Content uploaded by Kevin Laudner
Author content
All content in this area was uploaded by Kevin Laudner on Feb 26, 2014
Content may be subject to copyright.
A preview of the PDF is not available
The Immediate Effects of Muscle Energy Technique on Posterior Shoulder Tightness: A Randomized Controlled Trial
Abstract and Figures
Randomized controlled trial.
To compare a muscle energy technique (MET) for the glenohumeral joint (GHJ) horizontal abductors and an MET for the GHJ external rotators to improve GHJ range of motion (ROM) in baseball players.
Overhead athletes often exhibit loss of GHJ ROM in internal rotation, which has been associated with shoulder pathology. Current stretching protocols aimed at improving flexibility of the posterior shoulder have resulted in inconsistent outcomes. Although utilization of MET has been hypothesized to lengthen tissue, there are limited empirical data describing the effectiveness of such stretches for treating posterior shoulder tightness.
Sixty-one Division I baseball players were randomly assigned to 1 of 3 groups: MET for the GHJ horizontal abductors (n = 19), MET for the GHJ external rotators (n = 22), and control (n = 20). We measured preintervention and postintervention GHJ horizontal adduction and internal rotation ROM, and conducted analyses of covariance, followed by Tukey honestly significant difference post hoc analysis for significant group-by-time interactions (P<.05).
The group treated with the MET for the horizontal abductors had a significantly greater increase in GHJ horizontal adduction ROM postintervention (mean ± SD, 6.8° ± 10.5°) compared to the control group (-1.1° ± 6.8°) (P = .011) and a greater increase in internal rotation ROM postintervention (4.2° ± 5.3°) compared to the group treated with the MET for the external rotators (0.2° ± 6.3°) (P = .020) and the control group (-0.2° ± 4.0°) (P = .029). No significant differences among groups were found for any other variables (P>.05).
A single application of an MET for the GHJ horizontal abductors provides immediate improvements in both GHJ horizontal adduction and internal rotation ROM in asymptomatic collegiate baseball players. Application of MET for the horizontal abductors may be useful to gain ROM in overhead athletes.
Therapy, level 2b-.
Figures - uploaded by Kevin Laudner
Author content
All figure content in this area was uploaded by Kevin Laudner
Content may be subject to copyright.
... Seven of the studies compared sleeper stretch or cross-body stretch to a control group [38][39][40][41][42][43][44]. Five studies compared sleeper stretch and/or cross-body stretch plus glenohumeral dorsal gliding [16][17][18] or plus manual therapy techniques targeting posterior shoulder muscles [21,22] to stretching in isolation. ...
... (C) Forest plot for external rotation ROM. (D) Forest plot for pain intensity.[38][39][40][41][42]44]. ...
... (C) Forest plot for external rotation ROM. (D) Forest plot for pain intensity[38][39][40][41][42]44]. ...
Abstract: The primary aim of this was to assess the effectiveness of stretching for improving shoulder
range of motion (ROM) in overhead athletes with glenohumeral internal rotation deficit (GIRD). The
secondary aims were to compare whether the combination of stretching plus manual therapy was
more effective than stretching in isolation and if any stretching technique was superior to others.
A systematic review and a meta-analysis were designed. The MEDLINE, PEDro, Cochrane Library,
and Web of Science databases were searched. Clinical trials investigating the effects of stretching in
isolation or combined with other manual therapy techniques on ROM and pain intensity in athletes
with GIRD were included. The PEDro scale was used to assess the methodological quality of the
studies, and the certainty of evidence was assessed using the GRADE tool. Two independent asses�sors extracted data through a standardized form. The random-effects models were applied. Sixteen
randomized controlled trials were included in this systematic review with a meta-analysis, with a
methodological quality ranging from high to low. The stretching techniques in isolation showed
statistically significant improvements in internal rotation and horizontal adduction ROM. Adding
glenohumeral dorsal gliding to a stretching protocol showed better improvement in internal rotation
ROM than stretching in isolation. Stretching techniques with manual stabilization showed better bene�fits than self-stretching techniques. A very low certainty of evidence suggests that stretching produces
statistically significant changes for improving ROM in patients with glenohumeral internal rotation
deficit. The combination with glenohumeral dorsal gliding seems to produce better improvements.
