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Background: Pelvic girdle dysfunction is a common musculoskeletal disorder among pregnant women. It is a disabling condition affecting the ability of a pregnant woman to perform her daily functional activities. The scope of digital health in delivering rehabilitation services is growing exponentially, especially in the present COVID -19 pandemic crisis.Case description: A 29-year-old primigravida, at 32 weeks of gestation with severe pelvic girdle pain during bed transitions, sought physiotherapy consultation via video call, as she expressed difficulty in accessing Physiotherapy services due to the present pandemic crisis. Physiotherapy consultation was provided in 4 weekly sessions using a real-time video-based telerehabilitation program and the patient performed unsupervised exercise sessions for 30 minutes for 5 days per week for 4 weeks. The plan of care included muscle energy techniques, pelvic cloth belt, strengthening, stabilization exercises and stretching.Outcomes: The patient completed four sessions including evaluation and treatment and there was a reduction of pain scores for bed transitions from NPRS 8/10 during session one to NPRS 0/10 during session four. The Pelvic girdle dysfunction questionnaire showed a decrease in percentage scores from 54.6 to 4 at the end of physiotherapy sessions.Conclusion: Telerehabilitation was successfully used to manage a pregnant woman with pelvic girdle dysfunction.

ContextPrevious literature has demonstrated the prevalence and socioeconomic impact of postoperative pain in surgery patients. Somatic dysfunction has been demonstrated as a cause, but literature documenting osteopathic manipulative treatment (OMT) in surgery patients is lacking.ObjectiveTo describe typical patterns of and common treatments for somatic dysfunction in patients following laparoscopic cholecystectomy.MethodsThe authors retrospectively reviewed the billing records of all patients over 18 years of age who underwent laparoscopic cholecystectomy by a single surgeon and had postoperative outpatient OMT for right-side pain linked to somatic dysfunction between 2006 and 2018 at a community hospital in Grand Rapids, Michigan. Patients who underwent open cholecystectomy, who did not have documented somatic dysfunction, or had somatic dysfunction unrelated to their biliary disease were excluded.ResultsNine patients were selected for inclusion in this retrospective case series. All patients in the study demonstrated anterior right lower rib pain corresponding to posterior lower rib dysfunctions and rotated right and side-bent left thoracic spine dysfunctions between T5 and T11. Pain was successfully managed with muscle energy, high-velocity, low-amplitude, or soft tissue OMT.ConclusionPostoperative pain following laparoscopic cholecystectomy can be related to right-sided thoracic and rib dysfunctions. This is important for early diagnosis of surgical patients with somatic dysfunction and initiation of appropriate OMT to decrease morbidity related to pain, functional status, and quality of life.

Purpose: Shoulder and cervical pain, reduced mobility and disability are some of the major complications associated with surgeries of head and neck cancers affecting several domains of quality of life. In the present study we aimed to compare the effectiveness of Muscle Ener-gy Techniques (METS) and Active Range of Motion Exercises in reducing pain, improving shoulder mobility and function in patients post Modified Radical Neck Dissection (MRND). Methods: Forty eight subjects were randomly assigned to two groups. Group A received active range of motion (AROM) exercises and group B received Muscle energy techniques (METS). Both the groups were treated for a period of 10 consecutive days starting from the 3rd to 5th postoperative day. Data was collected on the 1st and 10th day of intervention. Results: Both groups showed highly significant improvements in shoulder range of motion , decrease in pain and better Global Rating Change cores(GRCS) (p=0.005). GRCS and shoul-der abduction showed significant improvement in group B when compared to group A, sug-gesting better clinical outcomes in those treated with Muscle Energy Techniques. Conclusion: This study showed that both METs and AROM exercises were effective in im-proving shoulder range of motion, function and reducing pain in patients post MRND but-Muscle Energy Techniques were more effective when compared to AROM exercises.

Context Colleges of osteopathic medicine (COMs) are required to provide hands-on osteopathic manipulative medicine (OMM) training during clerkship years, but this can be challenging given that students are in a variety of clinical sites and often train with allopathic physicians. Objective To identify student OMM practice patterns documented on required OMM practice logs detailing 10 OMM treatments each semester as part of a 3-semester third- and fourth-year clerkship curriculum and to determine whether these practice patterns varied by supervisor type (osteopathic vs allopathic) and semester. Methods The OMM practice logs from 2 class years were retrospectively reviewed for patient and supervisor characteristics and OMM treatment details. Semesters included 2 third-year semesters and an extended fourth-year semester. Results Between July 2015 and March 2018, 1018 OMM practice logs were submitted detailing 10,150 treatments involving 4655 clinical (45.9%) and 5474 volunteer (53.9%) patients. Logs contained up to 10 treatments per log; 26.0% included only clinical patients, 17.4% included only volunteer patients, and 56.6% included both. Significantly more clinical patients (1708 [36.7%]) were treated during the first semester of the third year than the other 2 semesters (PP=.34). Neuromusculoskeletal complaints accounted for 10,847 (90.7%) chief complaints, and nonneuromusculoskeletal complaints accounted for 1115 (9.3%). The most commonly treated body regions were the thoracic (6255 [61.4%]), cervical (4932 [48.4%]), and lumbar (4249 [41.7%]). More body regions were treated on clinical patients than on volunteer patients (mean, 2.7 vs 2.6, respectively; P=.04). Commonly used techniques were muscle energy (6570 [64.5%]); high-velocity, low-amplitude (4054 [39.8%]); soft tissue (3615 [35.5%]); balanced ligamentous tension/indirect techniques (2700 [26.5%]); and myofascial release (1944 [19.2%]). Conclusion More than 80% of students documented OMM practice on clinical patients for their required OMM practice logs. Both osteopathic and allopathic physicians provided supervision. Chief complaints and types of osteopathic manipulative treatment used were consistent with current clinical practice. Areas identified for enhanced didactic education included OMM for nonneuromusculoskeletal complaints.

Purpose of review Skeletal muscle wasting during critical illness is the result of disturbed metabolism. No proven effective interventions targeting skeletal muscle mass and function during critical illness currently exist. This review summarizes recent advances regarding the complexity of metabolic factors involved and the challenge of establishing the clinical effects of metabolic interventions targeting the muscle. Recent findings Although the catabolic state is limited to the acute phase of critical illness, its subsequent impact on muscle mass and function persists long after ICU discharge. Immobilization, inflammation and disturbed muscle energy and nutrient metabolism are key drivers of muscle protein loss. Current research focuses on the effects of enhanced protein provision, specific substrate delivery and physical exercise. Whilst some interventions have been successful at improving muscle mass, these effects do not always carry over into muscle function or strength. Summary Increased understanding of metabolic derangements during critical illness provides new potential targets for treatment. The potential of dietary protein to attenuate the muscle protein catabolic state has yet to be established in clinical trials. Basic research should focus on ways to further improve the anabolic potential of nutrition by unravelling mechanisms that regulate anabolic and catabolic pathways and energy metabolism.

