resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Don't Turn a 2 Into a 10
The Wong-Baker FACES Pain Rating Scale1 is so useful because it can be used by almost anyone. Patients can use the numbers associated with the faces depicted on the scale or select the face that demonstrates their current level of pain from 0-10.
A Healthy Dose of Failure is Vital to Your Success
As an acupuncturist I tend to see people after they have already suffered for years and "tried everything." They are so desperate for some relief that they want to know everything about how to get better, right now.
MPA Media Wins Seven Publishing Awards
MPA Media, publisher of Acupuncture Today, among other titles, has been recognized for editorial and design excellence with an unprecendented seven publishing awards by the ASBPE, the nation's largest organization for business-to-business publications.
Why Young People Need Chiropractic Now More Than Ever
According to a recent study published in BMC Musculoskeletal Disorders, "It is now widely acknowledged that neck pain (NP), mid back pain (MBP), and low back pain (LBP) (spinal pain) start early in life and that the lifetime prevalence increases rapidly during adolescence to reach adult levels at the age of 18."
News in Brief
National Chiropractic Health Month: Be Proactive; Collegiate Roundup: Academic Appointments at Parker, Logan.
The Spirit of the Point
After receiving a large amount of positive feedback on my San Zhen Protocols series, I have decided to focus this article on some relevant clinical aspects of acupuncture therapy prior to moving on to San Zhen Protocols III.
The Truth About Herbs
I appreciate the effort and research put into the article written in the June issue of Acupuncture Today regarding pesticides and Chinese herbs.
CCE Finally Takes a "Baby Step" Toward Reform
During a 16-month period from October 2010 to February 2012, I devoted four separate columns to the heavy-handed attempt by the Council on Chiropractic Education to radically change the chiropractic profession through the accreditation process.
A Glimpse Into China's Top Brain Hospital
The sounds of the city pass through the open window are overwhelming the microphone - car horns, construction machinery - and then there's the family at the adjacent bed talking loudly on cell phones, yet you can still hear the faint beep of our patients monitoring equipment.
9 Common Causes of Thyroid Imbalance and How You Can Help
How you sleep, how easily you wake up, and how much energy and stamina you have during the day are directly related to levels of the thyroid hormones.
A Vibrating Capsule for Constipation? Relevance to Your Chiropractic Practice
The relationship between gastrointestinal (GI) complaints and back pain is not typically written about or discussed.
The Science Behind Happiness
Are you happy right now? Whether yes or no, there are a myriad of reasons why you feel that way. A whole academic discipline has developed to find out what causes or obstructs happiness, and how to amplify it.
Thoughts to Live By
When speaking to your patients about their health make sure to ponder the following points and have them assess if they are making themselves even more sick by the thoughts they have about life. Are these some of the traits and thoughts that your patients might have?
Waking Up the Gluteus Maximus
In previous articles in this series, we expounded on the importance of the gluteus maximus (GM) in athletic performance and protecting the knee from injury. We also know there is a link between iliotibial band syndrome and GM weakness.
Pain Underfoot: Metatarsalgia
Foot pain can interfere significantly with normal activities and severely limit participation in sports. Metatarsalgia is foot pain involving the metatarsal bones in the forefoot – the complaint of pain on the bottom of the ball of the foot.
Healing Community Trauma in Israel and Palestine
It's the beginning of August and Israel and Hamas have just agreed to a 72-hour ceasefire after a month of brutal fighting. In the last four weeks, 1,830 Palestinians and 67 Israelis have been killed.
When Big Pharma Meets Chinese Medicine
Earlier this year, Bayer made a media splash with their decision to buy the Dihon Pharmaceutical Group Co., a Chinese TCM manufacturer.
History of Animal Acupuncture: Part II
In Part I of this article, I had gone back to 1969 and tried to describe the atmosphere and events of that year that engulfed many of the younger generation, some who were all the core members of the National Acupuncture Association.
Chiropractic Research in Review
Chiropractic Treatment of Lateral Epicondylitis; Cost / Benefit Analysis: Different Doses of SMT for Low Back Pain; Imaging for Occult Rib and Costal Cartilage Fractures; Treating Neck Pain: Thoracic Thrust Manipulation vs. Non-Thrust Mobilization.
MPA Media Wins 7 Publishing Awards
MPA Media, publisher of Dynamic Chiropractic and DC Practice Insights, among other titles, has been recognized for editorial and design excellence with an unprecedented seven publishing awards by the American Society of Business Publication Editors (ASBPE), the nation's largest organization for business-to-business publications.
April, 2010, Vol. 10, Issue 04
Stretching the Limits of Your Massage
By Teresa A. Schmidt, DPT, MS, OCS, LMT, CEAS, CHy
Massage therapists are in demand to serve the growing population of aging clients. To accomplish this goal, therapists must enhance their skills for improving mobility using evidence-based techniques.Muscle energy techniques (MET) have been used for almost 50 years to reduce abnormal muscle tension and to improve mobility. MET is a versatile intervention that may be employed to treat clients with neuromusculoskeletal conditions. MET was initially described within the osteopathic profession by Drs. T.J. Ruddy and Fred Mitchell.1,2 During the same period, Knott and Voss were developing the Proprioceptive Neuromuscular Facilitation (PNF) Technique in physical therapy.3 MET was later refined by several practitioners including Drs. Greenman, Lewit, Yale, Digiovanna, Stiles and Goodridge.1,4-7 Modern MET has been incorporated into multiple disciplines including massage, with the work of McAtee and Charland's active stretching and Mattes' Active Isolated Stretching (AIS).1,8 Dr. Leon Chaitow presents a contemporary overview of MET in his text, Muscle Energy Techniques.1
Massage clients often present with muscle spasm, painful trigger points, and limited range of motion (ROM). MET may be used during a massage session to enhance outcomes of improved mobility and comfort for clients. Evidence-based research indicates the value of MET in improving flexibility in clients of all ages, including rehab clients and the fragile elderly. Schiowitz reported that subjects with neck motion restrictions had a significant increase in cervical ROM after treatment with MET, as compared to a sham control group.10 Wilson et al. reported a significant improvement in function and decrease in disability in patients with low back pain treated with MET compared to those treated with traditional exercise and neuromuscular re-education alone.11 Contemporary muscle energy techniques are a part of interdisciplinary patient care, usually combined with manual therapy, massage and exercise.
