Overview of Osteopathic Manipulative Treatment: Muscle Energy Procedure – Cervical Vertebrae
In the 1950s, Dr. Fred Mitchell Sr. explored the movements of the pelvis and, based on his findings, he started a unique type of treatment for muscle issues using the actual movement of the muscles. This came to be known as the muscle energy technique, or MET.
MET employs the patient’s own muscle power during the treatment and has become a well-known tool used by osteopath practitioners. It is used to address a variety of issues with the body’s structure and function, more specifically within the muscular, nervous, vascular, and connective tissue system. This is commonly referred to as “somatic dysfunction”. In the neck region, somatic dysfunction usually surfaces as muscle tightness, sensitivity, lack of balance, and limited movement range.
MET operates on several physiological principles which can be divided into ten categories. Among them, the most frequently applied is called “post-isometric relaxation”. This involves gently stretching a muscle after it has been contracted, helping it to relax and lengthen. Typically, osteopathic doctors use MET to rectify somatic dysfunction that results in pain and discomfort, particularly in the region of the upper back.
Neck pain is a common problem, affecting about 15% of men and 23% of women. It can be caused by a variety of factors including poor posture, injuries, surgeries, certain cancers, nerve diseases, and a narrowing of the spine. However, it is mostly due to mechanical issues, meaning problems with the physical movement or alignment of the spine. Physical therapies and exercises are often effective ways to treat neck pain resulting from these issues, with osteopathic manual therapy being one such approach.
Anatomy and Physiology of Osteopathic Manipulative Treatment: Muscle Energy Procedure – Cervical Vertebrae
For Muscle Energy Technique (MET), it’s fundamental to understand how our muscles work. Muscles can contract in four different ways: isometric, concentric, eccentric, and isolytic. An isometric contraction is when our muscles tense up, but don’t move closer together. A concentric contraction is when the muscle shrinks as it contracts. An eccentric contraction is when the muscle grows longer even while contracting. Lastly, an isolytic contraction is when an outside force makes the muscle lengthen even while it contracts.
Muscles are composed of numerous muscle spindles, each containing 3 to 12 small muscle fibers encircled by a larger muscle fiber. Each of these spindles communicates with our nervous system in two ways – one motor (efferent which sends info out from the brain) and one sensory (afferent which takes info to the brain) connection. The sensory nerves monitor the tension and length in our muscles and help our brains determine the necessary reaction.
The connection between our muscles and nervous system helps control muscle tension. For example, the Golgi tendon organs (GTOs), nerve endings in our muscles, get activated when the muscle tension rises. It triggers a process that ultimately prevents the muscle from contracting too much and causing harm.
The understanding of this process is essential for MET, particularly for a method known as post-isometric relaxation. In this technique, instructions are given to the patient to apply force against the resistance. It leads to the activation of GTOs, resulting in a relaxed, less tense muscle. This relaxed state allows the muscle to be further stretched safely.
Separately, the neck, or the cervical spine, is a complex structure consisting of seven vertebrae. The upper two are unique and allows the head to nod and rotate. The lower five vertebrae are slightly different, with specialized structures to limit excessive movement and stabilizing the neck. Various ligaments and joints aid in the overall stability and movement of the cervical spine.
The cervical spine has spaces from where eight nerve roots emerge. These nerves provide sensation to different parts of the head, neck, shoulders, and arms and facilitate various movements. The design of the cervical spine permits a broad range of movements and postures, including rotating the head and bending the neck side to side.
Interestingly, different parts of the cervical spine specialize in different types of movement. For instance, most of the nodding action of the head occurs between the skull and the very first vertebra. Meanwhile, the joint formed by the first and second vertebrae mainly allows for the head to rotate. The lower cervical spine enables side-to-side bending. These specialized movements at different vertebral levels contribute to the overall flexibility and range of movements at the neck.
Why do People Need Osteopathic Manipulative Treatment: Muscle Energy Procedure – Cervical Vertebrae
If a doctor is considering using muscle energy therapy, a specific type of hands-on therapy that aims to help with problems in the neck, they first need to make sure two things are in place. First, they need to clearly identify the patient’s neck issue through physical examinations that give them hard evidence. This neck issue is also known as “cervical somatic dysfunction”. Second, the patient must be suitable to receive a type of treatment called “osteopathic manipulative treatment”, which involves the doctor using their hands to diagnose and treat illness or injury.
