Muscle Energy Muscle Energy TechniqueTechnique

Applied to the ShoulderApplied to the Shoulder

MUSCLE ENERGYMUSCLE ENERGY

TheoryTheoryMuscle energy technique is a manual therapy Muscle energy technique is a manual therapy procedure which involves the voluntary procedure which involves the voluntary contraction of a muscle in a precisely contraction of a muscle in a precisely controlled direction at varying levels of controlled direction at varying levels of intensity against a distinct counterforce applied intensity against a distinct counterforce applied by the operator.by the operator.

Muscle Energy TechniqueMuscle Energy Technique

Uses:Uses:Lengthen a shortened, contractured, or spastic muscle.Lengthen a shortened, contractured, or spastic muscle.Strengthen a weakened muscle or group of muscles.Strengthen a weakened muscle or group of muscles.To reduce localized edema.To reduce localized edema.Relieve passive congestion.Relieve passive congestion.To mobilize an articulation with restricted mobility.To mobilize an articulation with restricted mobility.

Types of ContractionTypes of Contraction

IsometricIsometricConcentric IsotonicConcentric IsotonicEccentric IsotonicEccentric IsotonicIsolyticIsolytic

These can also be biased by adding either These can also be biased by adding either distraction or compression to alleviate pain.distraction or compression to alleviate pain.

Principles EmployedPrinciples Employed

Reciprocal InhibitionReciprocal InhibitionAutogenic (postAutogenic (post--isometric) Inhibitionisometric) Inhibition

Isometric ContractionIsometric Contraction

Primarily reduce the tone in a hypertonic muscle and Primarily reduce the tone in a hypertonic muscle and reestablish its normal resting length. reestablish its normal resting length. Shortened and hypertonic muscles are frequently Shortened and hypertonic muscles are frequently identified as the major component of restricted identified as the major component of restricted motion of an articulation.motion of an articulation.Length and tone are governed by the fusiform motor Length and tone are governed by the fusiform motor system to the intrafusal fibers. system to the intrafusal fibers. The gamma system is the neurological control for this The gamma system is the neurological control for this system.system.Works on a reflex arc.Works on a reflex arc.

Autogenic (postAutogenic (post--isometric) Inhibitionisometric) Inhibition

Afferents from both Afferents from both GolgiGolgi tendon receptors and gamma tendon receptors and gamma afferents from muscle spindle receptors feed back to the cord.afferents from muscle spindle receptors feed back to the cord.Gamma efferents return to the intrafusal fibers resetting their Gamma efferents return to the intrafusal fibers resetting their resting length. resting length. This changes the resting length of the This changes the resting length of the extrafusalextrafusal fibers of the fibers of the muscle.muscle.After an isometric contraction, a hypertonic muscle can be After an isometric contraction, a hypertonic muscle can be passively lengthened to a new resting length.passively lengthened to a new resting length.

Reciprocal Reciprocal InnervationInnervation & & InhibitionInhibition

When an agonist muscle contracts and shortens, its When an agonist muscle contracts and shortens, its antagonist must relax and lengthen so that motion can antagonist must relax and lengthen so that motion can occur under the influence of the agonist muscle.occur under the influence of the agonist muscle.The contraction of the agonist reciprocally inhibits its The contraction of the agonist reciprocally inhibits its antagonist allowing smooth motion.antagonist allowing smooth motion.The harder the agonist contracts, the more inhibition The harder the agonist contracts, the more inhibition in the antagonist, causing relaxation.in the antagonist, causing relaxation.

Improved Tone & PerformanceImproved Tone & Performance

The second principle of isotonic MET is increasing The second principle of isotonic MET is increasing the tonus and improving the performance of a muscle the tonus and improving the performance of a muscle that is too weak for its musculoskeletal function.that is too weak for its musculoskeletal function.As a series of reps of isotonic contraction occur in As a series of reps of isotonic contraction occur in the muscle, against progressive resistance, the muscle, against progressive resistance, extrafusalextrafusalmuscle fiber participation in the contraction increases.muscle fiber participation in the contraction increases.Isotonic ME procedures reduce hypertonicity in a Isotonic ME procedures reduce hypertonicity in a shortened antagonist and increase the strength of the shortened antagonist and increase the strength of the agonist.agonist.

