CRAC is Contract Relax Antagonist Contract
SO WHAT EXACTLY IS AN ANTAGONIST MUSCLE?
https://youtu.be/QXPcWWyKJb8 The word “antagonist” is a derivative of the Greek word antagonistēs, which translates into some form of opponent or competitor, and which stems from a combination of the words anti- (“against”) and agonizesthai (“to contend for a prize”). So when you take origins into account, you’d be correct to suspect that an antagonist’s muscle is something to fight against. This is why it’s also helpful to know what an agonist is. The word agonist is a derivative of the Greek word agōnistēs, which is a combatant or a champion. With this in mind, you can put both the work of the exercise and the postures of the involved muscle groups into their proper focus. Still, you need to be careful about the application of the terms. If you think of the agonist’s muscle as your champion that’s actively agonizing against the weight, you could logically deduce that the antagonist muscle might be the muscle opposing it in a literal sense, fighting against it with the same ferocity Some of the most commonly used antagonist muscle pairs in the human body include quadriceps/hamstrings, biceps/triceps, shins/calves, pectorals/latissimus dorsi, trapezius/deltoids, Agonists create the normal range of motion of a joint, while subsequent antagonists return the joint to its normal position. Agonists and antagonists usually exist on opposite sides near a joint, such as the biceps and triceps with the elbow as well as the hamstrings and quadriceps at the knee. The biceps are in the front of the upper arm, and the triceps are in the back. When the biceps muscle contracts and the triceps relaxes, the forearm moves up. When the triceps muscle contracts and the biceps relaxes, the forearm moves down. Every human joint is controlled by multiple muscles, and each joint has antagonistic pairs to allow complete freedom of movement. Abdominal muscles, together with erectors, bend the spine forward and backward. Hip abductors and adductors move the legs together and apart. Iliopsoas and gluteals lift the knee. Quadriceps and hamstrings straighten the knee, while deltoids and latissimus dorsi muscles lift and lower the entire arm at the shoulder.
What is Contract-Relax Stretching?
Contract-relax stretching is a form of PNF stretching. PNF stands for proprioceptive neuromuscular facilitation. What does that mean? It means that it uses natural reflexes to further the stretching response. In contract-relax stretching, you must first isometrically contract the opposite muscle. Then after contracting, try to further stretch the intended target. For example, If trying to stretch the biceps: you would isometrically contract the triceps (opposite the biceps) for 10 seconds. Then, you would relax the triceps and try to further stretch the biceps by straightening the arm. This kind of stretching can be performed on any muscle with an antagonist (or muscle that performs its opposite motion) https://youtu.be/mml2IT42cXk
What is the neurophysiology behind contract-relax stretching?
Contract-relax stretching uses one of the simplest reflexes in the human body to give you a deeper stretch. Remember: reflexes are subconscious, so your mind doesn’t have to work to make this happen, it’s just a natural occurrence. The physiological phenomenon behind contract-relax stretching is reciprocal inhibition. Your body knows that when a muscle on one side of the joint is contracting (shortening) the other side of the joint needs to relax (lengthen) to allow this motion to occur. This is known as reciprocal inhibition. let’s use an example to explain this; let’s pretend we are stretching the hamstring: In contract-relax stretching, you would contract the quadriceps muscle before stretching the hamstring muscle. In this case, the quadriceps would contract to make the muscle spindle send a signal to the body. This signal reaches the spinal cord and sends two signals back out to the body:
- One signal comes right back to the muscle that sent it (the quadriceps), and says “keep on shortening and getting tighter!” This is sent by an alpha motor neuron.
- The other signal goes to the opposing muscle (the hamstrings in this case) and says “Relax! the other side needs to get shorter!” This signal comes from an inhibitory interneuron connecting to the alpha motor neuron of the hamstring. Therefore, this inhibitory interneuron is Inhibiting the hamstring from contracting. This in turn makes it fully relaxed.
