Muscle Energy And Articulatory Principles

Question 1

Who developed Muscle Energy?

Answer 1

T.J. Ruddy, DO who published “Ruddy’s Rapid Rhythmic Resistive Duction” in 1914

Question 2

Who further developed and amplified MET?

Answer 2

Fred Mitchell Jr., DO who wrote about it as early as 1948

Question 3

What is muscle energy?

Answer 3

Voluntary contraction of patient muscle in a precisely controlled direction with vary levels of intensity against a distinctly excused counterforce

It is a direct and active technique, but the patient’s motion is away from the barrier (so toward the somatic dysfunction)

Question 4

What are the 4 muscular contraction types?

Answer 4

Isometric contraction, Concentric isotonic contraction, Eccentric isotonic contraction, and Isolytic contraction

Question 5

What is isometric contraction?

Answer 5

Contraction of a muscle with no change in distance between the origin and insertion

Question 6

What is concentric isotonic contraction?

Answer 6

Contraction of a muscle with approximation of origin and insertion

Question 7

What is eccentric isotonic contraction?

Answer 7

Contraction of a muscle with separation of origin and insertion

Question 8

What is isolytic contraction?

Answer 8

It is NON-PHYSIOLOGIC

It is attempted concentration contraction, with an external force causing separation of origin and insertion

Question 9

What is Post-isometric relaxation?

Answer 9

When the muscle contracts, leading to increased tension in the Golgi-Tendon Organ, and leads to inhibition of muscle contraction

Question 10

What is joint mobilization using muscle force?

Answer 10

Restoration of motion to the joint with reflex relaxation of the previously hypertonic musculature by the pt exerting maximal muscle contraction that is comfortably resisted by the physician

Question 11

What is respiratory assistance?

Answer 11

Exaggerated respiratory motion in order to help generate muscular forces that typically may be involved with ventilation motions (in the spine, pelvis, and extremities)

Question 12

What is the oculocephalogyric reflex?

Answer 12

Eye movements that reflexively affect the cervical and truncated musculature as the body attempts to follow the lead provided by eye motion

Question 13

What is reciprocal inhibition?

Answer 13

When a gentle contraction is initiated in the agonist muscle, there is a reflex relaxation of that muscle’s antagonistic group

Question 14

What is crossed extensor reflex?

Answer 14

This is used for muscle in severely injured areas

When the flexor muscle in one extremity is contracted voluntarily, the flexor muscle in the contralateral extremity relaxes and the extensor contracts

Question 15

What’s the difference between Reciprocal Inhibition and Crossed Extensor Reflex?

Answer 15

Reciprocal inhibition benefits the ipsilateral side you are working on, whereas crossed extensor reflex benefits the contralateral side that you are working on

Question 16

What is isokinetic strengthening?

Answer 16

It is used to reestablish normal tone and strength in a muscle weakened by reflex hypertonicity of the opposing muscle group

In isokinetic contractions, the length change occurs at a constant velocity. Typically concentric contractions are used, where the muscle is permitted to shorten, but at a controlled slow rate

Question 17

What is isolytic lengthening?

Answer 17

It is used to lengthen a muscle shortened by contracture and fibrosis.

Maximal contraction by the patient, that can be comfortably resisted by the physician is used

Question 18

How does using muscle force to move one region of the body to achieve movement of another bone ore region work?

Answer 18

For some dysfunctions, it is often more effective to move one body structure by moving another body structure adjacent to it.

Muscular force is used to move the first structure and that body part’s response to the muscle force is transmitted to yet another part of the body

Ex) moving the shoulder can affect the neck muscles

Question 19

What the similarities and differences between isometric and isotonic procedures?

Answer 19

Isometric: careful positioning, light to moderate contraction, unyielding counterforce, relaxation after contraction, repositioning

Isotonic: careful positioning, hard to maximal contraction, counterforce permits controlled motion, relaxation after contraction, repositioning

Question 20

What are the indications for Muscle energy?