... Following the contraction, the subjects were asked to exhale to relax, and a gentle stretch was exerted till the new barrier and maintained for 30 seconds. From the new barrier, the protocol was performed for 3 repetitions [19]. Hold Relax Technique: The subjects were in a comfortable supine position, and the examiner moved the elbow joint to the end of its passive range of motion per the direction of restrictions in the elbow joint. ...
Background. An elbow joint that can move and is stable is important for work, play, and sports. Stiffness in the elbow after surgery is common and can make it difficult to perform daily activities. This is a significant problem for therapy. Therapeutic exercises, especially stretching exercises, are a crucial part of physiotherapy for alleviating elbow stiffness. Muscle Energy Technique (MET) is a manual therapy that uses mild isometric contractions to utilize the muscles’ energy to help with limited limb movement. On the other hand, Proprioceptive Neuromuscular Facilitation (PNF) is one of the best ways to improve motor performance and speed up recovery by increasing the range of motion and flexibility. The goal is to determine how MET over Hold‑Relax affects pain and range of motion when rehabilitating stiffness in the elbow after surgery. Methods. A quasi-experimental study was conducted on 12 patients post-elbow fracture fixation. Group A was given MET, while Group B received the Hold-Relax Technique three times a week for three consecutive weeks after the immobilization period. As baseline treatment, both groups received active ROM exercises. Pain (Visual Analog Scale) and ROM (goniometer) were assessed pre- and post-3 weeks. Results. In the third week, the two treatment groups showed a statistically significant difference in all parametric values (P < 0.05). However, Group B Hold-Relax’s mean difference and paired and unpaired t-test values were greater compared to Group A MET at the end of the third week. Conclusion. This study concludes that implementing PNF stretch (Hold-Relax) in conjunction with conventional treatment techniques in post-surgical stiffness is beneficial in enhancing the subject’s quality of life by reducing pain and restoring ROM. Hence, PNF (Hold-Relax) can be the best treatment option in physiotherapy practice.
... Our findings are consistent with studies that employed manual techniques in a single treatment session and measured ROM before and immediately after the intervention. Similar immediate and short-term improvements in IR and HADD have been reported in studies investigating the effects of instrumented soft-tissue mobilization (IASTM) [38][39][40], kinesiology tape [41], muscle energy techniques (MET) [27,42], dry needling of myofascial trigger points [43,44], and joint mobilization [45]. These findings suggest that various manual interventions can produce immediate improvements in shoulder ROM, similar to the effects observed with FM in our study. ...
This prospective study aimed to determine the impact of Fascial Manipulation® by Stecco (FM) on the range of motion (ROM) of internal rotation (IR) and horizontal adduction (HADD) in asymptomatic handball players, representing significant risk factors for shoulder injuries. A randomized controlled trial was conducted, with participants randomly assigned to either the investigated group (N = 29) receiving a single session of FM or the control group (N = 27) receiving no treatment. The ROM for IR and HADD were measured before, immediately after, and one month after the FM session. The investigated group experienced a statistically significant acute increase in
glenohumeral IR (14 degrees, p < 0.001) and HADD (14 degrees, p < 0.001) compared to the control group (p < 0.001). The positive effects of FM persisted one month post-treatment, with increased IR ROM by 12 degrees (p < 0.001) and HADD ROM by 11 degrees (p < 0.001). Participants in the investigated group reported lower subjective tightness/stiffness immediately after (p < 0.001) and one month after treatment (p = 0.002) compared to the control group. This study demonstrates that a single application of FM effectively improves glenohumeral ROM in the dominant throwing shoulder of asymptomatic handball players. It highlights the immediate and sustained positive effects of FM on IR and HADD. These findings support the use of FM as an effective method for enhancing shoulder ROM and reducing subjective tightness/stiffness.