So then, when the quadriceps muscle finishes contracting, and we suddenly go into a deeper hamstring stretch, the hamstring muscle is more relaxed than before and can allow for more motion! In the picture below the agonist muscle= is quadricep. The antagonist muscle= hamstrings.
How does this differ from static stretching?
Contract-relax stretching differs from static stretching in a few ways, but neurologically in one fundamental way. Static stretching relies on the GTO, not the muscle spindle as the signal messenger. The GTO. triggered by tension has the opposite response of the muscle spindle. The GTO inhibits the agonist muscle contraction and allows the antagonist muscle to contract more. In the example above, this means that if we contracted the quads, it would turn off the quads, and make the hamstrings turn on and start contracting. This is known as autogenic inhibition rather than the reciprocal inhibition used in contract-relax stretching. This GTO response kicks in after about 7-10 seconds when muscle tension has begun to increase in the muscle being stretched.
The Lengthening Reaction (Stretching)
When muscles contract (possibly due to the stretch reflex), they produce tension at the point where the muscle is connected to the tendon, where the The Golgi tendon organ is located. The Golgi tendon organ records the change in tension, and the rate of change of the tension, and sends signals to the spine to convey this information (See “1.6.1 – Proprioceptors”). When this tension exceeds a certain threshold, it triggers the “lengthening reaction” which inhibits the muscles from contracting and causes them to relax. Other names for this reflex are the “inverse myotatic reflex”, “autogenic inhibition”, and the “clasped-knife reflex”. This basic function of the The Golgi tendon organ helps to protect the muscles, tendons, and ligaments from injury. The lengthening reaction is possible only because the signaling of the Golgi tendon organ to the spinal cord is powerful enough to overcome the signaling of the muscle spindles telling the muscle to contract. Another reason for holding a stretch for a prolonged period of time is to allow this lengthening reaction to occur, thus helping the stretched muscles to relax. It is easier to stretch, or lengthen, a muscle when it is not trying to contract.
Components of the Stretch Reflex
The stretch reflex has both a dynamic component and a static component. The static component of the stretch reflex persists as long as the muscle is being stretched. The dynamic component of the stretch reflex (which can be very powerful) lasts for only a moment and is in response to the initial sudden increase in muscle length. The reason that the stretch reflex has two components is that there are actually two kinds of intrafusal muscle fibers: “nuclear chain fibers”, which are responsible for the static component; and “nuclear bag fibers”, which are responsible for the dynamic component. Nuclear chain fibers are long and thin and lengthen steadily when stretched. When these fibers are stretched, the stretch reflex nerves increase their firing rates (signaling) as their length steadily increases. This is the static component of the stretch reflex. Nuclear bag fibers bulge out in the middle, where they are the most elastic. The stretch-sensing nerve ending for these fibers is wrapped around this middle area, which lengthens rapidly when the fiber is stretched. The outer-middle areas, in contrast, act like they are filled with viscous fluid; they resist fast stretching, then gradually extend under prolonged tension. So, when a fast stretch is demanded of these fibers, the middle takes most of the stretch at first; then, as the outer-middle parts extend, the middle can shorten somewhat. So the nerve that senses stretching in these fibers fires rapidly with the onset of a fast stretch, then slows as the middle section of the fiber is allowed to shorten again. This is the dynamic component of the stretch reflex: a strong signal to contract at the onset of a rapid increase in muscle length, followed by slightly “higher than normal” signaling which gradually decreases as the rate of change of the muscle length decreases.
