Pelvic Girdle Dysfunction Interventions: Muscle Energy Technique: Difference between revisions

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* Patient education
* Patient education
* [[Taping]] (for example kinesiotaping)
* [[Taping]] (for example kinesiotaping)
Manual therapy has been utilised and shown to be effective in the treatment of various musculoskeletal conditions.<ref>Clar C, Tsertsvadze A, Hundt GL, Clarke A, Sutcliffe P. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997823/ Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report]. Chiropractic & manual therapies. 2014 Dec 1;22(1):12.</ref> Specifically, for the treatment of sacroiliac joint dysfunction, which is part of pelvic girdle dysfunction, manual therapy techniques are frequently incorporated in the treatment. Some of these techniques are manipulation, [[Muscle Energy Technique|muscle energy technique]] (MET), [[Mckenzie Method|McKenzie method]], [[Maitland's Mobilisations|Maitland’s mobilisation]], and [[Mobilization with Movement|Mulligan’s mobilisation]].<ref>Bindra S. A study on the efficacy of muscle energy technique as compared to conventional therapy on lumbar spine range of motion in chronic low back pain of sacroiliac origin. Human Biol Rev. 2013;2(4):13.</ref><ref name=":1">Alkady SM, Kamel RM, AbuTaleb E, Lasheen Y, Alshaarawy FA. [https://www.ijphy.org/index.php/journal/article/view/403 Efficacy of mulligan mobilization versus muscle energy technique in chronic sacroiliac joint dysfunction]. International Journal of Physiotherapy. 2017 Oct 1;4(5):311-8.</ref> Of these techniques, MET is a popular technique used among physiotherapists and osteopaths. Muscle energy techniques are used to treat soft tissue, mobilise joint, stretch tight muscles and fascia, reduce pain and improve circulation and lymphatic drainage.<ref name=":0">Thomas E, Cavallaro AR, Mani D, Bianco A, Palma A. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6710873/ The efficacy of muscle energy techniques in symptomatic and asymptomatic subjects: a systematic review]. Chiropractic & Manual Therapies. 2019 Dec 1;27(1):35.</ref> Muscle energy technique can be defined as “a manual treatment in which a patient produces a contraction in a precisely controlled position and direction against a counterforce applied by a manual therapist.”<ref name=":0" /> MET works on two basic principles i.e. post isometric relaxation and reciprocal inhibition.<ref name=":2">Kansagara PR, Patel JK. [https://medicopublication.com/index.php/ijpot/article/view/3757/3533 Muscle Energy Technique for Sacroiliac Joint Dysfunction--An Evidence Based Practice.] Indian Journal of Physiotherapy & Occupational Therapy. 2019 Apr 1;13(2).</ref>
Manual therapy has been utilised and shown to be effective in the treatment of various musculoskeletal conditions.<ref>Clar C, Tsertsvadze A, Hundt GL, Clarke A, Sutcliffe P. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3997823/ Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report]. Chiropractic & manual therapies. 2014 Dec 1;22(1):12.</ref> Specifically, for the treatment of sacroiliac joint dysfunction, which is part of pelvic girdle dysfunction, manual therapy techniques are frequently incorporated in the treatment. Some of these techniques are manipulation, [[Muscle Energy Technique|muscle energy technique]] (MET), [[Mckenzie Method|McKenzie method]], [[Maitland's Mobilisations|Maitland’s mobilisation]], and [[Mobilization with Movement|Mulligan’s mobilisation]].<ref>Bindra S. A study on the efficacy of muscle energy technique as compared to conventional therapy on lumbar spine range of motion in chronic low back pain of sacroiliac origin. Human Biol Rev. 2013;2(4):13.</ref><ref name=":1">Alkady SM, Kamel RM, AbuTaleb E, Lasheen Y, Alshaarawy FA. [https://www.ijphy.org/index.php/journal/article/view/403 Efficacy of mulligan mobilization versus muscle energy technique in chronic sacroiliac joint dysfunction]. International Journal of Physiotherapy. 2017 Oct 1;4(5):311-8.</ref> Of these techniques, MET is a popular technique used among physiotherapists and osteopaths. Muscle energy techniques are used to treat soft tissue, mobilise joints, stretch tight muscles and fascia, reduce pain and improve circulation and lymphatic drainage.<ref name=":0">Thomas E, Cavallaro AR, Mani D, Bianco A, Palma A. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6710873/ The efficacy of muscle energy techniques in symptomatic and asymptomatic subjects: a systematic review]. Chiropractic & Manual Therapies. 2019 Dec 1;27(1):35.</ref> Muscle energy technique can be defined as “a manual treatment in which a patient produces a contraction in a precisely controlled position and direction against a counterforce applied by a manual therapist.”<ref name=":0" /> MET works on two basic principles i.e. post isometric relaxation and reciprocal inhibition.<ref name=":2">Kansagara PR, Patel JK. [https://medicopublication.com/index.php/ijpot/article/view/3757/3533 Muscle Energy Technique for Sacroiliac Joint Dysfunction--An Evidence Based Practice.] Indian Journal of Physiotherapy & Occupational Therapy. 2019 Apr 1;13(2).</ref>


