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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-.
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... The reduction in horizontal adduction range of motion has also been linked to an increase in injury rates among overhead athletes. Hence the stretching techniques and MET's is incorporated to reduce the risk of injury 21 . Kevin G, et al., (2008) stated that in overhead athletes, the sleeper stretch was found to be responsible for improved shoulder flexibility and Range of Motion (ROM) 22 . ...
Introduction: Posterior shoulder tightness is the extensibility limitations of the soft tissue, due to repetitive tensile loading in overhead athletes such as cricket and other sports. Bowling is the main cause for Posterior shoulder tightness. Hence the Sleeper stretch with muscle energy technique is proposed to be effecting in improving range, flexibility and functional ability. Purpose: To examine the effectiveness of Sleeper stretch with Muscle energy technique on posterior shoulder tightness among college level cricket bowlers. Materials and Methods: The study design was a single group experimental study design. On inclusion criteria one hundred and thirty one subjects were selected through convenient sampling technique. The subjects were given sleeper stretch combined with muscle energy technique for 8 consecutive weeks for 5 times in a week, post-test assessment was taken and the data analysis was done respectively. Results: The result of the study post intervention of internal rotation is (72.29° ± 3.73°, P = 0.001<0.05), Horizontal adduction (38.51° ± 2.70°. P = 0.001<0.05), flexibility of posterior capsule (109.81° ± 2.65° P = 0.001<0.05), DASH score for functional ability is (4.43 ± 1.53). Through Pearson chi square test there is a significant association in internal rotation (χ2 = 61.38, P = 0.001<0.005), Horizontal adduction (χ2 = 16.11, P = 0.001<0.05) and no significant association in flexibility of posterior capsule (χ2 = 0.98, P = 0.806>0.05) and DASH Score (χ2 = 4.25, P = 0.120>0.05). Conclusion: Effect of sleeper stretch with MET on PST showed effective results in improving internal rotation range, horizontal adduction, flexibility, functional ability among college level cricket bowlers.
... 56 GIRD and PST improvement was significantly greater using therapistassisted CBS compared to self-SS and self-CBS. 45 An immediate increase in HAdd was noted with MET to the horizontal adductors 53 and with sustained stretch for HAdd and IR at the end of a 3-week follow-up period. 50 Therapist-assisted SS produced the greatest improvement in HAdd (4.3 cm) compared to CBS in sitting (0.75 cm), CBS in supine (2 cm) and towel stretch (0.85 cm). ...
Objective
To systematically scope the literature on posterior shoulder tightness (PST) and define a therapist-instructed and therapist-administered management framework.
Design
Scoping review.
Literature search
We searched MEDLINE, EMBASE, CINAHL, Scopus and Google Scholar from inception to December 2021.
Study selection criteria
Peer-reviewed studies written in English, French, Greek, Japanese or Tamil, with extractable pre- and post-intervention data. Physiotherapy interventions amenable for posterior shoulder structural (muscle, capsule) causes of PST within an adult population.
Data synthesis
Arksey and O’Malley's framework was implemented and the PRISMA extension for scoping reviews directed our data synthesis. The data charted from each study included authors, title, study year, location, study design; participant number, age, sex; PST intervention and parameters; patient-reported outcomes; and results. Themes were organized into therapist-instructed and therapist-administered rehabilitation strategies, as well as combined treatment methods.
Results
Of 2777 articles identified from our search strategy, 21 articles were included. Therapist-instructed interventions included cross-body stretch (CBS), sleeper stretch (SS), a combination of the two and general stretching. Therapist-administered interventions included CBS, SS, instrument-assisted soft tissue mobilization (IASTM), muscle energy techniques, dry needling and Fauls protocol (12 therapist-assisted stretches). Combined interventions of tape with self-stretching and IASTM and stretching were also identified.
Conclusion
Based on the current evidence, CBS and SS are the most researched treatments for PST and seem to be effective at improving PST. Furthermore, stabilization of the scapula while performing these stretches optimized the stretch targeted to the PST and ROM benefits for horizontal adduction.