Overall EffectOverall Effect

These muscle contractions affect the surrounding fascia, These muscle contractions affect the surrounding fascia, connective tissue ground substance interstitial fluids, and alteconnective tissue ground substance interstitial fluids, and alter r muscle physiology by reflex mechanisms. muscle physiology by reflex mechanisms. FascialFascial length and tone is altered by muscle contraction.length and tone is altered by muscle contraction.Alteration in fascia influences biomechanical function, Alteration in fascia influences biomechanical function, biochemical, and immunological functions.biochemical, and immunological functions.The contraction produces metabolic processes to occur and the The contraction produces metabolic processes to occur and the patient may experience soreness within 12patient may experience soreness within 12--36 hours after 36 hours after treatment.treatment.

Elements of Muscle EnergyElements of Muscle Energy

PatientPatient--active contractionactive contractionControlled Joint PositionControlled Joint PositionDirection specific muscle contractionDirection specific muscle contractionOperator applied specific counterforceOperator applied specific counterforce

Muscle Energy Technique LabMuscle Energy Technique Lab

The Principles of diagnosis and treatment are:The Principles of diagnosis and treatment are:•• To evaluate ROM in all planesTo evaluate ROM in all planes•• To evaluate strength of all muscle groupsTo evaluate strength of all muscle groups•• To treat restricted ROM by isometric technique at To treat restricted ROM by isometric technique at

the restrictive barrierthe restrictive barrier•• If weakness is detected, to treat by a series of If weakness is detected, to treat by a series of

concentric isotonic contractionsconcentric isotonic contractions

Muscle Energy ProcedureMuscle Energy Procedure

Athlete is seated.Athlete is seated.Operator stands behind.Operator stands behind.Operator sets the scapula.Operator sets the scapula.Operator controls the athleteOperator controls the athlete’’s arm at the elbow.s arm at the elbow.Operator induces movements.Operator induces movements.ROM and EOR isometrics are tested.ROM and EOR isometrics are tested.Strength testedStrength testedRetestRetest

3-5 repetitions of muscle effort for 3-7 seconds each

Muscle Energy LabMuscle Energy Lab

ARTICULAR & Muscle Energy TechniquesARTICULAR & Muscle Energy Techniques

Glenohumeral JointGlenohumeral Joint•• Primary movement loss is of ER and abduction.Primary movement loss is of ER and abduction.•• Loss of the ability for the humeral head to move Loss of the ability for the humeral head to move

from the cephalic to caudal end of the glenoid from the cephalic to caudal end of the glenoid during abduction.during abduction.

Muscle Energy LabMuscle Energy Lab

Glenohumeral JointGlenohumeral JointEasy mechanics, but must be specificEasy mechanics, but must be specific

•• Flexion/extensionFlexion/extension•• Lateral RotationLateral Rotation•• Medial RotationMedial Rotation•• AbductionAbduction•• Horizontal AdductionHorizontal Adduction

Muscle Energy LabMuscle Energy Lab

Acromioclavicular Joint Acromioclavicular Joint Little motion = very significantLittle motion = very significantCheck motion with operator behind the athlete ER and adduct theCheck motion with operator behind the athlete ER and adduct thearm feeling for gapping.arm feeling for gapping.

Restricted AbductionRestricted AbductionHorizontal flex to 30 degrees and abduct and monitorHorizontal flex to 30 degrees and abduct and monitorAthlete pulls elbow to the side of the body, operator Athlete pulls elbow to the side of the body, operator maintains fixation.maintains fixation.

Restricted ER & IRRestricted ER & IRHorizontal flexion to 30 degrees then abduct to barrier.Horizontal flexion to 30 degrees then abduct to barrier.For IR restriction, thread arm under elbow and over athleteFor IR restriction, thread arm under elbow and over athlete’’s s wrist IR to barrier. Athlete induces ER.wrist IR to barrier. Athlete induces ER.

