Research Review: Muscle Energy Technique on Non-Specific Lumbopelvic Pain

Complete Reference: Selkow NM, Grindstaff TL, Cross KM, Pugh K, Hertel J, Saliba S. Short-Term Effect of Muscle Energy Technique on Pain in Individuals with Non-Specific Lumbopelvic Pain: A Pilot Study. J Manual and Manip. Ther 2009; 17(1): E14–E18.

Clinical Relevance:

Low back pain effects nearly 80% of the adult population. It is the most costly injury in terms of workers’ compensation costs and indemnity. Oftentimes clinicians treat non-specific low back pain with unfocused rehabilitation, medications, or biophysical modalities. Hypertonicity of neuromyofascial tissue can be the primary cause of low back pain. This can be quickly and effectively addressed with manual therapy techniques.

Introduction:

Muscle Energy Techniques (MET) is a form of manipulative therapy that has been used to treat muscle imbalance and pain disorders. Clinicians have frequently utilized MET as a tool to treat lumbopelvic pain (LPP). Lumbopelvic pain is often associated with muscular imbalance which can cause unilateral anterior innominate rotation of the pelvis. The purpose of this study is to examine the effectiveness of a single MET treatment for immediate lumbopelvic pain reduction and pain reduction 24 hours following treatment.

Study Limitations:

  • Control group had a higher visual analog scale (VAS) for current pain than worst pain.
  • Only 1 MET treatment intervention was used
  • Subjects were selected from general population, not from health care settings.
  • No measures taken to confirm if the pain was secondary to lumbopelvic disorder.
  • Post-study measure pain but did not measure correction of anterior innominate rotation.

Methods:

Subjects:

  • 20 subjects taken from general population; 10 control and 10 treatment
  • 16 male; 4 female
  • Average age; control group = 29.7 years, treatment group = 24.1 years
  • Subjects must have acute episode of LPP and demonstrated anterior innominate rotation of at least 2°.
  • Subjects exclusions: LBP for > 6 weeks, radicular pain below the knee, history of back surgery, or have been diagnosed by a physician.

Dependent Variables:

  • Current pain
  • Worst pain over 24 hours
  • Pain provocation test yielded greatest pain
  • Pain intensity produced by the provocation test

Independent Variables:

  • Treatment Condition
    • MET treatment
    • Control
  •  Time
    • Pretest
    • Post treatment
    • 24 hours post treatment            

Procedures:

  • Double blind, randomized, controlled trial
  •  Examiner #1 – performed 5 sacro-illiac pain provocative exams then notified in writing of physical exam findings to ensure treatment was performed on proper side for treatment group
  • Examiner #2 – Performed MET or control treatment

Instrumentation:

  • Visual Analog Scale (VAS) – used to measure subjective pain rating
  • PALM – Palpation meter to measure relative anterior innominate rotation

Statistical Analysis:

  • Baseline VAS current and worst pain measured by t-tests.
  • 2X3 repeated ANOVA to analyze treatment and control groups for current VAS, worst over 24 hour VAS, and worst pain provocation VAS
  • Mann-Whitney U test analyzed difference in the number of pain provocative tests pre and post treatment.

Results:

  • VAS worst pain; significant difference with MET treatment group for worst pain over 24 hours (F=5.36, P= .03)
  • No significant difference for VAS of current pain (F=3.93, P=.06
  • No significant difference for VAS pain provocation (F=0.81, P=.46)
  • Significant pain reduction for both groups (P=.04) between days

Conclusion:

Overall, worst pain over 24 hours was significantly reduced following MET treatment when compared to the control. As a clinician working with clients and non-specific low back look for muscle imbalances that can be corrected with manual therapy techniques such as muscle energy, which inhibits overactive tissue then allows for elongation.

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