With the MyoKinesthetic System, there are two ways to perform an evaluation, one is fast and easy, the other takes a little longer. I like to call these the “Calculator” way and the “Long Division” way. The Long Division way is the original method I developed to determine a problem. It is much more reliable. However the faster way gets you to the correct problem 65%-80% of the time.
With Long Division, you do a postural analysis and, if needed, functional muscle testing to determine the nerve problem. A postural analysis can be very detailed. The easiest way to determine a nerve problem from posture is to look for gross abnormalities, making postural analysis very quick. We evaluate the head to determine a nerve problem by looking at four postures:
- Lateral Flexion
To get a true reading, we have to do a “Yes/No” test. There are five righting reflexes in the head; the eyes are the biggest factor. The brain will ALWAYS make the eyes perpendicular to gravity as best as it can. For a true reading of how a person’s head is sitting, have the person close his or her eyes and nod “yes” and then “no” and then come back to where it feels most comfortable. If the person’s eyes open at any moment during the evaluation, start again.
I say to the person “come back to where you feel comfortable” and then I take a quick look. Are any of the four postures listed above noticeable? You will either see it or you won’t — it should be obvious one way or the other. Then, move on to the scapula or the shoulder. If you have to ask yourself “Does he or she have this posture?” the answer becomes “no.”
Physical therapists have been trained very well in postural analysis and can get very detailed in what they see. However, to determine a nerve problem from posture, you don’t have to get bogged down in the minutia.
“Posture is an outward expression of the nervous system" is what I always say.
If posture is so close to being balanced that we have to sit and determine if we see it or not, then that person is pretty close to being balanced. My goal is to see where in the nervous system the problem lies.
I spent two years in my practice without talking to patients prior to evaluating them. I had them fill out the paperwork and did a postural analysis. Based on their posture, I would ask “Do you have pain here and here and trouble moving this or that?”
Their eyes would get big and they would say “How did you know?” because the only thing I said to them up to this point was “Please, stand here.” Then I’d tell them that based on their posture, these are the common things people have or can’t do.
Examples of Postural Analysis:
Patient one enters the office with the following postures:
|Head in Flexion||C1, 2, 3, 4, 5, 6, 7, 8, T1|
|Depressed Scapula||C3, 4, 5|
|Shoulder Abducted||C5, 6, 7, 8|
|Shoulder Internal Rotated||C5, 6|
|Forearm Pronated||C5, 6|
As you can see, the C5 nerve shows up in EVERY posture. When one nerve root is the common denominator, people usually see HUGE differences as soon as they stand up after the FIRST treatment. In this example, no muscle testing was needed. You can simply look at the posture and determine the problem.
Patient two shows the following postures:
|Head in flexion||C1, 2, 3, 4, 5, 6, 7, 8, T1|
|Adducted Scapula||C5, 6, 7, 8|
|Abducted Shoulder||C5, 6, 7, 8|
|Medial Rotated Shoulder||C5, 6|
|Pronated Forearm||C5, 6|
In this example, we already know from posture that this person has either a C5 or a C6 nerve problem. Which is it? To know for sure, we will have to do some muscle testing. I have broken down which muscles to test to differentiate between two nerve roots. So for our example of patient two, we can narrow down to one nerve root with a muscle test.
There are many different ways to muscle test. I personally like to do functional muscle testing. That means if I want to test the biceps muscle, then the biceps muscle is going to fire during the test. However, if you have a certain way that you like to muscle test you can test that way. You will get to the same result.
We can muscle test the Rhomboids and Levator Scapula. If either one of these test weak, this person has a C5 problem. If these don’t test weak, we test the muscles listed under C6 to see if a muscle there tests weak. Not all of the muscles listed need to test weak. Only one muscle needs to test weak to confirm a C6 issue.
To confirm a C5 problem from a C6 problem
- Scapular Adduction & Downward Rotation:
- Shoulder Elevation:
- Levator Scapula
To confirm a C6 problem from a C5 problem
- Shoulder Extension:
- Latissimus Dorsi
- Shoulder Flexion & Adduction:
- Forearm Pronation:
- Pronator Teres
- Shoulder Horizontal Adduction:
- Pectoralis Major
- Wrist Flexion:
- Flexor Carpi Radialis
- Thumb Opposition:
- Opponens Pollicis
- Wrist Extension:
- Ext. Carpi Rad Longus
- Ext. Carpi Rad Brevis
- MCP Extension:
- Extensor Digitorum
- Extensor Indicis
- Extensor Digiti Minimi
Keep in mind, “posture is an outward expression of the nervous system.” So person two has either a C5 or a C6 problem, and we only need one weak muscle along the pathway that can differentiate these two nerves to confirm a problem.
There is yet one more scenario that could happen.
Postural analysis patient three:
|Extended head||C1, 2, 3|
|Elevated Scapula||C3, 4|
|Abducted Scapula||C3, 4, 5|
|Abducted Shoulder||C5, 6, 7, 8|
|Medial Rotated Shoulder||C5, 6|
This person has a C3 or a C5 problem, because three postures have C3 and three postures have C5. Here we can muscle test from posture to narrow down to the nerve problem.
