688 L 8/17 Principles of Muscle Energy

Somatic Dysfunction

the impaired or altered function of related components of the body framework system

TART

tissue texture changes

asymmetry

restricted motion

tederness

5 Other Features to Look for in Physical Exam

temperature

texture

moisture

edema

erythema

Acute Somatic Dysfunction Skin Temperature

hot

Chronic Somatic Dysfunction Skin Temperature

cold

Acute Somatic Dysfunction Skin Texture

boggy/rigid

Chronic Somatic Dysfunction Skin Texture

ropy/stringy

Acute Somatic Dysfunction Skin Moisture

increased/moist

Chronic Somatic Dysfunction Skin Moisture

decreased/dry

Acute Somatic Dysfunction Skin Edema

present

Chronic Somatic Dysfunction Skin Edema

not present

Acute Somatic Dysfunction Skin Erythmea

increased prolonged redness

Skin Erythmea Exception

the skin can be red after a technique, but it is only a problem if it is in one spot or hurts

Chronic Somatic Dysfunction Skin Erythmea

prolonged blanching

Active Motion

movement produced voluntarily by the patient (the patient is active)

Passive Motion

motion induced by the osteopathic practitioner while the patient remains relaxed (patient is passive)

Active OMT Methods

any technique in which the patient voluntarily performs an osteopathic practitioner-directed motion (patient does work)

Passive OMT Methods

any technique in which the patient is instructed to restrain from voluntary muscle contraction (physician does the work)

Barriers

every motion has a barrier (the limit of motion), but not everyone has a somatic dysfunction

abnormal restriction of motion is what we are checking for

5 Barriers

anatomic

physiologic

elastic

pathologic

restrictive

Anatomic Barrier

the limit of motion imposed by anatomic structure, the limit of passive motion, going beyond this results in damage to the tissues

Physologic Barrier

the normal limit of active motion

Elastic Barrier

the range between the physiologic and anatomic barriers in which passive ligamentous stretching occurs before tissue disruption

Pathologic Barrier

restriction of joint motion associated with pathologic change of tissues (like osteophytes)

Restrictive Barrier

a functional limit that abnormally diminishes the normal pathologic range, this is the one you are looking for when screening for somatic dysfunction

Osteophytes

boney lumps that grow on the bones (on the zygapophyseal joints of the spine or other joints)

Normal Joint Rotation Diagram

Barrier with Somatic Dysfunction Diagram

Restrictive Barrier Zone

position through which direct techniques move where the somatic dysfunction is, starts with the feather’s edge of the barrier and ends with the hard edge

Feather’s Edge of the Barrier

the spot where you can just barely feel resistance (the very edge)

Hard Edge

the end of the restrictive barrier zone where the joint locks out and will not move any further

Position of Laxity

position at which the tissues are as soft/loose as they can be, moving away from this position will increase the tension in the tissues

Direct Technique

the restrictive barrier is engaged and a final activating force is applied to correct somatic dysfunction

Indirect Technique

the restrictive barrier is disengaged and the dysfunctional body part is moved away from the restrictive barrier

Muscle Energy Technique

a form of omt in which the patient’s muscles are actively used on request, from a precisely controlled positon, in a specific direction, and against a distinctly executed physician counterforce

an active, direct method

Dr. Fred Mitchell DO

created muscle energy, named because of its reliance on active patient effort through muscle contraction

Dr. Ed Stiles

a guy that is still alive that took one of Dr. Fred Mitchell’s class, said that mitchell wasn’t going to teach the class again if the people didn’t get it

6 Proposed Mechanisms of Muscle Energy

*post-isometric relaxation

*joint mobilization using muscle force

respiratory assistance

oculocephalogyric reflex

reciprocal inhibition

crossed entensor reflex

Post-Isometric Relaxation: Goal

muscle relaxation

Post-Isometric Relaxation: Physiological Basis

after performing this contraction, the neuromuscular apparatus is in a refractory state in which passive stretching may be performed without encountering a myotatic reflex

physician resists contraction then “takes up the slack”

Isometric Contraction

length of muscle does not change during the contraction

Isotonic Contraction

the length of the muscle changes during contraction but the force/weight does not

Post-Isometric Relaxation: Force of Contraction

gentle pressure, 10-20 lbs of pressure at most

Myotatic Reflex

stretch reflex, an involuntary automatic response to a muscle being stretched, makes the muscle think it might be torn

we want to avoid this reflex for muscle energy

Triggers of Myotatic Reflex Must Overcome:

the amount of stretch

rate of stretch

Principles of Diagnosis Using Muscel Energy Technique

get an accurate diagnosis (without an accurate diagnosis, you cannot perform an appropriate treatment)

check the motion one plane at a time, then learn to “stack” the barriers to treat multiple planes of motion at the same time

Treatment Using MET

After obtaining diagnosis, physician positions the body part to be treated to its initial resistance (feather’s edge of the restrictive barrier)

Patient is instructed to provide an appropriate muscle effort in a specific direction (away from the barrier) as the physician provides counterforce for 3-5 seconds – isometric contraction

Instruct the patient to completely relax for 3-5 seconds

After the patient has completely relaxed, the physician repositions the patient to the new feather’s edge of the restrictive barrier

Repeat steps 2-4 until maximum level of improvement is achieved, typically 3-5 times*

final stretch to make sure it all of the somatic dysfunction was treated

Return the patient to neutral and then recheck the somatic dysfunction

Indications for MET

presence of somatic dysfunction in absence of contradictions

Relative Contraindictions for MET

patient is uncooperative or unresponsive

language barrier

infection, hematoma, or tear of involved muscle

fracture or dislocation of involved joint

rheumatologic conditions causing instability of the cervical spine

undiagnosed joint swelling of involved joint

positioning  that comprises vasculature

severe osteoporosis

primary or secondary neoplastic process in the area to be treated

patient is too young to cooperate*

hypermobility – can make it hard to feel the barrier (we’ll screen for this in lab)

2 Absolute Contraindictions for MET

no somatic dysfunction

patient refusal

Safety and Efficacy of MET

safe if applied correctly, avoid vigorous contractions because that can make met less effective and result in spasms of soreness

localized appropriately → go to the feather’s edge of a barrier