Muscle Energy Techniques as a conservative treatment for Lumbar Pain

Meghan Kieninger

Lumbar pain, both acute and chronic, remains one of the leading causes for a patient to seek medical care.  In fact, the Centers for Disease Control and Prevention, attributes lumbar pain as the most common type of pain reported, with 25% of Americans claiming some kind of back pain in the past three months (2020).  On a global scale, in an assessment from the Global Burden of Disease 2010 study, lumbar pain ranked highest in terms of disability, and sixth in terms of overall burden, out of 291 other diseases (Hoy et al, 2014). Overall decreased lumbar mobility, in addition to increased pain and disability are the main impairments in patients with chronic LBP.

In a further assessment of the Global Burden of Disease 2010 study, the lumbar area and lumbar pain was defined as, “pain in the area on the posterior aspect of the body from the lower margin of the twelfth ribs to the lower gluteal folds with or without pain referred into one or both lower limbs that lasts for at least one day”(Hoy et al, 2014). 

With such a high incidence of injury, it is necessary to explore all treatment options, or combination of treatments, to facilitate efficient and effective return to a patient’s prior level of function.  Treatments can include but aren’t limited to; conservative care of physical therapy, pain management, pharmaceutical regimens, lifestyle adaptations, and surgical interventions. 

 Physical Therapy utilizes a myriad of treatment options to address both acute and chronic lumbar pain, specifically manual treatment as well as therapeutic exercises to address strength and stability through the core and lumbar musculature.  Manual therapy addresses skeletal and soft tissue function through mobilization and manipulation techniques. 

Muscle Energy Technique (MET), is an unofficial form of manual treatment, that utilizes the muscle’s energy in the form of gentle isometric contraction that creates muscle relaxation by activating the autogenic or reciprocal inhibition physiological response.  It has been hypothesized that MET can be used to lengthen and strengthen muscles, to increase fluid mechanics and decrease local edema, and to mobilize a restricted articulation” (Wilson et al, 2003), all of which can be a part of relieving lumbar pain.

Ultimately, lengthening of the muscle, forcing additional muscular control and function, allows for additional mobility and decreased mechanical dysfunction.  MET can be effective when used by patients who show limited range of motion in the lumbar area, and is typically most effective in patients with facet joint dysfunction as the cause of the lumbar pain. 

More specifically, isometric MET entails the following steps:

1. Isolation of the target joint and/or muscle barrier through joint positioning, generally to a pathologic barrier.
2. This is followed by active muscle contraction by the patient in a specific direction, generally away from the restriction, for a specified period against provider-applied counterforce. Conventionally, the amount of force generated by the patient should be the maximum amount comfortably tolerated by both the patient and practitioner.
3. Relaxation of the contracted muscle.
4. Passive movement of the patient’s anatomy toward a new pathologic barrier
5. Repeat steps 1 to 4 as tolerated until physiologic pain sufficiently relieved and/or the achievement of the desired range of motion. (Waxenbaum, 2021).

Although treatment plans for lumbar pain can be multi-factorial, MET can be an effective adjunct to physical therapy treatment.  The goal of MET is to facilitate muscle relaxation, achieved through reducing the tone in antagonist muscle, after a complimentary agonist isometric contraction, this occurs at the cellular level.  This is not a treatment to attempt without the supervision of a licensed physical therapist. 

This article has been approved and reviewed by the scientific writing team lead of Esurgi: Ishtiak Ahmed Chowdhury

References

Capt Eric Wilson, O. P.-S. (2003). Muscle Energy Technique in Patients with Acute Low Back Pain; A Pilot Clinical Trial . Journal of Orthopedic and Sports Physical Therapy , 502-512.

Chaitow, L. (2013). Muscle Energy Techniques by Leon Chaitow. Edinburgh: Churchill Livingston .

Hoy D, March L, Brooks P et al. The Global Burden of Low Back Pain: Estimates from the Global Burden of Disease 2010 Study. Ann Rheum Dis. 2014 Jun;73(6):968-74.

Greenman P. Principles of Manual Therapy. 2nd ed. Baltimore, MD: Williams & Wilkins; 1996.

Centers of Disease Control and Prevention. (2020). Acute Low Back Pain. Retrieved from Centers of Disease Control and Prevention : https://www.cdc.gov/acute-pain/low-back-pain/index.html#ftn1

 Wahyuddin, W., Vongsirinavarat, M., Mekhora, K., Bovonsunthonchai, S., & Adisaipoapun, R. (2020). Immediate effects of muscle energy technique and stabilization exercise in patients with chronic low back pain with suspected facet joint origin: A pilot study. Hong Kong physiotherapy journal : official publication of the Hong Kong Physiotherapy Association Limited = Wu li chih liao, 40(2), 109–119. https://doi.org/10.1142/S1013702520500109

Waxenbaum JA, Lu M. Physiology, Muscle Energy. 2021 Jul 26. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan–. PMID: 32644455.