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Muscle rigidity and spasms occur with neurological disease and may contribute to contractures and shortening of muscle fibers that can interfere with motor behaviors, such as ambulation, or activities of daily living, such as combing hair, feeding or dressing. The neuromuscular technique (NMT) and muscle energy technique (MET) are nursing interventions that can reduce pain and muscle rigidity, lengthen muscle fibers and increase range of motion necessary for normal motor behavior. Nurses can use these techniques in patients with acute neurological diseases and those recovering in rehabilitation and long-term care settings. With some neurological diseases, muscle rigidity, increased muscle tone and muscle spasms reduce the range of motion of joints and the quality of movement. These changes often lead to contractures and impairments in performing daily tasks or ambulating, and thus, to loss of independence. Soft tissue manipulation can be used to reduce muscle tension and spasms, reduce pain and enhance the range of motion of joints whose function depends on the involved muscles. Soft tissue manipulation may also improve movement during specific tasks. Although the muscle relaxation achieved with manipulation techniques is primarily short-term, long-term effects occur. This article describes two techniques of soft tissue manipulation, their mechanisms of action, assessment and implementation. A case study is used to illustrate application of the techniques and possible long-term effects.

Aim & Objectives: Chronic Obstructive Pulmonary Disease (COPD) accounts 17 million lives in India, which will rise to 22 million by 2016 & it kills 250 people every hour. Global initiative for Obstructive Lung Disease (GOLD) portrayed skeletal muscle dysfunction as a significant contributor to severity in these patients resulting in reduced exercise capacity and impaired Quality of life. Muscle Energy technique (MET) had been a well known treatment in musculoskeletal disorders, yet literature supporting its use in chronic respiratory disorders is limited. So the present research is design to study the effects of MET on pulmonary function in COPD subjects and describes its impact on Conventional chest Physiotherapy. Method: 30 Moderate & Severe staged COPD patients in 40-60 years age group were allocated into two groups: Conventional Chest Physiotherapy (CPT) and Conventional Chest Physiotherapy with MET(CPT + MET) group. Chest expansion, Dyspnea, Exercise tolerance, Respiratory rate, Heart rate, Oxygen saturation and Quality of life were the variables that recorded prior and after the intervention for three days. Results: Significant improvement was seen in both groups on all 3 days with greater improvements in CPT with MET group in form of increased chest expansion, reduced Dyspnea, increased exercise tolerance, regulation of autonomic dysfunction and improved Quality of life. Discussion: Study reveals the potential benefits of MET on pulmonary function and its efficacy in upgrading the Conventional chest Physiotherapy in COPD subjects. It also recognizes the importance of management of Accessory Inspiratory muscle dysfunction in providing a better Quality of life in COPD patients. Conclusion: MET proved to be a highly magnificent technique in improving pulmonary function and must be thus incorporated as a basic part of pulmonary rehabilitation in COPD subjects.

Objective: Different treatment approaches have been advocated for adhesive capsulitis, but there is not much scientific evidence to support the standard treatment. The purpose of this study is to establish best and efficient protocol for treatment of idiopathic adhesive capsulitis. Method and subjects: 30 subjects including both sexes between 40-60 years, Diagnosed adhesive capsulitis were selected and with lottery random sampling method were assigned in two groups (A or B) with 15 subjects each. Group A received moist pack for 15 minutes, active ROM exercises and Maitland mobilization. Group B received moist pack for 15 minutes, active ROM exercises and Muscle Energy Technique (MET). Both the groups were treated 6 times a week for 2 weeks and were told to continue the exercises at home. All the subjects were measured for pain by VAS, for all shoulder movements by goniometer on first day before starting treatment and on 15th day after treatment. Result: There was significant improvement from pre-treatment levels in pain and ROM in both groups. Although the ROM improvement was seen more in Maitland mobilization group and reduction in pain was seen more in MET group. Conclusion: MET is more effective in reducing pain so when pain of an acute or chronic nature, makes controlled contraction of involved muscles difficult, the therapeutic use of the antagonists by MET can patently be of value and as soon the pain subsides Maitland mobilization can be incorporated to increase ROM.

