Met/Art Principles

Question 1

What is muscle energy?

Answer 1

The pts muscles are actively used on request from a precisely controlled position, in a specific direction, against a distinctly executed physician counterforce
An active and direct technique

Question 2

Muscle energy cannot be used if the pt is what?

Answer 2

In a coma, uncooperative, too young to follow commands or unresponsive

Question 3

Describe the contributions TJ Ruddy, DO made to the history of muscle energy

Answer 3

Published first article in 1914

• eye and cervical spine treatment
• used rapid, repetitive in contractions 1-2 per second against resistance

Question 4

Describe the role Fred L Mitchell, DO played in the history of muscle energy

Answer 4

Wrote about muscle energy technique as early as 1948
1950-60s taught courses with Paul Kimberly, DO entitled The Pelvis and its Environs
1970 taught a course in Iowa to 6 students, 5 of which because osteopathic college faculty
Developed and amplified MET

Question 5

What is an eccentric contraction?

Answer 5

Muscle tension allows the origin and insertion to separate in effect to lengthen the muscle

Question 6

What is a concentric contraction?

Answer 6

Contraction of a muscle resulting in the approximation of the origin and insertion to shorten the muscle

Question 7

What is an isotonic contraction?

Answer 7

A concentric or eccentric contraction against a steady but yielding counterforce allowing a constant tone (constant weight)

Question 8

What is an isokinetic contraction?

Answer 8

A concentric contraction in which the joint motion is at a constant rate/speed (weight can vary)

Question 9

What is an isolytic contraction?

Answer 9

A type of eccentric contraction in which the muscles concentric contraction is overpowered by a stronger counterforce (weight is greater than max effort) leading to a lengthening of the muscle

Question 10

What is an isometric contraction?

Answer 10

The distance between the origin and the insertion of the muscle is maintained at a constant length
Neither concentric or eccentric

Question 11

What are the 9 physiologic principles of muscle energy?

Answer 11

Post-isometric relaxation, reciprocal inhibition, crossed extensor reflex, respiratory assistance, oculocephalogyric reflex, isokinetic strengthening, isolytic lengthening, joint mobilization using muscle force and using muscle force to move one region of the body to achieve movement of another bone or region

Question 12

What is the most common form of muscle energy?

Answer 12

Post isometric relaxation

Question 13

What is the goal of post isometric relaxation?

Answer 13

Muscle relaxation

Question 14

What is the physiologic basis of post isometric relaxation?

Answer 14

Immediately after an isomeric contraction the neuromuscular apparatus is in a refractory state during which passive stretching may be performed without encountering strong myotactic reflex opposition
With muscle contraction there may also be increased tension on the Golgi organ propioreceptors in the tendons; this inhibits the active muscle’s contraction

Question 15

What is the force of contraction used in post-isometric relaxation?

Answer 15

Sustained gentle pressure (10-20lbs)

Question 16

What is the goal of reciprocal inhibition?

Answer 16

To lengthen a muscle shortened by cramp or acute spasm

Question 17

What is the physiologic basis of reciprocal inhibition?

Answer 17

When a gentle contraction is initiated in the agonist muscle there is a reflexive relaxation of that muscle’s antagonistic group
Ex. Cramping hamstring (agonist), contraction of quad (antagonist)

Question 18

What force of contraction is used in reciprocal inhibition?

Answer 18

Think ounces, not pounds of pressure

Question 19

Describe the steps to post isometric relaxation

Answer 19

Pt contracts away from the restrictive barrier (indirect)
Physician resists the contraction towards the restrictive barrier (direct) for 3-5 seconds so the origin and insertion of the muscle remain at the same distance (no movement)
Both pt and physician completely relax (1-2 seconds) and then the pt is passively moved into the new restrictive barrier
This is repeated 3-5 times or until no new barriers are reached

Question 20

Describe the steps of reciprocal inhibition?

Answer 20

Initial set up: passive movement into the restrictive barrier (direct)
Pt contracts toward the restrictive barrier (direct)
Physician resists the contraction towards the restrictive barrier (direct) for 3-5 seconds so the origin and insertion of the muscle remain at the same distance (no movement)
Pt relaxes and after complete relaxation is passively placed into the new restrictive barrier

Question 21

What is the goal of crossed extensor reflex?

Answer 21

To treat an are so severely injured (ex. Fractures or burns) that it cannot be manipulated or is inaccessible

Question 22

What is the physiologic basis for crossed extensor reflex?

Answer 22

This form of muscle energy technique uses the learned “cross patter locomotion reflexes” (walking) in the CNS
When the flexor muscle in one extremity is contracted voluntarily the flexor muscle in the contralateral extremity relaxes and the extensor contracts

Question 23

What force of contraction is used for crossed extensor reflex?

Answer 23

Think ounces, not pounds of pressure

Question 24

What is the goal of the oculocephalogyric reflex?

Answer 24

To affect reflex muscle contractions using eye motion

Question 25

What is the physiologic basis of the oculocephalogyric reflex?

Answer 25

The eye movements reflexively affect the cervical and truncal musculature as the body attempts to follow the lead provided by eye motion

Question 26

What force of contraction is used during the oculocephalogyric reflex?

