Professional Documents
Culture Documents
Journal of
Bodywork and
Movement Therapies
www.elsevier.com/jbmt
Received 17 April 2008; received in revised form 15 June 2008; accepted 17 June 2008
KEYWORDS
Muscle;
Hamstring;
Stretching;
Isometric;
Osteopathic
medicine
Corresponding author at: A. T. Still Research Institute, A. T. Still University of Health Sciences, 800 W. Jefferson St., Kirksville, MO
63501, USA. Tel. +1 660 626 2530 Fax: +1 660 626 2099.
E-mail address: gfryer@atsu.edu (G. Fryer).
1360-8592/$ - see front matter & 2008 Elsevier Ltd. All rights reserved.
doi:10.1016/j.jbmt.2008.06.011
ARTICLE IN PRESS
A comparison of two muscle energy techniques for increasing exibility
Introduction
Muscle energy technique (MET) is a manual procedure that uses controlled, voluntary isometric
contractions of a targeted muscle group and is
widely advocated by authors in the eld of
osteopathy. MET is claimed to be useful for
lengthening a shortened muscle, improving range
of motion at a joint and increasing drainage of uid
from peripheral regions (Greenman, 2003). Muscle
energy procedures, and related post-isometric
procedures such as proprioceptive neuromuscular
facilitation (PNF), have been demonstrated to be
more effective than static stretching for improving
the extensibility of shortened muscles (Handel
et al., 1997; Magnusson et al., 1996a; Sady et al.,
1982).
Passive stretching of various muscle groups,
particularly the hamstrings, has been reported to
improve the length and extensibility of muscles in
both short and long-term periods of stretching
(Bandy et al., 1997; Bandy et al., 1994; Feland
et al., 2001; Roberts and Wilson, 1999). Additionally, many researchers have reported that postisometric stretching techniques, such as MET and
PNF, produce greater changes in range of motion
and muscle extensibility than static or ballistic
stretching, immediately following treatment
(Cornelius et al., 1992; Moore and Hutton, 1980;
Tanigawa, 1992; Wallin et al., 1985) and in the
longer term (Handel et al., 1997; Magnusson et al.,
1996a; Sady et al., 1982; Wallin et al., 1985). The
exact mechanism by which increased muscle
extensibility occurs is still unclear, and probably
involves both neurophysiological (including changes
to stretch tolerance) and mechanical factors (such
as viscoelastic and plastic changes in the connective tissue elements of the muscle) (Fryer, 2006).
Although there are many variations of the
application of MET, with most authors in the eld
of osteopathy advocating a post-isometric stretch
for increasing muscle length, the recommended
duration for the passive stretch component varies.
A typical application of MET for the purpose of
lengthening a shortened muscles involves the
following steps: (1) stretch the muscle to a
palpated barrier or to the patients tolerance of
stretch, (2) the patient produces a voluntary
isometric contraction of the muscle under stretch
against the clinicians controlled and equal counterforce, (3) the muscle is allowed to relax, while
the clinician maintains a stretch for a dened
period, (4) the clinician takes up the slack
following relaxation so that the muscle has been
lengthened to a new barrier, (5) this process is
repeated several times. It is possible to alter the
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M. Smith, G. Fryer
Measures
AKE was used to measure hamstring extensibility.
AKE has been commonly used by researchers for the
measurement of hamstring length (Handel et al.,
1997) and has been demonstrated to be a reliable
measure (Sullivan et al., 1992).
The participants were requested to lie supine
and the experimental hip exed to 901 and
strapped to a stabilizing bar. The thigh of the
opposite leg was rmly secured to minimize
rotation of the pelvis (Sullivan et al., 1992). Joint
markers were placed on the greater trochanter,
lateral femoral condyle, head of the bula and
lateral malleolus to provide a point of reference to
measure degree of knee extension (Figure 1). The
participants were asked to extend the knee as far
as possible, and a photograph was taken of this
position using a digital camera by Researcher 1.
This procedure was performed three times. The
digital images were analyzed using SiliconCOACH
Pro software to determine the angle of AKE, and
the mean of the three measures used for analysis.
Procedure
Researcher 1 measured the AKE of the investigated
leg and then left the room. Researcher 2 (GF; a
registered osteopath with 15 years clinical experience) entered the room and assigned participants
to treatment groups via lottery draw. Researcher 2
(MS; a nal-year osteopathic student) treated the
experimental leg of the participants according to
the group allocation (Figure 2), and then left the
room. Researcher 1, who was blinded to the
treatment allocations, re-entered the room and
performed the post-treatment AKE measurement
All participants returned 1 week later, receiving
the same measurement and treatment procedure
as previously described. There were no restrictions
to participant activity between treatments.