... This sort of stiffness causes the head of the humerus to shift in a superior and posterior direction, causing an increase in external rotation and a decrease in IR ROM, ultimately resulting in an abnormality in the shoulder ROM of the athletes. Overhead athletes frequently perform posterior shoulder stretching as part of prevention programs to reduce the risk of shoulder injuries 15 . The sleeper stretch was described by Burkhart et al. 16 in which the athlete's shoulder and elbow of the side to be stretched are flexed to 90° while lying in the side-lying position on the throwing side to maintain the scapula over the table. ...
Tennis players often experience posterior shoulder pain due to restricted internal rotation (IR) range of motion (ROM) of the glenohumeral joint. No research has compared the effects of modified sleeper stretch (MSS) versus modified cross-body stretch (MCBS) on tennis players’ upper limb functions and IR ROM. The study aimed to compare the efficacy of modified sleeper and cross-body adduction stretch in improving shoulder IR ROM and upper limb functions in tennis players. Thirty male lawn tennis players (aged 20 to 35 years) with more than 15° glenohumeral IR deficiency on the dominant side compared to the non-dominant side were recruited and divided into two groups: Modified sleeper stretch group (MSSG) and modified cross-body stretch group (MCBSG). MSSG received MSS, and MCBSG received MCBS, 3–5 repetitions once daily for 4 weeks. Upper limb functions were measured using the Disability of the Arm, Shoulder, and Hand (DASH) scale, and the IR ROM of the shoulder joint was measured using a universal goniometer. Both groups observed significant (p < 0.05) DASH scores and IR ROM improvements. DASH scores decreased by 85% in MSSG and 79.60% in MCBSG. IR ROM increased by 94.64% in MSSG and 89.52% in MCBSG. No significant differences (p > 0.05) were found in post-intervention DASH scores and IR ROM values between both groups. MSS and MCBS improved upper limb functions and IR ROM of the shoulder joint in the selected sample population of lawn tennis players. No difference was observed between both stretching techniques in improving upper limb functions and IR ROM of the shoulder joint.
... The techniques that the therapy used had been examined previously, with results published by the research group and others. 15,[17][18][19][20][22][23][24][25][26][27][28][29][30][31] Based on each patient's goals and subjective complaints and on findings from the initial evaluation, the CPA protocol was individualized to treat sites that presented with restricted mobility within each patient's body. 32 The therapy used various site-specific pressures across the restrictive bands of adhered tissues and structures, working progressively deeper from the most superficial tissues, to restore mobility via myofascial release. ...
Background • Female infertility is a complex issue encompassing a wide variety of diagnoses, many of which are caused or affected by adhesions. Objectives • The study intended to examine the rates of successful treatment of infertile women using a protocol of manual physical therapy to address underlying adhesive disease leading to infertility. Methods • The research team designed a retrospective chart review. Setting • The study took place in a private physical therapy clinic. Participants • Participants were 1392 female patients who were treated at the clinic between the years of 2002 and 2011. They had varying diagnoses of infertility, including occluded fallopian tubes, hormonal dysfunction, and endometriosis, and some women were undergoing in vitro fertilization (IVF). Intervention • All patients underwent whole-body, patient-centered treatments that used a protocol of manual physical therapy, which focused on restoring mobility and motility to structures affecting reproductive function. Outcome Measures • Improvements demonstrated in the condition(s) causing infertility were measured by improvements in tubal patency and/or improved hormone levels or by pregnancy. Results • The results included a 60.85% rate of clearing occluded fallopian tubes, with a 56.64% rate of pregnancy in those patients. Patients with endometriosis experienced a 42.81% pregnancy rate. The success rate was 49.18% for lowering elevated levels of follicle stimulating hormone (FSH), with a 39.34% pregnancy rate in that group, and 53.57% of the women with polycystic ovarian syndrome (PCOS) achieved pregnancy. The reported pregnancy rate for patients who underwent IVF after the therapy was 56.16%. The results also suggested that the treatment was effective for patients with premature ovarian failure (POF). Conclusion • The manual physical therapy represented an effective, conservative treatment for women diagnosed as infertile due to mechanical causes, independent of the specific etiology. (Altern Ther Health Med. 2015;21(3):32-40.) Amanda D. Rice, PhD, is the director of clinical studies; Kelseanne P. Breder, BA, is an intern. Both are in the research department at Clear Passage Physical Therapy in Gainesville, Florida. Kimberley Patterson, PTA, is a therapist; Leslie B. Wakefield, DPT, is a physical therapist; Evette D. Reed, PT, is a physical therapist; and Belinda F. Wurn, PT, is a clinical director. All are located in the clinical department at Clear Passage Physical Therapy. C. Richard King, III, MD, is the medical director of Clear Passage Physical Therapy. Lawrence J. Wurn, LMT, is a therapist in the clinical department and the research director in the research department at Clear Passage Physical Therapy.
