Principles Of ME

Question 1

Ropey vs boggy muscle feel

Answer 1

Ropey = chronic dysfunction

Boggy = acute dysfunction

Question 2

Indications for Muscle energy

Answer 2

Relax hypertonic muscles

Stretch tight fascial planes

Mobilize restricted joints

Strengthen weak muscles

Regain muscle balance

Decrease pain from muscle imbalances

Question 3

Contraindications for ME

Answer 3

Fractures

Dislocations

Serious tissue damage

No consent

Hematologists diseases w/ inflammation

Muscle spasms

Entrapments

Patients w/ low vitality

Question 4

Basic ME concepts

Answer 4

Patient is placed in position to act towards restrictive barrier

Physcian counter force matched patient contraction force (isometric contractions)

Question 5

Ways ME can be used

Answer 5

Patient direct cooperation

Respiratory assistance
- use inhalation and exhalation in combination

Ocular assistance
- really only used in cervical ME after trauma

Question 6

Types of ME

Answer 6

Post isometric relaxation (uses direct restricted barrier with muscles)

Joint mobilization w/ muscles: (moves bones in specific directions)

Reciprocal inhibition: (uses contraction of the antagonist muscle to forcefully relax the agonist muscle)

Crossed extensor reflex: (patient contracts opposite muscle while you work on the intended muscle)

Question 7

Two types of relaxation in ME

Answer 7

Voluntary and therapeutic (or involuntary)

Question 8

Myofascial shortening

Answer 8

Increasing muscle mass while also increasing fibrous tissue mass
- can affect passive and active ROM

Question 9

End feel

Answer 9

Sensation evoked when moving the body toward the barrier

Anatomical barrier = soft/springy feel

Restrictive barrier = rough/solid feel

Question 10

Feather edge of the barrier

Answer 10

The beginning of the restrictive barrier. NOT the end point.

Starting treatment point of ME since it disarms the defense neurological mechanisms of the body

Question 11

Direct mechanism behind post isometric relaxation

Answer 11

Contraction stretches surrounding tissues of the joint /muscles

Golgi tendon organs sense the change in tension and cause a reflexive relaxation of the agonist muscle fibers

Question 12

Direct mechanisms behind reciprocal inhibition

Answer 12

Contraction towards the restrictive barrier causes antagonist muscles to contract. This in turn causes the dysfunctional muscles to reflex during repositioning phase.

Question 13

Most common sequela of OM

Answer 13

Muscle stiffness/soreness

Question 14

Somatovisceral vs viscerosomatic reflexes

Answer 14

Somato: somatic problems lead to changes in visceral structures

Viscero: visceral problems lead to neuromuscular dysfunctions

Question 15

How long is the force during ME maintained?

Answer 15

Usually 5 seconds (until the contraction is palpable at the appropriate location)

Question 16

Difference between abduction and adduction hip ME

Answer 16

Abduction = patient will try to abduct against physician adducting. STABILIZE IPSILATERAL PELVIS

Adduction = patient tries to adduct against physician abducting. STABILIZE THE CONTRALATERAL LEG

Question 17

Tight hamstrings ME

Answer 17

Patient is supine and physician sits at the same side of the table as the extremity to be treated

• patient distal leg is on the physician shoulder and the physician hands are just above the patients knee stabilizing
• patient brings heel down and pushes away from physician. Afterwards physician flexes and extends patient knee towards the new featheed edge

Question 18

Treatment of tight quadriceps

Answer 18

Physician flexes lower leg to the barrier and then the patients flexes leg against physician force

Afterwards the physician moves the patient towards the new featheredge

Question 19

Internal and external hip rotation ME

Answer 19

Compare ROM of both sides and determine restricted side (site of somatic dysfunction)

• can be done supine or prone

Patient moves in the direct of the somatic treatment name
Physician moves in the opposite side

• when doing prone, make sure to stabilize the ipsilateral pelvis*

Question 20

Piriformis ME

Answer 20

Piriformis is the primary hip external rotator.

Because the patient is placed with affected leg crossed over the good leg, the physcian actually moves the patient internal rotation where the patient externally rotates against.

STABLIZE HIP

Question 21

Tibiofemoral motion

Answer 21

Medial surface of the joint internally rotates tibia during flexion (short leg)

Medial surface of the joint externally rotates tibia during extension (Long leg)

Question 22

Tibial dysfunction screening

Answer 22

Patient sits at table with legs hanging off

• physician dorsiflexion ankle at about 90 degrees and then internally and externally rotates tibia looking for differ cents in end feel and ROM.

Question 23

Tibiotalar joint facts

Answer 23

Plantar flexion = 10-55 degrees

Dorsiflexion = 5-40 degrees

5x more likely to sprain ankle if the ankle joints are inflexible

More common dysfunctions are found with plantar flexion (less stable)

Question 24

Cuboid vs navicular bones facts

Answer 24

Inversion ankle sprains often cause cuboid and navicular bone droppage

Navicular drops = external rotation of bone and the lower portion moves inward

Cuboid drops = internal rotation of bone and the lower portion moves outward

Problems with the navicular causes decreased inversion

Problems with cuboid causes decreased eversion

Question 25

Navicular (externally rotated) bone drop ME

Answer 25

One hand of physician stabilizes the patients talus, with the other hand on the navicular bone

Physician induces internal rotation/ eversion of the navicular bone to the restrictive feathered edge

Patient inverts the foot to match the pressure

Question 26

Cuboid (internally rotated) bone drop

Answer 26

One hand of physician stabilizes the patients talus, with the other hand on the navicular bone

Physician induces external rotation/ inversion of the navicular bone to the restrictive feathered edge

Patient everts the foot to match the pressure