Lecture 7: Muscle Energy

Question 1

T.J. Ruddy, DO

Answer 1

Ruddy’s Rapid Rhythmic Resistive Duction
1914= first published article
Eye and cervical spine treatment
Used rapid, repetitive contractions 1-2 per second
against resistance

Question 2

Fred L. Mitchell, Sr., DO

Answer 2

Wrote about Muscle Energy Technique as early as 1948

has developed and amplified MET

Question 3

Muscle energy

Answer 3

Voluntary contraction of patient muscle

Varying levels of intensity

In a precisely controlled direction

Against a distinctly executed counterforce

Question 4

Muscle energy- active technique

Answer 4

Patient contributes the corrective

force

Question 5

Muscle energy-direct technique

Answer 5

positioned to the restrictive barrier

Question 6

in muscle energy which was it patients motion?

Answer 6

Patient’s motion is away from the barrier

Question 7

Isometric contraction

Answer 7

Contraction of a muscle with no change in distance between the origin and insertion

Question 8

Concentric isotonic contraction

Answer 8

Contraction of a muscle with
approximation of origin and insertion
- The “Curl” part of the biceps curl

Question 9

Eccentric isotonic contraction

Answer 9

Contraction of a muscle with
separation of origin and insertion
-(Like the relaxation phase of a bicep curl)

Question 10

“Isolytic” contraction

Answer 10

Attempted concentric contraction, with an external force causing separation of origin and insertion

Question 11

what are physiological principles?

Answer 11

Using muscle force to move one region of the body to achieve movement of another bone or region

Question 12

Post-isometric relaxation

Answer 12

**most common form of MET
-Muscle contraction-> increased tension in Golgi tendon organ->
inhibition of muscle contraction

Question 13

Joint mobilization using muscle force

Answer 13

Restoration of motion to the articulation results in a gapping, or reseating of the distorted joint relations with reflex relaxation of the previously hypertonic musculature.

Question 14

Joint mobilization using muscle force-Force of Contraction

Answer 14

Maximal muscle contraction that can be comfortably resisted by the physician (up to 30 to 50 lb of pressure depending on the joint treated)

Question 15

Respiratory assistance

Answer 15

muscular forces involved in these techniques are generated by the simple act of breathing.
-The physician usually applies a fulcrum against which the respiratory forces can work.

Question 16

Respiratory assistance-Force of Contraction

Answer 16

Exaggerated respiratory motion

Question 17

Oculocephalogyric reflex

Answer 17

eyemovements reflexively affect the cervical and truncal musculature as the body attempts to follow the lead provided by eye motion

Question 18

Oculocephalogyric reflex-Force of Contraction

Answer 18

Exceptionally gentle

Question 19

Reciprocal inhibition

Answer 19

When a gentle contraction is initiated in the agonist muscle, there is a reflex relaxation of that muscle’s antagonistic group

Question 20

Reciprocal inhibition-Force of Contraction

Answer 20

Think ounces,not pounds of pressure

Question 21

when is Crossed extensor reflex used?

Answer 21

Used in the extremities where the muscle that requires treatment is in an area so severely injured (e.g., fractures or burns) that it is directly unmanipulable or inaccessible.

Question 22

Crossed extensor reflex

Answer 22

When the flexor muscle in one extremity is contracted voluntarily, the flexor muscle in the contralateral extremity relaxes and the extensor contracts.

Question 23

Crossed extensor reflex-forece of contraction

Answer 23

Think ounces, not pounds of pressure

Question 24

what side does reciprocal inhibition act on?

Answer 24

Ipsilateral – Same side

Question 25

what side does crossed extensor reflex act on?

Answer 25

Contralateral – opposite side

Question 26

what is Isokinetic strengthening used for?

Answer 26

To reestablish normal tone and strength in a muscle weakened by reflex hypertonicity of the opposing muscle group

Question 27

Isokinetic strengthening

Answer 27

In Isokinetic contractions, the length change occurs at a constant velocity. Typically concentric contractions are used, where the muscle is permitted to shorten, but at a controlled slow rate.

Question 28

Isokinetic strengthening-force of contraction

Answer 28

Sustained gentle pressure (10 to 20 lb of pressure)

Question 29

when is Isolytic lengthening used?

Answer 29

To lengthen a muscle shortened by contracture and fibrosis.

Question 30

Isolytic lengthening-

Answer 30

the vibration used here has some effect on the myotatic units in addition to mechanical and circulatory effects

Question 31

Isolytic lengthening-force of contraction

Answer 31

Maximal Contraction that can be comfortably resisted by the physician (30 to 50 lb of pressure)

Question 32

Using muscle force to move one region of the body to achieve movement of another bone or region

Answer 32

Muscular force is used to move the first structure and that body part’s response to the muscle force is transmitted to yet another part of the body.

Question 33

Using muscle force to move one region of the body to achieve movement of another bone or region-force of contraction

Answer 33

Sustained gentle pressure (10 to 20 lb of pressure)

Question 34

Muscle Energy – Indications

Answer 34

balance muscle tone
strengthen reflexively weakened musculature
improve symmetry of articular motion
enhance the circulation of body fluids (blood, lymph, and interstitial fluid)
Lengthen a shortened, contractured, or spastic muscle group
Versatile to use in combination with other osteopathic manipulative techniques`

Question 35

Factors Influencing Successful Muscle

Energy - Patient

Answer 35

Contract too hard
Contract in the wrong
direction
Sustain the contraction for too short a time
Do not relax appropriately following contraction

Question 36

Factors Influencing Successful Muscle Energy - Operator

Answer 36

Not controlling the joint position in relation to the barrier movement
Not providing the counterforce in the correct direction
Not giving accurate instructions
Moving to a new joint position too soon after the patient stops contracting`

Question 37

Muscle Energy - Contraindications

Answer 37

Local fracture
Local dislocation
Moderate-to-severe segmental instability in the cervical spine
Evocation of neurologic symptoms or signs on rotation of the neck. Low vitality
Situations that could be worsened by muscle activity
Post-surgical patient - internal bleeding may be caused Immediately following myocardial infarction
Recent eye-surgery – use of Oculocephalogyric reflex
Unable/unwilling to follow verbal commands

Question 38

Articulatory Approach (springing technique)

Answer 38

Low velocity/high amplitude
Direct technique
History: as old as Osteopathy itself

Question 39

what is the Articulatory Approach

Answer 39

Gentle and repetitive motions through the restrictive barrier to restore physiologic motion
Can be applied to vertebral as well as extremity somatic dysfunction
May be used on a single joint, or an entire region
Applicable with the restrictive barrier is in the joint or periarticular tissues

Question 40

Articulatory Technique Indications

Answer 40

Well tolerated by
 Arthritic patients
 Elderly or frail
 Critically ill or post-operative patients
 Infants or very young patients
 Patients unable to cooperate
with instructions

Question 41

Articulatory Technique – Contraindications (relative)

Answer 41

Vertebral artery compromise

Avoid combination of rotation and extension in the cervical spine

Question 42

Articulatory Technique – Contraindications (absolute)

Answer 42

Local fracture or dislocation
 Neurologic entrapment syndromes
 Serious vascular compromise
 Local malignancy
 Local infection (e.g., cellulitis, abscess, septic arthritis, osteomyelitis)  Bleeding disorders

Question 43

Define Post isometric Relaxation

Answer 43

relaxation you get after a muscle contraction, where you are able to go further into a restrictive barrier. This is the principle of muscle energy