Background: Elbow is a very functional joint. Elbow stiffness is a significant cause of disability hampering the function of the upper extremity as a whole. Muscle Energy Techniques (METs) are relatively pain-free techniques used in clinical practice for restricted range of motion (ROM). Objective: To study the effects of MET on pain, ROM and function given early in the rehabilitation in post-surgical elbow stiffness. Methods: An RCT was conducted on 30 patients post elbow fracture fixation. Group 1 was given MET immediately post removal of immobilization while Group 2 received MET 1 week later along with the rehabilitation protocol. Pain (Visual Analogue Scale), ROM (goniometry) and function (Disability of Arm, Shoulder and Hand questionnaire) were assessed pre and post 3 weeks. Results: Group 1 showed greater improvement than Group 2, mean flexion and extension change between groups being [Formula: see text], 95%CI(5.9,17.4) and [Formula: see text], 95%CI(4.4,12.7), respectively. VAS and DASH scores improved better in Group 1, mean change being [Formula: see text], 95%CI(0.6,1.8) and [Formula: see text], 95%CI(13.5,22.8) for VAS and DASH scores, respectively. Conclusion: MET can be used as an adjunct to the rehabilitation protocol to treat elbow stiffness and can be given safely in the early stages of post elbow fracture rehabilitation managed surgically with open reduction and rigid internal fixation.

Background/Aims: Chronic low back dysfunction is a serious health problem affecting people at some time in their life; it impedes the mobility of the lumbar spine and adjacent joints leading to functional disabilities. Muscle Energy Techniques aim to normalise soft tissue structures, such as shortened or tight muscles, with no direct implication to the joint associated with these soft tissues. Kinesio taping supports damaged structures without restriction of mobility and at the same time may influence some of the mechanisms associated with muscle fatigue, such as blood flow and proprioception. The aim of this study was to investigate the effect of Muscle Energy Techniques and kinesio taping on pain level and spinal mobility in patients with chronic low back dysfunction. Methods: A total of 90 patients with chronic low back dysfunction were selected. All participants were randomly allocated into three groups; group A received cross (X) technique kinesio taping and conventional therapy, Group B received cross (X) technique kinesio taping, Muscle Energy Techniques and conventional therapy, Group C received Muscle Energy Techniques and conventional therapy. A visual analogue scale for pain severity and inclinometer for trunk range of motion were used to measure the results. Results: Results showed that there was no statistically significant difference between the post-treatment measurements of the three groups. Conclusions: A combination between Muscle Energy Techniques and kinesio taping with conventional therapy appears to improve pain and trunk range of motion in patients with chronic low back dysfunction.

Research Topic: To study and compare the effectiveness of active release technique and muscle energytechnique in subjects with hamstring tightness.Method: 60 normal healthy subjects (30 in each group) were recruited in the study under simple randomizationmethod. Group A received single session of Active Release Technique and Group B received single sessionof Muscle Energy Technique for hamstring tightness. Active knee extension test (90-90 test) were measuredpre-intervention and post-intervention. Data was analyzed using t-test.Results: Statically there is significant (p

Objective: The aim was to verify if manual lymphatic drainage (MLD) and muscular energy techniques (MET) helps on pain control and amplitude of mouth opening, in patients submitted to bilateral third molars surgeries. Methods: Thirty consecutive patients, aged between 18 and 45 years, 53.7% males, were randomized in two groups: physical therapy group (PG), treated with MLD and MET on one random side of the mouth, being the other side, the control (CG). Additionally, for CG, paracetamol and dexamethasone were prescribed. The control of pain and inflammation in the PG was performed using manual therapy techniques (MLD and MET) and paracetamol. Postoperative pain was evaluated through visual analogue scale (VAS) and maximum active mouth opening by using a digital caliper. Results: On the 8th postoperative day the VAS were 2.13 ± 1.84 in the CG and 0.33 ± 1.45 in the PG (p

Tension-type headaches, associated with young age, poor health, sleep disturbances, anxiety, stress, and poor posture, account for 90% of all headaches diagnosed by healthcare professionals. Diagnosis and treatment of the various headache subtypes are often aimed at determining the underlying cause but commonly involve over-the-counter pain medication. Because recurrence is common in tension-type headaches, with a subsequent refractory response to over-the-counter medications, adjunctive and alternative treatment modalities should be further studied. Here we present a case of tension headache initially non-responsive to pain medication but resolved with osteopathic manipulative treatment and lifestyle modifications. Osteopathic considerations and literature are also reviewed in the broader context of headache management.

Background: A therapeutic recommendation for restoring function in individuals with chronic low back pain (CLBP) is manual therapy through manipulative spinal or muscle energy techniques. Objectives: To compare the effectiveness of two osteopathic manipulative techniques on clinical low back symptoms and trunk neuromuscular postural control in male workers with CLBP. Method: Ten male workers with CLBP were randomly allocated to two groups: high-velocity low-amplitude (HVLA) manipulation or muscle energy techniques (MET). Each group received one therapy per week for both techniques during 7 weeks of treatment. Pain and function were measured by using the Numeric Pain-Rating Scale, the McGill Pain Questionnaire and the Roland Morris Disability Questionnaire. The lumbar flexibility was assessed by Modified Schober Test. Electromyography (EMG) and force platform measurements were used for evaluation of trunk muscular activation and postural balance, respectively at three different times: baseline, post intervention, and 15 days later. Results: Both techniques were effective ( p < 0.01) in reducing pain with large clinical differences (-1.8 to -2.8) across immediate and after 15 days. However, no significant effect between groups and times was found for other variables, namely neuromuscular activation and postural balance measures. Conclusion: Both techniques (HVLA thrust manipulation and MET) were effective in reducing back pain immediately and 15 days later. Neither technique changed the trunk neuromuscular activation patterns nor postural balance in male workers with LBP. Clinical implications: These results may facilitate clinical decision-making for CLBP management in physiotherapy programs.

Context Osteopathic manipulative medicine (OMM) is an adjunctive treatment approach available to geriatric patients, but few studies provide details about presenting conditions, treatments, and response to osteopathic manipulative treatment (OMT) in that patient population. Objectives To provide descriptive data on the presentation and management of geriatric patients receiving OMT at an outpatient osteopathic neuromusculoskeletal medicine (ONMM) clinic. Methods Data were retrospectively collected from electronic health records (EHR) at a single outpatient clinic for clinical encounters with patients over 60 years of age who were treated with OMT between July 1, 2016, and June 30, 2019. Records were reviewed for demographic information, insurance type, presenting concerns, assessments, regions treated, OMT techniques used, and treatment response. Results There were 9,155 total clinical encounters with 1,238 unique patients found during the study period. More women than men were represented for overall encounters (6,910 [75.4%] vs. 2,254 [24.6%]) and unique patients (850 [68.7%] vs. 388 [31.3%]; both p Conclusions Our results showed that geriatric patients receiving OMT at our clinic were predominately presenting for neuromusculoskeletal concerns associated with back, neck, and extremity conditions, consistent with national epidemiological data for this population. The most common OMT techniques were also consistent with those used nationally by osteopathic medical students and practicing physicians. Future longitudinal studies are needed to determine the length of time improvement persists and the overall health impact experienced by geriatric patients receiving OMT.

