Comparando o efeito da liberação miofascial e técnica de energia muscular no ângulo craniovertebral e cefaleia em pacientes com cefaleia tensional / Comparing the effect of myofascial release and muscle energy technique on craniovertebral angle and headache in tension-type headache patients

INTRODUÇÃO: Cefaleias tensionais podem ser induzidas pela postura da cabeça para frente, e há uma grande quantidade de evidências disponíveis para o manejo de cefaleias crônicas. Os dados corroboram uso de abordagens de terapia manual para gerenciar dores de cabeça do tipo tensional. Devido à postura anterior da cabeça, a região do músculo suboccipital torna-se curta, resultando em aumento da lordose e dor no pescoço. Pacientes com uma postura de cabeça ainda mais para frente têm um ângulo craniovertebral menor, o que, por sua vez, causa cefaleia do tipo tensional. OBJETIVO: O objetivo deste estudo é comparar os efeitos da terapia de liberação miofascial (LMF) e da técnica de energia muscular (TEM) com exercícios gerais do pescoço no ângulo crânio-vertebral e na cefaleia em pacientes com cefaleia do tipo tensional. MÉTODOS: No total, 75 indivíduos com cefaleia tensional e sensibilidade muscular suboccipital foram recrutados e randomizados cegamente em três grupos: o grupo LMF, o grupo TEM e o grupo controle (25 indivíduos em cada grupo). Um ângulo pré-crânio vertebral foi obtido por método fotográfico e um questionário de índice de incapacidade pré-cefaleia foi preenchido. O grupo LMF recebeu liberação crânio-basal na região suboccipital com exercícios de pescoço; o grupo TEM recebeu relaxamento pós-isométrico na região suboccipital com exercícios, e o grupo controle recebeu apenas exercícios por 2 semanas. Após duas semanas, o ângulo pós-craniano e o questionário de cefaleia foram coletados e medidos. RESULTADOS: O ângulo crânio-vertebral e o índice de cefaleia mostraram melhora significativa nos grupos TEM e LMF. Não houve diferença significativa quando os grupos TEM e LMF foram comparados. Quando comparados com o grupo controle, tanto o TEM quanto o LMF apresentaram aumento significativo do ângulo crânio-vertebral. Houve melhora significativa no índice de cefaleia após TEM, LMF ou exercício de rotina no pescoço. CONCLUSÃO: Comparado ao grupo controle, o LMF apresenta melhores resultados do que o TEM no ângulo crânio-vertebral e cefaleia.

INTRODUCTION: Tension headaches can be induced by forward head posture, and there is a wealth of evidence available for managing chronic headaches. The data support the use of manual therapy approaches to manage tension-type headaches. Because of the forward head posture, the suboccipital muscle region becomes short, resulting in an increase in lordosis and neck pain. Patients with an even more forward head posture have a smaller craniovertebral angle, which in turn causes tension-type headache. OBJECTIVE: This study aims to compare the effects of Myofascial release therapy (MFR) and Muscle energy technique (MET) with general neck exercises on the craniovertebral angle and headache in tension-type headache patients. METHODS: In total, 75 subjects with tension-type headache and suboccipital muscle tenderness were recruited and randomized blindly into three groups: the MFR group, the MET group, and the control group (25 subjects in each group). A pre-craniovertebral angle was taken by photographic method, and a pre-headache disability index questionnaire was filled in. The MFR group receives cranio-basal release in the suboccipital region with neck exercises, the MET group receives post­isometric relaxation in the suboccipital region with exercises, and the control group receives only exercises for two weeks. After two weeks, the postcranial angle and the headache questionnaire were taken and measured. RESULTS: Craniovertebral angle and headache index showed significant improvement in both the MET and MFR groups. There was no significant difference when MET and MFR groups were compared. When compared with the control group, both MET and MFR showed a significant increase in craniovertebral angle. There was a significant improvement in the headache index following MET, MFR, or routine neck exercise. CONCLUSION: Compared to the control group, MFR shows better results than MET on craniovertebral angle and headache.

