Abstract: This article discusses the concepts of the vertical dimension of a joint space and other concepts developed by Sharon (Weiselfish) Giammatteo, PhD, PT, IMP,C. This article also presents a case study of a 39 year old woman who received treatment with Integrative Manual Therapy (IMT) for pain in her right knee that she experienced during running. On initial evaluation, her greatest postural dynamic dysfunction was a severe limitation of her spinal mobility. The therapy that she received with IMT focused on Muscle Energy and ‘Beyond’ Technique for her spine, including her O/A and A/A joints. After treatment was completed, the patient presented with full spinal flexion and reported full elimination of her right knee pain during running.
The Effects of Muscle Energy and ‘Beyond’ Techniques
on Spinal Mobility
By Rosemary Hegarty PT, IMPC
Discussion:
Our practices are filled with clients that come to us because of complaints
of pain or dysfunction. It is our job as the health care practitioner to be
able to differentially diagnosis their dysfunction, understand the dynamics
of that dysfunction and to the best of our abilities use techniques to dimension
the dysfunction and restore a better balance to their bodies. In this case
report, I will present the affects of Muscle Energy and ‘Beyond’
Techniques for the pelvis and spine in a client who presents with a peripheral
joint problem. Many therapists have used Muscle Energy Techniques for years.
Sometimes we have gotten good results, sometimes not. Why is this? The solution
to part of this problem is understanding the problem. What are we trying to
restore when we use a Muscle Energy Technique? As health care practitioners
we are greatly indebted to Sharon (Weiselfish) Giammatteo, Ph.D., PT who developed
Muscle Energy and ‘Beyond’ä Technique to restore joint mobility.
In doing so, she not only gave us more effective techniques but has greatly
advanced our understanding of what we are actually trying to achieve when
performing a Muscle Energy and ‘Beyond’Ô Technique.
There are three aspects of normal joint mobility: articular balance, intra-articular
space and vertical dimension. Dr. (Weiselfish) Giammatteo defines articular
balance as “the relationship of the two articulating surfaces from anatomical
neutral throughout a full physiologic movement”1. If this relationship
is not maintained than normal physiologic motion can not be achieved. For
example, if the normal articular surfaces of the femoral head and acetabulum
are not maintained throughout a full range than full physiologic motion can
not be achieved. The second component of joint mobility is intra-articular
space. This space in joints is maintained by “energy that has a vibrational
molecular particle motion… This energy is entrapped within the fluid
of the spaces. …When the energy flow is affected in the extremity, total
body flow of energy through the intra-articular space is compromised”1.
When I am trying to correct an alignment problem, focusing on the energy in
the intra-articular space will help to correct the biomechanical problem.
The third component of joint mobility is vertical dimension. The vertical
dimension of the joint is maintained by the presence of the energy in the
joint space. If there is a disturbance in the vertical dimension, normal range
of motion can not be achieved.
This case report demonstrates how these techniques remarkably restore normal
joint mobility. It also shows how differential diagnosis is crucial in determining
what treatment should be initiated to affect a patient’s complaint.
History:
A 39-year-old female was referred to Desert Light Health Associates for complaints
of right knee pain with running. She had received minimal manual therapy and
no physical therapy prior to her treatment at Desert Light Health Associates.
She had knee pain for 2-3 years prior to treatment with Integrative Manual
Therapyä. On initial evaluation, her greatest postural dynamic dysfunction
was a severe limitation of her spinal mobility. She presented with spinal
flexion of 10%. Her extension was 20%. As stated above, the spinal joint mobility
limitation indicated that all her joints would have limitations in energetic
space. Therefore, a complaint of knee pain could be related to the spinal
mobility dysfunction.
Treatment:
Treatment was initiated with a specific Muscle Energy and ‘Beyond’ä
Technique sequence for the pelvis, sacrum, spine, and occipito-atlantal joints.
The sequence was as follows: Right pubes descended, left pubes elevated, right
downslip of ilium, mild right downslip of ischium, severe left downslip of
ischium, mild upslip of ilium, with bone bruise at interface. The client was
treated with Muscle Energy and ‘Beyond’Ô Technique for the
tibiotalar and subtalar joints. She was treated for type II dysfunction at
L5 and L4. The T9 vertebra was treated with a type II and type III dysfunction.
She received treatment at Occipito-atlantal and Atlanto-axial joints.
Results:
After completion of the above treatment the client presented with full spinal
flexion and extension. She also reported no right knee pain with running.
One month after treatment, the client retained her full spinal ranges of motion
and was running without right knee pain.