Lecture 7: Muscle Energy Flashcards
T.J. Ruddy, DO
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
Fred L. Mitchell, Sr., DO
Wrote about Muscle Energy Technique as early as 1948
has developed and amplified MET
Muscle energy
Voluntary contraction of patient muscle
Varying levels of intensity
In a precisely controlled direction
Against a distinctly executed counterforce
Muscle energy- active technique
Patient contributes the corrective
force
Muscle energy-direct technique
positioned to the restrictive barrier
in muscle energy which was it patients motion?
Patient’s motion is away from the barrier
Isometric contraction
Contraction of a muscle with no change in distance between the origin and insertion
Concentric isotonic contraction
Contraction of a muscle with
approximation of origin and insertion
- The “Curl” part of the biceps curl
Eccentric isotonic contraction
Contraction of a muscle with
separation of origin and insertion
-(Like the relaxation phase of a bicep curl)
“Isolytic” contraction
Attempted concentric contraction, with an external force causing separation of origin and insertion
what are physiological principles?
Using muscle force to move one region of the body to achieve movement of another bone or region
Post-isometric relaxation
**most common form of MET
-Muscle contraction-> increased tension in Golgi tendon organ->
inhibition of muscle contraction
Joint mobilization using muscle force
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.
Joint mobilization using muscle force-Force of Contraction
Maximal muscle contraction that can be comfortably resisted by the physician (up to 30 to 50 lb of pressure depending on the joint treated)
Respiratory assistance
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.
Respiratory assistance-Force of Contraction
Exaggerated respiratory motion
Oculocephalogyric reflex
eyemovements reflexively affect the cervical and truncal musculature as the body attempts to follow the lead provided by eye motion
Oculocephalogyric reflex-Force of Contraction
Exceptionally gentle
Reciprocal inhibition
When a gentle contraction is initiated in the agonist muscle, there is a reflex relaxation of that muscle’s antagonistic group
Reciprocal inhibition-Force of Contraction
Think ounces,not pounds of pressure
when is Crossed extensor reflex used?
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.
Crossed extensor reflex
When the flexor muscle in one extremity is contracted voluntarily, the flexor muscle in the contralateral extremity relaxes and the extensor contracts.
Crossed extensor reflex-forece of contraction
Think ounces, not pounds of pressure
what side does reciprocal inhibition act on?
Ipsilateral – Same side
what side does crossed extensor reflex act on?
Contralateral – opposite side
what is Isokinetic strengthening used for?
To reestablish normal tone and strength in a muscle weakened by reflex hypertonicity of the opposing muscle group
Isokinetic strengthening
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.
Isokinetic strengthening-force of contraction
Sustained gentle pressure (10 to 20 lb of pressure)
when is Isolytic lengthening used?
To lengthen a muscle shortened by contracture and fibrosis.
Isolytic lengthening-
the vibration used here has some effect on the myotatic units in addition to mechanical and circulatory effects
Isolytic lengthening-force of contraction
Maximal Contraction that can be comfortably resisted by the physician (30 to 50 lb of pressure)
Using muscle force to move one region of the body to achieve movement of another bone or region
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.
Using muscle force to move one region of the body to achieve movement of another bone or region-force of contraction
Sustained gentle pressure (10 to 20 lb of pressure)
Muscle Energy – Indications
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`
Factors Influencing Successful Muscle
Energy - Patient
Contract too hard
Contract in the wrong
direction
Sustain the contraction for too short a time
Do not relax appropriately following contraction
Factors Influencing Successful Muscle Energy - Operator
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`
Muscle Energy - Contraindications
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
Articulatory Approach (springing technique)
Low velocity/high amplitude
Direct technique
History: as old as Osteopathy itself
what is the Articulatory Approach
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
Articulatory Technique Indications
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
Articulatory Technique – Contraindications (relative)
Vertebral artery compromise
Avoid combination of rotation and extension in the cervical spine
Articulatory Technique – Contraindications (absolute)
Local fracture or dislocation Neurologic entrapment syndromes Serious vascular compromise Local malignancy Local infection (e.g., cellulitis, abscess, septic arthritis, osteomyelitis) Bleeding disorders
Define Post isometric Relaxation
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