Context Diagnosis of somatic dysfunction is based on subjective palpatory osteopathic assessments. This subjectivity has posed a challenge for researchers in studying osteopathic medicine. The development and use of radiological imaging techniques to objectively confirm or quantify muscle tissue stiffness associated with somatic dysfunction could be of benefit in osteopathic clinical practice, training, and further research. Objectives To investigate the feasibility of ultrasound shear wave elastography (SWE) to quantify muscle tissue stiffness in somatic dysfunction before and after osteopathic manipulative treatment (OMT). Methods In this prospective study, we assessed lumbar spine somatic dysfunction in 20 adult patients before and after a single OMT session using standard osteopathic palpatory assessments by osteopathic physician faculty members in the Department of Osteopathic Principle and Practice at Rocky Vista University College of Osteopathic Medicine (Utah campus). Shear wave velocity (SWV, m/s) was measured in lumbar paraspinal muscle tissue using a commercial ultrasonography scanner on all participants immediately before and after OMT. In this study, OMT techniques targeted the iliocostalis lumborum and included the articulatory technique, balanced ligamentous tension, facilitated positional release, high-velocity, low-amplitude technique, muscle energy, myofascial release, and the Still technique at the discretion of the osteopathic physician. The difference in SWV between muscle tissues with and without dysfunction, and differences in SWV of dysfunctional tissue before and after OMT were examined using unpaired and paired t tests, as appropriate. The correlation between SWV measurements and osteopathic assessments was examined by the Spearman rank correlation. Intra- and interobserver reliability was analyzed using intraclass correlation coefficient. Results The difference in SWV between muscle tissues with and without somatic dysfunction was significant before OMT (mean [SD], 1.93 [0.44] vs 1.69 [0.19]; P=.03) and was not significant after OMT (mean [SD], 1.69 [0.19] vs 1.53 [0.31]; P=.05). The difference in SWV in the same tissue with somatic dysfunction before and after OMT was significant (mean [SD], 1.93 [0.44] vs 1.52 [0.3]; Pr=0.72). Intra- and interobserver reliability for performing SWE in somatic dysfunction was good (intraclass correlation coefficient >0.80). Conclusions The results of this study show that ultrasound SWE can objectively assess muscle tissue stiffness for diagnosis of somatic dysfunctions and for muscle tissue stiffness changes after OMT.

Context Under the Accreditation for Graduate Medical Education (ACGME) single accreditation system, there is likely to be increasing interest and opportunity for teaching osteopathic manipulative treatment (OMT) to allopathic residents and residency faculty. When learning OMT, allopathic physicians (MDs) have distinct needs compared with osteopathic medical students. For example, MDs already have a foundation in anatomy and medical vocabulary, but incorporating an osteopathic approach to patient care may require a paradigm shift. Thus, a unique approach to osteopathic education for MDs in residency programs with osteopathic recognition (OR) is needed. Objectives To create a longitudinal OMT elective for allopathic residents and residency faculty and assess its impact on attitudes and confidence regarding osteopathic principles and treatment. Methods Drawing from standard texts used during preclinical osteopathic education, a blended online and in-person laboratory modular curriculum for the OMT elective course was developed by osteopathic residents and faculty within the Department of Family Medicine and Community Health at the University of Wisconsin in Madison. The modalities of muscle energy, counterstrain, myofascial release, and soft tissue were included; the curriculum also reviewed autonomic physiology, somatovisceral, and viscerosomatic reflexes. A quality improvement study of the course was conducted via pre- and postcourse surveys to assess its impact on perceptions and confidence regarding the theory and practice, referral, and use of OMT. A precourse survey was distributed before the first module to obtain background information and assess participants’ prior OMT exposure, among other things. Nine months after the course ended, a corresponding postcourse survey was distributed. Pre- and postcourse surveys were individually matched to improve statistical analysis, using unique identifiers. Also, following each laboratory, a postlaboratory survey was collected about the participant’s experience for that lecture and for laboratory-specific quality improvement purposes. Two years after course completion, graduates were reached via phone or email for informal interviews to assess the perceived long-term impact from the elective. Results Eleven MDs from a total potential pool of 26 residents and approximately 120 attending physicians enrolled in the course; eight (72.7%) completed all modules and pre- and postcourse evaluations. Participants reported statistically significant gains in attitudes and confidence regarding OMT (“knowledgeable regarding OMT principles”: precourse mean, 2.50 [0.76], vs. postcourse mean, 3.37 [0.52]; p=0.021; “know how to treat using OMT”: precourse mean, 2.25 [1.39], vs. postcourse mean, 3.12 [1.25]; p=0.041). Several participants (five; 62.5%) had completed prior OMT training. There was an increase, albeit nonsignificant, in the use of OMT, with more providers using OMT (precourse mean, five, vs. postcourse mean, six; p=0.171), and providers using OMT more often (precourse OMT use monthly or more often, three, vs. postcourse OMT use monthly or more often, six; p=0.131). Conclusions Implementing a longitudinal elective curriculum is a feasible way to improve attitudes and confidence in OMT for MDs involved in a family medicine residency. Whether our elective leads to competency in OMT for allopathic residents and faculty remains to be formally evaluated. Our pilot established the feasibility and led to a revision of our curriculum; the elective continues to occur yearly. Future analyses will focus on competency assessment.

Neck is one of the most common site of musculoskeletal symptom manifestations. An impaired spinal curvature is a common finding in patients with mechanical neck pain. A pre-post quasi experimental pilot study was conducted at Fauji Foundation Hospital from January- March 2017,in which 12 patients with mechanical neck pain and straightening of the cervical spine were included and treated for 7 consecutive sessions consisting of muscle energy techniques (MET) in combination with facet joint mobilization. The objective of this study was to determine the effects of MET and facet joint mobilization on spinal curvature and functional outcomes in patients with neck pain. Outcome measurement tools that were included comprised of pain severity, neck disability index (NDI), cervical lordosis which was measured via x-ray based posterior tangential method, goniometry for cervical range of motion (ROM) and modified sphygmomanometer dynamometry (MSD) for isometric muscle strength. A significant difference was observed in pre and post treatment scores for all outcomes (p

Metabolic myopathy is referred to a rare group of inherited muscle diseases caused by specific enzymatic defects that lead to muscle energy defect and subsequently muscle dysfunction. They are divided into disorders of carbohydrate metabolism, disorders of lipid metabolism and mitochondrial disorders. Examples of the common metabolic myopathies are Pompe disease, McArdle’s disease, beta-oxidation defects and carnitine disorders. A unique clinical presentation should raise the suspicion of such rare muscle disorders specially when the patient has episodic muscle dysfunction and dynamic rather than static symptoms. Premature exertional fatigue and exercise-associated muscle cramps are other clues. However, they occasionally present as progressive muscle weakness mimicking dystrophic muscles disorders or multiorgan involvement. Early diagnosis and implementation of therapeutic strategy will help prevent acute muscle dysfunction, myoglobinurea and rhabdomyolysis. This strategy may include avoiding vigorous exercise and prolonged fasting, eating complex carbohydrates, carnitine and MCT supplementation and enzyme replacement therapy.

