Muscle Energy And Articulatory Principles Flashcards
Muscle energy is:
A ________ contraction of patient muscle
In a precisely controlled _______
Varying levels of ________
Against a distinctly executed ____________
Voluntary
Direction
Intensity
Counterforce
Is muscle energy an active or passive technique?
Active - patient contributes the corrective force
What is the direct technique for muscle energy?
Muscle energy positioned to the restrictive barrier
What is the patient’s direction of motion in muscle energy?
Away from the barrier
What are the 4 types of muscular contraction?
Isometric
Concentric isotonic
Eccentric isotonic
Isolytic
Which of the following refers to contraction of a muscle with no change in distance between the origin and insertion?
A. Isometric contraction
B. Concentric isotonic contraction
C. Eccentric isotonic contraction
D. Isolytic contraction
A. Isometric contraction
Which of the following refers to contraction of a muscle with separation of origin and insertion?
A. Isometric contraction
B. Concentric isotonic contraction
C. Eccentric isotonic contraction
D. Isolytic contraction
C. Eccentric isotonic contraction
Which of the following refers to contraction of a muscle with approximation of origin and insertion?
A. Isometric contraction
B. Concentric isotonic contraction
C. Eccentric isotonic contraction
D. Isolytic contraction
B. Concentric isotonic contraction
Which of the following refers to attempted concentric contraction, with an external force causing separation of origin and insertion?
A. Isometric contraction
B. Concentric isotonic contraction
C. Eccentric isotonic contraction
D. Isolytic contraction
D. Isolytic contraction
Which of the following refers to non-physiologic muscular contraction?
A. Isometric contraction
B. Concentric isotonic contraction
C. Eccentric isotonic contraction
D. Isolytic contraction
D. Isolytic contraction
Which of the following refers to the type of muscular contraction utilized in muscle energy techniques?
A. Isometric contraction
B. Concentric isotonic contraction
C. Eccentric isotonic contraction
D. Isolytic contraction
A. Isometric contraction
Which of the following refers to the “curl” part of the biceps curl?
A. Isometric contraction
B. Concentric isotonic contraction
C. Eccentric isotonic contraction
D. Isolytic contraction
B. Concentric isotonic contraction
Which of the following refers to the relaxation phase of the bicep curl?
A. Isometric contraction
B. Concentric isotonic contraction
C. Eccentric isotonic contraction
D. Isolytic contraction
C. Eccentric isotonic contraction
What physiologic principle refers to the most common form of MET?
Post-isometric relaxation
What physiologic principle of MET refers to muscle contraction –> increased tension in golgi tendon organ –> inhibition of muscle contraction
Post-isometric relaxation
[provides feedback inhibition on alpha motor neuron]
What physiologic principle of MET refers to:
Hypertonicity of musculature across a joint causing distortion of articular relationships and motion loss, increase in tone tends to compress joint surfaces, thinning the joint surfaces
Restoration of motion to the articulation results in gapping or reseating of distorted joint with reflex relaxation of the previously hypertonic musculature
Joint mobilization using muscle force
What is the force of contraction when performing MET via joint mobilization using muscle force?
Maximal muscle contraction that can be comfortably resisted by the physician (up to 30-50 lbs of pressure depending on the joint treated)
What is the physiologic basis for respiratory assistance?
The muscular forces involved in these techniques are generated by breathing
May involve direct use of respiratory muscles themselves, or motion transmitted to the spine, pelvis, and extremities in response to ventilation motions
Physician usually applies fulcrum against which respiratory forces can work
What provides the force of contraction with respiratory assistance techniques
Exaggerated respiratory motion
The physiologic basis for this technique is that eye movements reflexively affect the cervical and truncal musculature as the body attempts to follow the lead provided by eye motion
Oculocephalogyric reflex
How strong is the force of contraction used with oculocephalogyric reflex?