The Stretch Reflex
When the muscle is stretched, so is the muscle spindle (See “1.6.1 – Proprioceptors”). The muscle spindle records the change in length (and how fast) and sends signals to the spine which convey this information. This triggers the “stretch reflex” (also called the “myotatic reflex”) which attempts to resist the change in muscle length by causing the stretched muscle to contract. The more sudden the change in muscle length, the stronger the muscle contractions will be (plyometric, or “jump”, training is based on this fact). This basic function of the muscle spindle helps to maintain muscle tone and to protect the body from injury. One of the reasons for holding a stretch for a prolonged period of time is that as you hold the muscle in a stretched position, the muscle spindle habituates (becomes accustomed to the new length) and reduces its signaling. Gradually, you can train your stretch receptors to allow greater lengthening of the muscles. Some sources suggest that with extensive training, the stretch reflex of certain muscles can be controlled so that there is little or no reflex contraction in response to a sudden stretch. While this type of control provides the opportunity for the greatest gains in flexibility, it also provides the greatest risk of injury if used improperly. Only consummate professional athletes and dancers at the top of their sport (or art) are believed to actually possess this level of muscular control.
The nerve endings that relay all the information about the musculoskeletal system to the central nervous system is called “proprioceptors”. Proprioceptors (also called “mechanoreceptors”) are the source of all “proprioception”: the perception of one’s own body position and movement. The proprioceptors detect any changes in physical displacement (movement or position) and any changes in tension, or force, within the body. They are found in all nerve endings of the joints, muscles, and tendons. The proprioceptors related to stretching are located in the tendons and in the muscle fibers. There are two kinds of muscle fibers: “intrafusal muscle fibers” and “extrafusal muscle fibers”. Extrafusil fibers are the ones that contain myofibrils (See “1.2 – Muscle Composition”) and are what is usually meant when we talk about muscle fibers. Intrafusal fibers are also called “muscle spindles” and lie parallel to the extrafusal fibers. Muscle spindles, or “stretch receptors”, are the primary proprioceptors in the muscle. Another proprioceptor that comes into play during stretching is located in the tendon near the end of the muscle fiber and is called the “Golgi tendon organ”. The third type of proprioceptor, called a “Pacinian corpuscle”, is located close to the Golgi tendon organ and is responsible for detecting changes in movement and pressure within the body. When the extrafusal fibers of a muscle lengthen, so do the intrafusal fibers (muscle spindles). The muscle spindle contains two different types of fibers (or stretch receptors) which are sensitive to the change in muscle length and the rate of change in muscle length. When muscles contract it places tension on the tendons where the Golgi tendon organ is located. The Golgi tendon organ is sensitive to the change in tension and the rate of change of the tension.
What Happens When You Stretch
The stretching of a muscle fiber begins with the sarcomere (See “1.2 – Muscle Composition”), the basic unit of contraction in the muscle fiber. As the sarcomere contracts, the area of overlap between the thick and thin myofilaments increases. As it stretches, this area of overlap decreases, allowing the muscle fiber to elongate. Once the muscle fiber is at its maximum resting length (all the sarcomeres are fully stretched), additional stretching places force on the surrounding connective tissue (See “1.3 – Connective Tissue”). As the tension increases, the collagen fibers in the connective tissue align themselves along the same line of force as the tension. Hence when you stretch, the muscle fiber is pulled out to its full length sarcomere by the sarcomere, and then the connective tissue takes up the remaining slack. When this occurs, it helps to realign any disorganized fibers in the direction of the tension. This realignment is what helps to rehabilitate scarred tissue back to health. When a muscle is stretched, some of its fibers lengthen, but other fibers may remain at rest. The current length of the entire muscle depends upon the number of stretched fibers. According to `SynerStretch’: Picture little pockets of fibers distributed throughout the muscle body stretching, and other fibers simply going along for the ride. Just as the total strength of a contracting muscle is a result of the number of fibers contracting, the total length of a stretched muscle is a result of the number of fibers stretched – the more fibers stretched, the more length developed by the muscle for a given stretch.
