Overview of Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Piriformis Muscle
Osteopathic manipulative treatment (OMT) is a method that involves manually moving or manipulating bodily tissues to treat discomfort or issues in the body’s structure. It aims to improve the movement of muscles and joints, boost the connection between nerves and muscles, reduce pain, and balance the body’s chemistry.
Two specific techniques from OMT are often practiced in osteopathy, namely the Muscle Energy Technique (MET) and the Counterstrain Technique.
Muscle Energy is an active and direct method where the patient participates by tensing the muscle on focus while the doctor applies resistance or a counterforce. This can either be isometric (muscle tension without movement) or isotonic (muscle tension with movement), and isotonic forces can be concentric (muscle shortens) or eccentric (muscle lengthens).
Counterstrain Technique is a hands-off and indirect method where the doctor finds a point of sensitivity or tenderness, and uses the patient’s body to carefully position the patient to relieve pain.
Piriformis Muscle/Syndrome
Sometimes, if the piriformis muscle becomes enlarged, irritated, or overly used, it can cause piriformis syndrome. Because this is an often missed cause of back or buttock pain, many people may not realize they have it. Also, due to the muscle’s location in the pelvis, it can imitate sciatic pain, which can spread to the lower limbs. This is known as sciatic nerve entrapment syndrome, where the piriformis muscle presses on the sciatic nerve and causes pain.
Anatomy and Physiology of Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Piriformis Muscle
The piriformis muscle is a flat, pyramid-shaped muscle, similar to a pear, that is part of a group of muscles responsible for turning the hip outward. This group of muscles also includes the superior gemellus, obturator internus, inferior gemellus, quadratus femoris, and obturator externus muscles.
The piriformis muscle attaches close to the sacrum, a bone at the base of the spine, and the ligament attached to it. It then goes through a large hole in the pelvis and attaches to the femur, a bigger bone in the thigh. Depending on whether the hip is straight or bent, it will turn the hip outwards or move it away from the body’s middle line. This muscle works because of signals from the nerves that are attached at S1-S2 levels of the spine. The positions of the piriformis muscle in the pelvis make it cross paths with other nerves including the sciatic nerve, which sometimes also passes through this muscle.
Muscle energy techniques (METs) were introduced in 1974 by an American named Fred Mitchell. These techniques involve the patient’s own muscles in diagnosis and treatment. They involve controlled motions, following specific paths and resisting some force given by the person conducting the therapy. The regulation of posture and movement involves a kind of nerve reflex known as the reflex arc. This involves the nerves carrying signals from the muscles to the spinal cord and then causing the muscles to contract. A biological piece called the neuromuscular spindle, which is particularly sensitive to stretching, is responsible for this mechanism.
The core of the spindle, which is closely related to the connective tissue of the muscle, is the most important part. The spindle works alongside the surrounding muscle fibers. Upon stretch, the spindle signals different types of nerve fibers to respond, indicating either the stretching process or the new length the muscle reaches. This system also includes an automatic relaxation of the muscle working against the one being stretched. This concept forms the base of METs, as it can achieve greater joint movement through the balance of muscle contracting and relaxing around a joint. Also, METs can reduce overactivity in muscles and restore a more normal muscle length.
The strain counterstrain technique was devised in the 1950s by Dr. Lawrence H. Jones, an American osteopathic physician. This effective approach treats musculoskeletal disorders. The key concept involves finding a comforting position for each patient’s discomfort. This technique involves identifying tense spots (TP) that guide diagnosis and treatment by guiding to a comfortable body position for pain relief. When Dr. Lawrence Jones died, about 180 TPs and related techniques are recognized; now, we have over 200 TPs.
Unlike trigger points, TPs have different locations. The strain counterstrain technique is an osteopathic manual approach that involves passive repositioning towards a more comfortable position. This technique includes a gentle stretch in the opposite direction to the wrong stretch message. This position of comfort relieves pain and improves the dysfunctional area, reducing and stopping incorrect muscle reflexes.
Why do People Need Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Piriformis Muscle
If you have a problem in your body, such as your muscles or joints not working properly, this is called ‘somatic dysfunction’. If a muscle in your body is shorter or tighter than it should be, they are shortened or spastic. You might feel this kind of problem as back pain, either on its own or along with other nerve problems (neuropathy). If your hips are not even or aligned correctly, this is known as ‘pelvic imbalance’.
You might also have trouble moving a muscle, limb or joint as much as you normally should, this is known as limited ‘range of motion’ (ROM). If you have swelling in a certain area of your body, this is referred to as ‘localized edema’. ‘Trigger points’ are particular spots that are very sensitive to touch and can cause pain. You might feel it as a deep, aching soreness or a tightening in your muscles that won’t go away.
All these issues might lead to experiences of pain, which varies depending on the specific condition you have. It’s important to share all your symptoms with your doctor so they can come up with the best treatment plan for you.
When a Person Should Avoid Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Piriformis Muscle
There could be multiple reasons why a doctor might advise against certain treatments, such as a joint manipulation or massage therapy. These include:
If you’ve broken a bone (known as a fracture), it’s not safe to undergo these treatments.
If you have torn a ligament or tendon, which are the tissue that connect your muscles to your bones and help you move, treatments involving physical contact might cause further injury.
Similarly, if your joints, which are the parts of your body where your bones meet, are unstable, these treatments are not advised.
