Overview of Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Psoas Muscle Procedures
Psoas syndrome is a condition that occurs when the iliopsoas muscle, which helps us bend our hip, isn’t working correctly. This condition causes a variety of symptoms like lower back pain, groin pain, pelvic pain or pain in the buttocks. You may feel the back pain generally when standing, walking or changing your position from sitting to standing. The pain in the buttocks is usually on the opposite side and can spread down to the knee. Sometimes, you might also notice a “pop” or “snap” sound due to increased friction at certain points where the iliopsoas tendon rubs against bone causing a condition called Coxa Saltans or snapping hip. However, psoas syndrome can exist without this snapping hip.
Psoas syndrome is often found in people who do a lot of physical activities like jumping, dancing and running. It’s one of the top reasons for groin pain in these individuals. On the other hand, even non-athletes can experience psoas syndrome, usually from overusing the muscles that help the hip to bend and the leg to rotate externally. Most of the time, the treatment includes adjusting your activities, physical therapy, manual therapy (hands-on treatment), NSAIDs (types of medicines that reduce pain and swelling), and corticosteroid injections. If these methods don’t work, a surgical release of the iliopsoas muscle might be considered.
Two main techniques are used to address iliopsoas dysfunction through osteopathic manipulative treatment or OMT, a type of physical therapy. First is Muscle Energy Treatment (MET) which involves the provider taking the muscle or joint to its restrictive barrier and asking the patient to hold that position (isometric contraction) against the doctor’s push. After that, the muscle is relaxed, and then the provider pushes the muscle further into the restrictive barrier for three to five repetitions.
The second technique is Counterstrain (CS), where the provider finds the tender points that cause pain and gently moves the muscle or joint away from that position for about 90 seconds. During this, the provider monitors any changes in pain or improvement in the muscle texture. Once the muscle relaxes and the pain reduces, the provider brings the muscle or joint back to a neutral position so that hypersensitivity and improper sensory activity in the muscle or joint decrease.
Anatomy and Physiology of Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Psoas Muscle Procedures
The structure of the iliopsoas, which is a muscle in the lower back, is essential for understanding how it works, how it can cause pain (known as psoas syndrome), and how it can be treated using Metropolitan and counterstrain (MET and CS) therapy. The iliopsoas is made up of two parts: 1) the psoas muscle, which consists of the major and minor psoas muscles, and 2) the iliacus muscle.
The psoas major begins in the spine from the twelfth rib to the fifth lumbar vertebra (i.e., the lower back) and ends at a part of the thigh bone called the lesser trochanter. The psoas minor starts at the same spot and ends at the iliopubic eminence. The iliacus muscle begins inside the iliac fossa/sacral ala (a part of the pelvis) and ends at the same place as the psoas major.
The psoas major and minor muscles get their movement instructions from the first to the third branches of the lumbar plexus(an array of nerves in the lower back), while the iliacus receives its commands from the femoral nerve. Both the psoas and the iliacus muscles pass inwards towards the thigh bone under the inguinal ligament, a band of tissue in the lower abdomen. The iliopsoas primarily helps in bending the hip and rotating the leg outwards and also aids in maintaining a stable spine during hip bending. Some research suggests that the opposite psoas muscle is activated when bending the hip and possibly helps in keeping the spine stable.
OMT (osteopathic manipulative treatment) is used to treat issues caused by the iliopsoas to reduce pain, improve limb movement range, and restore normal movement and function in the nerves, muscles, and bones.
While there are multiple hypotheses about how MET works, there are two main principles: 1) post-isometric relaxation and 2) reciprocal inhibition. Both concepts leverage the biological mechanisms in muscle fibers and joints, including the alpha motor neuron and the Golgi tendon organ. Post-isometric relaxation suggests that the muscle relaxes after a short contraction period, thus relieving muscle tension and enabling the muscle to stretch further in the restrictive barrier. Reciprocal inhibition, on the other hand, proposes that a muscle relaxes after the opposing muscle contracts, allowing the muscle to stretch even further.
CS tenderpoints occur due to injury or improper muscle function, leading to changes in perception and increased muscle activity. During CS, the muscle is gently contracted to reset the Golgi tendon, a structure that senses changes in tendon tension, and return the muscle to its correct state and alignment.
Why do People Need Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Psoas Muscle Procedures
Before starting a special type of treatment called Osteopathic Manipulative Treatment (OMT), there should be something called ‘somatic dysfunction’ present. This term is just a fancy way of saying that there is an issue with how a joint or muscle is functioning or built. Somatic dysfunction can mean changes in the feel of your tissue, asymmetry (when one side doesn’t match the other), restricted movement, and tenderness or soreness. For example, someone might have issues with a muscle called the ‘iliopsoas’ which could be too tense, cause a restriction in extending the hip, or create tenderness in the iliopsoas area. People who may benefit from two types of OMT, MET (Muscle Energy Technique) or CS (Counterstrain) treatments, might also experience these symptoms, which are often associated with ‘psoas syndrome’.
Deciding whether to use MET or CS as a treatment method will depend on the patient’s current health status and the doctor’s preference. CS is a treatment that does not require the patient to actively participate. In this method, the doctor checks the psoas muscle, eases it into a comfortable position, and maintains that position for some time. This method is suitable for a patient in significant discomfort or for someone who struggles with coordinated muscle movements.
On the other hand, MET is an active treatment that needs the patient to help out. The patient has to apply pressure against the doctor using their muscle, which is then followed by muscle relaxation while the doctor eases the area of concern further into the restrictive barrier (basically pushing against the point where movement is restricted in the muscle/joint). During both these methods, it’s important for the patient to be able to give feedback to the doctor.
