in the reversal of this condition in vulnerable individuals and their children. Recent clinical evidence suggests that this might be the case.99–102

More research is needed before there will be a thorough understanding of the relationship between placing nutrition upon the tongue and the performance of a muscle when tested manually. One of the major problems in designing a research study is the number of factors that influence the manual muscle test, such as the cranial-sacral primary respiratory system, neurological reflexes, joint and muscle injuries creating arthrogenic muscle inhibition, and many others. As Goodheart first pointed out, ''… the nutritional factor is only one component of the composite whole of the particular problem posed by the particular patient."74

A primary limitation of this study was that it did not include patients without ASD; as a retrospective case-series report on patients with ASD, patients who undergo salivary assays usually have some form of ASD. Controls without this condition presenting to the clinician's practices were not common enough to create a control group.

Another limitation was that participant adherence to the study protocol could not be strictly monitored during saliva sample collection. Because waking samples were requested, adherence was left to the fidelity of each participant to follow the outlined procedure.

It is a weakness of our study that the sample size was limited and gender distribution was uneven. These factors made gender-specific statistical analyses less meaningful due to a low sample power, and we have therefore based our analyses on groups consisting of both men and women. Given the higher incidence of ASD in women (such as anxiety), this may represent the normal distribution of such conditions.

The next steps of objectifying possible measurable muscle impairments associated with ASDs are to increase the sample size; to study patients in other situations involving physical, biochemical, and psychosocial imbalances resulting in stress-related symptoms; to develop an appropriate control intervention; to solve the problem of blinding and double-blinding; to find additional steroid hormone disturbances that may be assessed by the AK MMT; and to compare the treatment effects of AK with other methods that reduce adrenal stress symptoms.

Finally, the effectiveness of the manual muscle test for diagnosis in this arena can only be established following a full-scale, randomized, controlled clinical trial with adequate follow-up and homogenized samples. A follow-up study showing the effect of AK treatment upon abnormal salivary cortisol values is currently under way.

This study supports a number of previous reports, showing that gustatory receptor-based sensorimotor challenges such as the ones used here may permit the clinician to assess the impact of biochemical substances on patient neurophysiology and muscle function. This approach may afford clinicians the use of an interactive means by which to predict the clinical utility of a given substance for a given patient with ASD. If true, this would represent a significant conceptual expansion of the standard nutritional examination process.

We believe that the correlations obtained between AK MMT findings and salivary hormone tests in cases with ASD are a first step in suggesting that MMT is a potentially useful, inexpensive, noninvasive tool in the assessment of a primary endocrine dysfunction in the general population.

Corresponding Author
Scott Cuthbert, DC
Chiropractic Health Center, PC
255 West Abriendo Avenue
Pueblo, CO  81004


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