Answer 20

Balance muscle tone, strengthen reflexively weakened musculature, improve symmetry of articular motion, enhance the circulation of body fluids, lengthen a shortened/contracture/spastic muscle group

Question 21

What are the first 5 steps of Muscle energy treatment?

Answer 21

1. Physician positions body part to be treated at position of initial resistance
2. Patient instructed in intensity, duration, and direction of muscle contraction
3. Physician directs patient to contract appropriate muscles
4. Physician uses counterforce in opposition to and equal to patient’s muscle contraction
5. Physician maintains forces until appropriate patient contraction is perceived at the critical articulation/area, taking 3-5 seconds

Question 22

What are the last 5 steps of Muscle Energy treatment?

Answer 22

6. The patient is directed to relax while the physician matches the decrease in patient force
7. Physician allows the patient to relax and sense the tissue relaxation
8. Physician takes up the slack permitted by the procedure and the slack is allowed by the decreased tension in the tight muscle, allowing it to be passively lengthened
9. Steps 1-8 are repeated 3-5 times until best possible increase in motion is obtained
10. Re-evaluate

Question 23

What 4 factors can affect successful Muscle Energy treatment at the fault of the patient?

Answer 23

Contracting too hard, contracting in the wrong direction, sustaining the contraction for too short a time, or not relaxing appropriately following contraction

Question 24

What 4 factors can affect successful muscle energy treatment at the fault of the physician?

Answer 24

Not controlling the joint position in relation to the barrier movement, not providing the counter force in the correct direction, not giving accurate instructions, or moving to a new joint position too soon after the patient stops contracting

Question 25

What are contraindications of Muscle energy?

Answer 25

Local fracture/dislocation, moderate-to-severe segmental instability of the cervical spine, neurologic symptoms on rotation of the neck, low vitality, a post-op patient/post-MI patient/recent eye-surgery patient

Question 26

What can muscle energy cause in terms of adverse reactions?

Answer 26

Tendon avulsion (when done in the elderly), rib fracture (in a patient with osteoporosis), and anterior chamber intraocular hemorrhage (in a patient post cataract removal and lens implant surgery)

Question 27

What is the articulatory approach?

Answer 27

It is gentle and repetitive motions through the restrictive barrier to restore physiologic motion by using low velocity and high amplitude directly

Question 28

What are the indications for the articulatory technique?

Answer 28

Arthritic patients, elderly/frail, critically ill or post-op, infants/young patients, or patients unable to cooperate with instructions

Question 29

What are the 7 steps of the Articulatory technique?

Answer 29

1. Put patient in position of comfort
2. Move the affected joint/body part until the restrictive barrier is engaged
3. A gentle but firm force is applied carrying the body part a short distance through the restrictive barrier
4. Force is applied rhythmically, typically 1 or 2 seconds of stretch, followed by a similar time frame releasing that stretch with the joint returning to a point just short of its restrictive barrier
5. As the patient responds, the barrier will shift position within the physiologic ROM
6. The applied forces should be comfortable for the patient and can describe it as a “good discomfort”
7. Continued until the location of the restrictive barrier reaches a plateau

Question 30

What are the relative contraindications for the articulatory technique?

Answer 30

Vertebral artery compromise

In order to avoid combination of rotation and extension in the cervical spine

Question 31

What are absolute contraindications for articulatory technique?

Answer 31

Local fracture/dislocation

Neurologic entrapment syndromes

Serious vascular compromise

Local malignancy

Local infection

Bleeding disorders

Question 32

What are the similarities and differences between MET and ART?

Answer 32

MET: direct, patient muscle contraction 3-5 times for 3-5 seconds, required patient cooperation, goal to alleviate somatic dysfunction

ART: direct, repetitive physician directed motions, passive technique with patient relaxed, goal to alleviate somatic dysfunction