Title: Bone Wizardry / OMM Mastery / 15.Muscle Energy
Tags: #BW_OMM::Technique::MET #BW_OMM::Type::Cloze BoneWizardry bonewizardry-free omm omt
On every note of this deck, unless a note says otherwise:
Review Links: - Bone Wizardry soft tissue techniques
- Practice: Muscle Energy QBank
Show outside sources
- StatPearls MET and counterstrain
- MET for thoracic restriction
- MET for exhaled ribs
- MET for sacral dysfunction

Q: [...]: a direct OMT technique where the patient voluntarily contracts targeted muscles on request, working against a steady counterforce held by the physician.
A: Muscle energy
Topic: Muscle Energy
Bone Wizardry Lock: Direct and active. The patient provides the contraction, the physician controls the barrier and holds the counterforce throughout.

Q: Muscle energy can be performed as an [...] or [...] technique.
A: active direct; active indirect
Comment: Most forms of muscle energy treatment are direct. Indirect is rarely used.
Topic: Muscle Energy
Bone Wizardry Lock: Nearly every clinical ME application is active direct. Active indirect appears on exams but is rarely used in practice.

Typical muscle energy treatment procedure:
1. Position so you engage the restrictive barrier
2. Have patient push against the opposing force
3. Maintain counterforce for 3-5 seconds
4. Relax and reposition
5. Recheck
Topic: Muscle Energy
Bone Wizardry Lock: The sequence: engage barrier, 3-5 second contraction, relax, take up slack to the new barrier, recheck. Three to five repetitions is standard. Each rep starts at the new barrier.

Q: Name 2 patient populations that muscle energy is contraindicated in:
1. [...]
2. [...]
A: Post-surgical; ICU
Topic: Muscle Energy
Bone Wizardry Lock: Post-surgical and ICU patients cannot safely generate the voluntary contraction ME requires. Those are your two hard stops.

Q: For treating the AA with muscle energy, you must position the patient's cervical spine at [...].
A: 45°
Topic: Muscle Energy
Bone Wizardry Lock: 45 degrees of cervical flexion locks out OA and isolates the AA joint. Wrong angle means you are treating the wrong level.

Q: To use muscle energy on the upper thoracic spine (T1-4), you use the [...] and [...] as a lever to induce motion at the dysfunctional segment.
A: head; neck
Topic: Muscle Energy
Bone Wizardry Lock: T1-4 lack a clean direct contact point, so the head and neck serve as a transmission lever down to the dysfunctional segment.

Q: With inhaled ribs (pump handle ribs), you perform muscle energy by [...] the patient down so that the tension is taken off the dysfunctional rib.
A: flexing
Q: With inhaled ribs (bucket handle ribs), you perform muscle energy by having the patient [...] for their [...] on the affected side.
A: reach; knee
Q: With inhalation rib SD, to perform muscle energy the physician follows the rib shaft into [...] with their hand during the [...] phase.
A: exhalation; expiratory
Comment: The patient is instructed to hold their breath at end-expiratory phase for 3-5 seconds. During this time the physician adjusts flexion/sidebending to the new restrictive barrier. Physician follows rib shaft into exhalation with their hand during the expiratory phase. On inhalation the physician resists inhalation motion of the rib.
Topic: Muscle Energy
Bone Wizardry Lock: Pump handle moves anterior-posterior, bucket handle moves laterally. Your setup position and the patient activation direction match which motion axis is restricted.

Q: With rib 1 in an exhalation dysfunction, the patient is instructed to place the [...] on the affected side across their [...] and tries to raise directly to the ceiling.
A: forearm; forehead
Q: With rib 2 in an exhalation dysfunction, the patient is instructed to turn their head [...] away from the dysfunctional side and lift their head to the ceiling.
A: 30°
Q: With rib 3-5 in an exhalation dysfunction, the patient is instructed to push the [...] of the affected side toward the opposite [...].
A: elbow; ASIS
Q: With rib 6-9 in an exhalation dysfunction, the patient is instructed to push their arm [...].
A: anteriorly
Q: With rib 10-12 in an exhalation dysfunction, the patient is instructed to [...] the arm.
A: adduct
Topic: Muscle Energy
Bone Wizardry Lock: Each rib group recruits a different muscle, so activation direction changes by group. Rib 1 uses forehead raise, rib 2 uses 30-degree head turn, ribs 3-5 go elbow to contralateral ASIS, ribs 6-9 push arm anterior, ribs 10-12 adduct.

