Introduction to muscle energy

Definitions & Key takeaways

According to Education Council on Osteopathic Principles (ECOP), muscle energy is defined as a form of osteopathic manipulative diagnosis and direct treatment in which the patient's muscles are actively used on request, from a precisely controlled position, in a specific direction, and against a distinctly executed counterforce.

During this technique, the therapist's hands apply pressure and movement to the muscles and other soft tissues of the body to restore balance and function. Muscle energy is used to treat a wide variety of conditions, including sports injuries, chronic pain, postural problems, and tension headaches.

Introduction to OMM

Introduction to muscle energy

WHAT IS MUSCLE ENERGY?
Muscle energy is defined by the Education Council on Osteopathic Principles (ECOP) as “a form of osteopathic manipulative diagnosis and direct treatment in which the patient’s muscles are actively used on request, from a precisely controlled position, in a specific direction, and against a distinctly executed counterforce.”

Muscle energy is a direct and active technique, meaning it engages a restrictive barrier and requires the patient’s participation in relieving the somatic dysfunction. The goal of muscle energy is to reduce pain and help normalize range of motion within a restricted joint or muscle by relieving tension within the surrounding muscle groups.
TYPES OF MUSCLE ENERGY

There are two types of muscle energy: post-isometric relaxation and reciprocal inhibition. 

For post-isometric relaxation, the patient is instructed to move away from the restrictive barrier, whereas for reciprocal inhibition, the patient is instructed to move toward the restrictive barrier. Post-isometric relaxation is much more commonly used.
STEPS OF MUSCLE ENERGY
  1. Diagnose the somatic dysfunction
  2. Position patient to their restrictive barrier
  3. Instruct patient to move away from the barrier (or toward it if using reciprocal inhibition)
  4. Resist patient’s force for 3–5 seconds
  5. Instruct patient to stop their force and allow for tissue relaxation
  6. Position patient to “feather edge” of the new restrictive barrier
  7. Repeat 3–5 times until their somatic dysfunction improves or resolves
  8. Recheck patient’s pain and range of motion to assess success
HOW DOES MUSCLE ENERGY WORK?
Muscle energy achieves pain relief and muscle relaxation by utilizing specialized structures in the muscles called Golgi tendon organs and muscle spindles. The Golgi tendon organ is a proprioceptor that senses how much tension a muscle is exerting. The muscle spindle is a mechanoreceptor that senses changes in muscle length. Together, these units help manage muscle control and coordination.

When the Golgi tendon organ senses increased tension within a muscle belly, it responds by inhibiting the contraction of the respective (agonist) muscle group while activating contraction of the opposing (antagonist) group. A muscle spindle within the muscle belly is activated when it senses an increase in length, resulting in contraction of the agonist muscle and relaxation of the antagonist muscle.

Post-isometric relaxation takes advantage of the physiology pertaining to Golgi tendon organs, resulting in relaxation of hypertonic musculature. Reciprocal inhibition, on the other hand, takes advantage of the biomechanics behind muscle spindles and prevents overstretching of muscles via activation of the antagonist muscle.
Figure 1. The Golgi tendon organ's location and role in muscle inhibition. When the Golgi tendon organ senses increased tension within a muscle belly, it responds by inhibiting the contraction of the respective (agonist) muscle group while activating contraction of the opposing (antagonist) group.
Author: Arman Israelyan, OMS-III
Editor: Matt Lipinski, DO
Illustrator: Robyn Hughes, MScBMC
Editor: Robyn Hughes, MScBMC