Sports Spine Specialist Chiropractic Team: Athletes strive to achieve their body’s maximum performance by participating in numerous training regimens consisting of strenuous exercises and physical activity and ensuring they meet all of their body’s nutritional requirements. Through proper fitness and nutrition, many individuals can condition themselves to excel in their specific sport. Our training programs are designed for athletes that look to gain a competitive edge in their sport.
We provide sport-specific services to help increase an athlete’s performance through mobility, strength, and endurance. Occasionally, however, the excess workouts can lead many to suffer injuries or develop underlying conditions. Dr. Alex Jimenez’s chronicle of articles for athletes displays in detail the many forms of complications affecting these professionals while focusing on the possible solutions and treatments to follow to achieve overall well-being.
Soccer is one of the most popular team sports in the United States, and offers an excellent form of exercise to children and adults alike. Unfortunately, the nature of the sport, the repeated movement and the chance of collision, add up to quite a few opportunities for injury.
Lower and upper extremity injuries, overuse injuries, and head, neck, and face injuries are commonplace. According to Stanford Children’s Health, “88,000 children 8-14 were treated in an emergency room for soccer-related injuries.”
Soccer players who take certain precautionary measures decrease their chances of injury. Let�s look at three ways you can avoid injury as a soccer player:
#1: Soccer: Use Proper Equipment
Donning proper fitting cleats, uniforms, and shin guards decrease the risk of being hurt in the first place. Make adjustments often, especially if the player is growing rapidly or fluctuates in weight.
#2: Get Checked Out By A Chiropractor Pre-Season
Soccer players who allow their fitness less to lapse increase the chance of injury. Visit a Doctor of Chiropractic to ensure there are no underlying issues with participating in strenuous activity. A chiropractor is also able to make sure the spine is aligned and muscles and joints are strong and functioning properly.
#3: Pay Attention To The Surroundings
A field that is not kept up well offers a greater chance of turning an ankle or falling. It’s vital to check out the playing area beforehand and note any uneven areas that could cause a player to trip.
In addition, consider the weather. Muddy, slick fields create extra issues, and particularly hot temperatures make players run the risk of dehydration or heat stroke. Prepare for weather issues in advance of the game.
If, even though you take all of these precautions, you still end up injured, there are several options for treatment. The injury is hopefully mild and heals on its own after a few days of rest. More serious injuries require a doctor visit, and one of these three treatments.
First, ice and elevate it: Keep weight off the injured area as much as possible, and elevate it with pillows. Use an ice bag wrapped in a towel to keep down swelling and inflammation. If the injury is painful, over the counter medication helps reduce discomfort.
Then, take a break: The last decision you want to make is to begin playing too soon and re-injure yourself. With more serious injuries, sitting out of a few games, or even an entire season, is a choice that promotes healing and health. Talk to your chiropractor about the timeframe the injury needs to be able to recover correctly, and follow his or her advice.
Finally, keep your chiropractic adjustments: Chiropractors are trained in treating the neuromusculoskeletal system as a whole. Many of the injuries suffered from soccer show an improvement after a few chiropractic visits.
Spinal and joint alignment, muscle healing, and tendon relaxation are all techniques chiropractors employ to promote and hasten healing. Additionally, chiropractors give insight on valuable ways to use nutrition and exercise to keep the body functioning at optimum capacity, to avoid re-injury.
Enjoying physical activity is essential to maintain a routine that provides a healthy, active lifestyle, and joining a soccer team is a great choice for children as well as adults. Knowing the advance precautions to put in place to avoid injury will help keep you strong and safe.
If, however, you or your child end up hurt, these forms of treatment will lessen healing time and get you back in the game at full speed. So give us a call to schedule your next appointment before you get back out on the pitch.
Chiropractic Treatment For Concussions
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Baseball Injuries: The crack of a ball against your bat, good! The crack of a back or shoulder, bad!
Baseball, the nationwide pass time, heats up in summer. From little league on up, individuals enjoy swinging the bat and running the bases. Unfortunately, the movements baseball requires can wreak havoc on a person’s body, leaving them with strained backs, hurt shoulders, and pulled muscles. According to Livestrong, there are over 600,000 injuries from playing baseball per year, and 5-14 year olds suffer from 117,000 of them.
The aspects of the game � running, sliding, twisting, and jumping � cause the body to maneuver into awkward positions. If you or a loved one has slid into first and felt a pop, or twisted to catch a fly ball and felt a snap, chiropractic care offers several ways to help put you on the road to a complete recovery.
Baseball Injuries: Manage Pain
Baseball injuries frequently involve large muscles, resulting in a high degree of pain. Chiropractic treatment offers relief from severe pain of many injuries involving the spine, muscles, and joints.
Using spinal adjustments, a chiropractor is able to help the body align itself properly, and sooth the injured area. Once the body functions normally, pain is diminished. Sometimes this can be accomplished in one visit, while other injuries require a few sessions before pain diminishes.
Increase Mobility
A strained neck, pulled back, or overextended knee may cause the individual serious issues in being able to move. Limping around slowly is nobody’s idea of fun!
Chiropractic adjustments are proven to help reduce inflammation and improve mobility in many injury cases. If that last baseball game has you unable to put weight on your knee, your neck won’t twist without pain, or your shoulder won’t lift your arm, it may be time to visit a chiropractor for evaluation.
Promote Healing
The premise of chiropractic care is to treat the entire body as a whole, not just the injured part. As the body becomes better aligned, it functions at a higher capacity, and begins to heal itself.
Most injuries resulting from playing baseball, such as tendonitis, strained muscles, torn rotator cuffs, and the like, heal faster with chiropractic care. Increased blood flow to the injured area, and less pressure on the body part (usually due to misalignment of the spine) allow the injured area to regenerate, and a greater chance to begin healing faster than without chiropractic care.
Avoid Medication
Even over-the-counter pain and anti-inflammatory drugs cause side effects in certain individuals. Allergies, stomach issues, and other reasons result in many injured people steering clear of medication to relieve pain and inflammation.
Chiropractic care provides these individuals a drug-free, less invasive way to help manage the pain and promote healing. More people every year are choosing to visit a chiropractor for pain relief instead of popping pain medicine.
Before jumping into a baseball game, or even if you or your children play regularly, remember that prevention is worth its weight in gold. Take care of your body by stretching beforehand, being aware of your physical limits, maintaining proper posture, and staying hydrated during the game. With a little extra effort, the chance of a baseball injury can be dramatically decreased.
Summer fun often includes activities such as baseball, whether in a league or in your back yard with your family. Avoid suffering from an injury as best you can, and, if you or your child end up with an achy knee, twisted elbow, or smarting shoulder, call you chiropractor to schedule a thorough evaluation as quickly as possible.
Prevention, Recognition & Management Of Youth Sports Injuries
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Stay Hydrated: Summer fun means outside activities in the warm sun, from strenuous pursuits like biking, hiking, and volleyball-playing, to more leisurely enjoyments like sunbathing on a float. No matter how you plan to enjoy the steamy summer months, maintaining hydration should be right up there with sunscreen on your list of important hot weather priorities.
Dehydration is a condition that ranges from mild to serious, and can happen quicker than you think. Right Diagnosis defines dehydration as “an abnormal condition in which the body’s cells are deprived of an adequate amount of water.” One of the main situations factoring into a person becoming dehydrated is heat.