Effect of Muscle Energy Technique on Piriformis Tightness in Chronic Low Back Pain with Radiation

Low back pain is a common condition in India. 90 % of Indian population experience low back pain at least once in their lifetime. Studies show that 98 % low back pain is because of mechanical disorder of spine. Piriformis tightness is one of the most misdiagnosed causes for low back pain or sacroiliac joint dysfunction. Various manual therapy approaches have been studied for reducing muscle tightness. We wanted to assess the effectiveness of muscle energy technique that is post-isometric relaxation technique on piriformis muscle tightness, its effectiveness in relieving low back pain with radiation, and increasing range of motion. METHODS60 patients were included in the study as per inclusion and exclusion criteria from Ravi Nair Physiotherapy College, Sawangi Meghe, and were randomly assigned in to two groups. The duration of study was 12 days (6 sessions / week) and follow up was taken on 27th day. Subjects in muscle energy technique experimental group were treated with post isometric relaxation technique (PIR), subjects in control group were given simple passive stretching of piriformis. All subjects were educated about proper ergonomics. RESULTSBoth interventions post isometric relaxation and simple stretching techniques were effective in terms of pain reduction, ROM (Range of Motion) improvement, piriformis tightness, disability with p < 0.05 with post isometric relaxation technique superseding simple stretching. Moreover, post isometric relaxation technique in muscle energy technique had sustained effects on follow-up in terms of relieving pain, disability and tightness for longer period of time. CONCLUSIONSMuscle energy technique gives immediate relief of pain improving ROM and decreasing tightness of piriformis and disability and has longer lasting effects.

Efficacy Of Muscle Energy Techniques As An Adjunct With Mulligans Mobilization In Adhesive Capsulitis Of Shoulder

Background: Adhesive Capsulitis most commonly referred to as ”Frozen Shoulder” is an insidious Painful Condition with progressive and gradual restriction of all planes of movement in the glenohumeral joint. Evidence shows Mulligan's mobilization with movement (MWM) mobilization technique is more effective than muscle energy techniques (MET) and conventional therapy in improving shoulder function. Therefore the present study intends to determine the efficacy of muscle energy techniques along with Mulligan’s mobilization with movement, in adhesive capsulitis of the shoulder joint. Methods: The present randomized controlled trial was conducted among 30 subjects including both sex groups aged between 40-60 years diagnosed with adhesive capsulitis of the shoulder. They were randomly assigned into two groups with 15 subjects each. Group A received Mulligan’s mobilization alone, and Group B received Mulligan’s mobilization along with MET. Both the groups received the treatment protocol six times a week for three weeks. Pre and post evaluation of pain was done by using the short-form McGill pain questionnaire, range of motion by the Universal Goniometer and the functional disability by using Shoulder Pain and Disability Index (SPADI). Results: There was a significant improvement (P<0.05) in pre and post-intervention levels in both groups. Between groups analysis, the results are: a range of motion improved 30%, and the values are flexion with a p-value of 0.010, for abduction, internal and external rotations with a p-value of 0.000 except for extension with a p-value of 0.109. On comparison of SPADI using Mann Whitney U test, it showed 50% improvement with a significant difference with a p-value of 0.001 and McGill improved for more than 70% with a p-value of 0.000. Conclusion: Mulligan’s mobilization along with Muscle Energy Technique is found to be more effective in improving quality of life among subjects with adhesive capsulitis of shoulder than Mulligan’s mobilization alone.

The Effectiveness of Muscle Energy Technique and Mobilization to Improve the Shoulder Range of Motion in Frozen Shoulder

Background: Frozen shoulder is defined as an idiopathic condition of the shoulder characterized by the spontaneous onset of pain in the shoulder with restriction of movement in every direction. Prevalence of frozen shoulder was found to be 3.06% in a regional community based study. Frozen shoulder is a discrete clinical diagnosis for painful restriction of shoulder motion that results from capsular fibrosis. It is usually present in age group between 40-60 years. Muscle Energy (MET) technique is very much beneficial in this condition. Muscle energy techniques are class of soft tissue osteopathic manipulation consisting of isometric contraction design to improve musculoskeletal function and reduce pain. MET combined along with scapular Mobilization gives much better effect. So, the aim of the study is to check the effectiveness of muscle energy technique and mobilization to improve shoulder range of motion frozen shoulder. Materials and methods: 60 patients were included in the study which was divided into two groups; Group A and Group B, 30 patients in each group. Subjects were randomly selected and assigned to each group. Pre-test measurements of the patient were done with the help of two measures VAS, Shoulder pain and disability index (SPADI) and Goniometer was used for assessing range motion of shoulder movements for each group. The Subjects in Group-A were given muscle energy technique. The Subjects in Group-B were given maitland technique. Then the Result analysis was done. Sreenivasu Kotagiri, Neeti Mathur, Vadana, Gayathri Balakavi, Anup Kumar Songa. The Effectiveness of Muscle Energy Technique and Mobilization to Improve the Shoulder Range of Motion in Frozen Shoulder. IAIM, 2019; 6(10): 64-73. Page 65 Results: On comparing Group A and Group B for post-treatment VAS and SPADI score, results showed a significant difference (p=0.001). The overall study proved that MET is beneficial in improving Pain and decreasing the disability level. Conclusion: The analysis obtained indicated that Group A (Muscle energy Technique) showed more significant improvement when compared to Group B (Mobilization).

