By Drs. Christopher Kent and Patrick Gentempo, Jr. Paraspinal EMG scanning is a popular technique for evaluating and characterizing the muscular dysfunction associated with the vertebral subluxation complex. Some critics of the technology have alleged that it is not a scientifically sound technique. The purpose of this paper is to demonstrate that EMG scanning is a reliable and scientifically sound procedure. Although static and motion palpation are popular techniques, they are only as effective as the examiner is skilled. A review of the literature on the interexaminer reliability of motion palpation of the lumbar spine demonstrated marginaltono reliability. Even in the hands of skilled clinicians, palpatory findings are highly subjective and difficult to quantify. [1-7] Some doctors feel rangeofmotion studies may be used to obtain the same information as that provided by paraspinal EMG studies. Paraspinal muscle dysfunction may result in altered or asymmetrical spinal motion, but is certainly not the only condition which may do so. Arthritic, congenital, metabolic, infectious, and neurological diseases may also present with alterations of spinal motion. These conditions may or may not be accompanied by paraspinal muscle dysfunction. [8,9] These techniques may be useful in clinical practice, but are not substitutes for paraspinal EMG studies. We urge readers to consider the following:

Spector conducted a study to determine the reliability of paraspinal surface EMG at New York Chiropractic College. Results of the study yielded correlation coefficients ranging between 0.73 and 0.97. [12] Thompson et al of the Mayo Clinic found EMG scanning technique correlates highly with attached electrode technique. [13] In summary, the reliability of surface EMG has been documented in studies conducted with New York Chiropractic College, the Mayo Clinic and the University of CaliforniaIrvine. A cooperative research program is currently underway at the University of the PacificStockton and Palmer College of ChiropracticWest. Few analytical techniques in chiropractic display such a high level of reliability.

Paraspinal EMG scanning falls within the scope of chiropractic for the following reasons: 1. It has been documented in studies conducted by universities, hospitals, and chiropractic colleges. It is a well established procedure in the healing arts. According to Dr. Jeffrey Cram who developed the technique of muscle scanning, surface EMG scanning is currently utilized in 80% of the pain clinics in the United States. [22] 2. It is completely noninvasive. 3. The technique is useful as an aid in detecting and characterizing vertebral subluxations. 4. EMG scans may be used to determine patient response to chiropractic care. 5. The technique has been taught in accredited chiropractic colleges. 6. EMG data has been accepted in courts of law. 7. The technique is well documented in chiropractic literature, including chiropractic trade publications and refereed journals. 8. The most vocal critics of the technique are those who have no formal training in the procedure, have not utilized it in clinical practice, and have not documented their disparaging remarks with references. Paraspinal EMG scanning has a solid foundation in the medical, chiropractic, and scientific literature. Properly used, it is an invaluable technique in the evaluation of the vertebral subluxation complex.   References 1. Keating J: “Interexaminer reliability of motion palpation of the lumbar spine: a review of the quantitative literature.” Proceedings of the Scientific Symposium on Spinal Biomechanics, International Chiropractors Association, May 1921, 1989. 2. Cassidy J, Potter G: “Motion palpation of the lumbar spine.” JMPT 1979; 2(3):151. 3. Gonella C, Paris S, Kutner M: “Reliability in evaluating passive intervertebral motion.” Phys Ther 1982; 62(4):436. 4. Bergstrom E, Courtis G: “An inter and intraexaminer reliability study of motion palpation in lateral flexion in the seated position.” Euro J Chiro 1986;34:121. 5. Love R, Brodeur R: “Inter and intraexaminer reliability of motion palpation for the thoracolumbar spine,” JMPT 1987 10(1):1. 6. Juli G, Bullock M: “A motion profile of the lumbar spine in an aging population assessed by manual examination.” Physiotherapy Practice 1987:3:70. 7. Boline P, Keating J, Brist J, Denver G: “Interexaminer reliability of palpatory examinations of the lumbar spine.” Am J Chiro Med 1988 1(1):5. 8. Calliet R: “Low Back Pain Syndrome.” FA Davis Co., Philadelphia, PA. 1977. 9. Calliet R: “Soft Tissue Pain and Disability.” FA Davis Co., Philadelphia, PA. 1977. 10. Komi P, Buskirk E: “Reproducibility of electromyographic measurements with inserted wire electrodes and surface electrodes,” Electromyography 10:357, 1970. 11. Cram J: Clinical EMG: “Muscle Scanning for Surface Recordings.” Biofeedback Institute of Seattle. Seattle, WA 1986. 12. Spector B: “Surface electromyography as a model for the development of standardized procedures and reliability testing.” JMPT 2(4):214, 1979. 13. Thompson J, Erickson R, Offord K: “EMG muscle scanning: stability of handheld electrodes.” Biofeedback Self Regul 14(1):55, 1989. 14. Kent C: “Documenting the vertebral subluxation complex with electromyography.” The Chiropractic Journal, April 1988. 15. Kent C. Gentempo P: “Computed tomography and electromyography in the evaluation of lumbar subluxation.” Today’s Chiropractic, September/October and November/December 1988. 16. Gentempo P: “Evaluating soft tissue injuries with electromyography: case studies.” Today’s Chiropractic, May/June 1988. 17. Gentempo P: “Characterizing the vertebral subluxation complex with paraspinal electromyography.” Submitted for publication. International Review of Chiropractic. 18. Shambaugh P: “Changes in electrical activity in muscles resulting from chiropractic adjustment: a pilot study.” JMPT 10(6):300, 1987. 19. Ellestad S, Nagle R, Boesler D, Kilmore M: “Electromyographic and skin resistance responses to osteopathic manipulative treatment for low back pain.” JAOA 88(8):991, 1988. 20. Houts M, Marmor L: “Proving Medical Diagnosis and Prognosis.” Matthew Bender, Times Mirror Books, 1989. 82A20. 21. Johnson v Carbon No. 862038064. Memorandum in support of admission of EMG muscle scans. Superior Court, State of Washington, County of Spokane. 22. Cram J: Personal communication.

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Seeing RED: A Guide to Scan Interpretation and Communication

This RED E-Book summarizes the chiropractic paradigm while providing a concise and easily remembered protocol to use when both performing and sharing scan data. It has been designed to be used by staff members and doctors as a communication tip sheet.

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