Muscle Energy And Articulatory Principles Flashcards
Who developed Muscle Energy?
T.J. Ruddy, DO who published “Ruddy’s Rapid Rhythmic Resistive Duction” in 1914
Who further developed and amplified MET?
Fred Mitchell Jr., DO who wrote about it as early as 1948
What is muscle energy?
Voluntary contraction of patient muscle in a precisely controlled direction with vary levels of intensity against a distinctly excused counterforce
It is a direct and active technique, but the patient’s motion is away from the barrier (so toward the somatic dysfunction)
What are the 4 muscular contraction types?
Isometric contraction, Concentric isotonic contraction, Eccentric isotonic contraction, and Isolytic contraction
What is isometric contraction?
Contraction of a muscle with no change in distance between the origin and insertion
What is concentric isotonic contraction?
Contraction of a muscle with approximation of origin and insertion
What is eccentric isotonic contraction?
Contraction of a muscle with separation of origin and insertion
What is isolytic contraction?
It is NON-PHYSIOLOGIC
It is attempted concentration contraction, with an external force causing separation of origin and insertion
What is Post-isometric relaxation?
When the muscle contracts, leading to increased tension in the Golgi-Tendon Organ, and leads to inhibition of muscle contraction
What is joint mobilization using muscle force?
Restoration of motion to the joint with reflex relaxation of the previously hypertonic musculature by the pt exerting maximal muscle contraction that is comfortably resisted by the physician
What is respiratory assistance?
Exaggerated respiratory motion in order to help generate muscular forces that typically may be involved with ventilation motions (in the spine, pelvis, and extremities)
What is the oculocephalogyric reflex?
Eye movements that reflexively affect the cervical and truncated musculature as the body attempts to follow the lead provided by eye motion
What is reciprocal inhibition?
When a gentle contraction is initiated in the agonist muscle, there is a reflex relaxation of that muscle’s antagonistic group
What is crossed extensor reflex?
This is used for muscle in severely injured areas
When the flexor muscle in one extremity is contracted voluntarily, the flexor muscle in the contralateral extremity relaxes and the extensor contracts
What’s the difference between Reciprocal Inhibition and Crossed Extensor Reflex?
Reciprocal inhibition benefits the ipsilateral side you are working on, whereas crossed extensor reflex benefits the contralateral side that you are working on
What is isokinetic strengthening?
It is used to reestablish normal tone and strength in a muscle weakened by reflex hypertonicity of the opposing muscle group
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
What is isolytic lengthening?
It is used to lengthen a muscle shortened by contracture and fibrosis.
Maximal contraction by the patient, that can be comfortably resisted by the physician is used
How does using muscle force to move one region of the body to achieve movement of another bone ore region work?
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
Ex) moving the shoulder can affect the neck muscles
What the similarities and differences between isometric and isotonic procedures?
Isometric: careful positioning, light to moderate contraction, unyielding counterforce, relaxation after contraction, repositioning
Isotonic: careful positioning, hard to maximal contraction, counterforce permits controlled motion, relaxation after contraction, repositioning
What are the indications for Muscle energy?
Balance muscle tone, strengthen reflexively weakened musculature, improve symmetry of articular motion, enhance the circulation of body fluids, lengthen a shortened/contracture/spastic muscle group
What are the first 5 steps of Muscle energy treatment?
- Physician positions body part to be treated at position of initial resistance
- Patient instructed in intensity, duration, and direction of muscle contraction
- Physician directs patient to contract appropriate muscles
- Physician uses counterforce in opposition to and equal to patient’s muscle contraction
- Physician maintains forces until appropriate patient contraction is perceived at the critical articulation/area, taking 3-5 seconds
What are the last 5 steps of Muscle Energy treatment?
- The patient is directed to relax while the physician matches the decrease in patient force
- Physician allows the patient to relax and sense the tissue relaxation
- Physician takes up the slack permitted by the procedure and the slack is allowed by the decreased tension in the tight muscle, allowing it to be passively lengthened
- Steps 1-8 are repeated 3-5 times until best possible increase in motion is obtained
- Re-evaluate
What 4 factors can affect successful Muscle Energy treatment at the fault of the patient?
Contracting too hard, contracting in the wrong direction, sustaining the contraction for too short a time, or not relaxing appropriately following contraction
What 4 factors can affect successful muscle energy treatment at the fault of the physician?
Not controlling the joint position in relation to the barrier movement, not providing the counter force in the correct direction, not giving accurate instructions, or moving to a new joint position too soon after the patient stops contracting
What are contraindications of Muscle energy?
Local fracture/dislocation, moderate-to-severe segmental instability of the cervical spine, neurologic symptoms on rotation of the neck, low vitality, a post-op patient/post-MI patient/recent eye-surgery patient
What can muscle energy cause in terms of adverse reactions?
Tendon avulsion (when done in the elderly), rib fracture (in a patient with osteoporosis), and anterior chamber intraocular hemorrhage (in a patient post cataract removal and lens implant surgery)
What is the articulatory approach?
It is gentle and repetitive motions through the restrictive barrier to restore physiologic motion by using low velocity and high amplitude directly
What are the indications for the articulatory technique?
Arthritic patients, elderly/frail, critically ill or post-op, infants/young patients, or patients unable to cooperate with instructions
What are the 7 steps of the Articulatory technique?
- Put patient in position of comfort
- Move the affected joint/body part until the restrictive barrier is engaged
- A gentle but firm force is applied carrying the body part a short distance through the restrictive barrier
- Force is applied rhythmically, typically 1 or 2 seconds of stretch, followed by a similar time frame releasing that stretch with the joint returning to a point just short of its restrictive barrier
- As the patient responds, the barrier will shift position within the physiologic ROM
- The applied forces should be comfortable for the patient and can describe it as a “good discomfort”
- Continued until the location of the restrictive barrier reaches a plateau
What are the relative contraindications for the articulatory technique?
Vertebral artery compromise
In order to avoid combination of rotation and extension in the cervical spine
What are absolute contraindications for articulatory technique?
Local fracture/dislocation
Neurologic entrapment syndromes
Serious vascular compromise
Local malignancy
Local infection
Bleeding disorders
What are the similarities and differences between MET and ART?
MET: direct, patient muscle contraction 3-5 times for 3-5 seconds, required patient cooperation, goal to alleviate somatic dysfunction
ART: direct, repetitive physician directed motions, passive technique with patient relaxed, goal to alleviate somatic dysfunction
