A Randomized Controlled Trial of the Immediate Effects of Muscle Energy Techniques on Posterior Shoulder Tightness.
Moore SD, Laudner KG, McLoda TA, Shaffer MA. J Orthop Sports Phys Ther. 2011 Apr 6. [Epub ahead of print]
We recently had a post on the effect of posterior mobilization techniques to improve posterior capsule mobility. This was based on the theory that the posterior capsule adaptively changes due to repetitive overhead throwing. Another theory is that the posterior muscles, including the rotator cuff and deltoid, may adaptively shorten causing decreases in both internal rotation and horizontal adduction. To address the muscular tightness that may be occurring, a muscle energy technique (MET) can be used. This technique has been effective in the spine and the lower extremity but has never been studied in the upper extremity. This study examined 61 division I baseball players that were randomly assigned to 1 of 3 groups: 1) MET for the horizontal abductors, 2) MET for the external rotators, and 3) a control group. In this study the MET interventions consisted of contract-relax stretches (isometric contraction: 5 sec, active assisted stretch: 30 sec, repeated 3 times). Glenohumeral internal rotation and horizontal adduction were measured prior to and immediately following the stretching technique. They found that the MET for the horizontal abductors group had a significantly greater increase in horizontal adduction motion compared to the control group and greater internal rotation compared to the MET for the external rotators group and the control group.
The results of this study suggest that a MET technique for the horizontal abductors significantly improved both horizontal adduction and internal rotation motion more than those stretched with the MET for the external rotators. MET is designed to improve the flexibility of muscles by reflexively inhibiting the agonist muscle during stretching. Based on these results the posterior shoulder muscles may have increased muscular tone at rest that increases muscular stiffness and therefore limits range of motion. Previous studies have shown that up to 4 days after eccentric exercise muscles have an increase in passive stiffness. The increases in range of motion may suggest that this passive muscular stiffness can be improved acutely. However, this study did not document the date of the last throwing session. It was only stated that the study was performed before any throwing had occurred on the day of testing. Therefore, it is impossible to know if there was decreased range of motion and increased passive muscular stiffness due to being within the 4 day window following throwing. With that being said, addressing both muscular and capsule tightness could be beneficial to maintain optimal glenohumeral range of motion and minimize the risk of shoulder and elbow injuries. However, we would need more research to confirm this hypothesis. Is this a commonly used technique in the clinic for overhead athletes? Have you had success?
Written by: Stephen Thomas
Reviewed by: Jeffrey Driban
Not being the brightest bulb in the box, I'd like to know exactly how this MET is performed in order to incorporate it into practice with my overhead athletes. I have noticed an abundance of trigger point/spasming in the posterior musculature with my athletes that come in complaining of lateral shoulder pain. I have had success in diminishing complaints by working these soft tissue issues and would like to incorporate something like this into practice…let me know!
Tommy great point. For the horizontal adduction MET you have the patient laying supine. Stabilize the scapula in the medial direction with one hand then horizontally adduct the humerus with the other until a stretch is felt. Hold that for 30 secs then have the patient contract against your resistance into horizontal abduction for 5 secs. Then repeat for 3 to 4 repetitions. The same can be done for the external rotators by stretching the patient into internal rotation and having them contract their external rotators against your resistance. Let us know if that improves motion and the trigger points in your athletes. Thanks again.
Funny, I have used MET/Contract relax tech for other areas of the body, and even with adhesive capsulitis patients (shld) that are limited sign into ER, but never thought about it with the posterior capsular tightness or GIRD.
Def a techinque I will try in the future.
I would assume when performing manual resistance in end ranges, close attention has to be paid to pain (intensity and location) during and after theses techniques.
I've been using MET with schoulder problems for a long time now. Not only athletes but also the ideopathic posterior capsule tightness (due to posture for example). I use a lot of contract-relax (=post facilitar inhibitions) and the reciproke inhibitions for the posterior shoulder 'capsule'. Mostly it's not the capsule which gives the limitation, that's why there's such spectaculair progress in a few weeks. The same techniques works with external rotation deficit, in which the subscap plays an important role. I use triggerpoint massage in the armpit together with the MET (Godgess-2003). Lately I'm trying to use dry needling in these muscles to inhibit the muscles and improve ROM, what is your experience with that technique?
Tom thanks for commenting. I agree its a technique I have not used at the shoulder but would imagine it has potential.
Ruben thanks for commenting. It go to hear that you have had success with this technique. I believe the ROM deficits we see in overhead athletes are caused by both cuff tightness and posterior capsule thickness so I would be interested in using the combination of MET with posterior joint mobs that I posted on earlier. This might be a winning combo! I am not familiar with the dry needling technique. Could you explain? Is it similar to prolotherapy?
You are right. Especially in overhead athletes the posterior capsule thickens due to an internal impingement of that tissue.
Here's an example of dry needling. It has nothing to do with prolotherapy, it's more like western acupuncture. Based on the work of Travel and Simmons: