Met/Art Principles Flashcards
What is muscle energy?
The pts muscles are actively used on request from a precisely controlled position, in a specific direction, against a distinctly executed physician counterforce
An active and direct technique
Muscle energy cannot be used if the pt is what?
In a coma, uncooperative, too young to follow commands or unresponsive
Describe the contributions TJ Ruddy, DO made to the history of muscle energy
Published first article in 1914
- eye and cervical spine treatment
- used rapid, repetitive in contractions 1-2 per second against resistance
Describe the role Fred L Mitchell, DO played in the history of muscle energy
Wrote about muscle energy technique as early as 1948
1950-60s taught courses with Paul Kimberly, DO entitled The Pelvis and its Environs
1970 taught a course in Iowa to 6 students, 5 of which because osteopathic college faculty
Developed and amplified MET
What is an eccentric contraction?
Muscle tension allows the origin and insertion to separate in effect to lengthen the muscle
What is a concentric contraction?
Contraction of a muscle resulting in the approximation of the origin and insertion to shorten the muscle
What is an isotonic contraction?
A concentric or eccentric contraction against a steady but yielding counterforce allowing a constant tone (constant weight)
What is an isokinetic contraction?
A concentric contraction in which the joint motion is at a constant rate/speed (weight can vary)
What is an isolytic contraction?
A type of eccentric contraction in which the muscles concentric contraction is overpowered by a stronger counterforce (weight is greater than max effort) leading to a lengthening of the muscle
What is an isometric contraction?
The distance between the origin and the insertion of the muscle is maintained at a constant length
Neither concentric or eccentric
What are the 9 physiologic principles of muscle energy?
Post-isometric relaxation, reciprocal inhibition, crossed extensor reflex, respiratory assistance, oculocephalogyric reflex, isokinetic strengthening, isolytic lengthening, joint mobilization using muscle force and using muscle force to move one region of the body to achieve movement of another bone or region
What is the most common form of muscle energy?
Post isometric relaxation
What is the goal of post isometric relaxation?
Muscle relaxation
What is the physiologic basis of post isometric relaxation?
Immediately after an isomeric contraction the neuromuscular apparatus is in a refractory state during which passive stretching may be performed without encountering strong myotactic reflex opposition
With muscle contraction there may also be increased tension on the Golgi organ propioreceptors in the tendons; this inhibits the active muscle’s contraction
What is the force of contraction used in post-isometric relaxation?
Sustained gentle pressure (10-20lbs)
What is the goal of reciprocal inhibition?
To lengthen a muscle shortened by cramp or acute spasm
What is the physiologic basis of reciprocal inhibition?
When a gentle contraction is initiated in the agonist muscle there is a reflexive relaxation of that muscle’s antagonistic group
Ex. Cramping hamstring (agonist), contraction of quad (antagonist)
What force of contraction is used in reciprocal inhibition?
Think ounces, not pounds of pressure
Describe the steps to post isometric relaxation
Pt contracts away from the restrictive barrier (indirect)
Physician resists the contraction towards the restrictive barrier (direct) for 3-5 seconds so the origin and insertion of the muscle remain at the same distance (no movement)
Both pt and physician completely relax (1-2 seconds) and then the pt is passively moved into the new restrictive barrier
This is repeated 3-5 times or until no new barriers are reached
Describe the steps of reciprocal inhibition?
Initial set up: passive movement into the restrictive barrier (direct)
Pt contracts toward the restrictive barrier (direct)
Physician resists the contraction towards the restrictive barrier (direct) for 3-5 seconds so the origin and insertion of the muscle remain at the same distance (no movement)
Pt relaxes and after complete relaxation is passively placed into the new restrictive barrier
What is the goal of crossed extensor reflex?
To treat an are so severely injured (ex. Fractures or burns) that it cannot be manipulated or is inaccessible
What is the physiologic basis for crossed extensor reflex?
This form of muscle energy technique uses the learned “cross patter locomotion reflexes” (walking) in the CNS
When the flexor muscle in one extremity is contracted voluntarily the flexor muscle in the contralateral extremity relaxes and the extensor contracts
What force of contraction is used for crossed extensor reflex?
Think ounces, not pounds of pressure
What is the goal of the oculocephalogyric reflex?
To affect reflex muscle contractions using eye motion
What is the physiologic basis of the oculocephalogyric reflex?