For more information read this Physiopedia Page: [[Muscle Energy Technique]]
For more information read this Physiopedia Page: [[Muscle Energy Technique]]
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=== Sacroiliac Joint Dysfunction ===
=== Sacroiliac Joint Dysfunction ===
* In an investigation on the effect of muscle energy technique (MET) on pain and function in patients with sacroiliac joint dysfunction it was concluded that MET is an effective tool in the management of sacroiliac dysfunction.<ref>Joshi R, Rathi M, Khandare S, Palekar TJ. [https://www.researchgate.net/publication/301339193_Effects_of_muscle_energy_technique_on_pain_and_disability_in_subjects_with_SI_joint_dysfunction Effect of muscle energy technique on pain and function in patients with sacroiliac dysfunction.] International Journal of Scientific Research and Education. 2017;5(6):6502-6.</ref>
* In an investigation on the effect of muscle energy technique (MET) on pain and function in patients with sacroiliac joint dysfunction, it was concluded that MET is an effective tool in the management of sacroiliac dysfunction.<ref>Joshi R, Rathi M, Khandare S, Palekar TJ. [https://www.researchgate.net/publication/301339193_Effects_of_muscle_energy_technique_on_pain_and_disability_in_subjects_with_SI_joint_dysfunction Effect of muscle energy technique on pain and function in patients with sacroiliac dysfunction.] International Journal of Scientific Research and Education. 2017;5(6):6502-6.</ref>
* Alkady et al (2017)<ref name=":1" /> investigated the efficacy of Mulligan mobilisation versus muscle energy techniques in patients with chronic sacroiliac joint dysfunction and concluded that Mulligan mobilisation was more effective than muscle energy technique.<ref name=":1" />
* Alkady et al (2017)<ref name=":1" /> investigated the efficacy of Mulligan mobilisation versus muscle energy techniques in patients with chronic sacroiliac joint dysfunction and concluded that Mulligan mobilisation was more effective than muscle energy technique.<ref name=":1" />
* A study on the effect of muscle energy technique (MET) on pain and disability in patients with SIJ dysfunction indicated that MET and mobilisation are both effective in the treatment of chronic low back pain due to SIJ dysfunction.<ref>Sharma D, Sen S. [https://www.researchgate.net/publication/301339193_Effects_of_muscle_energy_technique_on_pain_and_disability_in_subjects_with_SI_joint_dysfunction Effects of muscle energy technique on pain and disability in subjects with SI joint dysfunction.] Int J Physiother Res. 2014;2(1):305-11.</ref>
* A study on the effect of muscle energy technique (MET) on pain and disability in patients with SIJ dysfunction indicated that MET and mobilisation are both effective in the treatment of chronic low back pain due to SIJ dysfunction.<ref>Sharma D, Sen S. [https://www.researchgate.net/publication/301339193_Effects_of_muscle_energy_technique_on_pain_and_disability_in_subjects_with_SI_joint_dysfunction Effects of muscle energy technique on pain and disability in subjects with SI joint dysfunction.] Int J Physiother Res. 2014;2(1):305-11.</ref>
* In a comparative analysis of muscle energy technique (MET + corrective exercise) and conventional physiotherapy (TENS + corrective exercise) in patients with SIJ dysfunction, it was reported that along with corrective exercises, MET is moderately significant over conventional physiotherapy in improving function and decreasing pain.<ref>Dhinkaran M, Sareen A, Arora T. [https://www.researchgate.net/publication/283502940_Comparative_analysis_of_muscle_energy_techniques_and_conventional_physiotherapy_in_treatment_of_Sacroilliac_Joint_Dysfunction'-Indian_Journal_of_Physiotherapy_and_Occupational_Therapy_October_-_Decemb Comparative analysis of muscle energy technique and conventional physiotherapy in treatment of sacroiliac joint dysfunction]. Indian Journal of Physiotherapy and Occupational Therapy. 2011 Oct;5(4):127-30.</ref>  
* In a comparative analysis of muscle energy technique (MET + corrective exercise) and conventional physiotherapy (TENS + corrective exercise) in patients with SIJ dysfunction, it was reported that along with corrective exercises, MET is moderately significant over conventional physiotherapy in improving function and decreasing pain.<ref>Dhinkaran M, Sareen A, Arora T. [https://www.researchgate.net/publication/283502940_Comparative_analysis_of_muscle_energy_techniques_and_conventional_physiotherapy_in_treatment_of_Sacroilliac_Joint_Dysfunction'-Indian_Journal_of_Physiotherapy_and_Occupational_Therapy_October_-_Decemb Comparative analysis of muscle energy technique and conventional physiotherapy in treatment of sacroiliac joint dysfunction]. Indian Journal of Physiotherapy and Occupational Therapy. 2011 Oct;5(4):127-30.</ref>  
From this evidence it may be hypothesised that Muscle Energy Technique with conventional or other physiotherapy treatment may be helpful in reducing pain and improving function in patients with sacroiliac joint dysfunction, but further research is necessary and the current quality of research is low.<ref name=":2" />
From this evidence, it may be hypothesised that Muscle Energy Technique with conventional or other physiotherapy treatment may be helpful in reducing pain and improving function in patients with sacroiliac joint dysfunction, but further research is necessary and the current quality of research is low.<ref name=":2" />