When a Person Should Avoid Osteopathic Manipulative Treatment: Muscle Energy Procedure – Cervical Vertebrae
There are certain situations where muscle energy techniques, which are a type of physical therapy, aren’t recommended. Some of these are considered “absolute,” meaning they should always be avoided. These include when someone’s been injured, has a broken bone or a dislocated joint, has an infection, hasn’t agreed to the treatment, or has torn a muscle.
Other situations are considered “relative,” meaning they require more careful consideration. These include when a person’s neck is unstable, when someone is bleeding inside their body, or if they’ve recently had a heart attack or surgery. People with rheumatological conditions, which relate to joint diseases, are another example, but this mostly depends on how severe the disease is and which joints it affects.
The instability of the upper part of the neck has been noted in many studies involving people with rheumatoid arthritis, a type of joint disease. When a patient with this condition has neck pain, doctors should first use imaging, like X-rays or a CT scan, to check if their neck is unstable. Finally, people with a genetic condition known as Down syndrome can also have instability in their upper neck.
Equipment used for Osteopathic Manipulative Treatment: Muscle Energy Procedure – Cervical Vertebrae
The Muscle Energy Technique (MET), a kind of manual therapy provided by osteopaths, needs a solid and sturdy surface, along with a cushioned table. This setup ensures both the patient and the doctor are comfortable, and that the treatment can be provided in the best possible position.
Who is needed to perform Osteopathic Manipulative Treatment: Muscle Energy Procedure – Cervical Vertebrae?
You will need a doctor who is properly trained in a special type of treatment called muscle energy techniques. This is a way of helping your muscles to work better and feel better. It’s important that the doctor has the right skills and knowledge to do this safely and effectively.
Preparing for Osteopathic Manipulative Treatment: Muscle Energy Procedure – Cervical Vertebrae
Before starting any treatment for issues related to the body’s structures or muscles (known as somatic dysfunctions), it’s very important to get the right diagnosis. Here’s how doctors determine this:
Diagnosing problems with the OA (occipitoatlantal, where the neck and skull meet) joint:
1. The patient lies face-up while the doctor stands at the head of the table. The doctor holds the patient’s head so that their fingers are underneath the OA joint.
2. The doctor will then move the patient’s OA joint in various direction, looking for where it moves freely. This is key to identifying the nature of the problem. If they figure out which direction the joint bends easily, they can work out where it’s not rotating properly – this will be in the opposite direction.
Another way to find out what’s wrong is to look for which side is rotating first. The doctor holds the back of the patient’s head (the occiput). They then feel for which side of the OA joint is “deeper”. If it’s deeper on one side, that’s the side it’s rotating towards. So, it will bend in the opposite direction.
3. It’s also important for the doctor to make the OA joint move in a bending and stretching motion before making a diagnosis.
Diagnosing problems with the AA (atlantoaxial, the joint between the first and second neck vertebrae) joint:
1. The patient lies face-up while the doctor stands at the head of the table. The doctor bends the patient’s neck to a 45 degree angle to isolate the AA joint from the rest of the neck.
2. The doctor tests movement by turning the patient’s head in both directions.
3. The problem, or lesion, is named based on which direction the head rotates more easily.
Diagnosing problems with bones C2 to C7 in the neck (the rest of the vertebrae in the neck):
1. The patient lies face-up while the doctor stands at the head of the table. The doctor feels the sides of the ‘articular pillars,’ which are the bony edges of your neck vertebrae.
2. To cause the neck bones to side-bend, the doctor shifts (translates) them in the opposite direction. For example, shifting the bones to the right would cause the neck to bend to the left.
3. The doctor checks each neck bone by moving them in a bending and stretching motion to figure out the diagnosis.
How is Osteopathic Manipulative Treatment: Muscle Energy Procedure – Cervical Vertebrae performed
One treatment for neck pain includes muscle energy techniques, which involve the collaboration between you and the doctor to address dysfunction in the neck joints. These techniques are specialized, gentle stretching procedures which normalize alignment, promote relaxation and increase mobility.