The eye movements reflexively affect the cervical and truncal musculature as the body attempts to follow the lead provided by eye motion
What force of contraction is used during the oculocephalogyric reflex?
Exceptionally gentle
What is the goal of respiratory assistance?
Improve body physiology with the patient’s voluntary respiratory motions
What is the physiologic basis of respiratory assistance?
The muscular forces involved in these techniques are generated by the simple act of breathing
This may involve the direct use of the respiratory muscles themselves or motion transmitted to the spine, pelvis and extremities in response to ventilation motions
The physician usually applies a fulcrum against which the respiratory forces can work
Ex. Sacral dysfunction
What force of contraction is used in respiratory assistance?
Exaggerated respiratory motions
What is the goal of isolytic lengthening?
To lengthen a muscle shortened by contracture and fibrosis
What is the physiologic basis of isolytic lengthening?
It is postured that the vibration used here has some effect on the myotactic units in addition to the mechanical and circulatory effects
Ex. Contracture of the bicep
What force of contraction is used in isolytic lengthening?
Max contraction that can be comfortable resisted by the physician (30-50lb of pressure)
What is the goal of isokinetic strengthening?
To re-establish normal tone and strength in a muscle weakened by reflex hypertonicity of the opposing muscle group
What is the physiologic basis for isokinetic strengthening?
Where asymmetry of ROM exists there is also the potential for asymmetry in muscle strength
If there is shortening of an antagonist muscle attend to that first
It is believed that the agonist spontaneously increases their strength if the shortened or hypertonic fibers of the antagonists are lengthened first
Further restoration of strength can be accomplished through the use of an isokinetic contraction
The length change occurs at a constant velocity and the muscle is permitted to shorten but at a controlled slow rate
What is the goal of joint mobilization suing muscle force?
Restoration of joint motion in an articular dysfunction
What is the physiologic basis of joint mobilization using muscle force?
Hypertonicity of musculature across a joint can cause distortion of articular relationships and motion loss
This increase in muscle tone tends to compress joint surfaces and results in thinning of the intervening layer of synovial fluid and adherence of the joint surfaces
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
Ex. Anteriorly rotated pelvis
What force of contraction is used in joint mobilization using muscle force?
Max muscle contraction that can be comfortably resisted by the physician (up to 30-50lbs of pressure depending on the joint treated)
What is the goal of using muscle force to move one region of the body to achieve movement of another bone or region?
Treat somatic dysfunction
What is the physiologic basis for using muscle force to move one region of the body to achieve movement of another bone or region?
For some dysfunctions, it is often more effective to move one body structure by moving another body structure adjacent to it
Muscular force is used to move the first structure and that body part’s response to the muscle is transmitted to yet another part of the body
What force of contraction is used during using muscle force to move one region of the body to achieve movement of another bone or region?
Sustained genteel pressure (10-20lbs)
What are the indications of muscle energy?
Muscle energy is used to 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, contracture or spastic muscle group
Versatile to use in combination with other OMT
What factors can influence successful muscle energy?
Contract too hard
Contract in the wrong direction or counterforce in the wrong direction
Sustain the contraction for too short a time
Not giving accurate instructions (not telling the pt correct direction to push, correct amount of force to use or how long o substance the force)
Moving to a new joint position too soon after the pt stops contracting
What are the contraindications of muscle energy?
Local fracture, local dislocation, moderate to severe segmental instability in the C spine, evocation of neurologic sx or signs on rotation of the neck, low vitality
Situations that could be worsened by muscle activity such as a post surgical pt, immediately following MI or recent eye surgery
Unable/unwilling to follow verbal commands
What is articulatory approach?
Also called springing techniques
Low velocity/high amplitude (slow movement, long distance)
Passive and direct technique
Explain the articulatory approach
Gentle and repetitive motions throughout 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
What are the indications for articulatory technique?
Well tolerated by arthritic Paris, elderly or frail, critically ill or post op pts, infants or very young pts, pts unable to cooperate with instructions
Reminder
Review slides on muscle energy and ART steps
What are the relative contraindications of articulatory technique?
Vertebral artery compromise
-avoid combination of rotation and extension in the C spine
What are the absolute contraindications of articulatory technique?
Local fracture or dislocation Neurologic entrapment syndromes Serious vascular compromise Local malignancy Local infection Bleeding disorders