Therapeutic Observation of Electroacupuncture plus Muscle Energy Technique for Upper Crossed Syndrome / 上海针灸杂志

Objective To observe the clinical efficacy of electroacupuncture plus muscle energy technique (MET) in treating upper crossed syndrome (UCS).Method Forty UCS patients were randomized into a treatment group and a control group, 20 cases in each group. The control group was intervened by electroacupuncture, while the treatment group was treated with MET to relax and regulate the cervical and shoulder muscles in addition to electroacupuncture. The two groups were treated once a day, for 3 weeks in total. The Visual Analogue Scale (VAS), Neck Disability Index (NDI), Hamilton Depression Scale (HAMD) and Pittsburgh Sleep Quality Index (PSQI) were observed before and after the intervention, and the clinical efficacies were compared between the two groups.Result After the treatment, the VAS, NDI, HAMD, and PSQI scores were significantly changed in both groups (P<0.05). The scores of all parameters in the treatment group were significantly different from those in the control group (P<0.05). The total effective rate was 95.0% in the treatment group versus 85.0% in the control group, and the between-group difference was statistically significant (P<0.05).Conclusion Electroacupuncture plus MET can improve the pain, depression, sleep disorder, and the quality of life of UCS patients.

Effect of Spencer Muscle Energy Technique on pain and functional disability in cases of adhesive capsulitis of shoulder joint

Background: Adhesive capsulitis is characterized by a painful, gradual loss of both active and passive glenohumeral motion resulting from progressive fibrosis and ultimate contracture of the glenohumeral joint capsule. Patients with Adhesive capsulitis have difficulties in everyday activities (dressing, grooming, and performing overhead reaching activities and so on for a period of several months to several years) and shoulder pain disturbing sleep at night on the affected side. Muscle energy technique helps in increasing shoulder range of motion. MET is unique in its application as the client provides the initial effort while the practitioner facilitates the process. One of the main uses of this method is to normalize joint range, rather than increase flexibility, and techniques can be used on any joints with restricted Range of Motion (ROM) identified during the passive assessment. So the study was done to evaluate the effect of MET on adhesive capsulitis. Aim: This study was designed to evaluate the effect of Spencer MET on Pain and Functional Disability in Adhesive Capsulitis of Shoulder joint. Materials and methods: An Interventional study was conducted at Out Patient Department of General Hospitals in Ahmedabad. The subjects were selected according to inclusion criteria. The Pretraining outcome of Pain (VAS) and SPADI was taken and then subjects were divided into two groups’ one case and other control. Group A: was given conventional treatment along with MET for adhesive capsulitis. Group B: not getting any additional training for adhesive capsulitis other than Contractor ES, Agnihotri DS, Patel RM. Effect of Spencer Muscle Energy Technique on pain and functional disability in cases of adhesive capsulitis of shoulder joint. IAIM, 2016; 3(8): 126-131. Page 127 conventional treatment. The study was conducted for 6 months and treatment was given for 4 weeks 3 days a week and once a day. After 4 weeks post treatment outcome data were analysed for results. Results: Data was analysed using SPSS software version 20 and Microsoft Excel 2007. In case and control both pain (VAS), SPADI showed significant improvement (p; 0.05). But there was more significant improvement in case as compared to control group in SPADI but not in VAS. Conclusion: The Spencer MET is more effective increasing functional ability in patients with adhesive capsulitis as compared to conventional treatment.

Effect of Muscle Energy Technique on Pain Perception and Functional Disability of Women with Postnatal Low Back Pain.

