Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedure - Piriformis Muscle

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 counterstrain 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. 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.