Muscle energy technique (MET) is a common conservative treatment for pathology around the spine, particularly lumbopelvic pain (LPP). MET is considered a gentle manual therapy for restricted motion of the spine and extremities 1 and is an active technique where the patient, not the clinician, controls the corrective force 2 . This treatment requires the patient to perform voluntary muscle contractions of varying intensity, in a precise direction, while the clinician applies a counterforce not allowing movement to occur 2 . For many years, MET has been advocated to treat muscle imbalances of the lumbopelvic region such as pelvis asymmetry. The theory behind MET suggests that the technique is used to correct an asymmetry by targeting a contraction of the hamstring or the hip flexors on the painful side of the low back and moving the innominate in a corrected direction. It is worth noting however, that evidence suggests that nonsymptomatic individuals have also been shown to have pelvis asymmetries. Despite this, MET is frequently used by manual therapy clinicians.Unfortunately, few studies have examined the effectiveness of MET. Previous research has found that MET of the low back improved self report of disability when used with supervised neuromuscular reeducation and resistance exercise training 2 , but the effect of MET as an isolated treatment has not been determined. Cervical range of motion increased after 7 MET sessions, which consisted of four 5-second contractions over a 4-week period, and lumbar extension increased after 2 sessions per week for 4 weeks 4,5 . Five-second contractions have shown greatest results with application at the atlanto-axial joint 6 and the thoracic spine 1 . While MET was successful in two studies, the effect of one treatment session was not reported and only range of motion was assessed. Roberts 7 indicated the short-term effects of MET as decreased pain, increased range of motion, decreased muscle tension and spasm, and increased strength. However, these effects seemed to last only a few seconds to minutes, indicating that for continued benefit, MET would have to be applied multiple times throughout the day 7 . At present, the treatment window and lasting effect of a single MET session is undefined 1,2,4-11 . Evidence to support the use of lumbar manipulation in patients with acute lumbopelvic pain with moderate severity has been reported 12,13 , yet, because the treatment pattern of manually trained clinicians varies, we were interested to determine if MET offered similar benefits (albeit, short-term) in patients with acute LPP. Subsequently, the purpose of this ABSTRACT: Muscle energy technique (MET) is a form of manual therapy frequently used to correct lumbopelvic pain (LPP), herein the patient voluntarily contracts specific muscles against the resistance of the clinician. Studies on MET regarding magnitude and duration of effectiveness are limited. This study was a randomized controlled trial in which 20 subjects with self-reported LPP were randomized into two groups (MET ...

Severe brachial plexus injuries are rare in sports, but they have catastrophic results with a significant loss of function in the involved upper extremity. Nerve root avulsions must be timely managed with prompt evaluation, accurate diagnosis, and surgical treatment to optimize the potential for a functional outcome. This case report describes the mechanism of injury, diagnostic evolution, surgical management, and rehabilitation of a college football player who sustained a traumatic complete nerve root avulsion of C5 and C6 (upper trunk of the brachial plexus). Diagnostics included clinical evaluation, magnetic resonance imaging, computed tomography myelogram, and electromyogram. Surgical planning included nerve grafting and neurotization (nerve transfer). Rehabilitation goals were to bring the hand to the face (active biceps function), to stabilize the shoulder for abduction and flexion, and to reduce neuropathic pain. Direct current stimulation, bracing, therapeutic exercise, and biofeedback were used to maximize the use of the athlete’s upper extremity. Although the athlete could not return to sport or normal function by most standards, his results were satisfactory in that he regained an ability to perform many activities of daily living.

The decrease in T(MVIC) immediately after brace application was not accompanied by differences between bracing conditions. Wearing a knee brace or neoprene sleeve did not seem to affect the deterioration of quadriceps function after aerobic exercise.

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Background:The National Athletic Trainers’ Association (NATA) advocates for cervical spine immobilization on a rigid board or vacuum splint and for removal of athletic equipment before transfer to an emergency medical facility.Purpose:To (1) compare triplanar cervical spine motion using motion capture between a traditional rigid spine board and a full-body vacuum splint in equipped and unequipped athletes, (2) assess cervical spine motion during the removal of a football helmet and shoulder pads, and (3) evaluate the effect of body mass on cervical spine motion.Study Design:Controlled laboratory study.Methods:Twenty healthy male participants volunteered for this study to examine the influence of immobilization type and presence of equipment on triplanar angular cervical spine motion. Three-dimensional cervical spine kinematics was measured using an electromagnetic motion analysis system. Independent variables included testing condition (static lift and hold, 30° tilt, transfer, equipment removal), immobilization type (rigid, vacuum-mattress), and equipment (on, off). Peak sagittal-, frontal-, and transverse-plane angular motions were the primary outcome measures of interest.Results:Subjective ratings of comfort and security did not differ between immobilization types (P > .05). Motion between the rigid board and vacuum splint did not differ by more than 2° under any testing condition, either with or without equipment. In removing equipment, the mean peak motion ranged from 12.5° to 14.0° for the rigid spine board and from 11.4° to 15.4° for the vacuum-mattress splint, and more transverse-plane motion occurred when using the vacuum-mattress splint compared with the rigid spine board (mean difference, 0.14 deg/s [95% CI, 0.05-0.23 deg/s]; P = .002). In patients weighing more than 250 lb, the rigid board provided less motion in the frontal plane (P = .027) and sagittal plane (P = .030) during the tilt condition and transfer condition, respectively.Conclusion:The current study confirms similar motion in the vacuum-mattress splint compared with the rigid backboard in varying sized equipped or nonequipped athletes. Cervical spine motion occurs when removing a football helmet and shoulder pads, at an unknown risk to the injured athlete. In athletes who weighed more than 250 lb, immobilization with the rigid board helped to reduce cervical spine motion.Clinical Relevance:Athletic trainers and team physicians should consider immobilization of athletes who weigh more than 250 lb with a rigid board.