When a Person Should Avoid Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Psoas Muscle Procedures
There are times when people can’t have MET, or Muscle Energy Techniques, because of various reasons:
If a person has a broken bone in the area where the treatment needs to be done, they won’t be able to have MET. If their pelvis or hip joint is not stable, they can’t go through this treatment. Nor can they have MET soon after surgery or if they have low energy levels.
A person also can’t have MET if they can’t perform isometric contraction – that’s a type of muscle contraction where the muscle doesn’t change its length. Finally, they won’t be able to have MET if they are unable to follow instructions.
Similar conditions apply to CS, or Contractile Stretching. A person can’t undergo CS in these situations:
If they can’t relax voluntarily, if they can’t provide feedback to the doctor, CS won’t be possible. Again, if they have a broken bone where the treatment needs to be given, they can’t have CS. And if they’ve torn a ligament or tendon – the tissues that connect bones and muscles – in the area that needs treatment, they are not suitable for CS.
Equipment used for Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Psoas Muscle Procedures
The only piece of equipment needed for this procedure is a sturdy OMT (osteopathic manipulative treatment) or massage table. This is a special type of table that is specifically designed to support the human body during treatments like osteopathy or massage therapy.
Who is needed to perform Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Psoas Muscle Procedures?
A medical professional who has the right training in OMT (Osteopathic Manipulative Treatment) is needed. OMT is a type of treatment where a doctor uses their hands to move and adjust your muscles and joints. This can help to reduce pain and improve your overall health.
Preparing for Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Psoas Muscle Procedures
Before a doctor carries out a therapeutic technique known as Osteopathic Manipulative Treatment (OMT), it is important for him or her to explain to the patient the benefits, potential risks and other alternative methods so that the patient can make an informed decision. The patient’s consent is essential before moving forward with the OMT.
After the patient has given their approval, the doctor would then determine the patient’s level of pain, examine the mobility and power of the muscle that’s causing the problem and carry out any necessary neurological tests. The doctor would also examine the structure of the patient’s lower back, pelvis, and hip. If treating the iliopsoas muscle, which is located near the hip, a specific test called the Thomas test would be conducted to evaluate the flexibility of the muscle.
How is Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Psoas Muscle Procedures performed
Muscle Energy Technique is a type of manual therapy used by doctors and physical therapists to treat pain and limited mobility. It’s done in different positions depending on your needs. Here are two ways it can be done:
1. When you are lying face down (prone position):
– The doctor stands on the opposite side of your pain area.
– The doctor places one hand on the back of the affected hip and grips the region just above the knee of the same leg with the other hand.
– Your hip is gently straightened until some resistance is felt.
– You are then told to press your hip downwards for 3 to 5 seconds (this is isometric contraction, where your muscles contract but do not move). This is followed by a relaxation phase.
– Your hip is moved further into a straight position until resistance is felt again.
– The process of isometric contraction and relaxation is repeated 3 to 5 times.
– After the final repetition, your leg is gently returned to the normal, relaxed position.
– The area is then examined to see if the pain or stiffness has improved.
2. When you are lying face up (supine position):
– The doctor stands on the same side as your pain area.
– You are asked to bend the opposite knee and hip, bringing it towards your chest.
– While keeping that leg in position, the doctor exerts a downward force just above your knee until resistance is felt.
– You are instructed to attempt to lift your knee upward for 3 to 5 seconds, followed by a relaxation phase.
– The process of attempted lifting and relaxation is repeated 3 to 5 times.
– After the final repetition, your leg is returned to the resting position.
– Again, the doctor examines to see if the treatment has improved your condition.
Lastly, there’s a method known as Counterstrain which can be occasionally used. In this method, you lie face up and the doctor finds and records the level of discomfort at a specific point in your muscle, typically near your pelvic bone. The doctor then gently flexes both your hips and allows your lower legs to rest against their own thigh. You might also need to cross your ankles and let your hips rotate sideways. As your pain begins to subside, the doctor maintains that position for about 90 seconds. The treatment ends by returning you to a resting position and reassessing the pain at the initial trigger point.
Possible Complications of Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Psoas Muscle Procedures
When done properly, Myofascial Release Therapy (MET) and Carpal Tunnel Syndrome (CS) treatments are generally quite safe. However, it’s not uncommon for patients to feel a bit of muscle soreness after these treatments. This is often a normal part of the process and goes away by itself after a while. To limit or reduce any discomfort after the treatment, patients should rest enough and make sure to drink plenty of fluids.
What Else Should I Know About Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure – Psoas Muscle Procedures?
The iliopsoas muscle is a major muscle in the body that links your lower back, pelvis, and leg. Sometimes, this muscle can malfunction and cause a condition known as “psoas syndrome.” It tends to occur more frequently in people who already have certain back or hip issues. According to a study, about 24% of patients who underwent a specific hip surgery were found to have inflammation in the iliopsoas tendon, a part of this muscle.
One effective therapy for this syndrome is osteopathic manipulative treatment (OMT), a type of hands-on therapy used to diagnose, treat, or prevent illness or injury. Compared to other non-surgical interventions like steroid injections or medication, this therapy has fewer adverse effects.
If the psoas syndrome goes without proper treatment, it can force your body to make adjustments along the movement pathways of your body (the “kinetic chain”). This can lead to problematic changes in other parts of your body like your chest, a muscle called the piriformis (located in the buttock area), your sacrum (the triangle-shaped bone located at the bottom of your spine), pelvis, and knee.