Background: Myofascial trigger point (MTrP) is a hyperirritable point or spot, usually within a taut band of skeletal muscle or in the muscle fascia which is painful on compression and can give rise to characteristic-referred pain and motor dysfunction. Studies suggest that various types of massage forms are available for treating MTrPs. Aims: To find the difference in effect of two forms of massage techniques: Ischemic compression and muscle energy technique (MET) on upper trepezius MTrPs. Settings and Design: Quasi experimental design was conducted with convenient sampling method. Materials and Methods: Patients ( n = 30) who fulfil the screening criteria were randomly assigned to Group A ( n = 15) treated with ischemic compression and ultrasound and Group B ( n = 15) treated with MET and ultrasound for 4 weeks and they were assessed at baseline and after 4 weeks. Outcome measures included pain intensity by visual analog scale (VAS) and range of motion by universal goniometer. Statistical Analysis Used: Intergroup analysis was done with Mann-Whitney test and intragroup analysis was done with Wilcoxon signed-rank test. Results: Statistically, no significant ( P > 0.05) changes in the scores were found in the Groups A and B for VAS, and statistically significant ( P < 0.05) changes in the scores were found in the Groups A and B for Range of Motion (ROM) with greater change scores in the Group B compared with Group A. Conclusion: Treatment program consisting of MET with ultrasound may be more effective in reducing pain and improve ROM in patients in upper trepezius MTrPs.

Background: Success in sports depends on athlete's ability to develop and produce a specific set of coordination and joint range of motion/flexibility. Purpose of the study is to compare efficacy of muscle energy technique and static passive stretching on hamstring flexibility in healthy Indian college athletes. Subjects: The subjects were healthy Indian college athlete from Bangalore metropolitan area. Method: 30 healthy college athlete subjects with hamstring tightness were randomly allocated to two study groups. Groups-A (n=15) subjects were treated with Muscle energy technique (Isometric contraction - using post isometric relaxation, approximately 30% of patient's strength, Duration of contraction is 20 seconds, muscle is taken to its new restriction barrier and held in this position for at least 60 seconds, three repetition with 15 second of rest interval) where as other group-B (n=15) were treated with static passive stretching (No warm up was allowed prior stretching, Subjects received three stretches of 60 seconds). The treatment was given for 1 day. Outcome Measure: Subjects were assessed for hamstring flexibility by measuring straight leg raise angle i.e. active straight leg raising range of motion prior and immediately after intervention. Measurement was done by standard universal goniometer. Results: Paired Samples t -Test showed that Muscle Energy Technique and static Passive Stretching both the treatments are significant (P=0.000). Mann-Whitney Test showed a statistically significant improvement in the Muscle Energy technique group when compared to static passive stretching. Conclusion: A muscle energy technique is more effective than static passive stretching for improvement in hamstring flexibility.

Objectives of the Study: The objective of the study is to know the effect of Muscle Energy Technique on pain and range of motion on OA knee. Methodology: 30 subjects fulfilled the selection criteria and were selected randomly from Department of physiotherapy, SVIMS, BIRRD, Tirupati. The study conducted for a period of 6 weeks. Two groups comprising of 15 members each were formed. Conventional therapy was given to group I and METS was given to group II. Subjects were evaluated pre and post treatment for VAS and ROM. Results: To test the significance of the mean difference between the two groups, unpaired t test was done. It is statistically shown that there is some significant impact in the parameters VAS and ROM. The results showed that, experimental group had more significant improvement in all parameters than control group. Conclusion: Upon analyzing the differences between both the groups further, it was found that experimental group has shown significant improvement when compared to the control group. Hence MET plays an important role on decreasing pain and increasing ROM in OA.

Objective: To establish the best possible long term effective choice of treatment program for deactivating MTrP's by using the combination of muscle energy technique with strain-counterstrain technique Design: Pretest-Posttest control group design Setting: Outpatient physiotherapy department, Taneja Hospital, Preet Vihar New Delhi. Patients: Fourty five subjects (only male) with Myofascial Trigger Points Pain. Subjects were randomly placed into three groups: Experimental group A (n=15), Experimental group B (n=15) and a Control group C (n=15). Intervention: The experimental group A received muscle energy technique in combination with straincounterstrain technique and experimental group B received muscle energy technique alone whereas control group received conventional treatment only. Main Outcome Measures: Pain pressure threshold was assessed with the pressure threshold meter (PTM). Pain and functional status of the patients were measured by a visual analogue scale (VAS) and the Neck Disability Index scores respectively. Results: Within group analysis revealed significant improvement in pain pressure threshold, functional status and reduction in pain intensity in all groups. Between group analysis revealed significant difference between group A, group B and group C. Further post hoc analysis revealed significant difference between group A and B, group A and C and group B and C for all variables even after one week of follow up after the termination of intervention. Conclusion: The combination of muscle energy technique with strain-counterstrain has been shown to produce greater improvement in pain pressure threshold on pressure threshold meter, function status on neck disability index scores and reduction in pain intensity on visual analogue scores even after one week of the termination of intervention. This shows the long term effectiveness of combination of two manual techniques deactivating the myofascial trigger point's pain.