Types of Muscle Contractions (Stretching)
The contraction of a muscle does not necessarily imply that the muscle shortens; it only means that tension has been generated. Muscles can contract in the following ways: “isometric contraction” This is a contraction in which no movement takes place because the load on the muscle exceeds the tension generated by the contracting muscle. This occurs when a muscle attempts to push or pull an immovable object. “isotonic contraction” This is a contraction in which movement *does* take place because the tension generated by the contracting muscle exceeds the load on the muscle. This occurs when you use your muscles to successfully push or pull an object. Isotonic contractions are further divided into two types: “concentric contraction” This is a contraction in which the muscle decreases in length (shortens) against an opposing load, such as lifting a weight up. “eccentric contraction” This is a contraction in which the muscle increases in length (lengthens) as it resists a load, such as pushing something down. During a concentric contraction, the muscles that are shortening serve as the agonists and hence do all of the work. During an eccentric contraction, the muscles that are lengthening serve as the agonists (and do all of the work).
Cooperating Muscle Groups (Stretching)
When muscles cause a limb to move through the joint’s range of motion, they usually act in the following cooperating groups: “agonists” These muscles cause movement to occur. They create the normal range of movement in a joint by contracting. Agonists are also referred to as “prime movers” since they are the muscles that are primarily responsible for generating the movement. “antagonists” These muscles act in opposition to the movement generated by the agonists and are responsible for returning a limb to its initial position. “synergists” These muscles perform or assist in performing, the same set of joint motion as the agonists. Synergists are sometimes referred to as “neutralizers” because they help cancel out, or neutralize, extra motion from the agonists to make sure that the force generated works within the desired plane of motion. “fixators” These muscles provide the necessary support to assist in holding the rest of the body in place while the movement occurs. Fixators are also sometimes called “stabilizers”. As an example, when you flex your knee, your hamstring contracts, and, to To some extent so do your gastrocnemius (calf) and lower buttocks. Meanwhile, your quadriceps are inhibited (relaxed and lengthened somewhat) so as not to resist the flexion (See “1.6.4 – Reciprocal Inhibition”). In this example, the hamstring serves as the agonist or prime mover; the quadricep serves as the antagonist, and the calf and lower buttocks serve as the synergists. Agonists and antagonists are usually located on opposite sides of the affected joint (like your hamstrings and quadriceps, or your triceps and biceps), while synergists are usually located on the same side of the joint near the agonists. Larger muscles often call upon their smaller neighbors to function as synergists. The following is a list of commonly used agonist/antagonist muscle pairs: * pectorals/latissimus dorsi (pecs and lats) * anterior deltoids/posterior deltoids (front and back shoulder) * trapezius/deltoids (traps and delts) * abdominals/spinal erectors (abs and lower back) * left and right external obliques (sides) * quadriceps/hamstrings (quads and hams) * shins/calves * biceps/triceps * forearm flexors/extensors
Connective Tissue (Stretching)
Located all around the muscle and its fibers are “connective tissues”. Connective tissue is composed of a base substance and two kinds of protein-based fiber. The two types of fiber are “collagenous connective tissue” and “elastic connective tissue”. Collagenous connective tissue consists mostly of collagen (hence its name) and provides tensile strength. Elastic connective tissue consists mostly of elastin and (as you might guess from its name) provides elasticity. The base substance is called “mucopolysaccharide” and acts as both a lubricant (allowing the fibers to easily slide over one another), and as a glue (holding the fibers of the tissue together into bundles). The more elastic connective tissue there is around a joint, the greater the range of motion in that joint. Connective tissues are made up of tendons, ligaments, and the fascial sheaths that envelop, or bind down, muscles into separate groups. These fascial sheaths, or “fascia”, are named according to where they are located in the muscles: “endomysium” The innermost fascial sheath envelops individual muscle fibers. “perimysium” The fascial sheath that binds groups of muscle fibers into individual fasciculi (See “1.2 – Muscle Composition”). “epimysium” The outermost fascial sheath that binds entire fascicles (See “1.2 – Muscle Composition”). These connective tissues help provide suppleness and tone to the muscles.
Is contract-relax stretching better or worse than static stretching?