Answer 26

Exceptionally gentle

Question 27

What is the goal of respiratory assistance?

Answer 27

Improve body physiology with the patient’s voluntary respiratory motions

Question 28

What is the physiologic basis of respiratory assistance?

Answer 28

The muscular forces involved in these techniques are generated by the simple act of breathing
This may involve the direct use of the respiratory muscles themselves or motion transmitted to the spine, pelvis and extremities in response to ventilation motions
The physician usually applies a fulcrum against which the respiratory forces can work
Ex. Sacral dysfunction

Question 29

What force of contraction is used in respiratory assistance?

Answer 29

Exaggerated respiratory motions

Question 30

What is the goal of isolytic lengthening?

Answer 30

To lengthen a muscle shortened by contracture and fibrosis

Question 31

What is the physiologic basis of isolytic lengthening?

Answer 31

It is postured that the vibration used here has some effect on the myotactic units in addition to the mechanical and circulatory effects
Ex. Contracture of the bicep

Question 32

What force of contraction is used in isolytic lengthening?

Answer 32

Max contraction that can be comfortable resisted by the physician (30-50lb of pressure)

Question 33

What is the goal of isokinetic strengthening?

Answer 33

To re-establish normal tone and strength in a muscle weakened by reflex hypertonicity of the opposing muscle group

Question 34

What is the physiologic basis for isokinetic strengthening?

Answer 34

Where asymmetry of ROM exists there is also the potential for asymmetry in muscle strength
If there is shortening of an antagonist muscle attend to that first
It is believed that the agonist spontaneously increases their strength if the shortened or hypertonic fibers of the antagonists are lengthened first
Further restoration of strength can be accomplished through the use of an isokinetic contraction
The length change occurs at a constant velocity and the muscle is permitted to shorten but at a controlled slow rate

Question 35

What is the goal of joint mobilization suing muscle force?

Answer 35

Restoration of joint motion in an articular dysfunction

Question 36

What is the physiologic basis of joint mobilization using muscle force?

Answer 36

Hypertonicity of musculature across a joint can cause distortion of articular relationships and motion loss
This increase in muscle tone tends to compress joint surfaces and results in thinning of the intervening layer of synovial fluid and adherence of the joint surfaces
Restoration of motion to the articulation results in a gapping or reseating of the distorted joint relations with reflex relaxation of the previously hypertonic musculature
Ex. Anteriorly rotated pelvis

Question 37

What force of contraction is used in joint mobilization using muscle force?

Answer 37

Max muscle contraction that can be comfortably resisted by the physician (up to 30-50lbs of pressure depending on the joint treated)

Question 38

What is the goal of using muscle force to move one region of the body to achieve movement of another bone or region?

Answer 38

Treat somatic dysfunction

Question 39

What is the physiologic basis for using muscle force to move one region of the body to achieve movement of another bone or region?

Answer 39

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 is transmitted to yet another part of the body

Question 40

What force of contraction is used during using muscle force to move one region of the body to achieve movement of another bone or region?

Answer 40

Sustained genteel pressure (10-20lbs)

Question 41

What are the indications of muscle energy?

Answer 41

Muscle energy is used to balance muscle tone, strengthen reflexively weakened musculature, improve symmetry of articular motion, enhance the circulation of body fluids (blood, lymph, and interstitial fluid), lengthen a shortened, contracture or spastic muscle group
Versatile to use in combination with other OMT

Question 42

What factors can influence successful muscle energy?

Answer 42

Contract too hard
Contract in the wrong direction or counterforce in the wrong direction
Sustain the contraction for too short a time
Not giving accurate instructions (not telling the pt correct direction to push, correct amount of force to use or how long o substance the force)
Moving to a new joint position too soon after the pt stops contracting

Question 43

What are the contraindications of muscle energy?

Answer 43

Local fracture, local dislocation, moderate to severe segmental instability in the C spine, evocation of neurologic sx or signs on rotation of the neck, low vitality
Situations that could be worsened by muscle activity such as a post surgical pt, immediately following MI or recent eye surgery
Unable/unwilling to follow verbal commands

Question 44

What is articulatory approach?

Answer 44

Also called springing techniques
Low velocity/high amplitude (slow movement, long distance)
Passive and direct technique

Question 45

Explain the articulatory approach

Answer 45

Gentle and repetitive motions throughout the restrictive barrier to restore physiologic motion
Can be applied to vertebral as well as extremity somatic dysfunction
May be used on a single joint or an entire region

Question 46

What are the indications for articulatory technique?

Answer 46

Well tolerated by arthritic Paris, elderly or frail, critically ill or post op pts, infants or very young pts, pts unable to cooperate with instructions

Question 47

Reminder

Answer 47

Review slides on muscle energy and ART steps

Question 48

What are the relative contraindications of articulatory technique?

Answer 48

Vertebral artery compromise

-avoid combination of rotation and extension in the C spine

Question 49

What are the absolute contraindications of articulatory technique?

Answer 49

Local fracture or dislocation 
Neurologic entrapment syndromes 
Serious vascular compromise 
Local malignancy 
Local infection 
Bleeding disorders