Think you drink enough water and don’t need to worry about dehydration? Consider these points:
The ability to recognize thirst diminishes in individuals in their late 30’s or older.
A person’s body is made up of roughly 70% water.
When you lose 2% of the body’s water content, you are considered dehydrated.
Dehydration symptoms range from unpleasant confusion, muscle weakness, and fatigue to extremely dangerous ones like seizures, kidney failure, and death. The good news is that if you stay hydrated in the first place is relatively easy if you take a few precautions up front.
#1: Drink Plenty Of Water
Make it a habit of carrying water with you during the summer months, and sipping on it throughout the day, especially if you are planning on outside activities. Invest in a couple of BPA-free water bottles for yourself and your family to tote with them on their summer adventures.
Not a big fan of plain water? Try adding lemon, cucumber, and mint sprigs to liven it up! Mix up in a big pitcher the night before so the flavor has time to penetrate. Another option is flavor packets, which are individual packets of flavors like green tea, watermelon, and peach.
#2: Eat The Right Foods
Liquids aren’t the only way your body gets water. Avoid dehydration by eating foods with a high water content.
Choices like celery, watermelon, cucumbers, carrots, and citrus fruits all offer exceptional hydrating ability. Pack these as snacks for the pool or beach, or to enjoy before and after an outdoor workout.
#3: Steer Clear Of Certain Drinks
As yummy and refreshing as an icy beer or frosty margarita tastes, alcohol can contribute to dehydration. If you decide to indulge, limit yourself to one or two, and drink a large glass of water along with your beverage to counteract the alcohol’s effects.
#4: Avoid Overexertion
Exercise is a wonderfully healthy pursuit; however, keep an eye on the temperature. If it is going to be exceptionally hot and humid, choose to exercise either early in the morning, or after sunset, when temperatures are lower and the sun isn’t beaming.
#5: Wear Proper Attire
Dress in light, airy clothing in fabrics that breathe. Protect your head with a cap or hat that shades your face. Avoid black clothing, which tends to absorb the sun and make you hotter.
#6: Stay Hydrated & Be Prepared
Extreme heat makes everyday issues like a flat tire or dead battery life-threatening. Visit a mechanic to confirm your vehicle is in good shape to lessen the chances of getting stranded. Carry extra water or sports drinks in your vehicle, and keep your cell phone charged. If your car breaks down, either stay in your car to wait for help, or stand in the grass instead of on the sizzling pavement.
When you stay hydrated is essential for good health all the time, and during the summer in particular. Implement these easy tips into your daily routine so you and your family maintain hydration and enjoy hot weather outdoor fun.
Chiropractic Treatment For Concussions
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School is out, and the cool, fresh water of the local swimming pool awaits beckoning. Long, sunny days, the smell of sunscreen, and the laughter of the playing children will fill the next few months.
However, there are elements of this delightful picture that can end up causing harm to children and adults alike. It’s important to take a few key precautions when enjoying a day at the pool this summer. Doing so will minimize the risk of the summer laughter turning to tears.
Here are six bright ways for adults and children to stay safe at the pool this summer.
Pool Safety Tips:
#1: Enroll In Swimming Lessons
Playing in the water is a fun, refreshing activity, but can turn dangerous quickly. According to the Red Cross, the single biggest precaution to take to ensure summer safety is to make sure your children are able to swim. Book age appropriate swimming lessons for your children as young as possible.
#2: Avoid Spills With Water Shoes Or Rough Bottom Sandals
Nothing brings a playful pool day to a screeching halt like a slip and fall on the side of the pool. This goes for you, too, Mom and Dad!
Bare feet offer no traction on wet and slick concrete, and falling can cause serious accidents that require stitches, casts, and, well, chiropractic visits! Make it a rule to wear water shoes or sandals around the pool at all times.
#3: Take Measures To Fight Off Swimmer’s Ear
Swimmer’s ear is a common condition that is brought on by water remaining in the ear canal, allowing germs to grow. Yuk!
The CDC reports that this condition results in an astonishing 2.4 million doctor visits every year. Guard against this by teaching your children to tilt each side of their heads toward the ground to drain their ears, and to dry their ears thoroughly with a towel every time they get out of the pool.
If you or one of your little swimmers experience ear pain after a pool day, take them to the doctor as soon as possible to begin treatment.
#4: Beware Of Little Critters
Hot days and bare skin are too much temptation for bees, mosquitoes, and ticks. Bites from these creatures range from itchy to extremely serious. Ward them off with bug spray, or sunscreen with insect repellent.
Ticks in particular are dangerous. If you or your child gets bitten by a tick, remove it promptly and clean the area thoroughly.
#5: Be Cautious Of Overdoing It
A day at the pool can be a blast for the young ones, but wagging the cooler and lawn chairs back and forth to the pool can exhaust an adult, causing injury. Remember to lift heavy items with your legs, and don’t overload yourself. An extra trip to the car is worth it to avoid a neck or back strain.
#6: Prepare For Disaster
Okay, that is a little melodramatic, but it pays to be prepared in the event of an emergency. Pack a small kit with alcohol, tweezers, bug bite cream, and bandages. Keep the kit in your car or pool bag. Better safe than sorry.
Pool days are a big part of the hot summer months, and are usually lazy and enjoyable. Keep them that way by taking these six tips to heart and talking to your children about the pool rules. With a little preparation up front, the chance of fun-dampening or dangerous instances happening to your family will be greatly minimized.
Prevention, Recognition & Management of Youth Sports Injuries
This article is copyrighted by Blogging Chiros LLC for its Doctor of Chiropractic members and may not be copied or duplicated in any manner including printed or electronic media, regardless of whether for a fee or gratis without the prior written permission of Blogging Chiros, LLC.
Muscle Energy Techniques: A revolution has taken place in manipulative therapy involving a movement away from high velocity/low amplitude thrusts (HVT � now commonly known as �mobilization with impulse� and characteristic of most chiropractic and, until recently, much osteopathic manipulation) towards gentler methods which take far more account of the soft tissue component (DiGiovanna 1991, Lewit 1999, Travell & Simons 1992).
Greenman (1996) states that: �Early [osteopathic] techniques did speak of muscle relaxation with soft tissue procedures, but specific manipulative approaches to muscle appear to be 20th century phenomena.� One such approach � which targets the soft tissues primarily, although it also makes a major contribution towards joint mobilization � has been termed muscle energy technique (MET) in osteopathic medicine. There are a variety of other terms used to describe this approach, the most general (and descriptively accurate) of which was that used by chiropractor Craig Liebenson (1989, 1990) when he described muscle energy techniques as �active muscular relaxation techniques�. Muscle energy techniques evolved out of osteopathic procedures developed by pioneer practitioners such as T. J. Ruddy (1961), who termed his approach �resistive duction�, and Fred Mitchell Snr (1967). As will become clear in this chapter, there also exists a commonality between Muscle energy techniques and various procedures used in orthopaedic and physiotherapy methodology, such as proprioceptive neuromuscular facilitation (PNF). Largely due to the work of experts in physical medicine such as Karel Lewit (1999), MET has evolved and been refined, and now crosses all interdisciplinary boundaries.