=== Pregnancy-related Pelvic Girdle Pain ===
=== Pregnancy-related Pelvic Girdle Pain ===
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* Beales et al (2015)<ref name=":3">Beales D, Hope JB, Hoff TS, Sandvik H, Wergeland O, Fary R. Current practice in management of pelvic girdle pain amongst physiotherapists in Norway and Australia. Manual therapy. 2015 Feb 1;20(1):109-16.</ref> reported that physiotherapists use MET as an alternative to exercises performed solely by the patient in the management of Pregnancy-related Pelvic Girdle Pain.<ref name=":3" />   
* Beales et al (2015)<ref name=":3">Beales D, Hope JB, Hoff TS, Sandvik H, Wergeland O, Fary R. Current practice in management of pelvic girdle pain amongst physiotherapists in Norway and Australia. Manual therapy. 2015 Feb 1;20(1):109-16.</ref> reported that physiotherapists use MET as an alternative to exercises performed solely by the patient in the management of Pregnancy-related Pelvic Girdle Pain.<ref name=":3" />   
* Licciardone et al (2010) investigated the effect of MET as part of a multimodal treatment regime on pregnant women with lumbopelvic pain, but only reported a weak effect (0.27 for pain using a VAS).<ref>Licciardone JC, Buchanan S, Hensel KL, King HH, Fulda KG, Stoll ST. Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial. American journal of obstetrics and gynecology. 2010 Jan 1;202(1):43-e1.</ref>  
* Licciardone et al (2010) investigated the effect of MET as part of a multimodal treatment regime on pregnant women with lumbopelvic pain, but only reported a weak effect (0.27 for pain using a VAS).<ref>Licciardone JC, Buchanan S, Hensel KL, King HH, Fulda KG, Stoll ST. Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial. American journal of obstetrics and gynecology. 2010 Jan 1;202(1):43-e1.</ref>  
* More recently Ceprnja and Gupta (2019)<ref name=":4">Ceprnja D, Gupta A. Does muscle energy technique have an immediate benefit for women with pregnancy‐related pelvic girdle pain?. Physiotherapy Research International. 2019 Jan;24(1):e1746.</ref> investigated the immediate effectiveness of a MET in the management of pain in women with PPGP within a single session of physiotherapy. The study participants were treated with a MET and sham transcutaneous electrical nerve simulation in a randomised order. The primary outcome measures in this study were the self-reporting of pain using a VAS and function using the Timed Up and Go. The results showed no statistically significant difference between scores for the VAS and the Timed Up and Go, following the use of MET, sham TENS or standard care which was recorded after each intervention. There was however, a statistically significant improvement in pain and function from baseline compared with each time of measurement thereafter. The authors suggest that the improvements may have been due to a placebo effect with the knowledge that care is being provided, mechanical unloading during the session or familiarisation with the test procedures.<ref name=":4" />  
* More recently Ceprnja and Gupta (2019)<ref name=":4">Ceprnja D, Gupta A. Does muscle energy technique have an immediate benefit for women with pregnancy‐related pelvic girdle pain?. Physiotherapy Research International. 2019 Jan;24(1):e1746.</ref> investigated the immediate effectiveness of a MET in the management of pain in women with PPGP within a single session of physiotherapy. The study participants were treated with a MET and sham transcutaneous electrical nerve stimulation in a randomised order. The primary outcome measures in this study were the self-reporting of pain using a VAS and function using the Timed Up and Go test. The results showed no statistically significant difference between scores for the VAS and the Timed Up and Go test, following the use of MET, sham TENS or standard care which was recorded after each intervention. There was, however, a statistically significant improvement in pain and function from baseline compared with each time of measurement thereafter. The authors suggest that the improvements may have been due to a placebo effect with the knowledge that care is being provided, mechanical unloading during the session or familiarisation with the test procedures.<ref name=":4" />  


