Osteopathic Manipulative Treatment: Muscle Energy Procedure – Lumbar Vertebrae (Muscle Energy Technique)

Overview of Osteopathic Manipulative Treatment: Muscle Energy Procedure – Lumbar Vertebrae

Low back pain is a common issue that affects nearly 90% of people at some point in their lives. About 10% of these individuals end up with the pain becoming chronic, meaning it lasts for a long time. The complex nature of low back pain makes it hard to pinpoint what causes it in many cases – only about 15% of cases have a known cause. This condition can lead to discomfort and even impact a person’s mental health, leading to feelings of depression and anxiety.

Healthcare providers around the world still struggle to find effective ways to treat back pain. However, a method called the Muscle Energy Technique (MET) could be a promising solution. Through MET, healthcare professionals manipulate different parts of the spine, including the bones (vertebrae), disks, ligaments, and muscles, which has shown to provide significant relief for both acute and chronic low back pain.

The Muscle Energy Technique was first introduced by Dr. Fred Mitchell, Sr. in the 1950s. It is a hands-on technique where the patient is actively involved. The patient is moved into positions that address their specific barriers, and then they are instructed to use their own muscles to apply a force in a specific direction. MET is based on certain principles, one of the most important being post-isometric relaxation. Here, muscles that were initially tensed are allowed to relax, which aids in mobilizing the joints and tackling tissue restrictions. The end result is reduced pain and improved blood flow.

Using MET can be particularly useful as an alternative to opioid medications, which are often overused and only mask the pain without addressing the underlying issue. The underlying issues often include misalignment or incorrect positional sense of the spine and surrounding muscles. MET, on the other hand, directly addresses these issues by realigning spinal segments using the body’s own muscles. This helps to reduce pain, improve blood flow and enhance the flexibility of the muscles and joints.

This procedure could be particularly useful in addressing nonspecific low back pain, which is often caused by misalignment of the lumbar spine and its associated tissues. Through an osteopathic evaluation, clinicians can identify specific issues and relieve associated pain using MET.

Anatomy and Physiology of Osteopathic Manipulative Treatment: Muscle Energy Procedure – Lumbar Vertebrae

The topics covered in this article involve muscle energy mechanisms, but our main focus will be on a specific treatment for lower back discomfort, called post-isometric relaxation. This treatment involves the patient pushing against the doctor in a particular direction. This movement triggers a response in the body that encourages muscle relaxation. It’s believed that this response can help to improve comfort and movement in the affected area.

To understand how this works, we need to know a bit about the lower back. The lower part of our backs, or the ‘lumbar spine,’ is made of five bones that naturally curve inward, sitting above the tailbone. These bones are bigger than those in the rest of our spine. This helps keep our backs steady, while still allowing us to move freely. The primary job of these bones is to help our torsos move.

Compared to the rest of the spine, each of these five bones is bigger and doesn’t have the small extension or ‘costal facets’ and holes or ‘foramina’ that other parts of the spine do. Between each of the bones is a disc that helps to cushion any heavy loads or pressure. These discs are made up of a squishy center surrounded by tougher strands of collagen. These discs are thinner on the back side, making them more prone to potential damage like rupture and herniation. This often leads to lower back pain if the nerves on the back of the discs become irritated.

The sticking out parts or ‘processes’ at the back of the lumbar spine and the connecting structures or ‘pedicles’ are key components. The pedicle, which sits on top third of the back of each vertebra, serves as a bridge between the body of the vertebra and the sticking out part or ‘processes’. Pain at these processes can potentially cause discomfort in the lower limbs too.

The lumbar spine also contains various supporting structures, or ligaments, that provide stability. One of such is the ligamentum flavum which ties each bone to the next. If this ligament becomes thicker than usual, it can compress nerves, often causing injuries when the spine bends excessively. There are other important ligaments too, that serve as supports and help prevent strain in the lower back.

Also, it’s important to know about the muscles in this area since they play a crucial role in treatment. For example, the first three lumbar vertebrae connect to the diaphragm, the muscle helping us breathe. Also, some crucialback and hip musclesstart from, or are connected to, these lumbar vertebrae. Sometimes, tension in these muscles can be the cause of back pain. One of these muscles, the multifidus, helps support the lower back during various activities like standing, sitting, walking, and lifting. Dysfunction in these muscles is another common cause of lower back pain.

Why do People Need Osteopathic Manipulative Treatment: Muscle Energy Procedure – Lumbar Vertebrae

Muscle Energy Technique (MET), a specific type of massage therapy focused on the muscles and joints, can be used to treat either acute (sudden and severe) or chronic (long-lasting) lower back pain. It’s also used to treat tight back muscles, reduced flexibility, or stiffness in the lower spine. These are all conditions where the muscles or joints in your lower back are not functioning properly and are causing discomfort or pain.

