Osteopathic Manipulative Treatment: Muscle Energy Procedure - Sacral Dysfunctions

Osteopathic manipulative treatment particularly focuses on various manual techniques, such as muscle energy techniques (METs), and is used by healthcare providers to diagnose and address structural causes of back pain. These techniques address sacral dysfunctions in patients experiencing low back pain, aiming to alleviate symptoms. The sacrum is a triangular-shaped, weight-transferring bone at the bottom of the vertebral column, which is highlighted as a crucial element in treating back pain and correcting abnormal gait. Low back pain is a common complaint and is a challenge to diagnose and treat. Studies indicate that approximately 85% of patients suffering from low back pain cannot receive a precise diagnosis for their symptoms. Medical schools often instruct that a significant portion of back pain originates from musculoskeletal issues. However, as specific etiologies are less commonly identified, persistent pain leading to restricted activities can substantially diminish patients' quality of life. METs have been essential in correcting structural restrictions leading to low back pain, especially when related to sacral dysfunction. Dr Fred Mitchell, Sr initially developed these techniques in the 1950s after deducing the kinematic motion of the pelvis. MET is largely considered a direct, active treatment, as patients are often positioned toward a barrier, prompting them to move to generate an activating force. There are 9 physiological principles in muscle energy, including post-isometric relaxation, respiratory assist, joint mobilization using muscle force, oculocephalic reflex, reciprocal inhibition, crossed extensor reflex, isokinetic strengthening, isolytic lengthening, and muscle force in one region of the body to achieve movement in another. Among the 9 types of METs, post-isometric isolation stands out as the most commonly used technique. In this approach, the patient is positioned toward a barrier and applies an activating force toward freedom. The isometric contraction induced by this method leads to reciprocal inhibition and relaxation of the antagonistic muscle, effectively addressing soft tissue restrictive barriers and mobilizing joints. This process contributes to pain reduction and improved circulation. Furthermore, sacral motion within the sacroiliac joint can result in 10 somatic dysfunctions, including left-on-right torsion, right-on-left torsion, left-on-left torsions, right-on-right torsions, left or right unilateral flexion or extension, and bilateral flexion or extensions. This article elaborates on diagnosing such sacral dysfunctions and describes the METs used for their correction.