Chapter 15 - Muscle Energy

Question 1

Explain how ME (post-isometric relaxation) works

Answer 1

Isometric contraction –> Golgi tendon organs sense increase tension –> cause reflex relaxation

Question 2

Explain how ME (reciprocal inhibition - direct) works

Answer 2

Take the muscle into the restrictive barrier like normal, but then contract the antagonist muscle against resistance (causes reflex relaxation of the agonist muscle)

Question 3

Explain how ME (reciprocal inhibition - indirect) works

Answer 3

Take the muscle into the position of EASE, then contract the antagonist muscle against resistance (causes reflex relaxation of the agonist muscle)

Question 4

Joint mobilization using ME - exlain

Answer 4

Flexing a muscle pulls the bony attachment (ex. innominate rotation dysfunction)

Question 5

Oculocephalogyric reflex ME - explain

Answer 5

Uses EOM contraction to reflexively effect the cervical and truncal musculature

Question 6

Respiratory assistance ME - explain

Answer 6

Uses voluntary respiratory motion to restore rib motion (ex.)

Question 7

Crossed extensor reflex ME - explain

Answer 7

Contraction of one muscle relaxes that muscle on the other side and contracts the antagonist muscle on the other side

Question 8

Which is more important in ME: localization or intensity of force?

Answer 8

LOCALIZATION

Question 9

Contraindications to ME

Especially what type of ME?

Answer 9

Post-surgery
ICU

Post-isometric relaxation

Question 10

Upper T spine (T1-4) - ME patient position

Answer 10

Used head and neck to move the segment

Question 11

Lower T spine (T5-T12) - ME patient position

Answer 11

Patient grabs same side neck with same side hand, then grabs elbow with contralateral hand.
Doc reaches across to manipulate torso.

Question 12

Lower T spine ME - difference for doc for neutral vs. non-neutral dysfunction

Answer 12

Neutral = under-over
Non-neutral = over-over

Question 13

Inhalation rib dysfunction:

• Target rib
• Patient/doc position/movement

Answer 13

Lowest rib in group

Monitor anterior rib while using knee to flex patient. Sidebend patient if BUCKET-HANDLE dysfunction. Encourage exhalation, resist inhalation. For BUCKET-HANDLE dysfunction, patient reaches for ipsilateral knee during exhalation.

Question 14

Exhalation rib dysfunction:

• Target rib
• Patient/doc position/movement

Answer 14

Highest rib in group

Patient’s ipsilateral hand on forehead. Grasp rib angle posteriorly and pull INFERIORLY during INHALATION. Hold breath at full inhalation while:

• 1. Raising head to ceiling
• 2. Turning head 30º AWAY and raising to ceiling
• 3-5. Pushing elbow toward opposite ASIS
• 6-9. Push arm anterior
• 10-12. Adduct arm

Question 15

Rib 1 exhalation ME - muscle?

Answer 15

Anterior and Middle Scalenes

Question 16

Rib 2 exhalation ME - muscle?

Answer 16

Posterior Scalene

Question 17

Ribs 3-5 exhalation ME - muscle?

Answer 17

Pec minor

Question 18

Ribs 6-9 exhalation ME - muscle?

Answer 18

Serratus anterior

Question 19

Ribs 10-11 exhalation ME - muscle?

Answer 19

Latissimus dorsi

Question 20

Rib 12 exhalation ME - muscle?

Answer 20

Quadratus lumborum

Question 21

Lumbar ME - position

Answer 21

Same as lower T-spine (under-over, over-over)

Question 22

Forward sacral torsion - position

Movement

Monitoring what?

Answer 22

Lateral recumbent, axis down, chest to table (Sims)
Flex hips, drop legs off table (SB, engage axis)

Patient lifts ankles to ceiling

Posterior movement of the moving sacral sulcus

Question 23

Backward sacral torsion - position

Movement

Monitoring what?

Answer 23

Lateral recumbent, axis down, back to table
Pull lower arm up to rotate torso
Flex hips, drop legs off table (SB, engage axis)

Patient lifts ankles to ceiling

Anterior movement of the moving sacral sulcus

Question 24

Superior pubic shear - ME

Answer 24

Drop leg off table (EXT hip), Abduct, patient flexes hip and pushes medially (Adducts)

Question 25

Inferior pubic shear - ME

Answer 25

Flex and abduct hip and knee

Patient pushes knee toward opposite foot (extension, adduction)

Question 26

Posterior fibular head ME

Answer 26

Prone, flex knee, cup lateral ankle with doc’s hand
Plantarflex and invert foot, internally rotate tibia
Patient dorsiflexes against resistance