Interestingly, MET can also help with some issues related to your prostate, descending colon (the part of your large intestine that moves waste towards the rectum), sigmoid colon (the last section of your large intestine), rectum (the final section of your digestive tract), and lower extremities (legs). This is due to something called “viscerosomatic reflexes”, which are connections between your internal organs and your musculoskeletal system. So, by treating certain muscle issues, we might also improve some related organ problems.

In general, MET is considered a safe procedure and it has a low risk of causing any harm when done correctly. It’s always crucial that the person performing this procedure is appropriately trained and experienced.

When a Person Should Avoid Osteopathic Manipulative Treatment: Muscle Energy Procedure – Lumbar Vertebrae

There are some situations where MET, a type of treatment for the lower back, should not be done. These include:

1. If someone recently had surgery on the lower back.
2. If they’ve had a serious injury to the back, like a fracture or something squeezing the spinal cord.
3. If they have cauda equina syndrome, a rare disorder that causes severe lower back pain.
4. If they have cancer in the lower back.
5. If the cancer started somewhere else but has now spread to the lower back.
6. If they have an infection in the bone in the lower back (osteomyelitis).
7. If they have severe osteoporosis, which is a condition where bones are very weak and can break easily.

In addition, MET might not be a good idea for seriously sick patients in the intensive care unit who are very weak. Putting too much muscle force on them could make their condition worse. For these patients, other types of MET might be used instead that don’t require as much force.

Finally, MET isn’t suitable for people who can’t follow verbal directions.

Equipment used for Osteopathic Manipulative Treatment: Muscle Energy Procedure – Lumbar Vertebrae

The tools used for Muscle Energy Technique (MET), a type of manual therapy, include a padded table or a comfortable surface where the patient can sit or lay down. This surface is adjusted to a suitable height for the doctor who is treating the patient.

Who is needed to perform Osteopathic Manipulative Treatment: Muscle Energy Procedure – Lumbar Vertebrae?

There are certain healthcare workers who are specially trained in a type of treatment called osteopathic manipulative medicine. This method involves using hands-on techniques to diagnose, treat, and prevent illness or injury. These healthcare professionals use their knowledge and skills to enhance your body’s natural ability to heal itself. They may use techniques such as stretching, gentle pressure, and resistance to help restore balance to your body and help you feel better.

Preparing for Osteopathic Manipulative Treatment: Muscle Energy Procedure – Lumbar Vertebrae

Before starting the treatment, doctors understand how important it is to accurately identify the problem. Issues in the lower back can be divided into two types based on a rule of spinal mechanics known as Fryette’s law. These types are known as type 1 (neutral group dysfunctions) and type 2 (non-neutral dysfunction).

A basic way to figure out which type of issue is present involves checking both sides of the spine. If one side of the spine has moved towards the back, that can indicate which direction the spine rotated.

Patients are asked by the doctors to lean forward and then lean backward until the specific level of the spine becomes clearly visible. This helps the doctors to observe any changes in the position of the spine. If the spine appears more level while bending forward or backward, this indicates a type 2 dysfunction which involves an extended or flexed spine. On the other hand, if the spine continues to be unleveled, it shows a type 1 (neutral) dysfunction.

Usually, the type 1 dysfunction involves a group of spine segments bending sideways and rotating in opposite directions. For example, neutral rotation towards the right and sideways bending towards the right. On the other hand, in type 2 dysfunction, the spine segments rotate and bend sideways in the same direction.

How is Osteopathic Manipulative Treatment: Muscle Energy Procedure – Lumbar Vertebrae performed

Muscle Energy Technique (MET), a type of manual therapy, can help to reduce lower back pain. There are several ways to perform this treatment, either with the patient sitting upright or lying down on their side. Regardless of the technique, the goal is the same: to gently move the patient’s body and then have them push back against the therapist’s resistance.