Background Diffuse idiopathic skeletal hyperostosis (DISH) syndrome and lumbar epidural lipomatosis are relatively asymptomatic neurological conditions, with findings often seen incidentally on radiological studies. Objective The aim of this paper is to present unique findings of concomitant, symptomatic DISH syndrome and lumbar epidural lipomatosis and to discuss the osteopathic diagnosis and treatment implications. Methods Concomitant, symptomatic variants are rare and present challenges to treatment and management, as seen with a 60-year-old African American woman who presented with worsening disequilibrium and new-onset bilateral fingertip numbness. Past medical history was significant for alcohol abuse disorder, hypertension, hyperlipidemia, and multiple episodes of self-resolving vertigo and lower extremity neuropathy. Results The patient was referred to the neurology department for stroke workup, which was negative. Osteopathic structural exam revealed thoracolumbar and sacral dysfunctions. Magnetic resonance imaging revealed findings consistent with thoracic DISH syndrome and lumbar epidural lipomatosis in the areas of somatic dysfunctions. Conclusions Due to minimal information on osteopathic manipulative treatment in rare neurological diseases, only gentle techniques of myofascial release, balanced ligamentous tension, and muscle energy were performed with resultant minimal improvement, thus highlighting the necessity for better guidelines and further research.

Background Increased intramuscular peroxisome proliferator-activated receptor gamma coactivator-1α (PGC-1α) with exercise directly or indirectly affects other tissues, but the effector pathway of PGC-1α has not been clearly elucidated. The purpose of this study was to investigate the effect of exercise and/or dietary change on the protein levels of the soleus muscle energy-sensing network and meteorin-like (Metrnl), and additionally to analyze the detraining and retraining effects in high-fat diet (HFD)-induced obese mice. Methods One hundred male C57BL/6 mice were divided into normal-diet + sedentary (CO, n = 20) and HFD + sedentary (HF, n = 80) groups, and obesity was induced in the HF group through consumption of a 45% HFD for 6 weeks. The HF group was subdivided into HF only (n = 20), HF + training (HFT, n = 20), dietary change + sedentary (HFND, n = 20), and HFND + training (HFNDT, n = 20) groups, and the mice in the training groups underwent a treadmill training for 8 weeks, 5 times per week, 40 min per day. The HFT and HFNDT groups underwent 8-week training, 8-week detraining, and 4-week retraining. Results An 8-week training was effective in increasing the protein levels of soleus muscle AMP-activated protein kinase (AMPK), PGC-1α, and plasma Metrnl in the obese mice (P

Background: The efficacy of ischemic compression, strain/counterstrain, and muscle energy techniques were supported by literatures to relieve myofascial trigger points. However, no high-level research is available regarding the integrated neuromuscular inhibition technique (INIT). Objective: To document the efficacy of INIT in improving cervical function by reducing the trigger points on upper trapezius muscle over the traditional approach. Methods: Thirty adults in the age group of 18–35 years diagnosed with mechanical neck pain with upper trapezius trigger point were selected by the simple random sampling for two group pretest-posttest design. They were allocated randomly into two equal groups, Group A and Group B, respectively. Group A received hydrocollator pack, INIT, neck strengthening exercises, scapular stabilization exercises, shoulder stabilization exercises, postural correction, and ergonomic advice while Group B received the same treatment except INIT. They were treated for six sessions on alternate days for 2 weeks. Visual analog scale, neck disability index, and tenderness grading scale were noted at baseline, 3rd session, and 6th session after the above treatment on both the groups and analyzed. Results: In all the outcome measures, Group A showed significant (P < 0.05) improvement when compared to Group B. Conclusion: There is a sufficient evidence to prove the efficacy of INIT in improving cervical function by reducing the trigger points on upper trapezius muscle

Goal of research - the study aims to justify the statement that osteopathy is an effective method of diagnostics and treatment.Materials and methods. The study examined 5 000 patients with different clinical symptoms who underwent osteopathic treatment sessions. A variety of osteopathic techniques were used: e. g. soft tissue techniques, articulations, muscle energy techniques and trusts, fascial techniques, strain-counterstrain, visceral techniques on the thoracic and abdominal cavities, cranial techniques, etc. In some cases, the following additional research methods were used: electroencephalography, echocardiogram, Doppler sonography, etc.Results. All the patients showed signifi cant improvement in the condition with complete regression of clinical symptoms and with the improvement of the results of additional research methods.Conclusion. The osteopathic treatment has shown to be highly effective in diagnostics and correction in this group of patients. It corresponds to the basic principles of medicine of the future.

Background and purpose Muscle energy techniques (METs) are used to reduce tension in neck muscles and therefore, can be used together with Swedish massage to enhance its effect. The aim of this study was to assess if using METs combined with massage could improve sleep quality. Materials and methods In this prospective, randomised controlled trial forty patients with chronic cervical spine pain were divided into two equal groups. Both groups attended 10 sessions of Swedish massage, and the study group additionally attended MET-sessions. Sleep disturbances were assessed with the Pittsburgh Sleep Quality Index (PSQI). Results A significant improvement in terms of sleep disturbances was seen in both groups. The MET group demonstrated improvement in all PSQI components. In the control group, the improvement included only 4 components of the index. Conclusion Massage therapy combined with relaxing METs may be more effective than massage therapy alone in this group of patients.

The increasing use of computer in daily life has brought about numerous musculoskeletal problems. Impairments in the head, neck and shoulders are more common compared with the other parts of the body. The aim of this study was to compare the effect of two manual treatments in two separate groups, i.e., active release technique (ART) and muscle energy technique (MET) on the latent trigger points (LTrPs) in the upper trapezius muscle. The set criteria in the study included the active range of cervical lateral flexion, pain intensity on the visual analog scale (VAS), and the upper trapezius muscle thickness.This clinical trial study assessed the outcome measures within and between groups before and after the intervention. The target population were 64 (32 males, 32 females) participants who had been selected from among the staff members and the students of a rehabilitation school, and the employees of an engineering company who had LTrPs in their upper trapezius muscle and were from 18 to 50 years old.The immediate effects of MET and ART on the patients of each groups with LTrPs in their upper trapezius muscle were increased active range of cervical lateral flexion (P 0.001), decreased pain intensity on VAS (P 0.05) and decreased thickness of the upper trapezius muscle (P 0.01).Both manual techniques of ART and MET reduced the symptoms of LTrPs in the upper trapezius in the two groups equally, neither technique being superior to the other.