... The pre-contraction elongation which involves the contraction of muscles before their stretching is a part of manual therapy and is termed as the muscle energy technique (MET) (Chaitow, 2001). It has been successfully applied among athletes to improve the length of muscles that lack flexibility (Moore et al., 2011). Proprioceptive neuromuscular facilitation (PNF) has been proved to be effective in improving the muscle elasticity as well as the joint ROM. ...
[Objective] To assess and compare the immediate impact of muscle energy technique (MET) and proprioceptive neuromuscular facilitation (PNF) stretching on calf muscle flexibility in recreational athletes. [Method] A total 30 individuals participating in recreational activities were divided into two groups: Group A, which followed the MET protocol, and Group B which followed the PNF protocol. The range of motion (ROM) of ankle dorsiflexion was evaluated before and after the intervention. [Results] Analysis of data was conducted using non-parametric testing. The data within the group was examined using Wilcoxon signed rank test. The data was compared between group with Mann Whitney U test. The outcome was determined to be statistically significant (p value 0.001) for every group. Inter group analysis revealed a p value <0.05, indicating a substantial disparity in the effects of the two therapies. [Conclusion] In conclusion, both MET and PNF stretching techniques have an immediate impact on the flexibility calf muscle. However, MET has been demonstrated to be more efficient than PNF stretching in enhancing flexibility of the calf muscle.
Overhead sports place a significant amount of stress on the shoulder. There are a variety of activities and sports with overhead athletes including both throwing (baseball, softball, football, cricket) and nonthrowing (tennis, swimming, volleyball) sports. Although all of these overhead motions can lead to pathology, a large focus has been on the consequences of overhead throwing. Overhead-throwing sports place forces on the joints, muscles, tendons, and ligaments that vary through the spectrum of athletes, as does the potential injuries that may be caused by these forces. The primary joints that are commonly injured in overhead sports are the shoulder and the elbow. The goal of this article is to discuss the impact of overhead motions on the shoulder, with a primary focus on throwing, as well as to highlight the osteopathic approach to assessment, treatment, management, and prevention.
Introduction: Glenohumeral Internal Rotation Deficit (GIRD) is a common issue among collegiate athletes
Background. A substantial number of patients who undergo various neck dissection procedures experience shoulder dysfunction and pain, which can significantly complicate or disrupt daily routines, social engagements, and overall Quality of Life (QOL). Muscle Energy Techniques (MET) and mobilization have been demonstrated to effectively reduce shoulder pain and disability. Objective. The objective of this study was to examine the therapeutic benefits of MET and mobilization in improving shoulder pain and disability following neck dissection surgeries and compare these two techniques’ efficacies. Design. The present study employed a randomized, single-blind, controlled trial Methods. Thirty patients between the ages of 25 and 70 (13 men and 17 women) with shoulder dysfunction following six months’ post-neck dissection surgeries were enrolled in the study. Patients were equally randomized into two groups of 15per each: Group A received the Muscle Energy Technique (MET), and Group B underwent Maitland’s Mobilization. Both groups participated in identical conventional physiotherapy regimens. Both interventions were administered at a frequency of three sessions per week over four weeks. Visual Analogue Scale (VAS) for pain assessment, Shoulder Pain, and Disability Index (SPADI), in addition to shoulder range of motion (flexion, abduction, and lateral rotation), were measured before and after four weeks of intervention. Results. Following four weeks of intervention, both groups exhibited significant improvements in VAS, SPADI, and shoulder flexion, abduction, and lateral rotation, with p values ≤ 0.001. A comparison between the groups showed a statistically significant difference in all measured outcomes, favoring Group A, with p-values < 0.001. Conclusion. The Muscle Energy Technique (MET) and Maitland’s Mobilization were effective therapeutic strategies for alleviating shoulder pain and disability following neck dissection surgeries. However, the results showed that MET outperformed Maitland’s Mobilization strategies.
