resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
Multivitamin Supplement May Reduce Breast Cancer Recurrence
There is a great deal of controversy regarding the value of multiple vitamin supplements in cancer prevention.
AOM Hospital-Based Practice: A Future Reality?
The natural evolution of health care on the planet is integrative health. We may have some challenges ahead, but based on my research, all indicators are pointing in a positive direction. There seems to be an evolving consciousness among our patient population that is "getting it."
What You Say Isn't Always What Patients Hear
A few years ago, my aunt Edna (name changed for the purpose of this story) suffered a stroke. After a short hospital stay, she was transferred to a nursing home for rehabilitation. When she arrived at the nursing home, Edna requested a private room.
Chronic Pain: Become Part of the Solution
I have lectured to more than 7,000 chiropractic physicians over the past five years regarding the chronic pain and opioid epidemic in this country.
Treating Hip & Groin Pain With Abdominal Release of Upper Lumbar Nerve Impingements
Have you encountered patients with groin and hip pain you can't seem to solve? You know it's not a worn-out hip; you suspect the pain is somehow connected to the spine. But somehow, you just can't help them break through.
Increasing the Value of Spine Care: CMS Approves New Low Back Pain Registry
The Centers for Medicare and Medicaid Services has approved the Spine IQ Low Back Pain Registry as a qualified clinical data registry for the Physician Quality Reporting System (PQRS) in 2016.
An MD Who Understands the Opioid Epidemic
Doctors of chiropractic have an important role to play in ending the opioid epidemic and dealing with chronic pain by conservative means (see our top story in this issue) – but who's to blame for opioid dependence and abuse in the first place?
Introducing the Acupuncture Today Digital Edition
In response to the changing habits of our readers, Acupuncture Today will introduce a digital edition of the publication (in addition to our print edition) beginning with the August 2016 issue.
What's New in Phytonutrition: Mangifera Indica, "The King of Fruits"
One hundred percent pure Indian green mango fruit (mangifera indica), harvested at a special degree of ripeness for efficacy and taste, can now be concentrated as a phytonutrient nutraceutical powder.
Kansas Achieves Licensing Law
Kansas Governor Sam Brownback signed House Bill 2615 into law on Friday, May 13, 2016. HB2615 includes provisions for the licensure of acupuncturists in the state of Kansas.
How to Stay Sane During the Elections: Understanding Through the Lens of Chinese Medicine
In Chinese Medicine philosophy, everything consists of Yin and Yang. The law of polar opposites – one cannot exist without its opposite.
Adventures with the San Jiao
Those of us who have been in practice for several decades relish the way meridians and points reveal new diagnostic clues and new insights. I love to encourage my students to see this as an adventure that goes way beyond the textbooks.
An Emerging Partnership Model
Maryland University of Integrative Health (MUIH) has educated integrative health and wellness practitioners for the last 40 years, originally as an acupuncture clinic and school. The institution's transformative, relationship-centered programs integrate traditional wisdom with contemporary science
Sit or Stand? Analyzing a Mixed Message
I'm more than a bit confused. At my age, that seems to be a rather common occurrence. However, today more than ever, I'm getting a mixed message.
Three Tips to Help You Analyze the Acupuncture Case Studies of the NCCAOM Exam
Confirm the answer quickly by the elimination method. Case study:
After two treatments for back pain, a patient presents for a third
session complaining of rapid breathing and wheezing that is made worse
during cold weather.
Acupuncture's Impact on the World
For several years, I have been hearing about the town of Rothenburg, Germany. It seemed just a dot on a map until I arrived. It is the home of the TCM Kongress which began in 1968. It has been held annually for 47 years and it has only missed one year.
The Pertinent Negative
We all have to perform evaluations on patients. Most of us don't like doing it – exams take time, and worse it takes even more time after the evaluation to put together a narrative summary of the findings. Sometimes, this process becomes downright tedious.
Acupuncture Muscle Trigger Point and Oriental Medicine Sports Therapy
It is difficult to ascertain the internal condition of professional basketball player Lebron James during game one of the 2014 NBA finals, in which he developed debilitating muscle cramps that led to his premature removal from the game.
Believe it or not, an estimated one-third of your patients have eaten some form of fast food within 24 hours of their appointment with you.
Beating the Odds: Interview With Para-Powerlifter Adeline Dumapong-Ancheta
Since October 2015, the FICS Foundation, the charitable organization affiliated with the International Federation of Sports Chiropractic (FICS), has been supporting disabled athletes internationally.
Tai Chi Documentary Premier
First Run Features recently announced the world theatrical premiere of Barry Strugatz's documentary The Professor: Tai Chi's Journey West, which premiered last month at the Laemmle Music Hall in Los Angeles.
Insuring Quality Control in Herb Importation: An Interview with Wilson Lau
Wilson Lau is the vice president of Nuherbs, a Chinese herb importation company based in San Leandro, California. Before joining Nuherbs, he trained as a lawyer specializing in FDA law.
A Long-Overdue Win for Oregon Medicaid Patients - and the Implications for Other States
Beginning July 1, 2016, Oregon Medicaid patients with spinal pain (cervical, thoracic, lumbar, pelvic) who are determined to be low risk based on a biopsychosocial assessment tool (STarT Back – Keele University) can receive four chiropractic visits per episode.
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.
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