Exceptionally gentle
The physiologic basis to this technique is that when a gentle contraction is initiated in the agonist muscle, there is a reflex relaxation of that muscle’s antagonistic group
Reciprocal inhibition
How strong is the force of contraction used with reciprocal inhibition?
Think ounces, not pounds of pressure
What MET technique is 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
What is the physiologic basis for the crossed extensor reflex?
Form of MET using learned cross pattern locomotion reflexes engrammed into 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 is the strength of the force of contraction used in the crossed extensor reflex MET?
Think ounces, not pounds of pressure
What is the difference between reciprocal inhibition and the crossed extensor reflex?
Reciprocal inhibition is done on the ipsilateral side, while the crossed extensor reflex is meant to affect the contralateral side
What MET is used to reestablish normal tone and strength in a muscle weakened by reflex hypertonicity of the opposing muscle group?
Isokinetic strengthening
What is the physiologic basis for isokinetic strengthening?
Where asymmetry for ROM exists, there is also potential for asymmetry in muscle strength. If there is shortening of an antagonist muscle, attend to that first and feel the agonists spontaneously increase their strength if the shortened or hypertonic fibers are lengthened first
Once this is accomplished, further restoration of strength can be accomplished through the use of an isokinetic conraction.
In isokinetic contractions, the length change occurs at a constant velocity.
What type of muscle contractions are used with isokinetic strengthening MET?
Concentric contractions, where muscle is permitted to shorten, but at a controlled rate
What is the force of contraction used in isokinetic strengthening?
Sustained gentle pressure (10-20 lbs of pressure)
What MET is used to lengthen a muscle shortened by contracture and fibrosis?
Isolytic lengthening
What is the physiologic basis for isolytic lengthening?
It is postulated that the vibration used here has some effect on the myotactic units in addition to mechanical and circulatory effects
What is the force of contraction used in isolytic lengthening?
Maximal contraction that can be comfortably resisted by the physician (30-50 lbs of pressure)
What is the physiologic basis for the MET 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 force is transmitted to yet another part of the body
What is the force of contraction used when using muscle force to move one region of the body to achieve movement of another bone or region?
Sustained gentle pressure (10-20 lb of pressure)
What 3 things do isometric and isotonic procedures have in common?
Careful positioning
Relaxation after contraction
Repositioning
Isometric and isotonic METs both utilize careful positioning, relaxation after contraction, and repositioning. They are also different in several ways.
Which procedure (isometric or isotonic) utilizes hard to maximal contraction, and counterforce permits controlled motion?
Isotonic
Isometric and isotonic METs both utilize careful positioning, relaxation after contraction, and repositioning. They are also different in several ways.
Which procedure (isometric or isotonic) utilizes light to moderate contraction and an unyielding counterforce?
Isometric
T/F: METs are versatile to use in combination with other osteopathic manipulative techniques
T
What are some indications to using muscle energy techniques?
Balance muscle tone
Strengthen reflexively weakened musculature
Improve symmetry of articular motion
Enhance circulation of body fluids
Lengthen a shortened, contractured, or spastic muscle group
What are the first 3 steps in the sequence of a muscle energy technique?
- Physician positions body part to be treated and position of initial resistance
- Patient is instructed on intensity, duration, and direction of contraction
- Physician directs patient to contract appropriate muscle/group
MET - Sequence of technique:
- Physician positions body part to be treated and position of initial resistance
- Patient is instructed on intensity, duration, and direction of contraction
- Physician directs patient to contract appropriate muscle/group
What are the next 3 steps?
- Physician uses counterforce in opposition to and equal to the patient contraction
- Physician maintains forces until an appropriate patient contraction is perceived at critical area (takes 3-5 seconds)
- Patient is directed to relax while physician simultaneously matches the decrese in patient force
MET - Sequence of technique:
- Physician positions body part to be treated and position of initial resistance
- Patient is instructed on intensity, duration, and direction of contraction
- Physician directs patient to contract appropriate muscle/group
- Physician uses counterforce in opposition to and equal to the patient contraction
- Physician maintains forces until an appropriate patient contraction is perceived at critical area (takes 3-5 seconds)
- Patient is directed to relax while physician simultaneously matches the decrese in patient force
What are the next 4 steps?
