GENERAL CONCEPTS FOR MUSCLE ENERGY

TECHNIQUE(MET) AND SACROILIAC

DYSFUNCTION

BY: SENADA MEMED,SPTA

Morton College PTA Program
SI JOINT ANATOMY AND PHYSIOLOGY
• Sacroiliac joint dysfunction (SIJD) is a common
cause for low back pain

• The sacroiliac joint is a diarthrodial synovial joint

located between the sacrum and the ilium,
comprising the gluteus minimus, medius, and
piriformis muscle. As well as the sacroiliac
ligament.

• The sacroiliac joint (SIJ) cannot function

independently, therefore the ligamentous
structures and the muscles affect the stability of the
SIJ.

• It’s main function is to transfer weight between the

axial and lower appendicular skeletons

• The nerve supply for SIJ is mainly by the sacral rami

dorsal
 RECOGNIZING SIGNS AND SYMPTOMS OF SIJD
 SIJD can happen due to sudden or repetitive trauma between the muscles around the joint.

Risk factors for sacroiliac joint pain include leg length discrepancy, age, arthritis, history of spine surgery, pregnancy, and
trauma.
The most common symptoms for patients are lower back pain and the following sensations in the lower extremity:
pain, numbness, tingling, weakness, pelvis/buttock pain, hip/groin pain, feeling of leg instability (buckling, giving
way), disturbed sleep patterns, disturbed sitting patterns (unable to sit for long periods, sitting on one side), pain
going from sitting to standing.

Too much movement in the SIJ(hypermobility or instability): The pain is typically felt in the lower back and/or
hip and may radiate into the groin area.

Too little movement in the SIJ(hypomobility or fixation): The pain is typically felt on one side of the lower back or
buttocks and can radiate down the leg. The pain usually remains above the knee, but at times pain can extend to the
ankle or foot. The pain is similar to sciatica.
TESTING SIJ IMPAIRMENTS
 With the patient standing observe for symmetry from posterior aspect in the
heights of the iliac crests, PSIS and ASIS. With the hands on these bony
landmarks have the patient march in place and observe movements of the
innominate.

FINDINGS:
 General SIJ hypomobility: pelvis will rise up on the restricted side during the
test.
 Anterior rotated innominate: PSIS will be higher, and ASIS will be lower on the
involved side.
 Posterior rotated innominate: PSIS will be lower, and ASIS will be higher on the
involved side.
Clusters of Pain Provocation
Tests for Detecting Sacroiliac
Joint Pain

 Distraction test

 Compression test

 Thigh thrust test

 Gaenslen test

 Faber test

 3 out of 5 positive tests indicates SIJD,

positive test is if pain is reproduced at the SI
joint or buttocks during the test is performed.
 Muscle Energy Technique
- Muscle energy techniques are one of the
current therapies to treat joint
dysfunctions; especially for SIJD.

- An isometric muscle contraction is

applied against an external counter-force
to indirectly treat the joint dysfunction.

- The force exertion of muscles effectively

transfers the load from the spine through
the pelvis to the legs in order to increase
the stability on the SIJ.
 Muscle Energy Tech: STEPS
 SIJ hypomobility: “SHOT-GUN TECHNIQUE:

 Patient supine in a hook-lying position

 Patient contracts against our resistance to submaximal contractions, alternating between hip
adduction and abduction for a series of 3-5 repetitions holding each contraction for 5 seconds,
instructing them to breathe.

 Anterior rotated innominate:

 Patient supine

 Flexing the involved hip to the point of pain and/or restriction, then resist a series of
submaximal isometric hip extension contractions(in this case we are contracting glute max to rotate
the innominate posteriorly).

 Posterior rotated innominate:

 Patient prone

 Passively extend involved extremity to the restriction or point of pain, then resist a series of
submaximal isometric hip flexion contractions, we can put one hand on the pelvis, assist gliding the
pelvis anteriorly by pushing on the PSIS when the other hand lifts the femur (we are contracting
rectus femoris to rotate the innominate anteriorly).
 KEY POINTS
 The limb is placed into end range
 Patient is pushing with 70% of their maximum force
holding that contraction for 5 seconds.
 This technique is repeated 3-5 times until no more
barriers are felt.
 Make sure patient’s breathing is relaxed while
performing this technique.
 CONTRAINDICATIONs AND PRECAUTIONs FOR MET

 MET is contraindicated in patients who:

- May not tolerate the added exertion or be able to
actively participate in the treatment, Is this safe for my
- Are critically ill, post-surgical, or those that have patient?
increased risk of bleeding.

 Patients with impaired integrity of bones, joints,

and/or tendons should be considered as a relative
contraindication to MET. 
 Random Controlled Study
 Goal of this article:
- To evaluate the therapeutic effects of MET by considering the type of dysfunction and the direction of the corrective maneuver
in women with SIJD.
 Experiment:
- Randomized controlled clinical trial including 60 women with anterior or posterior innominate dysfunctions were randomly
divided into the treatment group and the control group. The range of flexion and extension of the lumbar, visual analogue scale (VAS), active straight leg
raising (ASLR), and pressure pain threshold (PPT) at five points were measured before, after, and 24 hours after MET.

 Results:

- Before, after, and 24 hours after the intervention, the mean change of the range of lumbar flexion and extension showed an increase. However, the mean
change of the level of VAS and ASLR decreased significantly (P < 0.05) .
• The average distance between the two skin points during forward bending by the modified Schober test increased significantly at pretest, immediately, and
24 hours after the test in the MET group, and no significant difference was observed in the control group at pretest, immediately, and 24 hours after the
test.
• The average distance between the two skin points during backward bending during the modified Schober test decreased significantly , indicating increased
range of extension.

Conclusion:
- According to the results of this study, using MET by considering the kind of dysfunction may more efficiently improve a patient’s symptoms. Increases the range of lumbar
flexion and extension up to 24 hours, increases the range of internal and external rotations of the hip up to 24 hours, increases the ability of ASLR up to 24 hours, decreases the
level of pain (VAS), and analgesic effects can continue up to 24 hours.  
 ARTICLE SUMMARY

 Based on the results of this study, MET helped relieve the level of pain.

 From the biomechanical point of view, an active tension of muscles around the SIJ maybe causes
the movement between the coxal bones the sacrum
 The gluteus maximus and rectus femoris have more biomechanical effects because of their lines of
action which creates effective / counteractive force on the SIJ.

Concentrations of endogenous pain inhibitors such as encephalin and endorphin increase during
MET

MET along with corrective exercises is significant physiotherapy for improving functional ability
and decreasing pain in patients with SIJD.
SIJD EXERCISES
 REFERENCES

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https://www.cedars-sinai.org/health-library/diseases-and-conditions/s/sacroiliac-joint-dysfunction.html 

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