Aims: To determine the effect of muscle energy technique (MET) on postnatal low back pain. Place and Duration of Study: Department of obstetrics and gynecology, Ain Shams University Hospital, and Outpatient Clinic of Faculty of Physical Therapy, Cairo University, between January and May 2013. Methodology: This study was carried out upon forty women diagnosed as postnatal low back pain. They were selected from outpatient clinics of gynecology of Ain Shams University Hospital, Cairo University. Their age ranged from 25-35 years, BMI<30kg/ m², they were all after normal vaginal delivery using local anaesthesia. Patients with radicular pain distal to the knee, previous low back surgery, low back pathology diagnosed by a physician, spondylolisthesis and chronic low back pain were excluded from the study. They were randomly assigned into two equal groups (A& B). Group (A) consisted of twenty subjects, with an average age 29.2±1.9Yrs, and BMI 27.28±2.1kg/m2 who received MET. Group (B) consisted of twenty patients, with an average age 28.58±2.2Yrs, and BMI 28.92±0.7kg/m2 who received sham technique. A hot pack was used for 15 minutes for both groups (A&B) before the treatment. This is to decrease pain, muscle spasm, and provide vasodilatation of the blood vessels supplying the area. The MET was applied three times per week for four weeks for patients in group A, and the sham technique was applied three times per week for four weeks for subjects of group (B). Assessment of all subjects in both groups (A&B) was carried out before and after the treatment program using Visual Analogue Scale (VAS) and Stratford Back Pain Functional Scale (BPFS). Results: There was a statistically highly significant decrease (P<0.001) in VAS scores and a statistically highly significant increase (P<0.001) in BPFS, after 4 weeks of the treatment program for group A than group B. Conclusion: Muscle energy technique is an effective and safe method in alleviating postnatal low back pain.

Effects of Western Massage Combined with Muscle Energy Technique on Masticatory Muscle Disorders / 中国康复理论与实践

Objective To observe the effect of the Western massage combined with muscle energy technique on masticatory muscle dis-orders. Methods 58 patients with masticatory muscle disorders were randomly divided into control group (n=29) and observation group (n=29). The control group accepted ultrashort wave therapy, while the observation group accepted the Western massage and muscle energy tech-nique. They were assessed with Visual Analogue Scale (VAS) of pain and Friction index of the temporomandibular joint (TMJ) before and 4 weeks after treatment. Results The scores of VAS and Friction index of the TMJ decreased in both groups (P<0.001), and decreased more in the observation group than in the control group (P<0.001). Conclusion The combination of Western massage and muscle energy technique is advanced for masticatory muscle disorders.

Effects of muscle energy technique combined with joint mobilization in the management of frozen shoulder / 中华物理医学与康复杂志

Objective To observe the therapeutic effects of muscle energy technique combined with joint mobilization on frozen shoulder.Methods Thirty-six patients with frozen shoulder were randomly assigned to:group A (treated with muscle energy technique plus joint mobilization),group B (treated with passive stretching with joint mobilization),and group C (treated with joint mobilization merely),and each had 12 patients.All the patients were treated accordingly for 3 times a week,totally for 4 weeks.The American Shoulder and Elbow Surgeons evaluation system (ASES) was adopted to evaluate clinical effects before and at the end of treatment.Results After 4 weeks of treatment,all patients' ASES scores were improved significantly (P ＜ 0.05).The improvement in the shoulder score index and shoulder range of motion were to a significantly better extent in group A than in the other two groups.Conclusion Muscle energy technique plus joint mobilization could effectively relieve pain increase the shoulder ROM and improve performance in activities of daily living in patients suffering from frozen shoulder.

Usefulness of Manual Medicine Therapy in Adhesive Capsulitis of Shoulder

OBJECTIVE: The purpose of this study was to determine the usefulness of manual medicine therapy in adhesive capsulitis of shoulder. METHOD: Twelve patients with adhesive capsulitis of shoulder were treated with the muscle energy technique of Greenman in manual medicine therapy. The muscle energy technique of Greenman was repeated 6 times for each subject. The therapeutic effect of manual medicine therapy was assessed by the shoulder range of motion (ROM) and visual analogue scale (VAS) before and after the treatment. Two patients took the fluoroscopic examination before and after the treatment. RESULTS: After the manual medicine therapy, active range of shoulder motion were increased by 30.0degrees in forward flexion, by 21.2degrees in abduction, by 11.2degrees in external rotation, and by 18.7degrees in internal rotation, respectively. The visual analogue scale was decreased after treatment. None of the subjects complained pain during treatment. The mobility of shoulder joint was improved and the rhythm of scapulohumeral joint was restored. CONCLUSION: The manual medicine therapy is an effective, tolerable and noninvasive treatment method for the painful adhesive capsulitis of shoulder.