There is lots of research out there showing the great short-term benefits of contract-relax stretches. One research study that showed 7 days of contract-relax stretching to the neck resulted in large increases in range of motion, but the effects quickly dwindled when the stretching was discontinued. While there is no denying that contract-relax stretching is effective, it may not be so clear as to whether or not it is that much more effective than static stretching. One study compared static stretching to contract-relax stretching with variable and controlled angles. The results show that with controlled angles, there was no difference between the two methods. But, when allowed to push to the point of pain in a range of motion, that contract-relax stretching had larger joint angles. Even with larger joint angles (aka bigger ranges of motion), the EMG responses (or muscle activity) were not different between the two methods.
The effect of the contract-relax-antagonist-contract (CRAC) stretch of hamstrings on a range of motion, sprint, and agility performance in moderately active males:
Background: Although stretching is done routinely to prevent injury during explosive sports activities, there is some concern that effective stretching might negatively impact performance. Objective: This study’s main objective was to investigate the impact of a specific stretch, the contract-relax-antagonist-contract (CRAC) stretch, in which the muscle to be stretched, namely, the hamstrings, are actively contracted and then relaxed. This is followed by the antagonist muscle (the quadriceps) contracting. Secondly, the impact of the stretch on performance was examined. Methods: A randomized control trial was used. Forty healthy active males between 21 and 35 years old were assigned to either receive three repetitions of CRAC or rest. Hamstring flexibility and the Illinois Agility Test were the primary outcome measures. Results: The intervention was effective in improving hamstring flexibility by 37% immediately post-application and was maintained for eight minutes thereafter. It had no significant effect on agility or sprint times. Conclusion: CRAC, when applied to stretch the hamstring muscles of active males, resulted in a large increase in active knee extension range of motion, without decreasing performance. Therefore, CRAC appears to be a safe and effective method of increasing the length of the hamstrings pre-sport activity and should be utilized by sports physiotherapists if deemed necessary. It was also shown to be beneficial following the initial assessment. Reciprocal inhibition describes the relaxation of muscles on one side of a joint to accommodate contraction on the other side. In some allied health disciplines, this is known as reflexive antagonism. The central nervous system sends a message to the agonist’s muscle to contract. The tension in the antagonist’s muscle is activated by impulses from motor neurons, causing it to relax. Reciprocal Inhibition: This topic is both more and less complicated than you might expect.Simply: Reciprocal inhibition is a neuromuscular reflex that inhibits opposing muscles during movement. For example, if you contract your elbow flexors (biceps) then your elbow extensors (triceps) are inhibited. This is the idea behind active stretching, and one component of PNF stretching. Complex: Reciprocal inhibition is a neuromuscular reflex – An increase in the neural drive of a muscle, or group of muscles, reduces the neural activity of functional antagonists. This plays a significant role in improving the efficiency of the human movement system and creating ideal arthro kinematics. This more nuanced definition encompasses the role of reciprocal inhibition in more complex issues in human movement science. Likely the most important point made in this definition is the terms “increase” and “reduction” implying that reciprocal inhibition is not a simple function of “on or off”. For example, postural dysfunction resulting in adaptive shortening and hypertonicity inhibits functional antagonists (tight psoas-inhibited glutes), but does not decrease the neural drive to the glute complex completely making it possible to move and function (although less than optimally). Or, when looking at complex muscle synergies during the multi-planer movement you may note that muscles may be antagonists in one plane, but not another. For example, the adductor Magnus – posterior head is a functional antagonist of the gluteus medius in the frontal plane but is a synergist during transverse plane external rotation. When an agonist contracts, in order to cause the desired motion, it usually forces the antagonists to relax (See “1.4 – Cooperating Muscle Groups”). This phenomenon is called “reciprocal inhibition” because the antagonists are inhibited from contracting. This is sometimes called “reciprocal innervation” but that term is