Muscle Energy And Articulatory Principles

Question 1

Muscle energy is:

A ________ contraction of patient muscle

In a precisely controlled _______

Varying levels of ________

Against a distinctly executed ____________

Answer 1

Voluntary

Direction

Intensity

Counterforce

Question 2

Is muscle energy an active or passive technique?

Answer 2

Active - patient contributes the corrective force

Question 3

What is the direct technique for muscle energy?

Answer 3

Muscle energy positioned to the restrictive barrier

Question 4

What is the patient’s direction of motion in muscle energy?

Answer 4

Away from the barrier

Question 5

What are the 4 types of muscular contraction?

Answer 5

Isometric
Concentric isotonic
Eccentric isotonic
Isolytic

Question 6

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

Answer 6

A. Isometric contraction

Question 7

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

Answer 7

C. Eccentric isotonic contraction

Question 8

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

Answer 8

B. Concentric isotonic contraction

Question 9

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

Answer 9

D. Isolytic contraction

Question 10

Which of the following refers to non-physiologic muscular contraction?

A. Isometric contraction
B. Concentric isotonic contraction
C. Eccentric isotonic contraction
D. Isolytic contraction

Answer 10

D. Isolytic contraction

Question 11

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

Answer 11

A. Isometric contraction

Question 12

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

Answer 12

B. Concentric isotonic contraction

Question 13

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

Answer 13

C. Eccentric isotonic contraction

Question 14

What physiologic principle refers to the most common form of MET?

Answer 14

Post-isometric relaxation

Question 15

What physiologic principle of MET refers to muscle contraction –> increased tension in golgi tendon organ –> inhibition of muscle contraction

Answer 15

Post-isometric relaxation

[provides feedback inhibition on alpha motor neuron]

Question 16

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

Answer 16

Joint mobilization using muscle force

Question 17

What is the force of contraction when performing MET via joint mobilization using muscle force?

Answer 17

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

Question 18

What is the physiologic basis for respiratory assistance?

Answer 18

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

Question 19

What provides the force of contraction with respiratory assistance techniques

Answer 19

Exaggerated respiratory motion

Question 20

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

Answer 20

Oculocephalogyric reflex

Question 21

How strong is the force of contraction used with oculocephalogyric reflex?

Answer 21

Exceptionally gentle

Question 22

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

Answer 22

Reciprocal inhibition

Question 23

How strong is the force of contraction used with reciprocal inhibition?

Answer 23

Think ounces, not pounds of pressure

Question 24

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?

Answer 24

Crossed extensor reflex

Question 25

What is the physiologic basis for the crossed extensor reflex?

Answer 25

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

Question 26

What is the strength of the force of contraction used in the crossed extensor reflex MET?

Answer 26

Think ounces, not pounds of pressure

Question 27

What is the difference between reciprocal inhibition and the crossed extensor reflex?

Answer 27

Reciprocal inhibition is done on the ipsilateral side, while the crossed extensor reflex is meant to affect the contralateral side

Question 28

What MET is used to reestablish normal tone and strength in a muscle weakened by reflex hypertonicity of the opposing muscle group?

Answer 28

Isokinetic strengthening

Question 29

What is the physiologic basis for isokinetic strengthening?

Answer 29

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.

Question 30

What type of muscle contractions are used with isokinetic strengthening MET?

Answer 30

Concentric contractions, where muscle is permitted to shorten, but at a controlled rate

Question 31

What is the force of contraction used in isokinetic strengthening?

Answer 31

Sustained gentle pressure (10-20 lbs of pressure)

Question 32

What MET is used to lengthen a muscle shortened by contracture and fibrosis?

Answer 32

Isolytic lengthening

Question 33

What is the physiologic basis for isolytic lengthening?

Answer 33

It is postulated that the vibration used here has some effect on the myotactic units in addition to mechanical and circulatory effects

Question 34

What is the force of contraction used in isolytic lengthening?

Answer 34

Maximal contraction that can be comfortably resisted by the physician (30-50 lbs of pressure)

Question 35

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?

Answer 35

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

Question 36

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?

Answer 36

Sustained gentle pressure (10-20 lb of pressure)

Question 37

What 3 things do isometric and isotonic procedures have in common?

Answer 37

Careful positioning Relaxation after contraction Repositioning

Question 38

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?

Answer 38

Isotonic

Question 39

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?

Answer 39

Isometric

Question 40

T/F: METs are versatile to use in combination with other osteopathic manipulative techniques

Answer 40

T

Question 41

What are some indications to using muscle energy techniques?

Answer 41

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

Question 42

What are the first 3 steps in the sequence of a muscle energy technique?

