Today’s OMM question involves a 34-year old patient who’s experiencing neck pain. What’s the optimal way to set up a muscle energy treatment for her cervical spine somatic dysfunctions?
A 34-year-old woman presents to your clinic with two weeks of neck pain. She describes a dull ache along the right side of the back of her neck. She has had no recent injuries. She has no past medical history. Her temperature is 37.7 ºC (99.9 ºF), pulse is 78/min, respirations are 14/min, blood pressure is 126/79 mmHg. On osteopathic structural exam, her occipitoatlantal (OA) joint has a deep right sulcus which evens out on flexion. Rotation of her atlantoaxial (AA) joint is restricted in rightward rotation. Her C4 vertebra is extended, sidebent left and rotated left.
Which of the following would be a correct way to set up a muscle energy treatment for her cervical spine somatic dysfunctions?
A. Engage her barrier by taking her OA joint into flexion, left sidebending and right rotation
B. Engage her barrier by taking her AA joint into left rotation
C. Engage her barrier by taking her AA joint into right rotation
D. Engage her barrier by taking her C4 into extension, left sidebending and left rotation
E. Engage her barrier by taking her C4 into extension, right side bending and right rotation
Scroll down for the correct answer!
The correct answer to today’s OMM Question is…
C. Engage her barrier by taking her AA joint into right rotation
Before we get to the Main Explanation, let’s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!
Incorrect answer explanations
The incorrect answers to today’s OMM Question are…
A. Engage her barrier by taking her OA joint into flexion, left sidebending and right rotation
Her OA joint is flexed, sidebent left and rotated right. Taking her into this position would be in her direction of freedom. In order to treat with muscle energy you would position her exactly opposite of this.
B. Engage her barrier by taking her AA joint into left rotation
She is restricted in rightward rotation, so her somatic dysfunction at the AA joint is leftward rotation. Placing her into leftward rotation here would engage her freedom of motion rather than her barrier.
D. Engage her barrier by taking her C4 into extension, left sidebending and left rotation
At C4 she is extended, sidebent left and rotated left. In order to treat with muscle energy you would position her exactly opposite of this in order to engage her barrier (restriction in motion).
E. Engage her barrier by taking her C4 into extension, right sidebending and right rotation
At C4 she is extended, sidebent left and rotated left. In order to treat with muscle energy you would place her into right sidebending and right rotation, as well as flexion rather than extension.
Main Explanation
Rotation and sidebending always go in opposite directions at the OA joint. For assessing the atlantoaxial (AA) joint, you flex the neck to engage the joint and then test only rotation. For the cervical spine, you also need to assess flexion/extension, sidebending and rotation. In the cervical spine, sidebending and rotation almost always occur to the same side.
When treating with muscle energy, remember to position the patient directly opposite of their somatic dysfunction (their freedom of motion), so as to engage their barrier (their restriction of motion). As you slowly engage the barrier for 3-5 seconds, instruct the patient to gently resist by returning their head toward neutral (i.e. moving it in the direction of their freedom of motion). Treatment of the AA joint with muscle energy involves only rotation in the neutral plane (though you test motion with the neck flexed to the joint).
→ Learn more about fibrous, cartilaginous, and synovial joints.
Major Takeaway
In order to treat with muscle energy, bring the patient to their barrier by placing them opposite of their somatic dysfunction. For treatment at the AA joint, keep the neck neutral, avoid sidebending, and rotate them opposite of their somatic dysfunction to engage their barrier.
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