Background and Purpose: This case report describes the examination, intervention and outcome of a patient with lumbar spondylolisthesis. The patient was managed by myofascial release of levator scapulae and cervico-thoracic central PA mobilization. There is no literature found describing these interventions for lumbar spondylolisthesis. Case Description: The patient was a 43 years old woman with LBA with radiating pain to left lower limb due to lumbar spondylolisthesis. She received stretching of levator scapulae, piriformis & rectus femoris, cervico-thoracic central PA mobilization, passive lumbar flexion mobilization, core strengthening exercises. Treatment was given 5 days a week for 20 sittings. Outcomes: Percentage of slippage. Conclusion: Stretching of levator scapulae and cervico-thoracic central PA mobilization may help in reducing forward slippage in lumbar spondylolisthesis.

Purpose of study: Muscular flexibility is an important aspect of normal human function . Limited flexibility has been shown to affect a person's level of function. Purpose of the study is to investigate the effectiveness of Eccentric Training and Muscle Energy Technique on hamstring flexibility in sedentary college students and to compare the effect between the boys and girls. Methodology: 40 healthy college students between the age groups of 18- 25 years were selected and were randomly assigned to two study groups. Group 1 (n= 20) subjects were treated with Eccentric Training where as Group 2 (n= 20) subjects were treated with Muscle Energy Technique. And each Group comprising of equal ratio of boys and girls. Treatment was given for 14 consecutive days and a follow up measurement was done one week after cessation of intervention. The outcome was measured in terms of Active knee extension test and Sit and reach test. Each intervention was performed for duration of 30 sec. Results: There was a significant difference in range of motion in Active knee extension test b/etween both the groups with (p= 0.005) in right side and left side (p=0.10), whereas in Sit and reach test there is no significant difference between both the groups with (p= 0.219) according to the paired and unpaired t- test. Conclusion: Results indicate that muscle energy technique is significantly improving hamstring flexibility. But there is no statically significant difference in muscle flexibility between boys and girl.

Background: Neck pain is a common problem within our society. Upper trapezius and the levator scapulae are the most common postural muscles that tends to get shorten leading to restricted neck mobility. If these group of muscles are treated it may provide with best results. There is lack of evidence to allow conclusions to be drawn about the effectiveness of Muscle energy technique (MET) when compared with stretching exercises for relieving mechanical neck pain. It would be interesting to study if these two techniques yield comparable outcomes and if one technique is superior to the next which should be the alternate choice of therapy . Objective: To evaluate the comparative effectiveness of Muscle energy technique and static stretching on pain and active cervical range of motion (ROM) in subacute mechanical neck pain Subjects and methods: 45 patients with subacute mechanical neck pain were randomly assigned to receive Muscle Energy Technique plus conventional physiotherapy (group 1, n = 15), static stretching plus conventional exercise program (group 2, n = 15) and conventional physiotherapy only (group 3, n = 15). Intervention: Group 1 received 6 sessions of Muscle Energy Technique and 10 sessions of conventional physiotherapy. Group 2 received 6 sessions of static stretching and 10 sessions of conventional physiotherapy. Group 3 received 10 sessions of conventional physiotherapy. All groups were treated for 2 weeks. Outcome measures: Pain intensity on 100mm VAS, active cervical lateral flexion range of motion, active cervical rotation range of motion. Results: Paired t-test was used for within group analysis. ANOVA followed by post hoc analysis was employed for between group comparisons. No significant difference was found in any of the outcome measure between MET and static stretching groups (p > 0.05) while both were found to be significantly better than the conventional exercise group (p < 0.05) between the 3 groups. Statistically significant improvements were found in all the 3 groups for all the outcome measures (p < 0.05). Conclusion: This study concluded that both the treatment techniques, muscle energy technique and static stretching were effective in alleviating the mechanical neck pain in terms of decreasing pain intensity and increasing active cervical range of motion as there was no significant difference between the two groups, however MET was superior than static stretching in decreasing pain intensity and increasing active cervical range of motion.

Bv using biopsies, skeletal muscle metabolism was investigated in 22 patients with severe chronic heart failure. All the patients were in New York Heart Association functional class IV and constituted a subgroup of the previously published CONSENSUS trial. After this initial investigation of muscle metabolism in patients with chronic heart failure, the influence of the angiotensin converting enzyme inhibitor, enalapril, on skeletal muscle metabolism was studied by randomizing the patients in a double-blind manner to receive either placebo (n = 11) or enalapril (n =11) in addition to conventional treatment. At the time of inclusion, the muscle content of energy-rich compounds, i.e. glycogen and the high energy phosphates, adenosine triphosphate (A TP) and phosphocreatine, was reduced as compared with healthy subjects and muscle lactate content tended to be higher than normal. Following study treatment, no significant changes occurred, neither within nor between the two subgroups. Thus, patients with severe chronic congestive heart failure display metabolic derangement in muscle, which, in this study, was not corrected by treatment with enalapril.