- Physican allows pt to relax and senses tissue relaxation with proprioception
- Physician takes up slack permitted by procedure, allowing decreased tension in tight muscle so that it is passively lengthened
- Repeat steps 1-8 three to five times
- Reevaluate initial dysfunction
What are some things that can go wrong due to patient error in METs?
Patient:
Contracts too hard
Contracts in wrong direction
Sustains the contraction for too short a time
Does not relax appropriately following contraction
What are some things that can go wrong with MET due to operator/physician error?
Not controlling the joint position in relation to the barrier movement
Not providing counterforce in correct direction
Not giving accurate instructions
Moving to a new joint position too soon after patient stops contracting
What are some contraindications to METs?
Local frature
Local dislocation
Moderate-to-severe segmental instability in the cervical spine
Evocation of neurologic symptoms or signs on rotation of neck
Low vitality
Unable/unwilling to follow verbal commands
One contraindication to METs are situations that could be worsened by muscle activity, what are some examples of this?
Post-surgical patient - could cause internal bleeding
Immediately following myocardial infarction
Recent eye surgery - use of oculocephalogyric reflex
Muscle energy has been shown to cause what potentially harmful conditions?
Tendon avulsion (with inappropriate force)
Rib fracture (in patient with osteoporosis)
Anterior chamber intraocular hemorrhage (in patient s/p cataract removal and lens implant)
What type of osteopathic approach utilizes direct “springing” techniques that are low velocity/high amplitude, and is as old as osteopathy itself?
Articulatory approaches
Articulatory approaches utilize ______ and ______ motions through restrictive barriers to restore physiologic motion
They are applicable with restrictive barriers in the joint or ________ tissues
Gentle; repetitive
Periarticular
What are some indications for articulatory techniques in terms of the types of patients they are well tolerated by?
Arthritic patients Elderly or frail Critically ill or post-op Infants or very young patients Patients unable to cooperate with instructions
With ARTs, the patient should be comfortable and able to ______; at no time is the ________ barrier to joint motion exceeded
Relax; anatomic
What are the first 4 steps of ART?
- Physician in position of comfort
- Physician moves affected joint/body part until restrictive barrier is engaged
- Gentle but firm force is applied carrying body part to a short distance through barrier
- This force applied rhythmically, typically 1-2 sec of stretch followed by a similar time frame releasing that stretch; joint is then permitted to return to point just short of restrictive barrier
Steps of ART:
- Physician in position of comfort
- Physician moves affected joint/body part until restrictive barrier is engaged
- Gentle but firm force is applied carrying body part to a short distance through barrier
- This force applied rhythmically, typically 1-2 sec of stretch followed by a similar time frame releasing that stretch; joint is then permitted to return to point just short of restrictive barrier
What are the last 3 steps?
- As pt responds, restrictive barrier shifts position within physiologic ROM, continue to reengage RB until normal ROM is reached
- Applied forces may cause discomfort, but good discomfort
- Technique continued until RB reaches plateau, or normal ROM is reached
What is the relative contraindication to articulatory technique?
Vertebral artery compromise (avoid combination of rotation and extension in cervical spine)
What are the absolute contraindications to articulatory techniques?
Local fracture or dislocation Neurologic entrapment syndrome Serious vascular compromise Local malignancy Local infection Bleeding disorders
What are the 2 similarities between MET and ART?
Both direct techniques, both have the goal of alleviating somatic dysfunction
The 2 primary differences between MET and ART have to do with activating forces and levels of patient cooperation, what are they?
MET:
Activating force is patient muscle contraction, patient cooperation is required
ART:
Activating force is repetitive physician directed motions, patient cooperation requires relaxation