MET has as one of its objectives the induced relaxation of hypertonic musculature and, where�appropriate (see below), the subsequent stretching of the muscle. This objective is shared with a number of �stretching� systems, and it is necessary to examine and to compare the potential benefits and drawbacks of these various methods (see Box 1.1).
MET, as presented in this book, owes most of its development to osteopathic clinicians such as T. J. Ruddy (1961) and Fred Mitchell Snr (1967), with more recent refinements deriving from the work of people such as Karel Lewit (1986, 1999) and Vladimir Janda (1989) of the former Czechoslovakia, both of whose work will be referred to many times in this text.
T. J. Ruddy (1961)
In the 1940s and 50s, osteopathic physician T. J. Ruddy developed a treatment method involving patient-induced, rapid, pulsating contractions against resistance which he termed �rapid resistive duction�. It was in part this work which Fred Mitchell Snr used as the basis for the evolution of MET (along with PNF methodology, see Box 1.1). Ruddy�s method called for a series of rapid, low amplitude muscle contractions against resistance, at a rate a little faster than the pulse rate. This approach is now known as pulsed MET, rather than the tongue-twisting �Ruddy�s rapid resistive duction�.
As a rule, at least initially, these patient-directed pulsating contractions involve an effort towards the barrier, using antagonists to shortened structures. This approach can be applied in all areas where sustained contraction muscle energy technique procedures are appropriate, and is particularly useful for self-treatment, following instruction from a skilled practitioner. Ruddy suggests that the effects include improved local oxygenation, venous and lymphatic circulation, as well as a positive influence on both static and kinetic posture, because of the effects on proprioceptive and interoceptive afferent pathways.
Ruddy�s work formed part of the base on which Mitchell Snr and others constructed MET and aspects of its clinical application are described in Chapter 3.
Fred Mitchell Snr
No single individual was alone responsible for MET, but its inception into osteopathic work must be credited to F. L. Mitchell Snr, in 1958. Since then his son F. Mitchell Jnr (Mitchell et al 1979) and many others have evolved a highly sophisticated system of manipulative methods (F. Mitchell Jnr, tutorial on biomechanical procedures, American Academy of Osteopathy, 1976) in which the patient �uses his/her muscles, on request, from a precisely controlled position in a specific direction, against a distinctly executed counterforce�.
Philip Greenman
Professor of biomechanics Philip Greenman (1996) states that:
The function of any articulation of the body which can be moved by voluntary muscle action, either directly or indirectly, can be influenced by muscle energy procedures … . Muscle energy techniques can be used to lengthen a shortened, contractured or spastic muscle; to strengthen a physiologically weakened muscle or group of muscles; to reduce localized edema, to relieve passive congestion, and to mobilize an articulation with restricted mobility.
Sandra Yale
Osteopathic physician Sandra Yale (in DiGiovanna 1991) extols MET�s potential in even fragile and severely ill patients:
Muscle energy techniques are particularly effective in patients who have severe pain from acute somatic dysfunction, such as those with a whiplash injury from a car accident, or a patient with severe muscle spasm from a fall. MET methods are also an excellent treatment modality for hospitalized or bedridden patients. They can be used in older patients who may have severely restricted motion from arthritis, or who have brittle osteoporotic bones.
Edward Stiles
Among the key MET clinicians is Edward Stiles, who elaborates on the theme of the wide range of MET application (Stiles 1984a, 1984b). He states that:
Basic science data suggests the musculoskeletal system plays an important role in the function of other systems. Research indicates that segmentally related somatic and visceral structures may affect one another directly, via viscerosomatic and somaticovisceral reflex pathways. Somatic dysfunction may increase energy demands, and it can affect a wide variety of bodily processes; vasomotor control, nerve impulse patterns (in facilitation), axionic flow of neurotrophic proteins, venous and lymphatic circulation and ventilation. The impact of somatic dysfunction on various combinations of these functions may be associated with myriad symptoms and signs. A possibility which could account for some of the observed clinical effects of manipulation.
As to the methods of manipulation he now uses clinically, Stiles states that he employs muscle energy methods on about 80% of his patients, and functional techniques (such as strain/counterstrain) on 15�20%. He uses high velocity thrusts on very few cases. The most useful manipulative tool available is, he maintains, muscle energy techniques.
J. Goodridge and W. Kuchera
Modern osteopathic refinements of MET � for example the emphasis on very light contractions which has strongly influenced this text � owe much to physicians such as John Goodridge and William Kuchera, who consider that (Goodridge & Kuchera 1997):
Localization of force is more important than intensity. Localization depends on palpatory proprioceptive perception of movement (or resistance to movement) at or about a specific articulation … . Monitoring and confining forces to the muscle group or level of somatic dysfunction involved are important for achieving desirable changes. Poor results are most often due to improperly localized forces, often with excessive patient effort.
Early Sources Of Muscle Energy Techniques
MET emerged squarely out of osteopathic tradition, although a synchronous evolution of treatment methods, involving isometric contraction and stretching, was taking place independently in physical therapy, called PNF (see Box 1.1).
Fred Mitchell Snr (1958) quoted the words of the developer of osteopathy, Andrew Taylor Still: �The attempt to restore joint integrity before soothingly restoring muscle and ligamentous normality was putting the cart before the horse.� As stated earlier, Mitchell�s work drew on the methods developed by Ruddy; however, it is unclear whether Mitchell Snr, when he was refining MET methodology in the early 1950s, had any awareness of proprioceptive neuromuscular facilitation (PNF), a method which had been developed a few years earlier, in the late 1940s, in a physical therapy context (Knott & Voss 1968).
PNF method tended to stress the importance of rotational components in the function of joints and muscles, and employed these using resisted (isometric) forces, usually involving extremely strong contractions. Initially, the focus of PNF related to the strengthening of neurologically weakened muscles, with attention to the release of muscle spasticity following on from this, as well as to improving range of motion at intervertebral levels (Kabat 1959, Levine et al 1954) (see Box 1.1).
Postisometric Relaxation & Reciprocal Inhibition: Two Forms Of MET (Box 1.2)
A term much used in more recent developments of muscle energy techniques is postisometric relaxation (PIR), especially in relation to the work of Karel Lewit (1999). The term postisometric relaxation refers to the effect of the subsequent reduction in tone experienced by a muscle, or group of muscles, after brief periods during which an isometric contraction has been performed.
The terms proprioceptive neuromuscular facilitation (PNF) and postisometric relaxation (PIR) (the latent hypotonic state of a muscle following isometric activity) therefore represent variations on the same theme. A further variation involves the physiological response of the antagonists of a muscle which has been isometrically contracted � reciprocal inhibition (RI).
When a muscle is isometrically contracted, its antagonist will be inhibited, and will demonstrate reduced tone immediately following this. Thus the antagonist of a shortened muscle, or group of muscles, may be isometrically contracted in order to achieve a degree of ease and additional movement potential in the shortened tissues.
Sandra Yale (in DiGiovanna 1991) acknowledges that, apart from the well understood processes of reciprocal inhibition, the precise reasons for the effectiveness of MET remain unclear � although in achieving PIR the effect of a sustained contraction on the Golgi tendon organs seems pivotal, since their response to such a contraction seems to be to set the tendon and the muscle to a new length by inhibiting it (Moritan 1987). Other variations on this same theme include �hold�relax� and �contract�relax� techniques (see Box 1.1).