Background Self-directed learning is a student-centered approach based on the students’ evaluation about their own learning needs. Self-directed practice is a component of the self-directed learning which focus on achieving manual and practical skills. Given the abundance of manual skills that students need to develop in the osteopathic curriculum, self-directed practice has become an attractive methodology. Most of the Italian osteopathic educational institutions recognize two types of educational curriculum: T1, for students without a healthcare background; and T2 for students who are already healthcare professionals. The aim of the present study is to investigate the attitudes of Italian osteopathic students toward self-directed practice during the summer break highlighting the possible differences between T1 and T2 students. Methods A web-based closed-ended survey was administered to the students attending one of the Italian osteopathic educational institutions which accepted to participate in the research. Results Two hundred sixty-eight students on 2549 participated to the survey. 64.92% of the students reported to have performed self-directed practice during the summer break. The main difficulty encountered by students in approaching self-directed practice was ‘lack of people to exercise with’. Most of the students performed self-directed practice between 1 to 5 h per week. The most common clinical condition encountered was Low Back Pain. The anatomical area most approached was lumbar spine. The most commonly simulated tests were the articular mobility tests. The techniques in which students trained the most were muscle energy techniques. Significant difference was found in self-engagement to the self-directed practice between T1 and T2 students (p = 0.026), and in the reasons to perform self-directed practice (p = 0.027). Conclusions The results of this study could be useful to reveal some aspects of students’ academic education and future clinical practice. Therefore this paper can be a useful tool for the institutions to develop strategies to overcome the reported problems students have towards self-directed practice. For example it should be discussed the possibility for the students to observe some senior osteopaths during their practice or to plan to maintain an open tutored didactic environment during the summer break as an extracurricular activity.

[Abstract] Determination of muscle energy expenditure by computer modeling and analysis is of great interest to estimate the whole body energy consumption, while avoiding the complex character of in vivo experimental measurements for some subjects or activities. In previous papers, the authors presented optimization methods for estimating muscle forces in spinal-cord-injured (SCI) subjects performing crutch-assisted gait. Starting from those results, this work addresses the estimation of the whole body energy consumption of a SO subject during crutch-assisted gait using the models of human muscle energy expenditure proposed by Umberger and Bhargava. First, the two methods were applied to the gait of a healthy subject, and experimentally validated by means of a portable gas analyzer in several 5-min tests. Then, both methods were used for a SO subject during crutch-assisted gait wearing either a passive or an active knee-ankle foot orthosis (KAFO), in order to compare the energetic efficiency of both gait-assistive devices. Improved gait pattern and reduced energy consumption were the results of using the actuated gait device. Computer modeling and analysis can provide valuable indicators, as energy consumption, to assess the impact of assistive devices in patients without the need for long and uncomfortable experimental tests. Ministerio de Economía y Competitividad; DPI2015-65959-C3-1-R Xunta de Galicia; ED431B2016/031

Background: Muscle energy technique (MET) is asn osteopathic treatment technique that is utilized frequently in the clinical setting, yet the overall effectiveness is minimally supported within literature. MET is an osteopathic technique that involves an isometric contract relax technique intended to improve alignment and enhance neuromuscular education. Objective: The purpose of this study was to determine the effectiveness of MET on running kinetics on subjects with low back pain. Method: A quasi-experimental research design was implemented and subjects, all of whom either had a history of or currently experience low back pain, underwent pre-intervention data collection of: anthropometric measurements, medical history, dorsaVi 3D running analysis, and a musculoskeletal and neurological clinical exam. Subjects underwent 6 weeks of isolated lumbo-pelvic MET at a frequency of twice a week, and were instructed to avoid all other treatment. Post-intervention data collected included a clinical exam and another dorsaVI running analysis. Results: Data was analyzed including: pre and post-treatment initial peak acceleration, ground contact time, and ground reaction force. A paired t-test comparing pre and post mean kinetic changes demonstrated the following p values: initial peak acceleration p = .80, ground contact time p = .96, and ground reaction force p = .68. Conclusion: This study demonstrated that isolated MET treatment is not statistically significant for changing 3D kinetic running variable in subjects with low back pain. Clinical Implications: Recommend healthcare providers to use a multi-treatment approach for low back pain. Future research should include a control group and larger sample size.

Knee rotationplasty (KRP) is a type of surgery in which the rotated ankle serves as a new knee after being removed for bone tumor. Although this limb salvage surgery is rarely indicated in properly selected patients, it may offer functional advantages over transfemoral amputation, and more durable results compared with a prosthesis. The walking mechanics of adult patients after KRP is believed to be close to that of below-knee amputees. In this study, we evaluated steady-state walking of KRP patients from the viewpoint of the overall muscle power needed to keep the body centre of mass in motion. Three adult patients after KRP, all athletes, were evaluated. Ground reactions during walking were recorded during six subsequent strides on a force treadmill. The positive mechanical work and power sustaining the motion of the centre of mass and the recovery of muscle energy due to the pendulum-like mechanism of walking were computed and compared with those obtained in previous studies from above-knee, below-knee amputees and healthy individuals. In KRP patients, walking was sustained by a muscle power output which was 1.4-3.6 times lower during the step performed on the rotated limb than on the subsequent step. The recovery of muscle energy was slightly lower (0.9) or higher (1.3-1.4 times) on the affected side. In two out of the three KRP patients, our findings were more similar to those from above-knee amputees than to those from below-knee amputees. After KRP, the rotated limb does not necessarily provide the same power provided by below-knee amputation. This may have a relevance for the paralympic classification of KRP athletes.

Background Low back pain (LBP) is responsible for considerable personal suffering due to pain and reduced function, as well as being a societal burden due to costs of health care and lost work productivity. Muscle energy technique (MET) is a manual therapy treatment technique used predominantly by osteopaths, physiotherapists and chiropractors which involves alternating periods of resisted muscle contractions and assisted stretching. It is unclear whether MET is effective in reducing pain and improving function in people with LBP. Objectives To examine the effectiveness of MET in the treatment of people with non-specific LBP compared with control interventions, with particular emphasis on subjective pain and disability outcomes. Methods Eight electronic databases and two clinical trials registers were searched from inception to May and June 2014 together with reference checking and citation searching of relevant systematic reviews. Randomised controlled trials assessing the effect of MET on pain or disability in patients with non-specific LBP were included. Two authors independently assessed the risk of bias and extracted the data. Meta-analysis was performed where clinical homogeneity was sufficient. The quality of the evidence for each comparison was assessed with the GRADE approach. Results There were 12 randomized controlled trials with 14 comparisons included in the review, with a total sample of 500 participants across all comparisons. Included studies were typically very small (n = 20–72), all except one were assessed as being at high risk of bias, and all reported short-term outcomes. For the purposes of pooling, studies were divided into seven clinically homogenous comparisons according to the patient population (acute or chronic LBP) and the nature of the control intervention. The meta-analyses and GRADE assessment provided low-quality evidence that MET provided no additional benefit when either compared to, or added to, other therapies on the outcomes of pain and disability in the short-term. Conclusion The quality of research related to testing the effectiveness of MET for treatment of people with LBP is poor. Studies were generally small and at high risk of bias due to methodological deficiencies. Studies conducted to date generally provide low-quality evidence that MET is not effective for patients with LBP. There is insufficient evidence to determine whether MET is likely to be effective in practice. Large, methodologically-sound studies are necessary to investigate the effectiveness of MET as an intervention for treatment of people with LBP.