... The muscle energy technique (MET) which is used to stretch or lengthen the muscle and fascia that lack flexibility, is another manual therapy intervention. In MET, the patient must exert force by contracting the targeted muscle against the therapist's counterforce before relaxing and receiving a passive stretch from the therapist.Three to five contractions can be included in one MET application, each contraction is hold for 5 seconds and each contraction is followed by a stretch that ranges from 3 -5 seconds to 30-60 seconds 13 . This technique can be used for any joint with restricted ROM. ...
Aim: To compare the effect of post isometric relaxation (PIR) muscle energy technique and high-grade Maitland mobilization technique on pain, glenohumeral joint abduction and external rotation, and functional activities in the subject of frozen shoulder. Study design: Randomized control trial Methods: A total of 60 patients were initially assessed for eligibility and 52 were included in the study after taking written consent. Patients were divided into two groups; Group A was treated with post isometric relaxation (PIR) technique and group B with Maitland grade (IV) mobilization for 4 weeks. Pain with a Numeric Pain rating scale, Glenohumeral joint abduction and external range of motion with a goniometer and shoulder function with shoulder pain and disability index were evaluated. Results: Both groups were similar at baseline (p> 0.05) and within-group comparison has shown that there was a significant improvement in all variables in both groups as p<0.05, but between-group comparison has shown that post-isometric relaxation (PIR) was more effective in reducing pain, improving range of motion and functional status and the mean difference between both groups for pain was 1.96, for shoulder abduction was 24.88, for external rotation was 10.42 and for SPADI was 23.27 with p<0.05 for all, showing that post isometric relaxation (PIR) muscle energy technique is superior to the Maitland grade IV mobilization technique in improving pain, Glenohumeral joint range, and shoulder function. Conclusion: Both Post isometric relaxation (PIR) and Maitland Mobilization are effective but post isometric relaxation (PIR) muscle energy technique is superior to the Maitland grade IV mobilization technique in improving pain, Glenohumeral joint range, and shoulder function. Keywords: Adhesive capsulitis, Maitland mobilization technique, Muscle energy technique, Shoulder pain and disability
Objectives:
The aim of the study was to assess short-term changes in shoulder muscle activity elicited by dry needling in chronic unilateral shoulder pain patients.
Methods:
A double-blind, placebo-controlled clinical trial was conducted, in which 30 volunteers with unilateral shoulder pain (USP) were recruited and randomly assigned to either real or sham dry needling conditions. Pain intensity scores, pressure pain threshold (PPT), glenohumeral internal rotation angles, and electromyographic activity during isotonic shoulder tasks (shoulder flexion and extension) were assessed before, immediately and 72 h after the intervention in the infraspinatus and deltoid muscles.
Results:
A single application of real dry needling resulted in lower pain intensity scores and a larger range in glenohumeral internal rotation 72 h after the intervention in comparison with sham dry needling. No differences in PPT or muscle activity were observed due to the intervention.
