Flashcards in Muscle Energy Deck (19):
Describe the general MET exercise using PIR in an acute context (according to lewitt).
- Patient's joint positioned at the point at which resistance is first perceived
- Pt uses no more than 20 % of their available strength to slowly, isometrically contract their agonist muscles (the muscles being stretched) for 7- 10 seconds
- Practitioner uses only a small amount of force to resist
- Pt relaxes their muscles slowly with the muscle maintained at the movement barrier
- Move the Pt's joint into the new resistance barrier
- Repeat as needed
In PIR, when may the patient inhale and exhale to focus contraction and relaxation (according to lewitt)?
- Inhale during contraction
- Exhale during relaxation
How long is the latency "window" during which the patient may be moved into a new resting position in PIR (according to lewitt)?
10 - 20 seconds
What is the 'neurological model' of PIR?
- The golgi tendon is loaded to influence the intrafusal fibers of muscles spindles that inhibits muscle tone
How is a chronic patient, or a patient with muscle fibrosis treated differently using PIR?
- The patient is treated more vigorously with a more aggressive stretch
How is the Janda approach of 'post-facilitation stretch different from that of a standard PIR?
- Contraction is done at mid-range position instead of end range
- The tissues are stretched IMMEDIATELY following contraction
- Stretch is held for at least 10 seconds
- 30 second rest periods
Describe the modified Janda approach.
- Pt moved into mid position
- Contraction of 20 - 35 % held for 7 - 10 seconds
- Rest period of 2 - 3 seconds for relaxation
- Move joint into a position JUST BEYOND the resistance barrier (patient may assist this movement)
- Hold for 30 seconds
- Repeat until no further gains can be made
Why may the patient assist the practitioner in moving the joint into it's new position?
- The antagonists are activated preventing a stretch reflex
How many PIR stretches can typically be performed until no more length gain is made?
2 - 3
What are the 3 major differences between Janda's and Lewitt's approaches to PIR?
- Janda's uses stronger and longer` contraction
- Janda's approach moves the patient PAST the resistance barrier
- Lewitt begins at the restriction barrier
What type of impairments/ injuries is reciprocal inhibition used for?
- Acute where the tissue cannot be contracted without pain
Why is the muscle contracted short of the resistance barrier in reciprocal inhibition?
- Contractions are easier to perform from mid-range
- The muscle has less of a chance of cramping from the mid-range position
What are 5 common patients errors when contracting a muscle in MET?
- Contracting too strong
- Contracting in the wrong direction
- Patient contracts too hastily (should be a slow build up)
- The patient doesn't contract for long enough
- The individual doesn't relax completely after the contraction
What suggestion can be given to the patient if they do not relax completely after contraction?
- Release, and relax
- Inhale and exhale once or twice
- "Now relax completely"
What error is commonly made with respect of the position of the joint by the practitioner in MET? How can this be fixed?
- Inaccurate or uncontrolled positioning
- Can be fixed with: Palpation and visualization of the joint and structures
What 3 errors are commonly made with regards to muscle contraction by the practitioner in MET? How can these errors be avoided?
- Inadequate force applied (Meet/ match force with isometric contraction, allow movement with isotonic concentric attraction, and overcome contractions with eccentric isotonic contraction)
- Counterforce applied in the wrong direction (pay attention to direction of force vector)
- Patient not instructed to move into and out of contraction gradually (use gradual force to apply resistance, provide proper instruction)
What errors does the practioner commonly make in the stretching portion of MET
- Moving too hastily or too far into the new position
- Not holding the stretch for the required 30 seconds
What is the only major side efffect of MET?
- Muscle soreness and stiffness, especially if MET is performed inappropriately