UPPER LIMB MUSCLE ENERGY TECHNIQUES
REGION	SOMATIC DYSFUNCTION	TREATMENT POSITION	PATIENT INSTRUCTION
Sternoclavicular (SC) joint	Superior medial clavicle	Abduct shoulder to 45º, extend and internally rotate into barrier	Lift upper extremity toward ceiling (flexion) while you (physician) resist
	Inferior medial clavicle	Flex shoulder to 90º with elbow extended	Retract upper extremity while you resist
Acromioclavicular (AC) joint	External rotation	Gently grasp AC joint to stabilize, internally rotate the shoulder	Externally rotate shoulder while you resist
	Internal rotation	Gently grasp AC joint to stabilize, externally rotate the shoulder	Internally rotate shoulder while you resist
Radial head*	Posterior radial head (pronation)	Supinate forearm, grasp posterior to radial head and apply anterior pressure when engaging each new barrier	Pronate forearm while you resist
	Anterior radial head (supination)	Pronate forearm, grasp anterior to radial head and apply posterior pressure when engaging each new barrier	Supinate forearm while you resist
Radiocarpal (wrist) joint	Flexion	Extend wrist	Flex wrist
	Extension	Flex wrist	Extend wrist while you resist
	Abduction	Adduct wrist	Abduct wrist while you resist
	Adduction	Abduct wrist	Adduct wrist while you resist

* radial head moves posteriorly with pronation and anteriorly with supination

Spencer technique of the shoulder involves engaging restrictive barriers and is usually passive. If a significant barrier is encountered, muscle energy can be used to help reduce this restriction by having the patient move directly opposite the direction of the Spencer technique step. Spencer technique can be used to treat general shoulder somatic dysfunction, bursitis, tenosynovitis, and adhesive capsulitis.

The patient lies in the lateral recumbent position with the shoulder to be treated facing up. A pillow is placed under the patient's head to remove drag on the shoulder from the cervical and shoulder girdle musculature.

Stages

• 1: Extension
• 2: Flexion
• 3: Circumduction with compression
• 4. Circumduction with traction
• 5a: Abduction
• 5b: Adduction / internal rotation
• 6: Internal rotation
• 7: Distraction in abduction ("Pump")