Lewit & Simons (1984) agree that while reciprocal inhibition is a factor in some forms of therapy related to postisometric relaxation techniques, it is not a factor in PIR itself, which is a phenomenon resulting from a neurological loop, probably involving the Golgi tendon organs (see Figs 1.1 and 1.2).
Liebenson (1996) discusses both the benefits of, and the mechanisms involved in, use of muscle energy techniques (which he terms �manual resistance techniques�, or MRT):
Two aspects to MRT [i.e. MET by another name] are their ability to relax an overactive muscle … and their ability to enhance stretch of a shortened muscle or its associated fascia when connective tissue or viscoelastic changes have occurred.
Two fundamental neurophysiological principles account for the neuromuscular inhibition that occurs during application of these techniques. The first is postcontraction inhibition [also known as postisometric relaxation, or PIR], which states that after a muscle is contracted, it is automatically in a relaxed state for a brief, latent, period. The second is reciprocal inhibition (RI) which states that when one muscle is contracted, its antagonist is automatically inhibited.
Liebenson suggests that there is evidence that the receptors responsible for PIR lie within the muscle and not in the skin or associated joints (Robinson 1982).
Where pain of an acute or chronic nature makes controlled contraction of the muscles involved difficult, the therapeutic use of the antagonists can patently be of value. Thus modern MET incorporates both postisometric relaxation and reciprocal inhibition methods, as well as aspects unique to itself, such as isokinetic techniques, described later.
A number of researchers, including Karel Lewit of Prague (Lewit 1999), have reported on the usefulness of aspects of MET in the treatment of trigger points, and this is seen by many to be an excellent method of treating these myofascial states, and of achieving the restoration of a situation where the muscle in which the trigger lies is once more capable of achieving its full resting length, with no evidence of shortening.
Travell & Simons (1992) mistakenly credited Lewit with developing MET, stating that �The concept of applying post-isometric relaxation in the treatment of myofascial pain was presented for the first time in a North American journal in 1984 [by Lewit]�. In fact Mitchell Snr had described the method some 25 years previously, a fact acknowledged by Lewit (Lewit & Simons 1984).
Key Points About Modern Muscle Energy Techniques
MET methods all employ variations on a basic theme. This primarily involves the use of the patient�s own muscular efforts in one of a number of ways, usually in association with the efforts of the therapist:
1. The operator�s force may exactly match the effort of the patient (so producing an isometric contraction) allowing no movement to occur � and producing as a result a physiological neurological response (via the Golgi tendon organs) involving a combination of:
� reciprocal inhibition of the antagonist(s) of the muscle(s) being contracted, as well as
� postisometric relaxation of the muscle(s) which are being contracted.
The operator�s force may overcome the effort of the patient, thus moving the area or joint in the direction opposite to that in which the patient is attempting to move it (this is an isotonic eccentric contraction, also known as an isolytic contraction).
The operator may partially match the effort of the patient, thus allowing, although slightly retarding, the patient�s effort (and so producing an isotonic concentric, isokinetic, contraction).
Other variables may be also introduced, for example involving:
l Whether the contraction should commence with the muscle or joint held at the resistance barrier or short of it � a factor decided largely on the basis of the degree of chronicity or acuteness of the tissues involved
How much effort the patient uses � say, 20% of strength, or more, or less
The length of time the effort is held � 7�10 seconds, or more, or less (Lewit (1999) favours 7� 10 seconds; Greenman (1989), Goodridge & Kuchera (1997) all favour 3�5 seconds)
Whether, instead of a single maintained contraction, to use a series of rapid, low amplitude contractions (Ruddy�s rhythmic resisted duction method, also known as pulsed muscle energy techniques)
The number of times the isometric contraction (or its variant) is repeated � three repetitions are thought to be optimal (Goodridge & Kuchera 1997)
The direction in which the effort is made � towards the resistance barrier or away from it, thus involving either the antagonists to the muscles or the actual muscles (agonists) which require �release� and subsequent stretching (these variations are also known as �direct� and �indirect� approaches, see p. 8)
Whether to incorporate a held breath and/or specific eye movements to enhance the effects of the contraction � desirable if possible, it is suggested (Goodridge & Kuchera 1997, Lewit 1999)
What sort of resistance is offered (for example by the operator, by gravity, by the patient, or by an immovable object)
Whether the patient�s effort is matched, overcome or not quite matched � a decision based on the precise needs of the tissues � to achieve relaxation, reduction in fibrosis or tonifying/ reeducation
Whether to take the muscle or joint to its new barrier following the contraction, or whether or not to stretch the area/muscle(s) beyond the barrier � this decision is based on the nature of�the problem being addressed (does it involve shortening? fibrosis?) and its degree of chronicity
Whether any subsequent (to a contraction) stretch is totally passive, or whether the patient should participate in the movement, the latter being thought by many to be desirable in order to reduce danger of stretch reflex activation (Mattes 1995)
Whether to utilize Muscle energy techniques alone, or in a sequence with other modalities such as the positional release methods of strain/counterstrain, or the ischaemic compression/inhibitory pressure techniques of neuromuscular technique (NMT) � such decisions will depend upon the type of problem being addressed, with myofascial trigger point treatment frequently benefiting from such combinations (see description of integrated neuromuscular inhibition (INIT), p. 197 (Chaitow 1993)).
Greenman summarises the requirements for the successful use of MET in osteopathic situations as �control, balance and localisation�. His suggested basic elements of MET include the following:
A patient/active muscle contraction, which
� commences from a controlled position
� is in a specific direction (towards or away from a restriction barrier)
The operator applies distinct counterforce (to meet, not meet, or to overcome the patient�s force)
The degree of effort is controlled (sufficient to obtain an effect but not great enough to induce trauma or difficulty in controlling the effort).
What is done subsequent to the contraction may involve any of a number of variables, as will be explained.
The essence of MET then is that it uses the energy of the patient, and that it may be employed in one or other of the manners described above with any combination of variables depending upon the particular needs of the case. Goodridge (one of the first osteopaths to train with Mitchell Snr in 1970) summarises as follows: �Good results [with MET] depend on accurate diagnosis, appropriate levels of force, and sufficient localization. Poor results are most often caused by inaccurate diagnosis, improperly localized forces, or forces that are too strong� (Goodridge & Kuchera 1997) (see also Box 1.3).
Using agonist or antagonist? (Box 1.4)
As mentioned, a critical consideration in MET, apart from degree of effort, duration and frequency of use, involves the direction in which the effort is made. This may be varied, so that the operator�s�force is directed towards overcoming the restrictive barrier (created by a shortened muscle, restricted joint, etc.); or indeed opposite forces may be used, in which the operator�s counter-effort is directed away from the barrier.
There is general consensus among the various osteopathic experts already quoted that the use of postisometric relaxation is more useful than reciprocal inhibition in normalizing hypertonic musculature. This, however, is not generally held to be the case by experts such as Lewit and Janda, who see specific roles for the reciprocal inhibition variation.
