Overview of Osteopathic Manipulative Treatment: Muscle Energy Procedure – AC Joint, Clavicle, SC Joint
Acromioclavicular (AC) joint injuries, which affect the joint at the top of the shoulder, are fairly common. A recent study showed that every year, 2 out of 10,000 people aged 18 to 75 experience these injuries. They occur most often in younger men, while older individuals may get more severe forms of the injury. Doctors exam these injuries based on x-rays images and specific details about the patient. Damage to nearby structures such as certain ligaments and muscles can suggest more serious damage to the AC joint.
There are a few different systems doctors use to rank how severe an AC joint injury is based on x-ray images, including Tossy and Rockwood classifications. In simple terms, Tossy divides injuries into three categories: sprain of the AC joint, partial dislocation of the AC joint, and complete dislocation of the AC joint. The Rockwood system is a little more detailed with six categories which includes damage to certain ligaments in the shoulder and different types of dislocations. For less severe injuries (types I and II in the Rockwood classification), treatment usually doesn’t involve surgery. However, for some injuries (types IV and VI), surgery may be needed. There is still some debate about whether surgery or non-surgery treatment is best for types III and V injuries.
The sternoclavicular (SC) joint, located at the base of the neck, can also be injured, much like the AC joint. Depending on the injury, the joint can be displaced forward (anterior) or backward (posterior). Injuries that cause it to displace forward can often be fixed without surgery, but those that cause backward displacement may require surgery. This is because of delicate structures located behind the collarbone that could be affected. Injuries to the SC joint are less common, making up less than 1% of all injuries to the pairing of bones that make up the “shoulder girdle” that were seen at a major trauma center over a 19-year period.
The non-surgical treatment of AC and SC joint injuries is the main focus of the study being discussed here. This treatment could involve muscle energy techniques frequently used in osteopathic manipulative treatment. This technique is generally used when there are overly tense muscles or restricted joints throughout the body, like those of the AC and SC joints. Most commonly used is the isometric variation of the muscle energy technique, where the patient actively contracts a muscle or joint against a resistance provided by the provider (like a therapist) for 3 to 5 seconds, relaxes, and then the provider moves the affected muscle or joint further into a position that it had restricted motion in. This process is usually repeated three to five times.
Anatomy and Physiology of Osteopathic Manipulative Treatment: Muscle Energy Procedure – AC Joint, Clavicle, SC Joint
The AC joint is a part of the complex structure of the shoulder. It’s where the acromion, a bony projection off the shoulder blade, and the outer part of the collarbone come together. These two bones have flat, oval-shaped surfaces where they meet. Between them, there’s a disc made of a material similar to cartilage, although this disc isn’t always a complete circle. The AC joint is held in place by muscles and ligaments, which are like tough, flexible cords that connect bones together. This includes the deltoid and trapezius muscles, the AC ligament, and the coracoclavicular ligaments. The latter are particularly important for keeping the joint stable.
The AC joint is a specific type of joint called a synovial joint that lets the bones glide against each other. This joint helps with lifting and bending the shoulder. Its blood supply comes from the suprascapular and thoracoacromial arteries, and it’s connected to the suprascapular, axillary, and lateral thoracic nerves. This joint is vital for movements of the shoulder blade which allows the arm more range of motion.
Similar to the AC joint, the SC joint is also a synovial joint. This joint connects the collarbone with the upper part of the breastbone and the first rib’s cartilage. This joint is stable because of various surrounding structures such as different ligaments and a muscle called the subclavius muscle. The SC joint lets your shoulder move in different ways, like side to side and front to back. Its blood supply comes from the internal thoracic and suprascapular arteries, and it’s connected to the medial supraclavicular and subclavius nerves. However, a problem with this joint can cause serious issues due to the important structures at the back of the joint, such as a collection of major blood vessels and the air pipe (trachea) and food pipe (esophagus).
The exact way the muscle energy technique works isn’t completely understood. But it seems to work by causing certain changes in the nervous system that allow the muscle to relax and affect how pain is felt.