Patients with blocked muscle glycogen breakdown (McArdle disease) have severely reduced exercise capacity compared to healthy individuals and are not assumed to produce lactate during exercise.The objectives were: 1) to quantify systemic and muscle lactate kinetics and oxidation rates and muscle energy utilization during exercise in patients with McArdle disease; and 2) to elucidate the role of lactate formation in muscle energy production.This was a single trial in a hospital.Participants were four patients with McArdle disease and seven healthy subjects.Patients and healthy controls were studied at rest, which was followed by 40 minutes of cycle-ergometer exercise at 60% of the patients' maximal oxygen uptake (∼35 W).Main outcome measures were systemic and leg skeletal muscle lactate, alanine, fatty acid, and glucose kinetics.McArdle patients had a marked decrease in plasma lactate concentration at the onset of exercise, and the concentration remained suppressed during exercise. A substantial leg net lactate uptake and subsequent oxidation occurred over the entire exercise period in patients, in contrast to a net lactate release or no exchange in the healthy controls. Despite a net lactate uptake by the active leg, a simultaneous unidirectional lactate release was observed in McArdle patients at rates that were similar to the healthy controls.Lactate is an important energy source for contracting skeletal muscle in patients with myophosphorylase deficiency. Although McArdle patients had leg net lactate consumption, a simultaneous release of lactate was observed at rates similar to that found in healthy individuals exercising at the same very low workload, suggesting that lactate formation is mandatory for muscle energy generation during exercise.

This case report presents two successful treatment outcomes of cervical disc herniation (CDH) with thoracic outlet syndrome (TOS) treated using manual therapy technique of the muscle energy technique (MET), ligamentous articular strain (LAS) and additional herbal medicine intake, acupuncture and pharmacopuncture sessions. Significant improvements were reported in the outcome measures at admission and at discharge for Visual Analogue Scale (VAS) and Neck Disability Index (NDI) scores and physical examinations followed by approximately three weeks of hospital admission. The successful outcomes suggest that integrative conservative management focused on muscle energy techniques (MET) and ligamentous articular strain (LAS) are effective in contributing to the conservative management of cervical disc herniation (CDH) with thoracic outlet syndrome (TOS).

AIM: To compare the efficacy of combination of muscle energy techniques and conventional therapy with conventional therapy alone in periarthritis of shoulder. MATERIALS AND METHODS: It was a comparative randomized study on two groups, 15 patients in each group. Group A was treated with Conventional therapy and Group B: was treated with Conventional therapy and Muscle energy techniques. Treatment was given for two weeks, six days a week. Assessment was taken before the starting of treatment and on the 3rd, 6th, 9th and 12th day of the treatment for range of motion, intensity of pain and functional deficit. Analysis was based on Visual Analog Scale (VAS) and Shoulder Pain and Disability Index (SPADI). RESULTS: There was a significant level of improvement (p

The purpose of this study was to investigate core muscle characteristics during walking in patients with multiple sclerosis (MS). Eight patients (4 men) with relapsing-remitting MS (aged 44.9 +/- 8.6 yr) and sex-matched controls (37.9 +/- 8.4 yr) walked on a treadmill for 15 min at a self-selected speed. Positron emission tomography/computed tomography imaging was used to measure core muscle activity immediately after walking based on glucose uptake. Activity was not different between the MS and control group for any of the identified muscles (p > 0.28). Within the MS group, side differences in activity were identified in the lateral flexor group, the external and internal obliques, and the rectus abdominis (p < 0.05), with the less-affected side being activated more. Furthermore, greater muscle volume was found on the more-affected side of the transversus abdominis, quadratus lumborum, and the low-back extensor group (p < 0.03). These muscle characteristics suggest patients with MS utilize compensatory mechanisms during walking to maintain balance and posture. These strategies likely result in increased muscle energy cost and early fatigability.

Background: Energetic cost contributes to movement impairments observed during stair negotiation in persons with knee osteoarthritis. Specifically, the intersegmental mechanical energy exchange may be diminished in the presence of pathologies. Research question: The purpose of this study was to evaluate mechanical energy efficiency in persons with knee osteoarthritis during stepping up and down based on mechanical energy analysis. Methods: Sixteen patients with medial knee osteoarthritis and 16 age-matched controls participated. A three-dimensional motion analysis system and force platforms were used to acquire biomechanical data. The participants were instructed to ascend/descend a 2-step staircase. The mechanical power exhibited during the stance phase at the lower step of the staircase were computed. Mechanical Energy Expenditure (MEE) was calculated as the integral of net joint power at each joint. Mechanical Energy Compensation (MEC) was defined as the proportion of muscle energy compensated by inter-segmental energy transfer. According to energy transfer modes, MEE and MEC were determined separately as three phases: concentric and eccentric transfer phases and no-transfer phase. Results: While stepping up, the patient group performed the task with less MEC at the ankle joint, which was observed prior to push-off. The patient group displayed less mechanical energy transfer from the shank to the foot segment. The concentric MEC at the hip joint in the late-stance phase of stepping down was lower in the patient group, which meant patients demonstrated less mechanical energy transfer from the pelvis to the thigh segment. Significance: It was disclosed that persons with knee osteoarthritis demonstrated less mechanical energy transfer while stepping up and down.

This paper proposes a novel control method to minimize muscle energy for power-assistant robotic systems that support the intended motions of a user under unknown external perturbations, using surface electromyogram (sEMG) signals. Conventional control methods based on force/torque (F/T) sensors have limitations to detect human intentions and could, presumably, misunderstand or distort such intentions because of external perturbations of the interaction forces, such as those found in activities of daily living. F/T sensors measure the sum of the applied force, including unknown external forces and human intention; thus, a power-assistant robot controller cannot exactly decompose the real human force. In this paper, we describe a counterexample that cannot be supported by conventional force-sensor-based control methods. We also verify why these control methods may guide human behavior in the wrong direction, and thus, have limitations under unknown external perturbations. We then propose a new control method to minimize the muscle energy indicated by sEMG signals. The proposed control approach is fundamentally based on the concept of power-assistance, in which a robot can reduce the users expended muscle energy while performing given tasks. The proposed control approach is verified through experiments using a power-assistant robotic system for the upper limbs under external perturbations.