Osteopathic clinicians such as Stiles and Greenman believe that the muscle which requires stretching (the agonist) should be the main source of �energy� for the isometric contraction, and suggest that this achieves a more significant degree of relaxation, and so a more useful ability to subsequently stretch the muscle, than would be the case were the relaxation effect being achieved via use of the antagonist (i.e. using reciprocal inhibition).
Following on from an isometric contraction � whether agonist or antagonist is being used � there is a refractory, or latency, period of approximately 15 seconds during which there can be an easier (due to reduced tone) movement towards the new position (new resistance barrier) of a joint or muscle.
Variations On The Muscle Energy Techniques Theme
Liebenson (1989, 1990) describes three basic variations which are used by Lewit and Janda as well as by himself in a chiropractic rehabilitation setting.
Lewit�s (1999) modification of MET, which he calls postisometric relaxation, is directed towards relaxation of hypertonic muscle, especially if this relates to reflex contraction or the involvement of myofascial trigger points. Liebenson (1996) notes that �this is also a suitable method for joint mobilisation when a thrust is not desirable�.
Lewit�s postisometric relaxation method
(Lewit 1999)
The hypertonic muscle is taken, without force or �bounce�, to a length just short of pain, or to the point where resistance to movement is first noted (Fig. 1.3).
The patient gently contracts the affected hypertonic muscle away from the barrier (i.e. the agonist is used) for between 5 and 10 seconds, while the effort is resisted with an exactly equal counterforce. Lewit usually has the patient inhale during this effort.
This resistance involves the operator holding the contracting muscle in a direction which would stretch it, were resistance not being offered.
The degree of effort, in Lewit�s method, is minimal. The patient may be instructed to think in terms of using only 10 or 20% of his available strength, so that the manoeuvre is never allowed to develop into a contest of strength between the operator and the patient.
After the effort, the patient is asked to exhale and to let go completely, and only when this is achieved is the muscle taken to a new barrier with all slack removed but no stretch � to the extent that the relaxation of the hypertonic muscles will now allow.
Starting from this new barrier, the procedure is repeated two or three times.
In order to facilitate the process, especially where trunk and spinal muscles are involved, Lewit usually asks the patient to assist by looking with his eyes in the direction of the contraction during the contracting phase, and in the direction of stretch during the stretching phase of the procedure.
The key elements in this approach, as in most MET, involve precise positioning, as well as taking out slack and using the barrier as the starting and ending points of each contraction.
What Is Happening?
Karel Lewit, discussing MET methods (Lewit 1999), states that medullary inhibition is not capable of explaining their effectiveness. He considers that the predictable results obtained may relate to the following facts:
During resistance using minimal force (isometric contraction) only a very few fibers are active, the others being inhibited
During relaxation (in which the shortened musculature is taken gently to its new limit without stretching) the stretch reflex is avoided � a reflex which may be brought about even by passive and non-painful stretch (see Mattes� views p. 3).
He concludes that this method demonstrates the close connection between tension and pain, and between relaxation and analgesia.
The use of eye movements as part of the methodology is based on research by Gaymans (1980) which indicates, for example, that flexion is enhanced by the patient looking downwards, and extension by the patient looking upwards. Similarly, sidebending is facilitated by looking towards the side involved. These ideas are easily proved by self-experiment: an attempt to flex the spine while maintaining the eyes in an upwards (towards the forehead) looking direction will be found to be less successful than an attempt made to flex while looking downwards. These eye-direction aids are also useful in manipulation of the joints.
Effects of Muscle energy techniques
Lewit (1999) discusses the element of passive muscular stretch in MET and maintains that this factor does not always seem to be essential. In some areas, self-treatment, using gravity as the resistance factor, is effective, and such cases sometimes involve no element of stretch of the muscles in question. Stretching of muscles during MET, according to Lewit (1999), is only required when contracture due to fibrotic change has occurred, and is not necessary if there is simply a disturbance in function. He quotes results in one series of patients in his own clinic in which 351 painful muscle groups, or muscle attachments, were treated by MET (using postisometric�relaxation) in 244 patients. Analgesia was immediately achieved in 330 cases and there was no effect in only 21 cases. These are remarkable results by any standards.
Lewit suggests, as do many others, that trigger points and �fibrositic� changes in muscle will often disappear after MET contraction methods. He further suggests that referred local pain points, resulting from problems elsewhere, will also disappear more effectively than where local anaesthesia or needling (acupuncture) methods are employed.
Janda�s postfacilitation stretch method
Janda�s variation on this approach (Janda 1993), known as �postfacilitation stretch�, uses a different starting position for the contraction and also a far stronger isometric contraction than that suggested by Lewit and most osteopathic users of Muscle energy techniques:
The shortened muscle is placed in a mid-range position about halfway between a fully stretched and a fully relaxed state.
The patient contracts the muscle isometrically, using a maximum degree of effort for 5�10 seconds while the effort is resisted completely.
On release of the effort, a rapid stretch is made to a new barrier, without any �bounce�, and this is held for at least 10 seconds.
The patient relaxes for approximately 20 seconds and the procedure is repeated between three and five times more.
Some sensations of warmth and weakness may be anticipated for a short while following this more vigorous approach.
Reciprocal inhibition variation
This method, which forms a component of PNF methodology (see Box 1.1) and Muscle energy techniques, is mainly used in acute settings, where tissue damage or pain precludes the use of the more usual agonist contraction, and also commonly as an addition to such methods, often to conclude a series of stretches whatever other forms of MET have been used (Evjenth & Hamberg 1984):
The affected muscle is placed in a mid-range position.
The patient is asked to push firmly towards the restriction barrier and the operator either completely resists this effort (isometric) or allows a movement towards it (isotonic). Some degree of rotational or diagonal movement may be incorporated into the procedure.
On ceasing the effort, the patient inhales and exhales fully, at which time the muscle is passively lengthened.
Liebenson notes that �a resisted isotonic effort towards the barrier is an excellent way in which to facilitate afferent pathways at the conclusion of treatment with active muscular relaxation techniques or an adjustment (joint). This can help reprogram muscle and joint proprioceptors and thus re-educate movement patterns.� (See Box 1.2.)
Strengthening variation
Another major muscle energy variation is to use what has been called isokinetic contraction (also known as progressive resisted exercise). In this the patient starts with a weak effort but rapidly progresses to a maximal contraction of the affected muscle(s), introducing a degree of resistance to the operator�s effort to put the joint, or area, through a full range of motion. The use of isokinetic contraction is reported to be a most effective method of building strength, and to be superior to high repetition, lower resistance exercises (Blood 1980). It is also felt that a limited range of motion, with good muscle tone, is preferable (to the patient) to having a normal range with limited power. Thus the strengthening of weak musculature in areas of permanent limitation of mobility is seen as�an important contribution in which isokinetic contractions may assist.
Isokinetic contractions not only strengthen the fibres which are involved, but also have a training effect which enables them to operate in a more coordinated manner. There is often a very rapid increase in strength. Because of neuromuscular recruitment, there is a progressively stronger muscular effort as this method is repeated. Isokinetic contractions, and accompanying mobilisation of the region, should take no more than 4 seconds at each contraction in order to achieve maximum benefit with as little fatiguing as possible, either of the patient or the operator. Prolonged contractions should be avoided. The simplest, safest, and easiest-to-handle use of isokinetic methods involves small joints, such as those in the extremities. Spinal joints may be more difficult to mobilise while muscular resistance is being fully applied.