really a misnomer since it is the agonists which inhibit (relax) the antagonists. The antagonists do *not* actually innervate (cause the contraction of) the agonists. Such inhibition of the antagonistic muscles is not necessarily required. In fact, co-contraction can occur. When you perform a sit-up, one would normally assume that the stomach muscles inhibit the contraction of the muscles in the lumbar, or lower, region of the back. In this particular instance, however, the back muscles (spinal erectors) also contract. This is one reason why sit-ups are good for strengthening the back as well as the stomach. When stretching, it is easier to stretch a muscle that is relaxed than to stretch a muscle that is contracting. By taking advantage of the situations when reciprocal inhibition *does* occur, you can get a more effective stretch by inducing the antagonists to relax during the stretch due to the contraction of the agonists. You also want to relax any muscles used as synergists by the muscle you are trying to stretch. For example, when you stretch your calf, you want to contract the shin muscles (the antagonists of the calf) by flexing your foot. However, the hamstrings use the calf as a synergist so you want to also relax the hamstrings by contracting the quadricep (i.e., keeping your leg straight). https://youtu.be/lvqoQQBoLc4 https://santabarbaradeeptissue.com/index.php/2019/03/26/met-is-an-active-technique-in-which-the-patient-is-also-an-active-participant/ Muscle Energy Technique (MET) is a technique that was developed in 1948 by Fred Mitchell, Sr, D.O. It is a form of manual therapy, widely used in Osteopathy, that uses a muscle’s own energy in the form of gentle isometric contractions to relax the muscles via autogenic or reciprocal inhibition and lengthen the muscle. As compared to static stretching which is a passive technique in which the therapist does all the work, MET is an active technique in which the patient is also an active participant. MET is based on the concepts of Autogenic Inhibition and Reciprocal Inhibition. If a sub-maximal contraction of the muscle is followed by stretching of the same muscle it is known as Autogenic Inhibition MET, and if a submaximal contraction of a muscle is followed by stretching of the opposite muscle then this is known as Reciprocal Inhibition MET. https://www.physio-pedia.com/Muscle_Energy_Technique https://youtu.be/zmp93Nk_xRc https://youtu.be/wg5lPSE4DQI Muscle Energy Technique Popularly known simply as MET, the muscle energy technique is a form of stretching commonly used by sports massage therapists, sports therapists, osteopaths, and physiotherapists, chiropractors, and fitness professionals. There is no standardized definition of this technique, which involves the active contraction of a muscle by the client against a resistive force provided by a second party (i.e., the therapist). Originating as an osteopathic technique in the late 1950s and early 1960s, there are today numerous variations and applications of this method of stretching. MET is believed to be particularly helpful in lengthening postural muscles, which are prone to shortening. Theoretically, the active contraction performed by the client against the resistance produced by the therapist is an isometric contraction and may therefore be helpful in strengthening muscles. Also, contraction of one muscle group decreases tone in the opposing muscle group, and MET may therefore be beneficial in helping to overcome cramping. There is some debate about the degree of force a client should use when contracting a muscle before it is stretched, although low levels of contraction are advocated, certainly no more than 25 percent of the client’s maximum force capacity. This is especially important should the technique be used in the early stages of rehabilitation after injury, when levels as low as 5 percent may be the most appropriate. MET is sometimes used with a pulsing motion (known as pulsed MET), which advocates claim helps reduces localized edema. MET is therefore used in the following circumstances:
- To stretch muscles, especially those considered to be postural rather than phasic
- To strengthen muscles
- Relax muscles, is especially useful for treating cramping muscles
- To help regain correct muscle function
- To reduce localized edema