Background: Innominate up-slip sacroiliac joint dysfunction accounts for 10% to 20% of all sacroiliac joint dysfunctions. There are not enough studies indicating the efficacy of muscle energy techniques on innominate up-slip sacroiliac joint dysfunction. Objective: To find out the effectiveness of muscle energy technique to quadratus lumborum for treating innominate up-slip sacroiliac joint dysfunction. Methodology: A case study, a male of age 44, who was diagnosed with innominate up-slip sacroiliac joint dysfunction, was included in the study and the visual analog scale (VAS) for pain was assessed and Oswestry disability index (ODI) was asked to be filled. Gillet test was performed before intervention which again was performed after the intervention. Supine to sit test was performed to assess the limb length discrepancy and was performed again after the intervention. Muscle energy technique was applied for two weeks. Pre and post outcome measures were recorded and compared. Results: The pre intervention score reflected the visual analog scale was 7; Oswestry disability index was 72%, Gillet test to be positive. The post intervention score reflected the visual analog scale was 0; Oswestry disability index was 4%, and Gillet test to be negative. Supine to sit test showed that there was a limb length discrepancy of 5 cm both at supine and prone. The pre and post interventions when compared showed significant effect of muscle energy technique on up-slip innominate sacroiliac joint dysfunction. Conclusion: Muscle energy technique was effective on treating innominate up-slip sacroiliac joint dysfunction.

Background: Trigger finger, or flexor tendon tenosynovitis, is a relatively common condition, and it is considered to be somewhat refractory to conventional treatment in persons with diabetes. Objectives: This article first reviews relevant literature and then presents a case of trigger digits in a male with diabetes. The authors' treatment—using acupuncture, osteopathic manipulation, and topical nonsteroidal anti-inflammatory drugs—is described. Intervention: The patient was treated with acupuncture once weekly for eight sessions. Osteopathic manipulation included myofascial release, muscle energy, and manipulation and articulation of the carpal bones. Topical Voltaren gel was also prescribed. Main Outcome measure: Resolution of trigger finger symptoms was sought. Results: Significant improvement was demonstrated and, at 1 year post-treatment, the patient remained asymptomatic. Conclusions: This case report suggests that physical modalities such as acupuncture and osteopathic manipulation can be...

Low back pain is considered one of the commonest condition in the western and industrialized countries. It is estimated that up to 50% of adults experience low back pain during their life span. People of all age group can be effected by this menace irrespective to their gender and quality of life. It has become one of the leading causes for the visit to physician thus also puts a heavy burden on the currency of the country. Physiotherapy is the most widely used form of treatment adopted for gaining relief from low back pain. The exercises include stretching, strengthening, range of motion exercises, McKenzie therapy and core stability exercises other techniques like muscle energy technique etc. It has been concluded in various studies core stability exercises and muscle energy technique are beneficial in low back pain patients but comparison of their effect needs to be established to provide early and better relief from the disability. Therefore objective of the study was to compare the effect of core stability exercises and muscle energy techniques on low back pain patients. 60 subjects aged 18 – 45 years with low back pain were made part of the study based on inclusion and exclusion criteria and were then divided into three groups named A, B and C. Group A received core stability exercise and conventional physiotheraphy and group B received muscle energy techniques and conventional physiotherapy. The exercise program was given on alternate days with a total of 24 sessions and progression of the activity was made within the tolerance of the patient. Pre and post treatment readings were taken of pain, ROM and quality of life scale. Results were analyzed using paired, unpaired ttest and ANOVA. Results showed that there is significant effect on pain, ROM and quality of life scale in the three groups but group A was clinically more significant than the other groups. The study concluded that patients with low back pain are benefitted more by core stability exercises. So, core stability exercises should be practiced more.

Magnetic resonance imaging represents a validated diagnostic tool in the investigation of neuromuscular disorders. Magnetic resonance imaging can detect key skeletal muscle abnormalities such as size, shape and signal intensity changes reflecting fatty infiltration, muscle atrophy or muscle edema. In vivo phosphorus magnetic resonance spectroscopy is able to provide objective measurements of muscle energy metabolism and cytosolic pH at rest, during exercise, and during recovery from exercise. Its primary role is the investigating of metabolic myopathies, and it has been used to detect the underlying biochemical mechanisms responsible for the development of fatigue. In this mini-review, we report the main contribution provided by conventional and advanced magnetic resonance imaging and phosphorus magnetic resonance spectroscopy in the exploration of fatigue in normal muscle and in neuromuscular disorders.

Background: Periarthritis or Adhesive shoulder occurs among 7-21% of the population, which was characterized by traumatic stiff shoulders in both active and passive range of actions. The aim of the study was to compare the efficacy between Muscle energy technique (MET) and Mobilization technique (MT) coupled with ultrasound therapy in reduction of pain and increasing functional ability of subjects with adhesive shoulder. Methods: 30 subjects were randomly assigned for the experimental study by the selection criteria and divided into 2 groups: Group A -Muscle energy technique with ultrasound therapy (METU) and Group B- Mobilization technique with ultrasound therapy (MTU). The period of intervention was 5 sessions per week for 21 days. The therapy progress was evaluated by VAS and SPADI scores pre and post every 7 days of therapy. Results: The analysis was non-blind randomized experimental study for the subjects with adhesive shoulders. Both the treatment groups showed improvement comparing pre and post treatment, while Group A showed significant difference compared to Group B in pain relief and functional abilities. Statistically comparing the mean values of SPADI of the two treatment groups has indicated METU (28.93) as more efficient than MTU (36.80) at P≤ 0.001. Conclusion: The current study has concluded that the muscle energy technique coupled with ultrasound therapy imparts more effective solution than the mobilization technique coupled with ultrasound. Hence, this study has demonstrated a better combination therapy regimen for the treatment of periarthritic shoulder the physiotherapists. Similarly, potential of this combination therapy can be explored on other types of ailments demanding physiotherapy.

Background: Physiotherapy is an essentialtreatment in the management of Mechanical Neck ache, still there was lack of literature seen supporting the effectiveness of Physiotherapy interventions with their doses targeting specific group of population. The focus of study was to see the effectiveness of Kaltenborn Grade III mobilization, Muscle Energy Techniques and their combination to improve range and functional ability in patients with Mechanical Neck ache. Methods: 72 patients with Mechanical Neck achewere randomly categorized in 3 groups (Mobilization, METs and Combination group. NDI scale and goniometry was used as an assessment tool to measure the outcome before and after treatment (follow up 1 week). Results: According to the results there was significant improvement seen in Combination group (Mobilization and METs) in terms of pain, which decreased from 7.70±0.69 to 1.25±1.93 (p=0.00), gain in ROM e.g. Cervical Flexion (27.29±2.38 to 37.54±3.14). Whereas, marked significance (p=0.00) was seen in the NDI score and percentage of Combination group. ANOVA tells us that difference was significant in all three groups in categories of pain (VAS), gain in cervical ranges and NDI score and percentage as p=0.00. Combination group had significant difference within the groups then METs and Mobilization group in all categories of VAS, Cervical ranges, NDI score and percentage. Conclusion: Combination of (Grade III Kaltenborn and METs) was seen more effective in terms of improving Mechanical Neck Pain, in smaller treatment session (7 days only).