The options available in achieving increased strength via these methods therefore involve a choice between either a partially resisted isotonic contraction, or the overcoming of such a contraction, at the same time as the full range of movement is being introduced (note that both isotonic concentric and eccentric contractions will take place during the isokinetic movement of a joint). Both of these options should involve maximum contraction of the muscles by the patient. Home treatment of such conditions is possible, via self-treatment, as in other MET methods.
Isolytic Muscle Energy Techniques
Another application of the use of isotonic contraction occurs when a direct contraction is resisted and overcome by the operator (Fig. 1.4). This has been termed isolytic contraction, in that it involves the stretching, and sometimes the breaking down, of fibrotic tissue present in the affected muscles. Adhesions of this type are reduced by the application of force by the operator which is just greater than that being exerted by the patient. This procedure can be uncomfortable, and the patient should be advised of this. Limited degrees of effort are therefore called for at the outset of isolytic contractions. This is an isotonic eccentric contraction, in that the origins and insertions of the muscles involved will become further separated, despite the patient�s effort to approximate them. In order to achieve the greatest degree of stretch (in the condition of myofascial fibrosis, for example), it is necessary for the largest number of fibers possible to be involved in the isotonic contraction. Thus there is a contradiction in that, in order to achieve this large involvement, the degree of contraction should be a maximal one, and yet this is likely to produce pain, which is contraindicated. It may also, in many instances, be impossible for the operator to overcome.
This stretches the muscles which are contracting (TFL shown in example) thereby inducing a degree of controlled microtrauma, with the aim of increasing the elastic potential of shortened or fibrosed tissues.
The patient should be instructed to use about 20% of possible strength on the first contraction, which is resisted and overcome by the operator, in a contraction lasting 3�4 seconds. This is then repeated, but with an increased degree of effort on the part of the patient (assuming the first effort was relatively painless). This continuing increase in the amount of force employed in the contracting musculature may be continued until, hopefully, a maximum contraction effort is possible, again to be overcome by the operator. In some muscles, of course, this may require a heroic degree of effort on the part of the operator, and alternative methods are therefore desirable. Deep tissue techniques, such as neuromuscular technique, would seem to offer such an alternative. The isolytic manoeuvre should have as its ultimate aim a fully relaxed muscle, although this will not always be possible.
Why Fibrosis Occurs Naturally
An article in the Journal of the Royal Society of Medicine (Royal Society of Medicine 1983) discusses connective tissue changes:
Aging affects the function of connective tissue more obviously than almost any organ system. Collagen fibrils thicken, and the amounts of soluble polymer decrease. The connective tissue cells tend to decline in number, and die off. Cartilages become less elastic, and their complement of proteoglycans changes both quantitatively and qualitatively. The interesting question is how many of these processes are normal, that contribute blindly and automatically, beyond the point at which they are useful? Does prevention of aging, in connective tissues, simply imply inhibition of cross linking in collagen fibrils, and a slight stimulation of the production of chondroitin sulphate proteoglycan?
The effects of various soft tissue approaches such as NMT and Muscle energy techniques will impact directly on these tissues as well as on the circulation and drainage of the affected structures, which suggests that the ageing process can be influenced. Destruction of collagen fibrils, however, is a serious matter (for example when using isolytic stretches), and although the fibrous tissue may be replaced in the process of healing, scar-tissue formation is possible, and this makes repair inferior to the original tissues, both in functional and structural terms. An isolytic contraction has the ability to break down tight, shortened tissues and the replacement of these with superior material will depend, to a large extent, on the subsequent use of the area (exercise, etc.), as well as the nutritive status of the individual. Collagen formation is dependent on adequate vitamin C, and a plentiful supply of amino acids such as proline, hydroxyproline and arginine. Manipulation, aimed at the restoration of a degree of normality in connective tissues, should therefore take careful account of nutritional requirements.
The range of choices in stretching, irrespective of the form of prelude to this � strong or mild isometric contraction, starting at or short of the barrier � therefore covers the spectrum from all- passive to all-active, with many variables in between.
Putting It Together
Many may prefer to use the variations, as described above, within individual settings. The recommendation of this text, however, is that they should be �mixed and matched� so that elements of all of them may be used in any given setting, as appropriate. Lewit�s (1999) approach seems ideal for more acute and less chronic conditions, while Janda�s (1989) more vigorous methods seem�ideal for hardy patients with chronic muscle shortening.
Muscle energy techniques offers a spectrum of approaches which range from those involving hardly any active contraction at all, relying on the extreme gentleness of mild isometric contractions induced by breath-holding and eye movements only, all the way to the other extreme of full-blooded, total- strength contractions. Subsequent to isometric contractions � whether strong or mild � there is an equally sensitive range of choices, involving either energetic stretching or very gentle movement to a new restriction. We can see why Sandra Yale (in DiGiovanna 1991) speaks of the usefulness of MET in treating extremely ill patients.
Many patients present with a combination of recent dysfunction (acute in terms of time, if not in degree of pain or dysfunction) overlaid on chronic changes which have set the scene for their acute current problems. It seems perfectly appropriate to use methods which will deal gently with hypertonicity, and more vigorous methods which will help to resolve fibrotic change, in the same patient, at the same time, using different variations on the theme of MET. Other variables can be used which focus on joint restriction, or which utilise RI should conditions be too sensitive to allow PIR methods, or variations on Janda�s more vigorous stretch methods (see Box 1.1).
Discussion of common errors in application of Muscle energy techniques will help to clarify these thoughts.
Why Muscle Energy Techniques Might Be Ineffective At Times
Poor results from use of Muscle energy techniques may relate to an inability to localize muscular effort sufficiently, since unless local muscle tension is produced in the precise region of the soft tissue dysfunction, the method is likely to fail to achieve its objectives. Also, of course, underlying pathological changes may have taken place, in joints or elsewhere, which make such an approach of short-term value only, since such changes will ensure recurrence of muscular spasms, sometimes almost immediately.
MET will be ineffective, or cause irritation, if excessive force is used in either the contraction phase or the stretching phase.
The keys to successful application of Muscle energy techniques therefore lie in a precise focusing of muscular activity, with an appropriate degree of effort used in the isometric contraction, for an adequate length of time, followed by a safe movement through the previous restriction barrier, usually with patient assistance.
Use of variations such as stretching chronic fibrotic conditions following an isometric contraction and use of the integrated approach (INIT) mentioned earlier in this chapter represent two examples of further adaptations of Lewit�s basic approach which, as described above, is ideal for acute situations of spasm and pain.
To Stretch Or To Strengthen?
Marvin Solit (1963), a former pupil of Ida Rolf, describes a common error in application of Muscle energy techniques � treating the �wrong� muscles the �wrong� way:
As one looks at a patient�s protruding abdomen, one might think that the abdominal muscles are weak, and that treatment should be geared towards strengthening them. By palpating the abdomen, however, one would not feel flabby, atonic muscles which would be the evidence of weakness; rather, the muscles are tight, bunched and shortened. This should not be surprising because here is an example of muscle working overtime maintaining body equilibrium. In addition these muscles are supporting the sagging viscera, which normally would be supported by their individual ligaments. As�the abdominal muscles are freed and lengthened, there is a general elevation of the rib cage, which in turn elevates the head and neck.