avoid direct painful contraction of a muscle that requires lengthening, such as in the case of piriformis, but there is little published research into these techniques, their relative effectiveness or therapeutic comfort. Design: A randomised controlled trial was performed on 30 asymptomatic male subjects, who were randomly allocated into one of 2 groups (PIR and RI) each of 15 subjects. The study was designed to establish any significant change in hip internal rotation range of movement following application of either PIR or RI muscle energy technique compared to control. Comparative outcome differences between the techniques were also assessed. Methods: One group received a post-isometric relaxation muscle energy technique, the other received a reciprocal inhibition muscle energy technique, both involving subsequent stretch to piriformis. Internal rotation of the hip was measured at 3 stages: control prior to treatment, after a sham treatment, and after the relevant intervention. Prone position was used throughout, and the measurements taken using a digital handheld inclinometer applied to the tibia. The data was analysed using Graphpad Prism 4 software; intra-group results were treated as one-way ANOVA comparisons of range of motion (control vs sham vs intervention), and inter-group results were treated as unpaired t tests comparing range of motion and change in range of motion. Results: Significant increases were found within both groups when comparing range of motion before and after treatment (P

Somatic dysfunctions of the sacroiliac joint (SIJ) are among the most frequent causes of acute and chronic disability of the lower spine. There is no active movement in the SIJ. It moves passively with lumbar flexion and the walking cycle. Any of these movements can be restricted. Additionally, there are dysfunctions that do not follow these physiological motion directions. The following possibilities exist: (a) The entire innominate has slipped superiorly, e.g. missing a step (upslip). (b) The entire innominate has slipped inferiorly, e.g. in a skiing accident when the straps did not open or falling off a horse while being caught in the stirrups (downslip). (c) The innominate is flared out (outflare). (d) The innominate is flared medially (inflare), e.g. after falling on the side of the pelvis; such lesions have been reported after vaginal delivery, for instance.

Time domain and frequency domain analyses were performed on smoothed and averaged electromyographic (IEMG) activity recorded intramuscularly from 6 muscles of the lips, tongue and jaw during speech in normal and athetoid cerebral palsy subjects. The speech IEMG waveforms in both groups were composed of slowly changing tonic activity merging with more rapidly changing phasic bursts. Significant increases both in the durations and average levels of IEMG activity in the athetoid subjects resulted in a 5- to 30-fold increase in the speech muscle energy expended by these subjects. The peak-to-peak amplitudes of the IEMG activity were significantly increased in the athetoid subjects, commensurate with their increased average levels, thus demonstrating that they could vary their muscle contraction levels over a wide range. The velocities (rates of change) of muscle IEMG activity did not differ significantly between the two groups. The velocity of the IEMG activity increased linearly with its amplitude in both subject groups, but the durations of the IEMG bursts nevertheless were highly variable. The slope of the velocity-amplitude relation in the athetoid subjects was less than half that in the normal subjects, suggesting that the frequency bandwidth of muscle activity was reduced in the athetoid subjects, despite a normal range of IEMG velocities. The frequency analysis confirmed this suggestion. The upper limit of the average frequency spectrum of voluntary muscle activity for speech was 7 Hz in the normal subjects, whereas this limit was 4 Hz in the athetoid subjects. In the normal subjects each muscle had a different frequency spectrum, whereas the spectra for the 6 muscles were remarkably uniform in the athetoid subjects, implying an abnormality in the functional organization of their muscles. The findings of this study showed clearly that the temporospatial patterns of voluntary muscle activity in the athetoid subjects were grossly abnormal. Since this voluntary activity was reproducible across multiple repetitions of the same speech sample, the dysarthria in these speakers may be attributed to abnormal control of voluntary activity, not to involuntary movement. The results support the view that the primary disability in cerebral palsy is a disruption of the physiological mechanisms which subserve the acquisition of motor skills.

The energy output of rabbit papillary muscle is examined and it is shown that there is more energy liberated in an afterloaded isotonic contraction than in an "equivalent" isometric contraction. This statement holds true regardless of whether equivalence is based on the proposition that tension or the time integral of tension is the best index of muscle energy expenditure. Besides the external work performed there is additional heat production in isotonic contractions and this heat increases as the afterload is decreased. The additional heat is more evident when tension rather than the time integral of tension is made the determinant of energy expenditure. It is shown in single contractions that the rate of isotonic heat production, regardless of afterload size, never exceeds the heat rate recorded in an isometric contraction at the same initial length. Experiments reveal no simple linear correlation between isotonic energy output and contractile element work. Problems associated with the compartmentalization of the energy output of a contraction are discussed.