Contract & Relax Modalities Muscle Energy Techniques Part I, Post Isometric Relaxation

Transcription

1 Contract & Relax Modalities Muscle Energy Techniques Part I, Post Isometric Relaxation

2 Objectives: Lecture By the end of this lecture series, you should have clinically-applicable understanding of Basic muscle microanatomy (review) Basic neuromuscular function (review) How these characteristics are utilized in muscle energy treatment techniques Hypertonicity, Neurologic inhibition, Adaptive shortening, Overactive synergist, Agonist, Antagonist, types of muscle contractions, Trigger point vs. Tender point

3 Objectives: Lab By the end of this lab series, you should have clinically-applicable skills: Identify Hypertonic, Neurologically inhibited, Overactive synergist and Adaptively shortened muscles Identify Agonist and corresponding Antagonist muscles/muscle groups Identify and perform clinically-indicated muscle energy treatment techniques (PIR, RI) as part of a treatment plan

4 Definitions Muscle tone / Hypertonicity Trigger Point (TrP) Tender point Adaptive shortening Neurologic Facilitation / Inhibition Agonist / Antagonist / Overactive synergist Isometric / Concentric / Eccentric contraction

5 Types of Contractions Concentric Eccentric Isometric

6 Microanatomy

7 Microanatomy Muscle spindle Protects from overstretching Agonist through protective contraction via Myotatic or stretch reflex Motor neuron also signals Antagonist to relax Spindle Stretch Shortens/facilitates

8 Microanatomy Golgi tendon organ Tendon Tension Relaxes/inhibits IMPORTANT: Tension stimulus can come from Without (body position or stretch) Within (muscle contraction)

9 Muscle Rules Motor neuron + associated muscle fibers = motor unit All fibers in a single motor unit contract fully and simultaneously, therefore Contraction force = number of motor units Contraction force partial contraction of motor units

10 Trigger vs. Tender point Trigger point Palpable band within a muscle Localized twitch response to snap palpation Latent vs. Active Tender point Tender to palpation

11 Range of Motion A P N P A B N = Neutral P = Physiological A = Anatomical B = Barrier

12 Muscle Energy Techniques Utilize characteristics of muscular contraction, inhibition and post-contraction relaxation period to manipulate tone functional length Hypertonicity Trigger point

13 Post-Contraction Inhibition/Relaxation Period of inhibition following muscle contraction Function of GTO

14 Respiratory Synkinesis Inhalation enhances muscle activation Exhalation enhances muscle relaxation EXCEPT: respiratory apparatus, i.e., mandibular elevators

15 MET Types Proprioceptive Neuromuscular Facilitation (PNF) Contract Relax Hold Relax Contract Relax Antagonist Contract (CRAC) Post Isometric Relaxation (PIR) Rhythmic Initiation Rhythmic Stabilization Slow Reversals Reciprocal Inhibition (RI)

16 PIR vs. Stretch PIR Contractile elements Hypertonic Active / Assisted Performed at beginning of resistance (barrier) Any stage of injury/condition Stretch Non-contractile elements Adaptively shortened Active / Passive / Assisted Performed at endrange Not utilized in Acute injury/condition

17 Hypertonic vs. Adaptively Shortened How do I tell the difference? Try PIR first! Why?

18 PIR Basics Assess for barrier Identify beginning of resistance Gentle, isometric contraction and hold Inspire and hold Release contraction Expire and breathe normally Wait for relaxation Gently assess for new barrier

19 Readings Liebenson C. Rehabilitation of the Spine: A Practitioner's Manual. Williams & Wilkins. Edition: 2nd edition, 2007, Chapter 19: Manual Resistance Techniques, p Chaitow, L. Muscle Energy Techniques. Churchill Livingstone. Second edition, 2001, Chapter 1, An Introduction to Muscle Energy Techniques, p

20 Sources Liebenson C. Rehabilitation of the Spine: A Practitioner's Manual. Williams & Wilkins. Edition: 2nd edition, Hammer, W. Functional Soft Tissue Examination and Treatment by Manual Methods, New Perspectives. Aspen Publishers, Inc. Second Edition, Guyton, A and Hall, J. Textbook of Medical Physiology. WB Saunders Company. Ninth edition, Chaitow, L. Muscle Energy Techniques. Churchill Livingstone. Second edition, 2001.