resourcesABOUT MT AUTHOR GUIDELINES CLASSIFIEDS EDITORIAL CALENDAR MEDIA GUIDE MASSAGE MART SCHOOLS & EDUCATION FEEDBACK
A Commonly Missed Spinal Fixation: The Upper Lumbar Spine (Part 2)
As mentioned in part 1, using a flexion-distraction table is a great way to unlock this particular fixation. You have found the stuck segment. You have determined whether it is unilateral, midline or bilateral.
Lime Jello on Morphine
Taste is in the eyes... actually the mouth... of the beholder. My food preferences have changed, lightening from the food of my youth. My parents loved heavy eastern European cuisine and I loved it as a child. Now I enjoy leaner, healthier whole foods.
The Tao of Gender
If you think gender is as simple as having a new client check off the "male" or "female" box on your intake form, we hope this article will expand your understanding and thus the reach of your health care.
Uncle Sam Needs You (Part 2)
Where chiropractic care has been used in the military health services, it has been deemed very successful.
Simple Ways To Find True Happiness
Patients in our clinics are always seeking happiness. As their health advocate, we need to ensure we inform them that in order to find happiness, they have to make sure to identify what makes them happy in the first place.
Essential Orthopedic Testing: Tests That Involve Standing on One Leg
Since these tests have a common mechanism of performance (standing on one leg), there are differential diagnostic concerns during testing. The tests cannot be completely isolated from each other for performance.
Chiropractic Research in Review
Predicting Pain With Disability in Office Workers; Traction Approaches for Discogenic Cervical Radiculopathy; Intra-Articular Gas Bubbles Following Manipulation; Nonresponsive Chronic Ankle Sprains: Think Tendon Rupture.
Pulse Diagnosis: What We Know
I am still finding pearls of wisdom from the books and papers that I inherited from my pulse diagnosis mentor Jim Ramholz.
The Wonders of Light Therapy: An Interview with Wes Burwell
I first met Wes Burwell in 2011 when he was teaching a class on light. Since then, every time I hear him speak, his understanding of the benefits, function and capacity of light has evolved.
Sports Science: What's in That Drink?
Athletes frequently ask me what the best liquid is to drink during exercise – water or a sports drink? Water provides the necessary hydration, but unfortunately, it lacks the key nutrients to aid in performance and recovery.
To The Finish Line With the Help of TCM
When acupuncturist Eddy De Smedt pursued a career in Traditional Chinese Medicine, he knew he wanted to make a difference.
The Heart Protector
On the physical level, the Pericardium is a double-layered sac of fibrous tissue that envelops the Heart. The space between the layers is filled with serous fluid that protects the Heart from external shock or trauma and lubricates to allow for normal Heart movement.
Correcting Pelvic Rotation Around the Long Axis: Adjustment Protocol
The pelvis can be considered a ring that can misalign on the sacrum rotating around the long axis. The following is a description of an adjustment that helps to correct sacroiliac rotation around the long axis.
Communication 101: Please Explain Yourself!
Twice this past week, I overheard conversations about chiropractic. As you can imagine, it is a topic my ears naturally pick up. In both cases, a patient was talking to a friend about their experience with a chiropractor.
AOMA Strengthens Leadership Team
AOMA Graduate School of Integrative Medicine, a leading college of acupuncture & herbal medicine, announced the appointment of Donna LaPoint Hurta, MBA as the new VP of Finance & Operations this Fall.
Managing Patient Expectations About Acupuncture
Last year, I attended the Pacific Symposium in San Diego for the first time in six or seven years. It was the 25th anniversary of this event, and on one evening there was a panel discussion with the title; "What is Qi?."
Jingei Diagnosis: An Effective and Powerful Diagnostic
I graduated from the Kotatama Institute under the direction of Drs. Masahilo and Katsuharu Nakazono in 1984. As a student, I was exposed to the practice of most of the various theories and modalites of Oriental Medicine.
Healing With TCM at San Quentin State Prison
For the prisoners at San Quentin State Prison, life-sentences are the reality of every day life. It is not often that prisoners get the opportunity to use alternative medicine to deal with common ailments they encounter behind bars such as, depression, anxiety and pain.
The Case for Immunization
As long as I have been a chiropractor, I have seen many in this profession oppose vaccinations. Indeed, it has often been taken as a "given" that to be a principled chiropractor requires a curmudgeon's willingness to hold aloft that banner of opposition.
Managing Today's Fertility Patient
I recently received an email from one of my fertility patients: "Got my lab results back. FSH is 11, AMH is 0.7. My doctor said these numbers aren't good. I guess I'm infertile. Just as a thought. Just set up an appointment to speak with an adoption agency."
Dr. George Goodman and His Legacy to Logan University
Those who knew him called him a revered leader, a visionary and one of chiropractic's biggest advocates. George A. Goodman, DC, Logan University's sixth and longest-serving president, passed away on Sept. 9. He was 70 years old.
Commingling Money: 12 Questions for the ACA About the CHAMP / NCLAF Merger
The American Chiropractic Association recently announced it was merging the National Chiropractic Legal Action Fund and the Chiropractic Health Advocacy and Mobilization Project into a single entity that will support both legal and legislative actions.
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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