Muscle energy technique

Muscle Energy Technique is a type of osteopathic manipulative treatment used in osteopathic medicine and physical therapy ^[1]. It is a form of osteopathic manipulative diagnosis and treatment in which the patient’s muscles are actively used on request, from a precisely controlled position, in a specific direction, and against a distinctly executed physician counterforce. It was first described in 1948 by Fred Mitchell, Sr, DO.^[2] Muscle energy techniques are used to treat somatic dysfunction, especially decreased range of motion, muscular hypertonicity and pain.

Pathophysiology

Injury can occur as a result of trauma, accidents, overuse, strain/sprain, etc., not all of which should be treated with muscle energy. These techniques are most appropriate for the following injury patterns:

• Decreased range of motion secondary to muscular spasticity, rigidity, hypertonicity or hypotonicity. Hypertonicity often follows overuse and can result in altered joint position, increased irritability and decreased elasticity. This injury pattern is often accompanied by a non-specific muscle ache in the area of injury.
• Interneuronal injury-- when dysfunction occurs at one joint or segment, the related agonist muscles are also affected. If uncorrected, the antagonistic muscles eventually become involved as well, leading to dysfunction of both muscle groups. This presents as decreased range of motion with pain and/or tenderness in the area.

Mechanism of Action for Muscle Energy Techniques

Muscle energy is a direct and active technique; meaning it engages a restrictive barrier and requires the patient's participation for maximal effect. As the patient performs an isometric contraction, the following physiologic changes occur:

• Golgi tendon organ activation results in direct inhibition of agonist muscles
• A reflexive reciprocal inhibition occurs at the antagonistic muscles
• As the patient relaxes, agonist and antagonist muscles remain inhibited allowing the joint to be moved further into the restricted range of motion.

Studies have shown that muscle energy techniques can significantly decrease disability and improve functionality in patients with disorders such as low back pain. ^[3]

Indications/Contraindications

Muscle energy techniques can be employed to reposition a dysfunctional joint and treat the affected musculature. Indications include, but are not limited to: muscular shortening, low back pain, pelvic imbalance, edema, limited range of motion, somatic dysfunction, respiratory dysfunction, cervicogenic headaches and many others.

These techniques are inappropriate whenever injuries such as fractures, avulsion injuries, severe osteoporosis, metastatic disease and open wounds exist. In addition, because these techniques require active patient participation, they are inappropriate for any patient that is unable to cooperate.

Techniques

Muscle energy techniques can be applied to most areas of the body. Each technique requires 8 essential steps:

1. Perform and obtain an accurate structural diagnosis.
2. Engage the restrictive barrier in as many planes as possible.
3. Physician and patient engage in an unyielding counterforce where the patient's force matches the physician's force.
4. The patient's isometric contraction has the correct amount of force, the correct direction of effort (away from the restrictive barrier) and the correct duration (3-5 seconds).
5. Complete relaxation occurs after the muscular effort.
6. The patient is repositioned into the new restrictive barrier in as many planes as possible.
7. Steps 3-6 are repeated approximately 3-5 times.
8. The structural diagnosis is repeated to see if the dysfunction has resolved.

References

1. ^ "Athletic Advantage Physical Therapy", Accessed April 28, 2008.
2. ^ Glossary of Osteopathic Terminology, Educational Council on Osteopathic Principles (ECOP), American Association of Colleges of Osteopathic Medicine (AACOM), Revised April 2009, page 31.
3. ^ [Wilson, E., et. al., "Muscle energy technique in patients with acute low back pain: a pilot clinical trial," J Orthop Sports Phys Ther, 2003 Sept., 33(9): 502-512.]

Sources

Updated by Western University of Health Sciences/COMP OMM Department

• Ward, Robert C. et al.; Foundations for Osteopathic Medicine (2nd ed.). Philadelphia: Lippincot Williams and Wilkins. ISBN 0-7817-3497-5.
• DiGiovanna, Eileen L. et al.; An Osteopathic Approach to Diagnosis and Treatment; 3rd ed.; Philadelphia: Lippincott Williams and Wilkins; 2005; ISBN 0-7817-4293-5
• Burns DK, "Gross range of motion in the cervical spine: the effects of osteopathic muscle energy technique in asymptomatic subjects." J Am Osteopath Assoc, 2006 Mar; 106(3): 137- 142
• Goodridge, J.P., "Muscle energy technique: definition, explanation, methods of procedure," JAOA, Dec 1981, 81(4): 249- 253.