Attention to tightening and hardening these supposedly weak muscles via exercise, observes Solit, results in no improvement in posture, and no reduction in the �pot-bellied� appearance. Rather, the effect is to further depress the thoracic structures, since the attachments of the abdominal muscles, superiorly, are largely onto the relatively mobile, and unstable, bones of the rib cage. Shortening these muscles simply achieves a degree of pull on these structures towards the stable pelvic attachments below.
The approach to this problem adopted by Rolfers is to free and loosen these overworked and only apparently weakened tissues. This allows for a return to some degree of normality, freeing the tethered thoracic structures, and thus correcting the postural imbalance. Attention to the shortened, tight musculature, which will also be inhibiting their antagonist muscles, should be the primary aim. Exercise is not suitable at the outset, before this primary goal is achieved.
The common tendency in some schools of therapy to encourage the strengthening of weakened muscle groups in order to normalise postural and functional problems is also discussed by Vladimir Janda (1978). He expresses the reasons why this approach is �putting the cart before the horse�: �In pathogenesis, as well as in treatment of muscle imbalance and back problems, tight muscles play a more important, and perhaps even primary, role in comparison to weak muscles� (Fig. 1.5). He continues with the following observation:
Clinical experience, and especially therapeutic results, support the assumption that (according to Sherrington�s law of reciprocal innervation) tight muscles act in an inhibitory way on their antagonists. Therefore, it does not seem reasonable to start with strengthening of the weakened muscles, as most exercise programmes do. It has been clinically proved that it is better to stretch tight muscles first. It is not exceptional that, after stretching of the tight muscles, the strength of the weakened antagonists improves spontaneously, sometimes immediately, sometimes within a few days, without any additional treatment.
This sound, well-reasoned, clinical and scientific observation, which directs our attention and efforts towards the stretching and normalizing of those tissues which have shortened and tightened, seems irrefutable, and this theme will be pursued further in Chapter 2.
Muscle energy techniques are designed to assist in this endeavor and, as discussed above, also provides an excellent method for assisting in the toning of weak musculature, should this still be required, after the stretching of the shortened antagonists, by use of isotonic methods.
Tendons
Aspects of the physiology of muscles and tendons are worthy of a degree of review, in so far as Muscle energy techniques and its effects are concerned (see also Box 1.5). The tone of muscle is largely the job of the Golgi tendon organs. These detect the load applied to the tendon, via muscular contraction. Reflex effects, in the appropriate muscles, are the result of this information being passed from the Golgi tendon organ back along the cord. The reflex is an inhibitory one, and thus differs from the muscle spindle stretch reflex. Sandler (1983) describes some of the processes involved:
When the tension on the muscles, and hence the tendon, becomes extreme, the inhibitory effect from the tendon organ can be so great that there is sudden relaxation of the entire muscle under stretch. This effect is called the lengthening reaction, and is probably a protective reaction to the force which, if unprotected, can tear the tendon from its bony attachments. Since the Golgi tendon organs, unlike the [muscle] spindles, are in series with the muscle fibres, they are stimulated by both passive and active contractions of the muscles.
Pointing out that muscles can either contract with constant length and varied tone (isometrically), or with constant tone and varied length (isotonically), he continues: �In the same way as the gamma efferent system operates as a feedback to control the length of muscle fibers, the tendon reflex serves as a reflex to control the muscle tone�.
The relevance of this to soft tissue techniques is explained as follows:
In terms of longitudinal soft tissue massage, these organs are very interesting indeed, and it is perhaps the reason why articulation of a joint, passively, to stretch the tendons that pass over the joint, is often as effective in relaxing the soft tissues as direct massage of the muscles themselves. Indeed, in some cases, where the muscle is actively in spasm, and is likely to object to being pummelled directly, articulation, muscle energy techniques, or functional balance techniques, that make use of the tendon organ reflexes, can be most effective.
The use of this knowledge in therapy is obvious and Sandler explains part of the effect of massage on muscle: �The [muscle] spindle and its reflex connections constitute a feedback device which can�operate to maintain constant muscle length, as in posture; if the muscle is stretched the spindle discharges increase, but if the muscle is shortened, without a change in the rate of gamma discharge, then the spindle discharge will decrease, and the muscle will relax.�
Sandler believes that massage techniques cause a decrease in the sensitivity of the gamma efferent, and thus increase the length of the muscle fibers rather than a further shortening of them; this produces the desired relaxation of the muscle. Muscle energy techniques provides for the ability to influence both the muscle spindles and also the Golgi tendon organs.
Joints & Muscle Energy Techniques
Bourdillon (1982) tells us that shortening of muscle seems to be a self-perpetuating phenomenon which results from an over-reaction of the gamma-neuron system. It seems that the muscle is incapable of returning to a normal resting length as long as this continues. While the effective length of the muscle is thus shortened, it is nevertheless capable of shortening further. The pain factor seems related to the muscle�s inability thereafter to be restored to its anatomically desirable length. The conclusion is that much joint restriction is a result of muscular tightness and shortening. The opposite may also apply where damage to the soft or hard tissues of a joint is a factor. In such cases the periarticular and osteophytic changes, all too apparent in degenerative conditions, are the major limiting factor in joint restrictions. In both situations, however, Muscle energy techniques may be useful, although more useful where muscle shortening is the primary factor.
The restriction which takes place as a result of tight, shortened muscles is usually accompanied by some degree of lengthening and weakening of the antagonists. A wide variety of possible permutations exists in any given condition involving muscular shortening which may be initiating, or be secondary to, joint dysfunction combined with weakness of antagonists. A combination of isometric and isotonic methods can effectively be employed to lengthen and stretch the shortened groups, and to strengthen and shorten the weak, overlong muscles.
Paul Williams (1965) stated a basic truth which is often neglected by the professions which deal with musculoskeletal dysfunction:
The health of any joint is dependent upon a balance in the strength of its opposing muscles. If for any reason a flexor group loses part, or all of its function, its opposing tensor group will draw the joint into a hyperextended position, with abnormal stress on the joint margins. This situation exists in the lumbar spine of modern man.
Lack of attention to the muscular component of joints in general, and spinal joints in particular, results in frequent inappropriate treatment of the joints thus affected. Correct understanding of the role of the supporting musculature would frequently lead to normalisation of these tissues, without the need for heroic manipulative efforts. Muscle energy techniques and other soft tissue approaches focus attention on these structures and offer the opportunity to correct both the weakened musculature and the shortened, often fibrotic, antagonists.
More recently, Norris (1999) has pointed out that:
The mixture of tightness and weakness seen in the muscle imbalance process alters body segment alignment and changes the equilibrium point of a joint. Normally the equal resting tone of the agonist and antagonist muscles allows the joint to take up a balanced position where the joint surfaces are evenly loaded and the inert tissues of the joint are not excessively stressed. However if the muscles on one side of a joint are tight and the opposing muscles relax, the joint will be pulled out of alignment towards the tight muscle(s).
Such alignment changes produce weight-bearing stresses on joint surfaces, and result also in shortened soft tissues chronically contracting over time. Additionally such imbalances result in reduced segmental control with chain reactions of compensation emerging (see Ch. 2).