- Head Extension:
- Capital Flexion — C1-C3
- Elevated Scapula:
- Lower Trap — C3-C4
- Abducted Scapula:
- Rhomboids — C5
- Middle Trap — C3-C4
- Lower Trap — C3-C4
- Abducted Shoulder:
- Coracobrachialis — C6-C7
- Pectoralis Major — C6-C8
- Latissimus Dorsi — C6-C8
- Medial Rotated Shoulder:
- Infraspinatus — C5-C6
- Teres Minor — C5-C6
- Posterior Deltoid — C5-C6
Based off posture, we know this patient has either a C3 or C5 problem. When we look at the different postures, we find that the Abducted Shoulder muscle test will not narrow down to either a C3 or C5 problem; so we can eliminate this posture.
Under the rest of the postures, there are muscles innervated by C3 but not by C5, and other muscles innervated by C5 but not by C3. We might muscle test under medial rotated shoulder since these muscles are innervated by C5 and C6. From posture we know they don’t have a C6 problem, so if any of these muscles test weak we will confirm a C5 problem. Along those lines, if the lower trap tested weak we would confirm a C3 nerve problem since posture has shown us there isn’t a C4 problem.
OK, those were three evaluation examples from the Long Division way. Now, let’s look at the Calculator way.
5 ways to determine when to do a C5 treatment:
1. Patient can present with nerve pain:
- The size of a silver dollar over the middle deltoid
Peripheral neuropathy — nerve pain — I used to adjust for nerve pain. Now I do the MyoKinesthetic System technique because I get faster and better results. If a person enters with nerve pain, there is no need to do any further evaluation to determine which treatment to do. Pain signals travel along the nerve pathway. With this treatment, we are going to change the signals to the brain from every muscle along this pathway. Peripheral neuropathy now becomes one of the easier things to determine to treat and responds just as easily and quickly.
2. Painful or weak movement:
- Abducting humerus
- Unable to reach into the back seat of the car while in drivers seat
- Laterally rotate humerus (hurts to comb hair)
- Bringing hand to opposite shoulder
Let me explain my definition of weak because I think a painful movement is self -explanatory. A weak movement is when someone says “This is as far as I can raise my arm, but it doesn’t hurt.” That’s usually followed with “This is not my problem area.”
The patient doesn’t associate a lack of movement without pain as a problem. But, when asked how long they’ve been unable to move that joint compared to the length of time they’ve experience pain somewhere else, movement usually has been an issue for a longer amount of time.
When we go into cause vs. compensation, we always want to treat the cause. Therefore, many times a weak movement will tell you which treatment to perform.
3. Conditions with C5:
- Mid-back pain or numbness
- Pain at the deltoid tuberosity
- Shoulder pain
- Frozen shoulder
- Anterior scalene syndrome
- Rotator cuff problems
Named conditions are those when the person comes in and says “I have just been diagnosed with ___.” These can help narrow down to a nerve root problem. If a person enters my office and says they have a rotator cuff problem, I like to have at least one of the other four "calculator" ways to be present as well to determine the treatment I am going to do.
4. Patient can present with any of the following postures:
- Adducted scapula with downward rotation
- Medially rotated humerus
- Abducted scapula with upward rotation
- Depressed scapula with abduction
- Adducted, medially rotated and flexed humerus
- Adducted shoulder (high shoulder)
- Extended Shoulder
Look for these specific postures to help determine a C5 problem.
5. Range of motion or muscle tests on the following muscles to determine a C5 problem:
- Serratus Anterior — Scapular Adduction — Bring arm into extension and then adduct and compare sides or strength test
- Infraspinatus and Teres Minor — Humeral Medial Rotation — While lying on stomach, abduct arm to 90 degrees, have patient medially rotate (bring palms up towards ceiling) and compare sides
- Rhomboids and posterior deltoid — Have patient bring right hand to left shoulder (to test right side), then bring fingers down onto left scapula, compare how low patient can touch one side to the other
- Supraspinatus, middle deltoid — Muscle test
- Anterior Deltoid — Muscle test
- Subclavius — Palpate for tenderness
The muscles listed under this section are mainly innervated by C5. Most muscles have more than one nerve innervation, but these muscles are mainly innervated by C5. So if one of these muscles are weak or is not working properly through the full range of motion, this could direct you to a C5 treatment.
Once we determine a C5 problem, we can do a treatment with confidence of a positive outcome. In order to do a complete treatment, we must treat every muscle innervated by C5 — that’s 31 muscles. Also each treatment must be done bilaterally. Again, during the treatment, we are focused on the nerve. We are not focused on the joint. We are not focused on the muscle. We really don’t care if the muscle under treatment relaxes or the joint increases in range of motion. We just want the nerve endings within each muscle to fire to send a signal to the brain that says “A change has happened here.”
With this technique, we are not focused on HOW to treat a muscle but rather WHICH muscles in combination we’re treating. By combining which muscles we treat together, we can impact specific nerves. The more specific we are the more confidence we can have in the outcome.
In order to get the nerve endings to fire, we just have to move the muscle into either a stretch position or a contracted position and apply some form of stimulation. The stimulation can be deep, light, glide, cross friction, static, etc. You can use your knuckles, elbows, forearms, fingers, and yes, even though I don’t recommend it, your thumb.
With 14 movements we can treat all 31 muscles. To do this bilaterally equals 28 movements treating 62 muscles. This treatment takes about 10 minutes to perform.