Why do People Need Osteopathic Manipulative Treatment: Muscle Energy Procedure – AC Joint, Clavicle, SC Joint
Muscle Energy Techniques (METs) were created by an American osteopath, Fred Mitchell Senior. These techniques involve the use of a person’s muscle strength in a very precise manner to help stretch and strengthen muscles. It does this by working with the body’s nervous system and mechanisms within the muscles themselves.
Essentially, the person voluntarily contracts their muscles in a specific way, with varying degrees of intensity, against a slight resistance provided by a therapist. These exercises can be active, meaning the person is using their own muscle strength.
These techniques can be split into isometric, where the muscle contracts but doesn’t change its length, and isotonic, where the muscle contracts and changes its length. These contractions can be used in three ways to help improve problem areas:
- A muscle stays the same size when contracting (isometric) and the resistance comes from the direction in which the muscle is tight (restriction).
- Contracting a muscle without changing its length, against the direction of restriction (where it is tight).
- Contracting a muscle while shortening it (isotonic) towards the direction of restriction.
Muscle Energy Techniques may be particularly beneficial for the following circumstances:
- In situations where muscles are too tight (hypertonic).
- When there is a problem with how a muscle or joint is working (somatic dysfunction).
- If joint movement is limited.
- To decrease swelling or overcrowding in an area by helping blood and body fluids circulate better.
When a Person Should Avoid Osteopathic Manipulative Treatment: Muscle Energy Procedure – AC Joint, Clavicle, SC Joint
The technique known as ‘muscle energy’ is quite secure and can be used for many conditions, except in a few very serious situations. These could include:
If you have a broken bone, tearing of a ligament, tendon, or muscle (these are structures that connect bones and help in movement), or an infection in your joint. A joint is a part where two or more bones meet, like the knee or elbow.
In case there’s no issue with your body’s framework, referred to medically as ‘no somatic dysfunction’, or if you, as the patient, don’t wish to opt for this technique.
Equipment used for Osteopathic Manipulative Treatment: Muscle Energy Procedure – AC Joint, Clavicle, SC Joint
When getting an osteopathic manipulative treatment, which is a type of hands-on care used to diagnose, treat and prevent illness and injury, there are certain items that your healthcare provider will need. This includes a specially designed table that you will lay on during the treatment, and a stool for the doctor to sit on while they work. These pieces of equipment are crucial to ensure the treatment is performed effectively and comfortably.
Preparing for Osteopathic Manipulative Treatment: Muscle Energy Procedure – AC Joint, Clavicle, SC Joint
Before starting any treatment, it’s important to look at the AC and SC joints in your shoulder. This means checking for swelling, redness or bruising, as well as testing how strong the muscles are around the joint and how well you can move your arm. These tests should be done before any treatment begins, and afterwards, to see if the treatment helped.
In this review, we discuss two conditions of the AC joint that can be treated with muscle energy techniques. The first condition is when the AC joint is rotated inward, and the second is when the AC joint is rotated outward.
To check these conditions, the doctor will touch the AC joint, located where your shoulder blade and collarbone meet. This is done by one hand going along your shoulder blade to the shoulder tip, while the other hand moves along your collarbone. To understand the level of movement or rigidity, your doctor will rotate your shoulder inwards and outwards while feeling the joint. This will be done for both right and left AC joint to note any differences. If there is less movement in say, the right joint when rotating externally as compared to the left, then the right AC joint is said to be internally rotated.
For the SC joint, which is where your collarbone meets your breastbone, we discuss two possible conditions. First is when the collarbone is pulled inward (adducted) and second is when the collarbone is stretched outward (horizontally extended).
One significant relation for understanding these conditions is how your shoulder and collarbone move together. If you lift your shoulders, the end of your collarbone near your breastbone lowers, and the outer edge close to the shoulder rises. You can think of it like a see-saw movement.
To check these conditions, the doctor will touch the clavicle joint, located where your collarbone and breastbone meet. This is best done with the patient lying on their back.
For the inwardly pulled collarbone, the doctor will ask you to lift both your shoulders to your ears at the same time. The shoulder that doesn’t lower as much is considered to have an inwardly pulled collarbone. For, the outwardly stretched collarbone, the doctor again checks the same joint by asking you to slowly move your shoulders into a stretched position. The joint that doesn’t drop downwards is considered to have an outwardly stretched collarbone.