== Examples of Muscle Energy Technique in Pelvic Girdle Region ==
== Examples of Muscle Energy Technique in Pelvic Girdle Region ==

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Introduction[edit | edit source]

Physiotherapists have a range of available options to address pelvic girdle dysfunction. Some of these methods include[1]:

Manual therapy has been utilised and shown to be effective in the treatment of various musculoskeletal conditions.[2] Specifically, for the treatment of sacroiliac joint dysfunction, which is part of pelvic girdle dysfunction, manual therapy techniques are frequently incorporated in the treatment. Some of these techniques are manipulation, muscle energy technique (MET), McKenzie method, Maitland’s mobilisation, and Mulligan’s mobilisation.[3][4] Of these techniques, MET is a popular technique used among physiotherapists and osteopaths. Muscle energy techniques are used to treat soft tissue, mobilise joints, stretch tight muscles and fascia, reduce pain and improve circulation and lymphatic drainage.[5] Muscle energy technique can be defined as “a manual treatment in which a patient produces a contraction in a precisely controlled position and direction against a counterforce applied by a manual therapist.”[5] MET works on two basic principles i.e. post isometric relaxation and reciprocal inhibition.[6]

For more information read this Physiopedia Page: Muscle Energy Technique

Evidence for Muscle Energy Technique in the Management of Pelvic Girdle Dysfunction[edit | edit source]

Sacroiliac Joint Dysfunction[edit | edit source]

  • In an investigation on the effect of muscle energy technique (MET) on pain and function in patients with sacroiliac joint dysfunction, it was concluded that MET is an effective tool in the management of sacroiliac dysfunction.[7]
  • Alkady et al (2017)[4] investigated the efficacy of Mulligan mobilisation versus muscle energy techniques in patients with chronic sacroiliac joint dysfunction and concluded that Mulligan mobilisation was more effective than muscle energy technique.[4]
  • A study on the effect of muscle energy technique (MET) on pain and disability in patients with SIJ dysfunction indicated that MET and mobilisation are both effective in the treatment of chronic low back pain due to SIJ dysfunction.[8]
  • In a comparative analysis of muscle energy technique (MET + corrective exercise) and conventional physiotherapy (TENS + corrective exercise) in patients with SIJ dysfunction, it was reported that along with corrective exercises, MET is moderately significant over conventional physiotherapy in improving function and decreasing pain.[9]

From this evidence, it may be hypothesised that Muscle Energy Technique with conventional or other physiotherapy treatment may be helpful in reducing pain and improving function in patients with sacroiliac joint dysfunction, but further research is necessary and the current quality of research is low.[6]

Pregnancy-related Pelvic Girdle Pain[edit | edit source]

  • Muscle energy techniques have been found to be more effective than mobilization techniques in females with post-partum low back pain due to sacroiliac joint dysfunction.[10]
  • Beales et al (2015)[11] reported that physiotherapists use MET as an alternative to exercises performed solely by the patient in the management of Pregnancy-related Pelvic Girdle Pain.[11]
  • Licciardone et al (2010) investigated the effect of MET as part of a multimodal treatment regime on pregnant women with lumbopelvic pain, but only reported a weak effect (0.27 for pain using a VAS).[12]
  • More recently Ceprnja and Gupta (2019)[13] investigated the immediate effectiveness of a MET in the management of pain in women with PPGP within a single session of physiotherapy. The study participants were treated with a MET and sham transcutaneous electrical nerve stimulation in a randomised order. The primary outcome measures in this study were the self-reporting of pain using a VAS and function using the Timed Up and Go test. The results showed no statistically significant difference between scores for the VAS and the Timed Up and Go test, following the use of MET, sham TENS or standard care which was recorded after each intervention. There was, however, a statistically significant improvement in pain and function from baseline compared with each time of measurement thereafter. The authors suggest that the improvements may have been due to a placebo effect with the knowledge that care is being provided, mechanical unloading during the session or familiarisation with the test procedures.[13]