For ER restriction, operatorFor ER restriction, operator’’s forearm is on posterior aspect of the s forearm is on posterior aspect of the elbow, grasping the anterior wrist, inducing ER. Athlete induceselbow, grasping the anterior wrist, inducing ER. Athlete induces IR.IR.

Muscle Energy LabMuscle Energy LabSternoclavicularSternoclavicular JointJointRestricted AbductionRestricted Abduction (inferior glide with posterior rotation)(inferior glide with posterior rotation)

Palpate & ShrugPalpate & Shrug1.1. Superior pressure with PNF patternSuperior pressure with PNF pattern

One hand over medial clavicle/ hand on forearmOne hand over medial clavicle/ hand on forearmIR/extension, athlete raises to ceiling (IR,AR)IR/extension, athlete raises to ceiling (IR,AR)

2.2. In sitting, superior pressure, 90/90, resist adduction (ER,PR)In sitting, superior pressure, 90/90, resist adduction (ER,PR)

Restricted Horizontal FlexionRestricted Horizontal FlexionTest with hands in fly position in supineTest with hands in fly position in supineME with operator on opposite side and athlete grabbing ME with operator on opposite side and athlete grabbing operators neck. Athlete pulls while operator creates operators neck. Athlete pulls while operator creates equal opposing pressure into posterior compression.equal opposing pressure into posterior compression.

Rotation Rotation (corrected as conjunct motion with Abduction)(corrected as conjunct motion with Abduction)

Muscle Energy LabMuscle Energy Lab

Scapulothoracic JointScapulothoracic Joint•• Anterior ElevationAnterior Elevation LatissimusLatissimus DorsiDorsi (C6C7)(C6C7)•• Posterior DepressionPosterior Depression SerratusSerratus Anterior (C6C7)Anterior (C6C7)•• Anterior DepressionAnterior Depression Levator Scapulae (C4C5)Levator Scapulae (C4C5)•• Posterior ElevationPosterior Elevation PectoralisPectoralis Minor (C7C8)Minor (C7C8)

Muscle Energy LabMuscle Energy Lab

First Rib First Rib •• DepressionDepression•• Positional Tests: During inspiration and expiration.Positional Tests: During inspiration and expiration.

Muscle Energy LabMuscle Energy Lab

Thoracic ExtensionThoracic Extension•• Seated thoracic Seated thoracic mobesmobes•• Prone thoracic Prone thoracic mobesmobes•• Sitting with and without arm elevationSitting with and without arm elevation

7 Step Procedure of Spencer7 Step Procedure of SpencerAthlete is laterally recumbentAthlete is laterally recumbentOperator stands and faces the athlete.Operator stands and faces the athlete.ONEONE Gently flex and Extend the arm in the sagittal plane, elbow Gently flex and Extend the arm in the sagittal plane, elbow

flexedflexedTWOTWO Flex arm elbow extended with rhythmic swinging Flex arm elbow extended with rhythmic swinging

movement.movement.THREETHREE Circumduct the abducted humerus with the elbow acutely Circumduct the abducted humerus with the elbow acutely

flexed in CW and CCW concentric circles while stabilizing the flexed in CW and CCW concentric circles while stabilizing the scapula. scapula.

FOURFOUR Circumduct the humerus around the stabilized scapula with Circumduct the humerus around the stabilized scapula with elbow extended, gradually increasing ROM in painelbow extended, gradually increasing ROM in pain-- free free fashion.fashion.

FIVEFIVE Abduct the arm against the stabilized scapula with the Abduct the arm against the stabilized scapula with the elbow flexed.elbow flexed.

SIXSIX AthleteAthlete’’s hand behind the lower ribs, gently pull the elbow s hand behind the lower ribs, gently pull the elbow forward and slightly inferior increasing the IR of the humerus forward and slightly inferior increasing the IR of the humerus in the glenoid. Springing repetitions to increase ROM but in the glenoid. Springing repetitions to increase ROM but without increase in pain.without increase in pain.

SEVENSEVEN Operator grasps the proximal humerus with both hands and Operator grasps the proximal humerus with both hands and tractions laterally with alternating pumping fashion.tractions laterally with alternating pumping fashion.

RETESTRETEST