This study investigated the effect of open and closed kinetic chain exercises in water on pain and LumboPelvic Stability in men with non-specific chronic low back pain. 60 men aged range 40-60 with (Non-Specific Low Back Pain; NSCLBP ) participated in this semi-experimental research which was randomly divided into one of three groups ( Closed Kinetic Chain Exercises; CKCE )in water (mean age 47.80 ± 5.43), (Open Kinetic Chain Exercises; OKCE) in water (mean age 46.10 ± 6.06) and the control group (with mean age 50.40 ± 5.43). The pain was measured by the visual Analogue Scale; VAS ) and (Lumbo Pelvic Stability; LPS) by the Pressure Biofeedback Unit. Based on the findings of this research, there is a significant improvement in pain reduction (P<0 .05) and increased LPS of patients with chronic back pain in the four tests of the groups of CKCE and OKCE exercises in water compared to the control group (P≤0 .05). The results of the present study showed that the implementation of CKCE and OKCE programs in water can reduce pain and increase the stability of the lumbar pelvic region and can be effective in the daily life of people such as walking, going up and down the stairs, sitting and standing up from the chair, and sleeping without pain.
This study examined whether the application of a muscle energy technique (MET) to the lumbar spine could significantly influence lumbar extension range of motion in an asymptomatic population. Twenty-six volunteer subjects, with limited range of motion in lumbar extension, were randomly assigned to either a control group or a treatment group. Thirteen subjects in the treatment group underwent eight sessions with the muscle energy technique, two times per week for 4 weeks. An independent group t test was used to analyze the data. The mean changes in scores, between pretest and posttest, were compared for both groups. Statistical significance was found at the p < .05 level indicating that the MET group significantly improved in lumbar extension range of motion.
The purpose of this study was to determine if a four week treatment period of muscle energy technique (MET) would significantly increase cervical flexion, extension, sidebending, and rotation in asymptomatic persons with limited range of motion (ROM). Eighteen volunteers qualified as subjects for the study following screening for neck ROM limitation. These subjects were then randomly assigned to either a control or MET group. A series of six, mixed, two-way analyses variance (ANOVA) were used to test for significant cervical ROM increases. The two factors examined were Group (MET vs. control) and Test (pre vs. post). Significant interactive effects for both left and right rotation were found (both F's > 4.8 and p's < 0.05) indicating a significantly greater ROM in the MET group. Trends toward significance were found for the remaining ranges of motion with the mean measures for each of the treatment groups showing an increase between pre-test and post-test. These results support MET as an effective technique for increasing cervical range of motion.
AbstractPurpose:To investigate the effectiveness of muscle energy technique in increasing passive knee extension and to explore the mechanism behind any observed change.Procedure:40 asymptomatic subjects were randomly allocated to control or experimental groups. Subjects lay supine with their thigh fixed at 90° flexion, and the hamstring muscle stretched to the onset of discomfort by passive knee extension. Knee range of motion was recorded with digital photography and passive torque recorded with a hand-held dynamometer. The experimental group received muscle energy technique to the hamstring muscle, after which the resistance to stretch and the range of motion were again measured. The knee was extended to the original passive torque and the angle at the knee recorded. If the onset of discomfort was not produced at this angle, the knee was further extended and the new angle was recorded.Results:A significant increase in range of motion was observed at the knee (p<0.019) following a single application of MET to the experimental group. No change was observed in the control group. When an identical torque was applied to the hamstring both before and after the MET, no significant difference in range of motion of the knee was found in the experimental group.Conclusions:Muscle energy technique produced an immediate increase in passive knee extension. This observed change in range of motion is possibly due to an increased tolerance to stretch as there was no evidence of visco-elastic change.