How is Osteopathic Manipulative Treatment: Muscle Energy Procedure – AC Joint, Clavicle, SC Joint performed
The Muscle Energy Technique is a manual therapy (therapy using hands) used to treat different issues with the AC joint, clavicle, and shoulder. Here are descriptions of how this technique can help correct an internally rotated AC joint, an adducted clavicle, and a horizontally extended clavicle.
The following instructions are for an internally rotated AC joint, which means the AC joint is rotated towards the body:
1. Patient sits with their arm relaxed away from the body and elbow slightly bent.
2. The therapist gently rotates the patient’s shoulder using a handshake grip, while checking the movement of the AC joint.
3. Then the patient tries to rotate their shoulder inwards against the therapist’s hand which is resisting this movement. This is done for about 3 to 5 seconds.
4. The therapist then asks the patient to relax and slowly moves the shoulder further into the position of resistance (or rotates the shoulder away from the body).
5. The last two steps are repeated around 3 to 5 times.
Here is how to correct an adducted (drawn towards the body) clavicle:
1. The therapist stands beside the patient at the treatment table.
2. The patient lifts the affected arm to about shoulder height with the thumb facing downwards.
3. The therapist positions his/her thigh against the patient’s lifted arm and with the other hand presses down on the SC joint (the joint connecting the collarbone and breastbone).
4. The patient is then asked to press their arm down against the therapist’s thigh, who resists this movement, for around 3 to 5 seconds.
5. After asking the patient to relax, the therapist then moves the shoulder further into the position of resistance while still maintaining downward pressure on the SC joint.
6. Steps 4 to 6 are then repeated 3 to 5 times.
7. Afterwards, the therapist checks the movements of the clavicle.
Now, let’s see the steps for a horizontally extended clavicle, which means the clavicle sticks out more towards the front of the body:
1. The therapist stands on the side of the treatment table opposite of the affected clavicle.
2. The therapist uses their hand to press gently on the front of the problematic SC joint.
3. The patient is asked to lift their hand towards the ceiling and put the other arm around the therapist’s neck.
4. The therapist then touches the shoulder blade area with their other hand.
5. The patient is asked to try pulling the shoulder blade down towards the treatment table. The therapist resists this action for about 3 to 5 seconds.
6. After advising the patient to relax, the therapist then further pushes the SC joint towards the back while pulling the patient’s shoulder towards the front.
7. The last three steps are repeated approximately 3 to 5 times.
8. And finally, the therapist checks the movements of the clavicle.
These methods aim to improve your joint mobility and reduce your discomfort. If you have these issues, your doctor or physical therapist will help you with these exercises.
Possible Complications of Osteopathic Manipulative Treatment: Muscle Energy Procedure – AC Joint, Clavicle, SC Joint
Studies suggest that major negative side effects are not commonly associated or directly linked with manual therapy (a treatment used to treat and manage conditions related to the body’s muscles and bones). For example, there isn’t any known connection between manual therapy and complications in the digestive system, although rarely, they can occur together by chance. Minor side effects like headaches, muscle soreness, and light-headedness do occur sometimes after manual therapy. These are usually not serious and don’t need additional medical treatment. However, patients should avoid hard physical activity after treatment and drink plenty of water to help the body recover.
What Else Should I Know About Osteopathic Manipulative Treatment: Muscle Energy Procedure – AC Joint, Clavicle, SC Joint?
Osteopathic manipulative treatment is a lesser-known alternative to surgery that can greatly benefit patients with problems in their AC (acromioclavicular) and SC (sternoclavicular) joints. The AC and SC joints connect the collarbone to the shoulder blade and breastbone respectively. This non-surgical method is typically best for types I and II AC injuries. However, there’s still some debate over its effectiveness for types III and V. In general, all non-surgical treatments should be completely tried out before resorting to surgery. Osteopathic manipulative treatment, which uses muscle energy, can effectively treat these non-surgical injuries and also help strengthen the surrounding structures for further support.
