Muscle Energy Treatment. Richard G. Schuster, DO OMEC 2010 San Francisco, California 27 Oct 2010

Transcription

1 Muscle Energy Treatment for the Lumbar Region Richard G. Schuster, DO OMEC 2010 San Francisco, California 27 Oct 2010

2 The Rationale Why would I go over muscle energy again?

3 The Rationale Why would I go over muscle energy again? It is structured, reliable and consistent. IT IS GENTLE!!! It can be done on anyone who can cooperate. It is very helpful in treating patients with lumbopelvic pain. I hope to teach it in a way that will allow you to understand what we are doing and why. I DON T WANT YOU TO MEMORIZE!

4 So what are we going to do? We are going to review the diagnosis and treatment of the lumbar spine. As I thought about this, I think it is all we can really do in the time allotted. The technique, though, h can be directly applied to the thoracic spine, and the principles to the rest of the body.

5 The Rules Muscle energy is a direct technique, so we are going to engage the barrier. We are going to utilize an activating force. We are going to going to hold the contraction ti for 3-5 seconds. We are going to take up the slack. We are going g to repeat it 3 times. We are going to recheck to be sure we did what we said.

6 The Rules sort sort of Muscle energy is a direct technique, so we are going to engage the barrier. But not really We are going gto utilize an activating force. We are going to going to hold the contraction for 3-5 seconds. We are going to take up the slack. We are going to repeat it 3 times. We are going to recheck to be sure we did what we said.

7 The Rules sort sort of Muscle energy is a direct technique, so we are going to engage the barrier. We are going to utilize an activating force. But much smaller than you learned! We are going to going to hold the contraction for 3-5 seconds. We are going to take up the slack. We are going to repeat it 3 times. We are going to recheck to be sure we did what we said.

8 The Rules sort sort of Muscle energy is a direct technique, so we are going to engage the barrier. We are going to utilize an activating force. We are going to going to hold the contraction for 3-5 seconds We might but it depends We are going to take up the slack. We are going to repeat it 3 times. We are going to recheck to be sure we did what we said.

9 The Rules sort sort of Muscle energy is a direct technique, so we are going to engage the barrier. We are going to utilize an activating force. We are going to going to hold the contraction for 3-5 seconds We are going to take up the slack. Very, very slowly! And we are going to wait before we do it. We are going to repeat it 3 times. We are going to recheck to be sure we did what we said.

10 The Rules sort sort of Muscle energy is a direct technique, so we are going to engage the barrier. We are going to utilize an activating force. We are going to going to hold the contraction for 3-5 seconds We are going to take up the slack. We are going g to repeat it 3 times. Only if we have to. We are going to recheck to be sure we did what we said.

11 The Rules sort sort of Muscle energy is a direct technique, so we are going to engage the barrier. We are going to utilize an activating force. We are going to going to hold the contraction for 3-5 seconds We are going to take up the slack. We are going gto repeat it 3 times. We are going to recheck to be sure we did what we said. Most assuredly!

12 Diagnosis The key to making muscle energy work is being sure what we have the correct diagnosis. i First we must identify the level of the restriction. Next we need to know where the barrier is. Another way of saying it is where is the restriction? Another way of saying it is where is the restriction? Once we know where it is restricted, we can approach the barrier to do the technique: But we are only going to approach the feather edge of the barrier.

13 Lumbar Diagnosis Identify the level of the restriction. Place your thumbs over the facet joints, just lateral to the spinous process. Ask the patient to slump or bend forward (flexion), then stick out her chest or belly (extension). Let your thumbs ride the Let your thumbs ride the tissues the way you would a standing flexion test.

14 So what have we done? With two simple moves we have gained the information we need. If we are looking at the picture, we know the barrier is to flexion, and that it won t sidebend and rotate to the right. Now we could say that L4 is ERSl, but we don t need to, to do the technique. We know what we need to do!

15 How do we do it? If this is L2 ERSr Barrier to flexion, sidebending and rotation left Ask the patient to put the right hand on the left shoulder This begins rotation The left hand behind her back This begins sidebending This makes it easier so we don t have to move her as much!

16 How do we do it? Drape your arm over her shoulder Ask her to slump or bend forward until the L2 spinous process moves This localizes it to the precise level. Take up what little slack remains in rotation and sidebending Just until you begin to feel the tension build under your monitoring hand. This is the feather edge of the barrier.

17 How do we do it? Now ask her to very gently pull forward with her left shoulder. Notice we are not asking her to straighten up. This engages too many muscles and we lose our localization. We are choosing rotation because she will have the tendency to flex when she does this which is the direction we want her to go.

18 How do we do it? Hold the contraction until you feel the tissues change under your finger/thumb. Pause as she relaxes, then slowly l take up the slack in rotation and sidebending only! Repeat this process until you have made the correction. The more localized you are, the fewer contractions it will take. Then recheck!

19 What if we needed to extend? In this case, the general principle is the same. Now, we extend until we feel the L2 spinous process move toward L3, but not L3 move. Take up the slack as before. This time ask them to push the shoulder upward. The tendency here is to extend just a little further, whereas if she pushed forward, she would likely flex more.

20 So what if you forget to IT DOESN T MATTER! As long as you approach the feather edge Only use one plane of motion for the contraction Only use enough force to feel a contraction Take up your slack slowly None of the rest matters! And RECHECK!

21 Thank you To all my mentors for all that they have taught me. To Stephanie Elkin and Joanne Genewick for helping with the pictures. My family for their continued support.