In particular, there are three points of focus: the occipitoatlantal joint (OA joint), the atlantoaxial joint (AA joint), and the rest of the cervical vertebrae (the bones of your neck).
The first technique is for when the OA joint, located at the top of the spine, is not working properly. Here’s what you can expect:
- The doctor will first identify the type of dysfunction in the OA joint. You might hear they use a series of terms or abbreviations to describe the issue.
- One of the doctor’s hands will hold your head while the other monitors the joint.
- They will adjust your head position based on your specific dysfunction.
- You’ll be asked to try to move your head back to a normal position while applying a gentle, steady force for a few seconds. This is called isometric force.
- Your head will be repositioned, and you’ll repeat the process of applying isometric force.
- This step-and-repeat process is usually done 3 to 5 times. The doctor will then reassess the joint.
The next technique is similar, but it pertains to the AA joint, which is just below the OA joint:
- Again, the type of dysfunction is identified first. In this case, it’s specific to the AA joint.
- Your neck is gently bent forward while the doctor holds your head. This is done to focus on the AA joint and discourage movement in other areas.
- Your head is turned toward the barrier based on your specific dysfunction.
- As before, you try to move your head back to a regular position while applying an isometric force for a few seconds.
- You’ll keep repeating this process, with your head being repositioned each time.
- After 3 to 5 repetitions, the doctor reevaluates the joint.
Finally, a similar technique is used for the rest of your cervical vertebrae:
- The doctor first determines the specific issue with one of the bones in your neck.
- They hold your head with one hand, and use the other to locate the specific bone of concern.
- They position your head in a particular way related to the dysfunction.
- You try to move your head back into a neutral position, applying a constant gentle force for a few seconds.
- Your head gets repositioned, and you repeat the process. This happens 3 to 5 times before the doctor reassesses the affected area.
The purpose of these techniques is to restore proper movement and position to your neck joints, relieving your discomfort and aiding the healing process.
Possible Complications of Osteopathic Manipulative Treatment: Muscle Energy Procedure – Cervical Vertebrae
Unwanted side effects from medical treatments are not common, but in some rare cases, they can include stroke, slipped disc, broken bones, or blood clots. After reviewing multiple research studies, it was found that a severe side effect that has been brought up often is cervical arterial dissection (CAD), which is a tear in the artery in the neck. However, right now, we don’t have enough information to know who might be at a higher risk of facing this complication.
What Else Should I Know About Osteopathic Manipulative Treatment: Muscle Energy Procedure – Cervical Vertebrae?
An osteopathic method can be used to ease muscle tightness and release stress in the spine. Frequently, the deep muscles in your neck can lead to pain both in the neck and in the head, as they can irritate a larger nerve in the head. Three out of four of the muscles at the base of your skull are connected by a nervous and sensory-rich bridge. When these muscles contract excessively or have small, painful knots known as trigger points, they can cause migraines and headaches. Muscle energy techniques (METs), a type of osteopathic treatment, can be used in these instances to provide relief.
This osteopathic method encourages the calming part of your nervous system to work correctly and helps restore the flow of blood and lymph, a fluid that carries important cells throughout your body. This approach can also benefit the function of breathing support muscles located in your neck, improving the breathing ability of patients suffering from fibromyalgia, a condition that causes chronic pain.
Chronic neck pain can often originate from past injuries. In these cases, the muscle tissue decreases while the fatty tissue increases. The increase in fatty tissue can lead to local inflammation causing pain, and the ability of the muscles to sense movement and balance diminishes, resulting in decreased coordination. MET doesn’t just relieve this pain; it restores the correct spacing in joints of the spine and enhances the muscles’ ability to contract and relax in a balanced manner. This overall aids neck muscles to work properly and decreases reasons for the pain.
MET can also help improve the shape of your neck’s curve, making it a potential treatment for neck injuries such as from a whiplash.
If the patient’s neck is very painful and lacks mobility, MET can be started gently, with the eye muscles being used alongside slight head movements up to the second bone of the neck (this combined movement is referred to as the oculocephalic reflex).