Q: To use muscle energy to treat a unilateral sacral flexion, you position the patient in the [...] position.
A: prone
To use muscle energy to treat a right unilateral sacral flexion, you place your left hypothenar eminence on the patient's right ILA.
Q: To use muscle energy to treat a unilateral sacral flexion, while the patient holds their breath, you push [...] on the ILA and hold for [...] seconds.
A: anteriorly; 3-5
Topic: Muscle Energy
Bone Wizardry Lock: Prone, hypothenar on the ILA, push anterior during breath hold at end-expiration. The ILA is posterior when the sacrum is flexed, so that is your contact target.

Q: To use muscle energy to treat a unilateral sacral extension, you treat the patient in the [...] position.
A: prone
To use muscle energy to treat a right unilateral sacral extension, place your left hypothenar eminence on the patient's right sacral sulcus.
Q: To use muscle energy to treat a unilateral sacral extension, as the patient exhales and holds their breath, you push [...] and [...] on the superior [...].
A: anterior; caudad; sulcus
Topic: Muscle Energy
Bone Wizardry Lock: Still prone, but contact moves from the ILA up to the sacral sulcus. Push anterior and caudad during end-expiration to drive the superior sacral pole down.

Q: To use muscle energy to treat a left-on-left sacral torsion, you position the patient in the [...] on the [...] side with face down.
A: lateral Sims position; left
Q: To use muscle energy to treat a left-on-left sacral torsion, the patient lies on their [...] side (axis side [...]).
A: left; down
Q: To use muscle energy to treat a left-on-left sacral torsion, [...] patient's hips until motion is felt at the lumbosacral junction. Induce [...] sidebending and engage a [...] sacral oblique axis.
A: flex; left; left
Q: A left-on-left sacral torsion is known as a [...] sacral torsion.
A: forward
Topic: Muscle Energy
Bone Wizardry Lock: Left-on-left is a forward torsion. Axis side down and face down (lateral Sims). Flex hips to the LS junction, then induce left sidebending to engage the left oblique axis.

Q: To use muscle energy to treat a right-on-left sacral torsion, you position the patient in [...] [...] with face [...].
A: left; lateral recumbent; up
Q: To use muscle energy to treat a right-on-left sacral torsion, the patient lies on their [...] side (axis side [...]).
A: left; down
To use muscle energy to treat a right-on-left sacral torsion,
1. Grasp patient's left arm and pull through to rotate his torso to the right.
2. Flex the patient's hips until motion is felt at the lumbosacral junction.
3. Drop the patient's legs off the table to induce left sidebending and engage a left sacral oblique axis.
Q: A right-on-left sacral torsion is also known as a [...] sacral torsion.
A: backward
Topic: Muscle Energy
Bone Wizardry Lock: Right-on-left is a backward torsion. Left axis is still down but face is up. Rotate trunk right first, flex hips to LS junction, then drop legs off the table to induce left sidebending.

Q: To use muscle energy to treat a right anterior innominate, treat the patient in the [...] position.
A: supine
Q: To use muscle energy to treat a right anterior innominate, [...] the patient's right hip and knee until resistance is felt.
A: flex
Q: To use muscle energy to treat a right anterior innominate, instruct the patient to [...] their hip against your counterforce for 3-5 seconds.
A: extend
Topic: Muscle Energy
Bone Wizardry Lock: For a right anterior innominate, you load the hip into flexion until you reach the barrier, then have the patient push back toward extension. Three to five seconds of effort, then take up the new slack.

Q: To use muscle energy to treat a right posterior innominate, treat the patient in the [...] position.
A: supine
To use muscle energy to treat a right posterior innominate,
1. Drop the patient's right leg off the table until resistance is felt.
2. Stabilize the patient's left ASIS with your right hand.
3. instruct the patient to flex their hip against your counterforce for 3-5 seconds.
Topic: Muscle Energy
Bone Wizardry Lock: For a right posterior innominate, you drop the leg into extension off the table until you hit the barrier, then ask the patient to flex against you. That isometric pull is what reseats the innominate.