If you’ve had a recent surgery, your body needs time to heal before undergoing any more treatment.
These treatments might not be necessary if you don’t have any physical issues (referred to as somatic dysfunction) or symptoms.
It’s important that you have a say in your treatment. This means that if you refuse a treatment or are not cooperating, the doctor won’t proceed with it.
Also, if there is an active infection or open wounds in the area that would be treated, it can be dangerous to proceed with treatments as it risks spreading the infection.
If your discomfort is due to damage in your nerves (a condition known as neuropathic pain), these treatments may not help and could potentially make the pain worse.
Lastly, if your pain is resulting from an infection, it is essential to treat the infection first rather than the symptom of pain.
Equipment used for Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Piriformis Muscle
The doctor may need a few pieces of equipment to make sure your treatment goes smoothly and comfortably. Ideally, the doctor will use a special type of treatment table, called an osteopathic manipulative treatment (OMT) table. This is a special table that helps the doctor perform the treatment. However, if they don’t have this available, they can also use an examination table or even a massage table. The most important thing is that the table can be adjusted to make sure both you and the doctor are comfortable and in the right position.
Also included in the materials needed for your treatment is a stool. This is important for the doctor to be able to reach and manipulate your body safely and efficiently.
Lastly, to enhance your comfort during the treatment, a pillow will be used. Ensuring your comfort throughout the procedure is a key factor in successful treatment.
Who is needed to perform Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Piriformis Muscle?
A doctor who has specialized training in a type of medicine called osteopathy is ready to do a procedure. The patient has agreed to this procedure and doesn’t have any medical conditions that would make it risky or unsafe. This type of doctor uses hands-on techniques to improve your health and ensure that your body’s systems are working properly.
Preparing for Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Piriformis Muscle
Before starting treatment, it’s crucial to check the condition of the piriformis muscle, a muscle in the buttock, which lies deep beneath the gluteus maximus. This examination serves two purposes. The first reason is to understand the current state and severity of the muscle problem. The second reason is to help measure how much the condition has improved after the treatment.
The doctor can choose one of three ways to check this muscle, depending on the treatment method:
1. Supine method: In this technique, the patient lays on their back (known as supine position). The doctor gently holds their ankles and rotates their feet inward to compare both sides. If one foot doesn’t rotate as much as the other, there could be a muscle contraction, or spasm, in the piriformis muscle.
2. Prone method: In this technique, the patient lays on their stomach (known as prone position). The patient’s knees are bent at 90 degrees and they’re asked to let their legs fall out to the sides. If one leg doesn’t fall out as far as the other, it could indicate a spasm in the piriformis muscle.
3. Tender-point/trigger-point: In this method, the doctor will locate the point of pain or discomfort on the piriformis muscle itself.
How is Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Piriformis Muscle performed
If you’re having a Counterstrain, here’s what the process might look like.
You’ll be laid face down on a table and the doctor will be sitting on the same side as your piriformis muscle that’s causing you discomfort. The piriformis muscle is located in the buttock area, near your hip joint.
The doctor will find the sensitive point on the body of the piriformis muscle, which is typically around 2 to 3 inches from a bony protrusion on the side of your upper thigh (the greater trochanter). Alternatively, the doctor can also determine this point by halving the distance between two points on the lower back side and the greater trochanter.
Next, the doctor will lift your lower leg off the edge of the table. They’ll bend your hip to about 135 degrees and move it outward and rotate it, adjusting as needed until you feel less tenderness in your muscle. They’ll hold your leg in this position for about 90 seconds and then slowly return your leg back to a normal position.
Afterwards, they will check again to make sure tenderness has been relieved.
During a Muscle Energy treatment, you will be positioned lying on your back with the doctor standing on the same side as the affected piriformis muscle.
Your knee on the affected side will be bent and your foot will be placed on the side of your other knee. The doctor will then push your knee towards the middle of your body until they meet resistance.
Next, you’re going to push against the doctor’s hand for around 3 to 5 seconds. After this, you’ll have a rest period, then push against resistance again. This sequence will happen three times. Note that you won’t be moving your knee during the time you’re pushing – it’s an “isometric” exercise, which means the muscle works but there isn’t any visible movement.
Finally, you’ll be returned to a neutral position and the doctor will reassess how your piriformis muscle is doing. This might be done with you continuing to lie on your back or in a face-down position.
Possible Complications of Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Piriformis Muscle
Osteopathic Manipulative Treatment (OMT), a type of hands-on care used by doctors to diagnose, treat, or prevent illness or injury, is usually very safe. However, some people might experience common side effects like feeling tired, having a headache, or feeling pain in a specific area or that spreads to other areas. These side effects usually go away within a day after the treatment.
What Else Should I Know About Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Piriformis Muscle?
Treatment for the piriformis muscle, a muscle located in the buttock near the hip joint, can come in different forms such as muscle relaxants, anti-inflammatory medications (NSAIDs), and steroid injections. However, using methods like counterstrain and muscle energy can also be an effective, yet more conservative, option to complement or replace other treatments.
Counterstrain and muscle energy are manual therapies, meaning they involve hands-on techniques to adjust and heal the body. These treatments usually need to be part of multiple sessions with an osteopathic practitioner. This is because if the muscle problem is long-standing, it takes time to alter the muscle’s character and the associated nerve responses.
The number of sessions required will vary depending on how the patient’s body reacts to the treatment and the root cause of the muscle dysfunction.