Muscle energy technique

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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.

Contents

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]

Pathophysiology

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:

Mechanism of action for muscle energy techniques

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]

Indications and contraindications

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.

Techniques

Muscle energy techniques can be applied to most areas of the body. According to one textbook, each technique requires 8 essential steps: [4]

  1. Perform and obtain an accurate structural diagnosis.
  2. Engage the restrictive barrier in as many planes as possible.
  3. Physician and patient engage in an unyielding counterforce where the patient's force matches the physician's force.
  4. The patient's isometric contraction has the correct amount of force, the correct direction of effort (away from the restrictive barrier), and the correct duration (5-10 seconds).
  5. Complete relaxation occurs after the muscular effort.
  6. The patient is repositioned into the new restrictive barrier in as many planes as possible.
  7. Steps 3-6 are repeated approximately 3-5 times or until no further improvement in range of motion is observed.
  8. The structural diagnosis is repeated to evaluate if the dysfunction has resolved or improved.

Types

There are several different types of muscle energy techniques:

  1. Post-Isometric relaxation: Treat by engaging the restrictive barrier in all planes.
  2. Reciprocal inhibition: Treat by contracting the antagonistic muscles, which causes the agonist muscle to relax through the reciprocal inhibition reflex arc.
  3. Joint mobilization using muscle force: Use muscle contraction to restore range of motion in a joint.
  4. Oculocephalogyric reflex: Treat cervical/truncal muscles by using extraocular muscle contraction.
  5. Respiratory assistance: Use the patient's voluntary respiratory motions to treat a somatic dysfunction. Commonly used in treating inhalation rib dysfunctions.
  6. Crossed extensor reflex: Use crossed extensor reflex to treat muscular injuries. For example, contraction of a muscle on the right side leads to relaxation of the same muscle on the left side. [8]

Effectiveness

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]

Related Research Articles

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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.

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References

  1. Chaitow, Leon (2013). Muscle Energy Techniques + Videos. Elsevier Science Health Science Division, 2013. ISBN   978-0702046537.
  2. Savarese, Robert G. (2003). OMT Review 3rd Edition. p. 135. ISBN   0967009014.
  3. "Glossary of Osteopathic Terminology" (PDF). American Association of Colleges of Osteopathic Medicine. April 2009. p. 28. Retrieved 25 August 2012.
  4. 1 2 Dowling, Dennis J. (2005). "Muscle Energy". In DiGiovanna, Eileen L.; Schiowitz, Stanley; Dowling, Dennis J. (eds.). An Osteopathic Approach to Diagnosis and Treatment (3rd ed.). Philadelphia: Lippincott Williams & Wilkins. pp. 83–5. ISBN   978-0-7817-4293-1.
  5. Savarese, Robert G. (2003). OMT Review 3rd Edition. pp. 1–2. ISBN   0967009014.
  6. Wilson E, Payton O, Donegan-Shoaf L, Dec K (September 2003). "Muscle energy technique in patients with acute low back pain: a pilot clinical trial". J Orthop Sports Phys Ther. 33 (9): 502–12. doi:10.2519/jospt.2003.33.9.502. PMID   14524509.
  7. Ballantyne, Fiona; Fryer, Gary; McLaughlin, Patrick (2003). "The effect of muscle energy technique on hamstring extensibility: The mechanism of altered flexibility". Journal of Osteopathic Medicine. 6 (2): 59–63. doi:10.1016/S1443-8461(03)80015-1.
  8. Savarese, Robert G. (2003). OMT Review 3rd Edition. pp. 135–136. ISBN   0967009014.
  9. Franke H, Fryer G, Ostelo R, Kamper S (2015). "Muscle energy technique for non-specific low-back pain". Cochrane Database of Systematic Reviews (2): CD009852. doi:10.1002/14651858.CD009852.pub2. PMC   10945353 . PMID   25723574.