There are various stretching approaches described by MET practitioners. Each approach has its benefits. Most utilize the effect of post-isometric stretching, in which the involved short muscle (the agonist) is isometrically resisted, followed by passive or active stretching of the agonist by activation of the antagonist and/or passive movement by the practitioner. In PNF, this is known as contract-relax and hold-relax.1,3,8 Two types of MET have been described: post-isometric relaxation (PIR) and reciprocal inhibition (RI).1,5,6
In PIR, the short agonist muscle is activated with a gentle resisted isometric contraction for up to 10 seconds, followed by relaxation and passive stretching into the motion barrier within the tolerance of the client. The isometric contraction of the short agonist loads the proprioceptive Golgi tendon organ (GTO) within the agonist, causing a reflexive relaxation of the muscle. (GTOs inhibit contraction via the Ib afferent fibers to the spinal cord and efferent motor neuron.) After an active contraction, there is a short latency period within which the short agonist is inhibited. In physiology, this is called the refractory period, which lasts about 15 seconds.1
Activation of the long antagonist also inhibits the short agonist by reciprocal inhibition. For example: When the flexors are activated, there is an automatic inhibition of the extensors by reflex action at the spinal cord level. It is useful to activate the antagonist during the stretch to take advantage of the relaxation response of reciprocal inhibition. Exhalation is often used during the stretching period to enhance the relaxation effect. If the client activates the long antagonist, the effect of the short agonist's stretch reflex will also be reduced. The combination yields a significant increase in the length of the agonist.10
Key features of effective MET stretches are the use of precise control of the joint being moved, specific resistance intensity to avoid damaging the muscle being stretched, and accurate timing of the stretch to begin after the short muscle has relaxed. MET has been shown to be effective in reducing hypertonicity, increasing ROM, and decreasing disability and pain.1
To summarize, the steps to perform basic post-isometric relaxation MET with reciprocal inhibition are as follows:
Case Report: Maggie is a 57-year-old female with a diagnosis of plantar fasciitis and Achilles tendinitis onset 2 weeks ago due to walking in a fundraiser for 5 miles. (She is used to walking up to one mile daily, but does no other exercise.) She complains of pain upon weight-bearing on both feet, especially after prolonged sitting and upon awakening. Pain decreases once she is walking for 20 minutes. She has custom orthotics for pronated feet, which she wears regularly. She is taking Ibuprofen 400 mg for pain.
Palpation reveals trigger points on both gastrocnemius heads bilaterally, calcaneii and plantar fascia, pain scale 8/10. Range of motion (ROM) is limited in ankle dorsiflexion from 0-10 degrees, (normal is 0-20 degrees). Muscle strength is 3+/5 is bilateral plantarflexors. Gait is short in step length with early heel rise.
Intervention consisted of massage to both feet and lower legs to improve circulation and relax musculature, muscle energy (contract-relax/PIR) to each gastroc/soleus complex for five reps, followed by full passive stretch with and without extended knees to increase ROM. The range of motion increased by 7 degrees in ankle dorsiflexion, pain reduced to 2/10 post-intervention. Outcomes were favorable on this initial visit. Client was instructed in home stretching and conditioning program and self-massage. Therapy will continue twice weekly for three weeks to achieve full ROM and normal strength and function of both feet.
Important Note: MET may result in some delayed-onset muscle soreness (DOMS). Modify the force and position for each client based on their individual response. Clients may be instructed in the use of ice to diminish DOMS. Practitioners may teach clients to perform their own home programs of MET stretches. There are strengthening programs using MET as well as joint mobilization techniques using MET for advanced practitioners. For more information on MET, review the references and Web sites provided at the end of this article.
The versatility and clinical efficacy of MET makes it a valuable addition to rehabilitation programs for clients with neuromusculoskeletal conditions across the lifespan. Learn to master these skills to make a real difference to your clients and to your practice.
Editor's note: All photographs in this article are the property of Educise Resources Inc.
Theresa A. Schmidt is a board-certified specialist in orthopedic physical therapy, massage therapist, personal trainer, certified ergonomic assessment specialist, and clinical hypnotherapist. Dr. Schmidt is founder and president of Flex Physical Therapy in Long Island, NY. She has served as faculty of Physical Therapy at Touro College and adjunct professor at CUNY Queens College and Nassau Community Colleges. Dr. Schmidt founded Educise Resources Inc., a professional continuing education and health enhancement company. She can be reached through www.educise.com.
Join the conversation
Comments are encouraged, but you must follow our User Agreementcomments powered by Disqus
Keep it civil and stay on topic. No profanity, vulgar, racist or hateful comments or personal attacks. Anyone who chooses to exercise poor judgement will be blocked. By posting your comment, you agree to allow MPA Media the right to republish your name and comment in additional MPA Media publications without any notification or payment.