The relationship between posterior capsule tightness and dysfunction has long been recognized clinically but has not been biometrically quantified. The purpose of this study was to quantify changes in range of motion and posterior capsule tightness in patients with dominant or nondominant shoulder impingement. Measurements of posterior capsule tightness and external and internal rotation range of motion were made in 31 patients with shoulder impingement and in 33 controls without shoulder abnormality. Patients with impingement in the nondominant arm had increased posterior capsule tightness and decreased internal and external rotation range of motion compared with controls. Patients with impingement in their dominant arm had increased posterior capsule tightness and reduced internal rotation range of motion but no significant loss of external rotation range of motion compared with controls. Posterior capsule tightness in impingement patients showed a significant correlation with loss of internal rotation range of motion. Patients with shoulder impingement in their nondominant arm had a more global loss of range of motion compared with patients having impingement in their dominant arm. We believe we have described a valid clinical measurement for identifying posterior capsule tightness in patients with shoulder impingement.
The purposes of this study were to determine the effects of static and hold-relax stretching on hamstring range of motion and to examine the reliability of the FlexAbility LE1000 compared with the goniometrically measured active knee-extension test. Forty-two participants (18-25 years old) were assigned to either a control, static, or hold-relax training group. Participants were stretched four times a week over a 6-week period, with four 30-s stretches per session using a straight-leg-raise method on the FlexAbility LE1000. It was determined that both static and hold-relax techniques significantly improved hamstring flexibility (ISLR: +33.08°± 9.08°and +35.17°± 10.39°, respectively). Participants of both techniques reached a plateau in flexibility improvement between Weeks 4 and 5. Thus, static and hold-relax stretching are equally effective in improving hamstring ROM. The FlexAbility LE 1000 and the goniometer were both found to be highly reliable. Therefore, either measurement technique could be used successfully to measure hip-flexion ROM.
The throwing motion is a complex movement pattern that requires flexibility, muscular strength, coordination, synchronicity of muscular firing, and neuromuscular efficiency. During the act of throwing, excessively high stresses are generated at the shoulder joint because of the unnatural movements frequently performed by the throwing. The thrower's shoulder must be flexible enough to allow the excessive external rotation required to throw a baseball. The overhead throwing motion places tremendous demands on the shoulder joint complex musculature to produce functional stability. The surrounding musculature must be strong enough to assist in arm acceleration but must exhibit neuromuscular efficiency to produce dynamic functional stability. During the act of pitching, the angular velocity at the shoulder joint exceeds 7,000 degrees per second and has been referred to as the fastest human movement. Tremendous forces are generated at the shoulder joint, at times up to one times body weight. Because of these tremendous demands, at incredible angular velocities, various shoulder injuries may occur. An understanding of the biomechanics of throwing will assist the clinician in the recognition of various injuries and their specific treatment approaches. In this paper, we discuss the biomechanics of the overhead throwing motion for baseball as well as football.
AbstractBackground:Muscle Energy Technique (MET) has been advocated for the treatment of restricted range of motion in the upper neck. There is little evidence, however, to support the effectiveness of MET to increase motion in the cervical spine, or determine the optimal duration of isometric contraction during the technique.Objectives:The aim of this study was to investigate the effect of various durations of MET isometric contractions on active atlanto-axial rotation range of motion.Methods:52 asymptomatic subjects (age range 18–43) who displayed a unilateral active atlantoaxial rotation asymmetry of 4° or more were randomly allocated to either a 5 (n=17) or 20-second (n=18) isometric contraction MET group, or a sham (n=17) treatment control group. Active atlanto-axial end-range measurements were recorded pre and post-intervention, and the examiner was blinded to group allocation.Results:Analysis with a one-way ANOVA revealed significant differences (P=0.04) in the mean change between the 5-second MET group and the control, but not between the 20-second MET group and control. MET using 5-second contractions produced the largest mean increase in rotation, both to the restricted (+6.65°) and non-restricted sides (+0.71°). The 5-second MET produced a large pre-post effect size (d=1.01), whereas the 20-second MET (d=0.68) and control (d=0.33) produced moderate and small effect sizes, respectively.Conclusion:This study failed to demonstrate a significant benefit in the use of a longer (20-second) isometric contraction when treating the upper cervical spine with MET. The use of a 5-second isometric contraction appeared to be more effective than longer contraction durations for increasing cervical range with MET, but further investigation is recommended.