Intervention
Subjects allocated to Group 1 (n 20; mean
age 21, SD 2; male: female 1:2) received
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A comparison of two muscle energy techniques for increasing exibility
315
Results
Analysis
All data were collated and analyzed using SPSS
professional version 16. Pre- and post-intervention
ROM measurements were analyzed for both groups
using a multi-variate (Hotellings T) SPANOVA.
Table 1
Prepost
Group 1
154.00
8.484
Group 2
145.52
(8.64)
142.23
150.23
7.89
Group 1
Group 2
147.62
145.12
153.7
151.48
6.05
6.37
Treatment Allocation
Group 1
155.00
Group 2
152.50
Average AKE
150.00
147.50
145.00
142.50
Week 1
Pre PPT
Week 1
Post PPT
Week 2
Pre PPT
Week 2
Post PPT
Treatment Time
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316
M. Smith, G. Fryer
Table 2
Treatment phase
Mean (SD)
Week
Week
Week
Week
Week
Week
8.24
2.49
8.70
5.75
.46
6.21
1
1
1
1
1
2
prepost
preWeek 2 pre
preWeek 2 post
postWeek 2 pre
postWeek 2 post
preWeek 2 post
(4.89)
(7.19)
(9.15)
(7.85)
(8.68)
(4.99)
p-value
0.00
0.04
0.00
0.00
0.74
0.00
periods, and between Week 1 post- and Week 2 pretreatment measurements, and between Week 2
pre- and post-measurements, suggesting both
short- and long-term signicant changes in AKE
(Table 2).
Discussion
Many variations of post-isometric stretching have
been advocated for the lengthening of shortened
muscles, but little research is available to help
clinicians choose the most efcacious method.
Although a few researchers have examined the
effect of varying the application of certain components in these techniques (Feland and Marin, 2004;
Mehta and Hatton, 2002; Rowlands et al., 2003),
little can yet be concluded concerning the most
efcacious application. A direct comparison between the methods advocated by Chaitow and
Greenman, two of the most commonly advocated
approaches to muscle stretching in the osteopathic
literature, had not previously been investigated.
The present study found that the immediate
prepost comparison of AKE at both treatment
periods were signicantly increased, demonstrating
an increase in the extensibility of the hamstring
muscle group. Although there was a signicant
within-group change over time, no signicant differences were evident between the two treatment
groups. Neither method in the present study was
found to produce signicantly greater gains in range
of motion on either treatment day or between
treatment days, suggesting that both treatment
techniques were equally effective for increasing
range of motion. This in itself is an important nding,
and implies that while MET may be more effective
than static stretching (Handel et al., 1997; Magnusson
et al., 1996a; Sady et al., 1982), variations in the
duration of post-isometric stretch do not signicantly
alter the efcacy for increasing muscle length.
However, it is worth noting that the Greenman
approach may be more time efcient because the
period between contractions is substantially shorter.
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A comparison of two muscle energy techniques for increasing exibility
formation in the repairing muscle (Lederman,
2005), and future study of these populations with
these stretching approaches may yield information
concerning relative treatment effectiveness that
proves valuable for clinicians.
Although the present study investigated MET
without comparison to either a control or static
stretching group, other researchers have reported
signicant differences between contractrelax
treatments and passive stretching (Tanigawa,
1992; Wallin et al., 1985; Moore and Hutton,
1980). While there were signicant differences
between pre-initial and post nal AKE measurements, a comparison to both a control and static
stretching would have added greater validity to the
results, and clearly demonstrated that both these
post-isometric techniques were superior to passive
stretching in this group of subjects.
The present study demonstrated that both the
Greenman and Chaitow approaches to MET resulted
in increased AKE, both immediately following the
treatments and 1 week after treatment. Further
study relating to the relative efcacy of the specic
components of MET techniques will be required to
determine most appropriate clinical application.
Conclusion
This study found that both Greenman and Chaitow
muscle energy approaches produced increased AKE
immediately after intervention, and demonstrated
a carryover effect 1 week later. There was a
signicant increase in range of motion of the knee
immediately following both treatments at both
weeks, and a signicant increase at the pretreatment measurement at Week 2. There was,
however, no signicant difference between the two
applications. This suggests that variations in the
elements of the techniques, such as the duration of
passive stretch, may not have a signicant inuence on the efcacy of the technique for increasing
hamstring extensibility.
References
Aron, A., Aron, E.N., 1999. Statistics for Psychology, second ed.
New Jersey, Prentice-Hall.
Bandy, W.D., Irion, J.M., 1994. The effect of time on static
stretch on the exibility of the hamstring muscles. Physical
Therapy 74 (9), 845850.
Bandy, W.D., Irion, J.M., Briggler, M., 1997. The effect of time
and frequency of static stretching on exibility of the
hamstring muscles. Physical Therapy 77, 10901096.
Ballantyne, F., Fryer, G., McLaughlin, P., 2003. Journal of
Osteopathic Medicine, April 6 (1), 37.
317