Examples of Muscle Energy Technique in Pelvic Girdle Region[edit | edit source]

In the course on Pelvic Girdle Dysfunction by Deborah Riczo, she describes an algorithm of three exercises that she uses with great success in her patients with pelvic girdle dysfunction. You can access the course here.

Resources[edit | edit source]

  • bulleted list
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or

  1. numbered list
  2. x

References[edit | edit source]

  1. ↑ Al-Subahi M, Alayat M, Alshehri MA, Helal O, Alhasan H, Alalawi A, Takrouni A, Alfaqeh A. The effectiveness of physiotherapy interventions for sacroiliac joint dysfunction: a systematic review. Journal of physical therapy science. 2017;29(9):1689-94.
  2. ↑ Clar C, Tsertsvadze A, Hundt GL, Clarke A, Sutcliffe P. Clinical effectiveness of manual therapy for the management of musculoskeletal and non-musculoskeletal conditions: systematic review and update of UK evidence report. Chiropractic & manual therapies. 2014 Dec 1;22(1):12.
  3. ↑ Bindra S. A study on the efficacy of muscle energy technique as compared to conventional therapy on lumbar spine range of motion in chronic low back pain of sacroiliac origin. Human Biol Rev. 2013;2(4):13.
  4. ↑ 4.0 4.1 4.2 Alkady SM, Kamel RM, AbuTaleb E, Lasheen Y, Alshaarawy FA. Efficacy of mulligan mobilization versus muscle energy technique in chronic sacroiliac joint dysfunction. International Journal of Physiotherapy. 2017 Oct 1;4(5):311-8.
  5. ↑ 5.0 5.1 Thomas E, Cavallaro AR, Mani D, Bianco A, Palma A. The efficacy of muscle energy techniques in symptomatic and asymptomatic subjects: a systematic review. Chiropractic & Manual Therapies. 2019 Dec 1;27(1):35.
  6. ↑ 6.0 6.1 Kansagara PR, Patel JK. Muscle Energy Technique for Sacroiliac Joint Dysfunction--An Evidence Based Practice. Indian Journal of Physiotherapy & Occupational Therapy. 2019 Apr 1;13(2).
  7. ↑ Joshi R, Rathi M, Khandare S, Palekar TJ. Effect of muscle energy technique on pain and function in patients with sacroiliac dysfunction. International Journal of Scientific Research and Education. 2017;5(6):6502-6.
  8. ↑ Sharma D, Sen S. Effects of muscle energy technique on pain and disability in subjects with SI joint dysfunction. Int J Physiother Res. 2014;2(1):305-11.
  9. ↑ Dhinkaran M, Sareen A, Arora T. Comparative analysis of muscle energy technique and conventional physiotherapy in treatment of sacroiliac joint dysfunction. Indian Journal of Physiotherapy and Occupational Therapy. 2011 Oct;5(4):127-30.
  10. ↑ Sachdeva S, Kalra S, Pawaria S. Effects of Muscle Energy Technique versus Mobilization on Pain and Disability in Post-Partum Females with Sacroiliac Joint Dysfunction. Indian Journal of Health Sciences and Care. 2018;5(1):11-7.
  11. ↑ 11.0 11.1 Beales D, Hope JB, Hoff TS, Sandvik H, Wergeland O, Fary R. Current practice in management of pelvic girdle pain amongst physiotherapists in Norway and Australia. Manual therapy. 2015 Feb 1;20(1):109-16.
  12. ↑ Licciardone JC, Buchanan S, Hensel KL, King HH, Fulda KG, Stoll ST. Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial. American journal of obstetrics and gynecology. 2010 Jan 1;202(1):43-e1.
  13. ↑ 13.0 13.1 Ceprnja D, Gupta A. Does muscle energy technique have an immediate benefit for women with pregnancy‐related pelvic girdle pain?. Physiotherapy Research International. 2019 Jan;24(1):e1746.
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