A disadvantage of this technique is that it may be applied in many ways, and training is required to learn how and when to use each. For further information, please see Muscle Energy Techniques (L. Chaitow, Churchill Livingstone 2001), where eight variations on the basic MET technique are described, along with information on how and when they might be used, and on which the basic MET protocol described here is based. Facilitated Stretching (E. McAtee and J. Charland, Human Kinetics 1999) is also a good source of starting positions for performing MET stretches. Basic MET Protocol A basic MET protocol is as follows: 1. Position the client so that both you and he are comfortable. Take the muscle to be stretched to a resistance barrier, that point where both you and the client can feel an increase in the resistance of the client’s tissues to further elongation. This barrier is the point at which you will start to stretch. Tell the client to let you know as soon as you reach this barrier, a point where he may feel an ever so slight stretch. This entire procedure should be pain-free. 2. Ask the client to contract his muscle (i.e., the one in which he feels the mild stretch) using a maximum of 25 percent of his muscle force, whilst you resist this contraction. Maintain the body part that is being stretched in a static position so the effect is an isometric contraction of the muscle you are about to stretch. It is important that it is the client who sets the level of contraction against which you resist, not the other way around. That is, clients should never be resisting your force; you should be resisting theirs. Remember, too, that when used as part of rehabilitation, clients should be instructed to use very low levels of contraction, perhaps as low as 5 percent of their maximal force. 3. After about 10 seconds ask the client to relax, and within the next 3 to 5 seconds, gently ease the body part further into the stretch so you find a new barrier position. Maintain this position for a few seconds before repeating the procedure up to two more times. You may meet therapists who ask a client to contract a muscle for more than 10 seconds, or who wait a couple of seconds before performing the stretch; many hold the client’s limb in the final stretch position for some time, encouraging a gentle relaxation of soft tissues. There are many variants of MET stretching, and I encourage you to experiment to discover what works for you. Getting Started With MET One of the reasons for including a brief description of MET is that the examples of passive stretches provided in chapters 5, 6, and 7 are all starting positions from which to apply the basic MET protocol described here. For example, if you wanted to apply this basic MET to the calf using this protocol, you would follow these steps: 1. Start with your client in either of the passive stretch positions shown here. 2. Ask your client to use 25 percent of her force to push her toes into your thigh (a) or hand (b), plantar flexing her ankles, and isometrically contracting her calf muscles. 3. Resist this contraction for 10 seconds. Then, once the client relaxes, gently dorsiflex her foot and ankle within the next 3 to 5 seconds to reach a new resistance barrier. https://youtu.be/XvN0LLaIMAI
Osteopathic manipulative treatment (OMT)
Muscle energy and counter strain technique are two of the modalities used in a larger group of treatments known as osteopathic manipulative treatments (OMT). Often, before more advanced therapies or medications, more conservative measures can be taken to help treat disease processes. This activity reviews the evaluation and treatment of the piriformis muscle and highlights the role of the interprofessional team in evaluating and treating this condition. Objectives:
Identify the indications for muscle energy and counterstain.
Describe the technique in which to treat the piriformis muscle using muscle energy.
Outline the technique by which to treat the piriformis muscle using counter strain.
Summarize how to evaluate the piriformis muscle prior to treating it using osteopathic manipulative treatment.
Osteopathic manipulative treatment (OMT) is a group of techniques developed using manual manipulation to treat somatic dysfunction. Its goal is to improve the range of motion of muscles/joints, enhance neuromuscular function, decrease overall pain, and improve biochemical balance. Two particular techniques often used in osteopathic practice are muscle energy technique (MET) and counter strain technique.
Muscle energy is an active and direct technique that engages the patient’s restrictive barrier. The patient contracts the muscle of interest while the physician introduces a counterforce. The counterforce can either be isometric or isotonic, and isotonic forces can be concentric or eccentric.
The Counterstrain technique is a passive and indirect technique that involves identifying a tender point or trigger point and using myofascial planes to maneuver the patient into a position that relieves pain.
Often, hypertrophy, irritation, or overuse of the piriformis muscle can lead to piriformis syndrome. Pain resulting from hypertrophy and overuse is an often overlooked cause of back or buttock pain. Additionally, due to the location of the muscle within the pelvis, it can mimic sciatic pain with radiation to the lower extremities. The piriformis muscle can cause sciatic nerve entrapment syndrome.
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