Here is a guide to one way of doing the treatment where the patient’s lower spine bends to the left and rotates to the right:

• Step 1: The patient sits on the edge of a treatment table, facing away from the therapist, who stands behind them. The patient crosses their arms over their chest.
• Step 2: The therapist stands behind the patient and puts their left elbow on the patient’s left shoulder. The therapist’s left hand reaches over to the patient’s right shoulder.
• Step 3: The therapist uses their right hand to feel the area of the lower spine that isn’t moving properly. The therapist keeps their hand here during the treatment to check how the spine is moving.
• Step 4: The therapist bends the patient to the right and rotates them to the left until they feel resistance. The aim is to position the patient’s body in a way that will help to correct the movement of their lower spine.
• Step 5: The therapist asks the patient to try and sit straight or turn to the right against the pressure of the therapist’s thumb. The patient uses about 30% of their strength to do this for 3 to 5 seconds.
• Step 6: The therapist repeats step 4 and then asks the patient to try and sit straight again.
• Step 7: Steps 4 to 6 are repeated 3 to 5 times.
• Step 8: The therapist checks the movement of the lower spine again to see if it has improved.

An alternative approach can be used when the patient’s lower spine is curved left and also turned left:

• Step 1: The patient sits down on the edge of a treatment table, with their back facing the therapist who can stand either beside or behind them. The patient should cross their arms over their chest.
• Step 2: The therapist stands behind the patient, placing their right elbow on the patient’s right shoulder. The therapist then reaches over with their right hand to the patient’s left shoulder.
• Step 3: The therapist uses their left hand to feel the area of the lower spine that isn’t moving properly. They keep their hand here during the treatment to monitor the back.
• Step 4: The therapist applies pressure to the patient’s right shoulder, causing the patient to bend to the right side. They then rotate the patient to the right just far enough to feel resistance, and then bend the patient’s back slightly backwards until they feel resistance. This moves the patient’s spine in a way that will help fix the issue.
• Step 5: While maintaining the position, the therapist asks the patient to try and sit straight, or turn to the left against the therapist’s thumb, or push their right shoulder up. The patient uses about 30% of their strength to do this for 3 to 5 seconds.
• Step 6: The therapist moves the patient back into position and asks them to try and sit straight again.
• Step 7: Steps 4 to 6 are repeated 3 to 5 times.
• Step 8: Finally, the therapist checks the lower spine again for improvement.

During this treatment, it’s important for the therapist to make sure that the part of the patient’s spine they’re treating is at the peak of the curve being formed. This will keep the other parts of the spine stable and help to correct the issue.

Possible Complications of Osteopathic Manipulative Treatment: Muscle Energy Procedure – Lumbar Vertebrae

Medical Exercise Therapy (MET) is generally considered to be safe with very few possible complications, especially when the right type of exercise is chosen. Some people doing MET might complain about temporary soreness that usually gets better after a few days. In some cases, patients might feel like they’ve been over-corrected or given more treatment than necessary, which may reverse their initial lower back problem.

Importantly, it’s crucial to keep an eye on the problem area during treatment and check it again after the therapy is completed. Using too much force during treatment can cause complications. This is because too much force can engage larger muscle groups, preventing the treatment from focusing precisely where it’s needed. In fact, there have been cases where tendons, which are the tissue connecting the muscles to bones, have been severely pulled or torn due to the use of excessive force.

What Else Should I Know About Osteopathic Manipulative Treatment: Muscle Energy Procedure – Lumbar Vertebrae?

There are many treatments for lower back pain like massages, physical therapy, exercises, spinal injections, electrical nerve stimulation, patches, creams, medication, and counseling. Yet, it’s not always clear how effective these treatments are. This is a problem because lower back pain is very common, costs a lot to treat, and there isn’t a decisive way to treat it. However, some studies suggest that Muscle Energy Technique (MET) can help decrease back pain. This method works by improving any misalignment or lack of function in the lower spine, which are common causes of non-specific lower back pain.

There was a small study done in 2003 where MET had shown significant improvement in people having acute lower back pain. Patients were treated with MET, where they underwent a series of muscle contractions. It was compared with a control group that wasn’t really treated. It was found that MET had improved the patients’ conditions by 83% compared to 65% in the control group. A review of multiple studies also found that MET effectively treats acute and chronic low back pain and other musculoskeletal pain such as chronic neck pain and elbow pain.

Back pain does not always originate from the lower back area. It could possibly come from other parts of the body as a sort of reaction. For instance, dysfunction in the sacrum (a bone at the base of the spine) or innominates (part of the pelvis) can cause lower back pain. Muscle knots in the thigh or buttock muscles could also cause pain in the lower back. Pain from the superior cluneal nerve, located in the lower back, can be mistaken for lumbar pain. Sprains in the lower leg could result in changes in knee and hip activity during walking, which could lead to pain in the lower back from improper walking patterns.

Thus, lower back pain isn’t always because of issues with the lower spine. When examining a patient with lower back pain, it’s important to take a detailed history of injuries and thoroughly examine the whole body.

To sum up, MET is a gentle method to manage lower back pain and it is quite safe for patients. However, more research is needed to understand how MET works.