Discussion:
A single application of real dry needling resulted in clinically significant changes in the short-term. No differences were detected in muscle activation in the infraspinatus or deltoid muscles. Complementary interventions and longer follow-up times may be required to observe changes in muscle activity.
OBJECTIVES: Muscle energy technique (MET) is a voluntary contraction of a patient’s muscle in a predetermined direction, at varying levels of intensity. Its commonly used as a treatment option in musculoskeletal rehabilitation. This study aims to investigate the effectiveness of MET in the treatment of people with musculoskeletal injuries with particular emphasis on flexibility, range of motion (ROM), and function. METHODS: Scopus (via Science Direct), CINAHL via (EBSCO), Embase (via OvidSP), PubMed, and PEDro were searched using specified keywords to select randomized controlled trials that assessed the effect of MET on flexibility, ROM, or function in patients with musculoskeletal disorders. Two authors extracted all related information from the included trials and presented them in an excel spreadsheet. Two other authors independently conducted the quality assessment. Meta-analysis was performed where homogeneity (similirty regarding population and outcomes) was sufficient and required data were available. RESULTS: A total of 42 studies were included. Yet, twelve joined the meta-analysis where six comparisons were conducted. Of them, four comparisons were composed of two trials, one comparison consisted of six, and another one was composed of four. No statistically significant differences were observed between MET and other comparators regarding function and ROM, especially in patients with low back or neck pain. MET was statistically significantly better than control or sham interventions on the flexibility of patients with sacroiliac joint (SIJ) problems. CONCLUSIONS: MET can produce better flexibility than placebo and control interventions in patients with SIJ problems. MET is not better than other interventions regarding function and ROM. Although the existence of multiple trials testing the effectiveness of MET, there is obvious heterogeneity. There is no sufficient evidence to reliably determine the clinical effect of MET in practice.
Introduction
Carpal tunnel syndrome is the most common median nerve neuropathy, accounting for 90% of all neuropathies, with prevalence in the general UK adult population ranging from 7–16% and bilateral symptoms reported in more than 50% of all cases. The pathophysiological mechanisms involved in the median nerve compression and traction are thought to be complex. This study compared the effectiveness of muscle energy technique and active release technique in patients with carpal tunnel syndrome.
Methods
This study involved a total of 30 male and female patients with carpal tunnel syndrome, aged between 30 and 50 years. The patients were randomly assigned to two equal groups, group A and group B. Group A received muscle energy technique, and group B received active release technique.
Results
Independent one-tailed t-tests revealed that the intragroup comparisons showed statistically significant increases in pinch grip strength and motor nerve conduction velocity of the median nerve post-treatment in group A (P=0.001 and 0.0001 respectively), while in group B, there were statistically significant increases in pinch grip strength and motor nerve conduction velocity post-treatment (P=0.037 and 0.043 respectively). The intergroup comparisons showed statistically significant differences in favour of group A.
Conclusions
Because there was little significant difference between the two groups, this study concluded that both treatment techniques were effective in increasing median motor nerve conduction and hand grip strength. However, muscle energy technique increased motor nerve conduction velocity and pinch grip muscle strength more than active release technique.
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.
Muscle Energy Technique (MET) is used commonly by osteopaths and other musculoskeletal therapists, however despite its widespread use there is little evidence to support its effectiveness in the treatment of spinal dysfunction. This study examined whether a single application of thoracic MET could significantly increase the range of motion in asymptomatic volunteers with restricted active trunk rotation. Fifty-nine volunteers were randomly assigned to either treatment (MET) or control groups and blinded pre- and post-active trunk rotation measures were recorded using a reliable measuring device. Volunteers in the treatment group received a single application of thoracic MET to correct their rotation restriction. MET applied to the thoracic spine in the direction of restricted rotation significantly produced increased range of active trunk rotation (p<0.0005), but not on the non-restricted side or in the untreated controls. This study supports the use of MET to increase restricted spinal rotation range of motion.
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.