Introduction: Therapeutic use of exercises and methods of increasing the range of motion in the joints is present in many rehabilitation programs. In addition to improving the range of motion may decrease pain , there may be improvement of the status of psychophysical status, the streamlining of the activities of daily living and the restoration of harmony between the antagonistic groups of muscles. The aim of the work was to assess whether stretching and postisometric relaxation are an effective methods of increasing the range of motion and reduction of pain and which of that therapeutic applications is more effective. In addition, set out the factors having significant impact on the neck pain ailments. Material and methods: In the investigation took part 20 women with neck pain, which are divided into two groups. The first group perform postisometric relaxation and the second stretching. Exploring the range of motion of the head and neck, and pain before and after therapy. To investigate factors affecting pain ailments used the survey. Results: in both groups, there has been significant increase in range of motion. There was no significant difference between the groups. In the group has been performing postisometric relaxation note significant much improvement of reducing pain ailments than in the second group. The survey revealed that the factors most influencing pain ailments on the neck are: the seating position, sleeping in the wrong position and level of physical activity. Conclusions: many studies shown that both stretching and postisometric relaxation are an effective methods of increasing the range of motion in the joints. Most of the work shown better results after postisometric relaxation treatment than stretching. The results presented in the work of the show the effectiveness of two methods to increase range of motion and only method of postisometric relaxation in reducing pain ailments.

The aim of this work is to propose a robust musculoskeletal model of the upper limb to serve as the basis for the study of different types of shoulder pathologies, including the use of anatomical or reverse prostheses. The multibody biomechanical model is defined by seven rigid bodies constrained by the sternoclavicular, acromioclavicular, and glenohumeral joints, each modeled as a three d.o.f. spherical joint; the humeroulnar and radioulnar joints, each modeled as one d.o.f. hinge joint; and the scapulothoracic articulation, modeled by two holonomic constraints that allow the scapula to glide over the thorax. The muscle system includes 21 muscles described by 37 individual segments using the obstacle-set method. The muscle contraction dynamics is represented by the Hill-type muscle model, being the activation of each muscle unknown. The muscle force sharing is a redundant problem in which an optimization technique is applied to find the muscle activations, and the corresponding muscle forces, by minimizing an objective function that represents muscle energy consumption. The fulfillment of the equations of motion of the biomechanical model are enforced and the stability of the glenohumeral joint and the scapulothoracic articulation is also imposed, thus providing two sets of constraints for the optimal problem. The validation of the model is carried out by comparing the results from an acquired motion, the abduction of the arm, with available data in the literature and with EMG data.

Context Empirical data for treating forward shoulder posture supports stretching the anterior shoulder musculature. Although muscle-energy techniques (METs) have been hypothesized to lengthen muscle, no data have described the usefulness of this technique among swimmers. Objective To determine if an MET provides improvements in resting pectoralis minor length (PML), forward scapular position, and scapular upward rotation in female collegiate swimmers. Design Controlled laboratory study. Setting Athletic training room. Patients or Other Participants Thirty-nine asymptomatic National Collegiate Athletic Association Division I women's swimmers (19 experimental, 20 control). Intervention(s) The experimental group received 2 treatment sessions per week for 6 weeks. The control group received no intervention during this 6-week period. Main Outcome Measure(s) We administered pretest and posttest measurements for PML, forward scapular position, and scapular upward rotation in positions of rest and 60°, 90°, and 120° of humeral elevation. The MET consisted of a 3-second stretch in the direction of the pectoralis minor fibers, followed by a 5-second isometric horizontal adduction contraction at 25% of maximum force. Immediately after this contraction, the entire sequence was repeated with the muscle being stretched to the new endpoint. A total of 4 cycles of MET were continuously applied per treatment session twice per week for 6 weeks. We conducted 1-way analyses of covariance to determine any between-groups postintervention test differences. Results The MET group had a greater increase in PML postintervention (P = .001, effect size = 1.6) and a greater decrease in forward scapular position postintervention (P = .001, effect size = 1.07) compared with the control group. No differences were found for scapular upward rotation (P > .10). Conclusions Our results indicate that 6 weeks of MET treatments applied to the pectoralis minor of asymptomatic female swimmers provided improvements in PML and forward scapular position compared with a control group.

Properly functioning skeletal muscle is critical for locomotion and performance of many activities of daily living. Muscle wasting and decreased function of skeletal muscle are important factors in many age-related morbidities. There are several pathways for generating ATP in skeletal muscle that allow adequate ATP supply to meet increased demand during muscle activity. A growing body of literature provides evidence that the aging process may be accompanied by changes in metabolic supply and demand during muscle contractions. Herein, we review a body of evidence that several pathways of ATP synthesis (anaerobic glycolysis, oxidative phosphorylation) may be impaired in aging skeletal muscle as well as several underlying molecular and cellular mechanisms. However, detrimental effects of aging on muscle energy metabolism are not universally accepted, particularly when physical inactivity is accounted for. We discuss this important concept as well as several potential countermeasures that may compress the period of morbidity in old age. In the second half of this review, we discuss how energetic demand of skeletal muscle is affected by aging, with specific focus on basal and contractile ATPase activity.

Summary This article describes the principles of evidence-based medicine and how these principles may be implemented in osteopathic practice and applied to the use of muscle energy technique. Because the feasibility of strict adherence to ‘evidence-based' principles is debated, an approach of ‘evidence-informed practice' is recommended. The principles and diagnostic and treatment practices associated with muscle energy technique are re-examined in light of recent research. Implications for the application of muscle energy are outlined, and recommendations are made regarding clinical practice.

Background: Muscle energy techniques (METs) have been used to treat cervical and thoracic range of motion (ROM) restrictions for over 40 years. Of the trials published on METs, most have examined the effectiveness of METs on ROM in the cervical and thoracic spine. Objectives: The aim of this systematic review was to investigate the sensitivity of cervical and thoracic rotation active range of motion, as an objective measure of function, for detecting changes associated with individuals receiving METs compared to (1) individuals receiving no treatment and (2) individuals receiving manipulation. Methods: Relevant databases were searched from January 1970 up to March 2010. Methodological quality of each included study was assessed using the PEDro scale. Effect sizes (Hedges' g) and their 95% confidence intervals were calculated for active rotation ROM scores between and within the MET and comparison groups. Results: Five randomized controlled trials were included in this review. Four studies address...