Several studies will be detailed (Chs 5 and 8) showing the effectiveness of Muscle energy techniques application in diverse population groups, including a Polish study on the benefits of Muscle energy techniques in joints damaged by haemophilia, and a Swedish study on the effects of Muscle energy techniques in treating lumbar spine dysfunction, as well as an American/Czech study involving myofascial pain problems. In the main, the results indicate a universal role in providing resolution or relief of such problems by means of the application of safe and effective muscle energy techniques.
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It’s a warm sunny day with a bit of a breeze, you are on the back nine about to sink a putt. When you swing, your back seizes up with severe pain. The beautiful day of golf turns into painfully riding in the golf cart back to the clubhouse, and you limping painfully to your car.
If you have ever strained your back during a golf game, you are not alone. It’s estimated of the 30 million golfers in the United States, 80% have experienced some sort of back pain. As fun as it is, swinging at golf balls puts an individual’s body in an awkward position, opening up the opportunity for injury.
While some golfers suffer through the pain by popping over-the-counter medications, others back away from playing as often, or stop altogether. There’s another way to combat back injuries caused by golfing, without meds. It’s not a magic wand, it’s chiropractic care!
Golfers are increasingly finding chiropractic care to be a valuable tool to help them deal with back injuries. Here are FORE! ways chiropractors can help injured golfers get off the couch and back on the green.
Golfers: Consistent Adjustments Can Avoid Injuries In The First Place.
Golfing, or any activity, is more enjoyable and causes less chance of injury if an individual’s body is in top condition and operating normally. Periodic spinal adjustments keep the body functioning at maximum capacity, and reduce the chances of being injured. If the neck and back are aligned correctly, awkward positioning such as a golf swing will have a less negative impact.
Chiropractic Treatment Can Reduce A Golfer’s Pain.
Back injuries can be extremely painful, and many turn to pain medications to gain relief and comfort. By treating the origin of the pain instead of just the symptoms, a chiropractor helps their patients manage the pain through manipulations, instead of drugs. Over the course of a few treatments, pain is often drastically diminished and much more manageable.
A Golf Injury Can Heal Quicker With Chiropractic Care.
Injuries to the back or neck can heal faster when chiropractors treat them than on their own. An experienced chiropractor can adjust the spine, and also work on the joints and surrounding tissue that can cause pain and hinder healing. Chiropractic evaluation considers the body as a whole. By treating the entire body, it promotes quicker healing of the injury.
Increased Mobility Can Be Gained With Chiropractic Visits.
Golfers who play often as well as those who only play a few times a year know mobility is essential to a good golf game. Stiff joints and a weak back not only mess with the golf game, but can be the very issues that end up causing an injury.
A chiropractic treatment schedule keeps the body loose and strong, and working in optimum fashion. This prevents injuries and increases the chances of playing the game of your life.
Golfers need to realize the sport can cause serious injuries just like “rougher” sports like football and rugby. It’s a good idea to stretch before playing, stay hydrated, and avoid overexertion.
If you are a golfer, chiropractic care is a valuable tool in staying healthy. Regular adjustments and manipulations keep your body on track and performing with maximum mobility at the top of your game. If you do suffer an injury, a chiropractor can help you manage your pain and decrease the time it takes to heal.
Professional Golfer Zach Johnson Trusts Chiropractic Care
Contact us today for more information on how we can help reduce the chance of injury for golfers, and promote healing.
This article is copyrighted by Blogging Chiros LLC for its Doctor of Chiropractic members and may not be copied or duplicated in any manner including printed or electronic media, regardless of whether for a fee or gratis without the prior written permission of Blogging Chiros, LLC.
Even if you have never stepped foot onto a court before, you may end up with tennis elbow. Occurring along the muscle that allows extension of the wrist, it is a painful condition that can linger for weeks or months.
Previously, tennis elbow primarily showed up in athletes. Due to the increased interest in physical fitness, tennis elbow is being found in everyday exercisers, as well as people who perform work-related repetitive motion.
Tennis elbow presents several symptoms. Pain will occur on the outside of the elbow an inch or so down from the bony part.
There may also be pain when the individual tries to extend the hand and fingers against resistance. Extreme weakness in the wrist is another symptom.
I Have Been Diagnosed With Tennis Elbow. Now What?
Tennis elbow is often difficult to diagnose, which can delay treatment. A correct diagnosis of tennis elbow is the first step towards being able to treat the condition and rehab the afflicted area. From there, a variety of treatments for tennis elbow are available.
Passive remedies like rest, ice, and arm braces are critical components to healing tennis elbow. Take measures to reduce the movements that aggravate the pain, and use ice at regular intervals to help minimize pain and inflammation.
An arm brace supports and stabilizes the area to promote healing. These remedies assist greatly in treating the condition, especially in the beginning.
Active remedies consist of stretching and strengthening exercises, and are vital aspects of improving the condition. Individuals suffering from tennis elbow should begin an exercise regimen as soon as the pain allows.
An individual dealing with tennis elbow may utilize a variety of medicinal remedies to manage pain and inflammation. Over-the-counter pain relievers and steroid injections are commonly used to treat the condition. Following doctor’s orders when taking medications is strongly recommended.
Untraditional remedies also provide vast improvements in tennis elbow, and these treatments have gained favor in the last few years due to their effectiveness. Regimens of massage therapy and acupuncture work on small areas contributing to the condition, and make significant strides in pain reduction and promote the body’s restorative healing process.
Another remedy that offers strong benefits to treating tennis elbow is chiropractic care. A chiropractor assesses the condition, then lays out a plan to promote healing.
Treatment often includes working to align the bones and treating the surrounding joints so they function at maximum capacity, and can “take up the slack” of the injured area while it heals. Chiropractic care serves the dual purpose of treating the condition directly, and healing the areas around the injury so that the body continues to strengthen and renew.
In a very small number of cases, the only remedy for tennis elbow is surgery. This is considered as the last straw, once all other forms of treatment have been exhausted.
The best way to treat tennis elbow is to avoid it in the first place. Be sure to stretch before exercising, consistently perform strengthening exercises, employ correct techniques and proper equipment during physical activity, and don’t overexert your arms (this goes for your entire body, by the way) during physical activity.
If you are diagnosed with tennis elbow, it’s essential to understand the variety of treatment options available. The best course is often a blend of more than one remedy. Chiropractic care should be part of your healing process, as it helps decrease pain, reduce healing time, and offers a non-medicinal approach to treating the body as a whole.
The Risks Of College Sports
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Promote Healing
#4: Avoid Overexertion
#4: Beware Of Little Critters
Edward Stiles
Liebenson (1996) discusses both the benefits of, and the mechanisms involved in, use of muscle energy techniques (which he terms �manual resistance techniques�, or MRT):
Using agonist or antagonist? (Box 1.4)
What Is Happening?
This stretches the muscles which are contracting (TFL shown in example) thereby inducing a degree of controlled microtrauma, with the aim of increasing the elastic potential of shortened or fibrosed tissues.
Muscle energy techniques are designed to assist in this endeavor and, as discussed above, also provides an excellent method for assisting in the toning of weak musculature, should this still be required, after the 
The relevance of this to soft tissue techniques is explained as follows:
