Muscle Energy Techniques (METs) describes a broad class of manual therapy techniques directed at improving musculoskeletal function or joint function, and improving pain. METs are commonly used by manual therapists, physical therapists, occupational therapist, chiropractors, athletic trainers, osteopathic physicians, and massage therapists. [1] Muscle energy requires the patient to actively use his or her muscles on request to aid in treatment. [2] Muscle energy techniques are used to treat somatic dysfunction, especially decreased range of motion, muscular hypertonicity, and pain.
Historically, the concept emerged as a form of osteopathic manipulative diagnosis and treatment in which the patient's muscles are actively used on request, from a precisely controlled position, in a specific direction, and against a distinctly executed physician counterforce. It was first described in 1948 by Fred Mitchell, Sr, D.O. [3]
Injury can occur as a result of trauma, accidents, overuse, strain/sprain, etc., not all of which should be treated with muscle energy. These techniques are most appropriate for the following injury patterns:
Muscle energy is a direct and active technique; meaning it engages a restrictive barrier and requires the patient's participation for maximal effect. A restrictive barrier describes the limit in range of motion that prevents the patient from being able to reach the baseline limit in his range of motion. [5] As the patient performs an isometric contraction, the following physiologic changes occur:
Despite the many claims made regarding the efficacy of these techniques, there are only two peer-reviewed studies that have shown that muscle energy techniques can significantly decrease disability and improve functionality in patients with disorders such as low back pain. [6] [7]
Muscle energy techniques can be employed to reposition a dysfunctional joint and treat the affected musculature. Indications include, but are not limited to: muscular shortening, low back pain, pelvic imbalance, edema, limited range of motion, somatic dysfunction, respiratory dysfunction, cervicogenic headaches, and many others.[ citation needed ]
These techniques are inappropriate when a patient has injuries such as fractures, avulsion injuries, severe osteoporosis, open wounds, or has metastatic disease. Additionally, because these techniques require active patient participation, they are inappropriate for any patient that is unable to cooperate.
Muscle energy techniques can be applied to most areas of the body. According to one textbook, each technique requires 8 essential steps: [4]
There are several different types of muscle energy techniques:
A 2015 Cochrane review concluded that Muscle Energy Technique is not effective for patients with low back pain, and that the quality of the research testing the effectiveness of MET is poor. [9]
Osteopathy, unlike osteopathic medicine, which is a branch of the medical profession in the United States, is a pseudoscientific system of alternative medicine that emphasizes physical manipulation of the body's muscle tissue and bones. In most countries, practitioners of osteopathy are not medically trained and are referred to as osteopaths.
Spasticity is a feature of altered skeletal muscle performance with a combination of paralysis, increased tendon reflex activity, and hypertonia. It is also colloquially referred to as an unusual "tightness", stiffness, or "pull" of muscles.
Torticollis, also known as wry neck, is a painful, dystonic condition defined by an abnormal, asymmetrical head or neck position, which may be due to a variety of causes. The term torticollis is derived from the Latin words tortus, meaning "twisted", and collum, meaning "neck".
Clonus is a set of involuntary and rhythmic muscular contractions and relaxations. Clonus is a sign of certain neurological conditions, particularly associated with upper motor neuron lesions involving descending motor pathways, and in many cases is accompanied by spasticity. Unlike small spontaneous twitches known as fasciculations, clonus causes large motions that are usually initiated by a reflex. Studies have shown clonus beat frequency to range from three to eight Hz on average, and may last a few seconds to several minutes depending on the patient’s condition.
Delayed onset muscle soreness (DOMS) is the pain and stiffness felt in muscles after unaccustomed or strenuous exercise. The soreness is felt most strongly 24 to 72 hours after the exercise. It is thought to be caused by eccentric (lengthening) exercise, which causes small-scale damage (microtrauma) to the muscle fibers. After such exercise, the muscle adapts rapidly to prevent muscle damage, and thereby soreness, if the exercise is repeated.
Manual therapy, or manipulative therapy, is a part of Physiotherapy, it is a physical treatment primarily used by physical therapists, occupational therapists to treat musculoskeletal pain and disability; it mostly includes kneading and manipulation of muscles, joint mobilization and joint manipulation. It is also used by Rolfers, massage therapists, athletic trainers, osteopaths, and physicians.
Myofascial trigger points (MTrPs), also known as trigger points, are described as hyperirritable spots in the skeletal muscle. They are associated with palpable nodules in taut bands of muscle fibers. They are a topic of ongoing controversy, as there is limited data to inform a scientific understanding of the phenomenon. Accordingly, a formal acceptance of myofascial "knots" as an identifiable source of pain is more common among bodyworkers, physical therapists, chiropractors, and osteopathic practitioners. Nonetheless, the concept of trigger points provides a framework which may be used to help address certain musculoskeletal pain.
Reciprocal inhibition describes the relaxation of muscles on one side of a joint to accommodate contraction on the other side. In some allied health disciplines, this is known as reflexive antagonism. The central nervous system sends a message to the agonist muscle to contract. The tension in the antagonist muscle is activated by impulses from motor neurons, causing it to relax.
Anterior cruciate ligament reconstruction is a surgical tissue graft replacement of the anterior cruciate ligament, located in the knee, to restore its function after an injury. The torn ligament can either be removed from the knee, or preserved before reconstruction through an arthroscopic procedure. ACL repair is also a surgical option. This involves repairing the ACL by re-attaching it, instead of performing a reconstruction. Theoretical advantages of repair include faster recovery and a lack of donor site morbidity, but randomised controlled trials and long-term data regarding re-rupture rates using contemporary surgical techniques are lacking.
The quadratus lumborum muscle, informally called the QL, is a paired muscle of the left and right posterior abdominal wall. It is the deepest abdominal muscle, and commonly referred to as a back muscle. Each is irregular and quadrilateral in shape.
Hypertonia is a term sometimes used synonymously with spasticity and rigidity in the literature surrounding damage to the central nervous system, namely upper motor neuron lesions. Impaired ability of damaged motor neurons to regulate descending pathways gives rise to disordered spinal reflexes, increased excitability of muscle spindles, and decreased synaptic inhibition. These consequences result in abnormally increased muscle tone of symptomatic muscles. Some authors suggest that the current definition for spasticity, the velocity-dependent over-activity of the stretch reflex, is not sufficient as it fails to take into account patients exhibiting increased muscle tone in the absence of stretch reflex over-activity. They instead suggest that "reversible hypertonia" is more appropriate and represents a treatable condition that is responsive to various therapy modalities like drug or physical therapy.
Counterstrain is a technique used in osteopathic medicine, osteopathy, physical therapy, massage therapy, and chiropractic to treat somatic dysfunction. It is a system of diagnosis and treatment that uses tender points, which are produced by trauma, inflammation, postural strain, or disease, to identify structures to manipulate. The manipulation uses light pressure to decompress the local nociceptors and mechanoreceptors responsible for the sensation of pain, returning central sensitization to its normal state. This technique extends Strain-counterstrain, a technique inhibits the reflexes by putting the tissues in a position of ease directly opposite to that of the reflex. Strain-counterstrain is also known as the Jones technique,, and spontaneous release by position. Counterstrain was developed by Lawrence Jones in 1955 and was originally called “Spontaneous Release by Positioning,” before being termed “strain-counterstrain.”
Dry needling, also known as trigger point dry needling and intramuscular stimulation, is a treatment technique used by various healthcare practitioners, including physical therapists, physicians, and chiropractors, among others. Acupuncturists usually maintain that dry needling is adapted from acupuncture, but others consider dry needling as a variation of trigger point injections. It involves the use of either solid filiform needles or hollow-core hypodermic needles for therapy of muscle pain, including pain related to myofascial pain syndrome. Dry needling is mainly used to treat myofascial trigger points, but it is also used to target connective tissue, neural ailments, and muscular ailments. The American Physical Therapy Association defines dry needling as a technique used to treat dysfunction of skeletal muscle and connective tissue, minimize pain, and improve or regulate structural or functional damage.
Muscle contractures can occur for many reasons, such as paralysis, muscular atrophy, and forms of muscular dystrophy. Fundamentally, the muscle and its tendons shorten, resulting in reduced flexibility.
Dynasplint Systems, Incorporated (DSI) is a company that designs, manufactures and sells dynamic splints that are used for range of motion rehabilitation. The corporate headquarters are located in Severna Park, Maryland and it is considered a major employer in Anne Arundel County. Products are Made in the US in Stevensville, Maryland. There is a national sales force throughout the US as well as a presence in Canada and Europe.
A spinal interneuron, found in the spinal cord, relays signals between (afferent) sensory neurons, and (efferent) motor neurons. Different classes of spinal interneurons are involved in the process of sensory-motor integration. Most interneurons are found in the grey column, a region of grey matter in the spinal cord.
Anatomical terminology is used to uniquely describe aspects of skeletal muscle, cardiac muscle, and smooth muscle such as their actions, structure, size, and location.
Muscle balance is necessary for muscles to perform their customary roles and move normally; muscle imbalance occurs when there is a lack of parity between corresponding agonist and antagonist muscles. Muscular imbalance can also arise when a muscle performs outside of its normal physiological muscle function.
Hydrogymnastics is a water-based therapeutic exercise. As its name suggests, this form of aquatic therapy or aquatic rehabilitation is performed in water, and it can take place in swimming pools at aquatic leisure centres and/or in home pools. Being a form of aquatic therapy, hydrogymnastics aims to improve the physical and psychological health and well-being of an individual. Hydrogymnastics can be performed by anyone, including youths, middle-aged people, the elderly, athletes and those with disabilities. Hydrogymnastics is often assisted by a qualified aquatic therapist and/or exercise physiologist. Although the effects of hydrogymnastics may vary between individuals belonging to different age groups and genders, hydrogymnastics mainly improves one's cardiovascular fitness, strength, balance and mobility.
Pelvic floor physical therapy (PFPT) is a specialty area within physical therapy focusing on the rehabilitation of muscles in the pelvic floor after injury or dysfunction. It can be used to address issues such as muscle weakness or tightness post childbirth, dyspareunia, vaginismus, vulvodynia, constipation, fecal or urinary incontinence, pelvic organ prolapse, and sexual dysfunction. Licensed physical therapists with specialized pelvic floor physical therapy training address dysfunction in individuals across the gender and sex spectra, though PFPT is often associated with women's health for its heavy focus on addressing issues of pelvic trauma after childbirth.
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