Answer 42

1. Physician positions body part to be treated and position of initial resistance 2. Patient is instructed on intensity, duration, and direction of contraction 3. Physician directs patient to contract appropriate muscle/group

Question 43

MET - Sequence of technique: 1. Physician positions body part to be treated and position of initial resistance 2. Patient is instructed on intensity, duration, and direction of contraction 3. Physician directs patient to contract appropriate muscle/group What are the next 3 steps?

Answer 43

4. Physician uses counterforce in opposition to and equal to the patient contraction 5. Physician maintains forces until an appropriate patient contraction is perceived at critical area (takes 3-5 seconds) 6. Patient is directed to relax while physician simultaneously matches the decrese in patient force

Question 44

MET - Sequence of technique: 1. Physician positions body part to be treated and position of initial resistance 2. Patient is instructed on intensity, duration, and direction of contraction 3. Physician directs patient to contract appropriate muscle/group 4. Physician uses counterforce in opposition to and equal to the patient contraction 5. Physician maintains forces until an appropriate patient contraction is perceived at critical area (takes 3-5 seconds) 6. Patient is directed to relax while physician simultaneously matches the decrese in patient force What are the next 4 steps?

Answer 44

7. Physican allows pt to relax and senses tissue relaxation with proprioception 8. Physician takes up slack permitted by procedure, allowing decreased tension in tight muscle so that it is passively lengthened 9. Repeat steps 1-8 three to five times 10. Reevaluate initial dysfunction

Question 45

What are some things that can go wrong due to patient error in METs?

Answer 45

Patient: Contracts too hard Contracts in wrong direction Sustains the contraction for too short a time Does not relax appropriately following contraction

Question 46

What are some things that can go wrong with MET due to operator/physician error?

Answer 46

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

Question 47

What are some contraindications to METs?

Answer 47

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

Question 48

One contraindication to METs are situations that could be worsened by muscle activity, what are some examples of this?

Answer 48

Post-surgical patient - could cause internal bleeding Immediately following myocardial infarction Recent eye surgery - use of oculocephalogyric reflex

Question 49

Muscle energy has been shown to cause what potentially harmful conditions?

Answer 49

Tendon avulsion (with inappropriate force) Rib fracture (in patient with osteoporosis) Anterior chamber intraocular hemorrhage (in patient s/p cataract removal and lens implant)

Question 50

What type of osteopathic approach utilizes direct "springing" techniques that are low velocity/high amplitude, and is as old as osteopathy itself?

Answer 50

Articulatory approaches

Question 51

Articulatory approaches utilize ______ and ______ motions through restrictive barriers to restore physiologic motion They are applicable with restrictive barriers in the joint or ________ tissues

Answer 51

Gentle; repetitive Periarticular

Question 52

What are some indications for articulatory techniques in terms of the types of patients they are well tolerated by?

Answer 52

``` Arthritic patients Elderly or frail Critically ill or post-op Infants or very young patients Patients unable to cooperate with instructions ```

Question 53

With ARTs, the patient should be comfortable and able to ______; at no time is the ________ barrier to joint motion exceeded

Answer 53

Relax; anatomic

Question 54

What are the first 4 steps of ART?

Answer 54

1. Physician in position of comfort 2. Physician moves affected joint/body part until restrictive barrier is engaged 3. Gentle but firm force is applied carrying body part to a short distance through barrier 4. 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

Question 55

Steps of ART: 1. Physician in position of comfort 2. Physician moves affected joint/body part until restrictive barrier is engaged 3. Gentle but firm force is applied carrying body part to a short distance through barrier 4. 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?

Answer 55

5. As pt responds, restrictive barrier shifts position within physiologic ROM, continue to reengage RB until normal ROM is reached 6. Applied forces may cause discomfort, but good discomfort 7. Technique continued until RB reaches plateau, or normal ROM is reached

Question 56

What is the relative contraindication to articulatory technique?

Answer 56

Vertebral artery compromise (avoid combination of rotation and extension in cervical spine)

Question 57

What are the absolute contraindications to articulatory techniques?

Answer 57

``` Local fracture or dislocation Neurologic entrapment syndrome Serious vascular compromise Local malignancy Local infection Bleeding disorders ```

Question 58

What are the 2 similarities between MET and ART?

Answer 58

Both direct techniques, both have the goal of alleviating somatic dysfunction

Question 59

The 2 primary differences between MET and ART have to do with activating forces and levels of patient cooperation, what are they?

Answer 59

MET: Activating force is patient muscle contraction, patient cooperation is required ART: Activating force is repetitive physician directed motions, patient cooperation requires relaxation