Muscle energy technique versus strain counterstrain in treatment of upper trapezius myofascial pain syndrome: a double-blinded randomized controlled trial

Haytham Ibrahim Morsi, Bassem Galal Eldin El Nahass, Mona Mohamed Ibrahim

Haytham Ibrahim Morsi, Bassem Galal Eldin El Nahass, Mona Mohamed Ibrahim – Muscle energy technique versus strain counterstrain in treatment of upper trapezius myofascial pain syndrome: a double-blinded randomized controlled trial –  Fizjoterapia Polska 2025; 25(2); 294-303

DOI: https://doi.org/10.56984/8ZG00E1X350

Abstract
Aim. The aim of this study was to examine the superiority of effectiveness of muscle energy technique (MET) combined with physical therapy (PT), strain counterstrain (SCS) combined with PT, and PT alone in terms of pain intensity, pain pressure threshold (PPT), cervical range of motion (CROM), and neck disability for patients with upper trapezius myofascial pain syndrome (MPS). Materials and methods. Fifty-four patients with upper trapezius MPS were randomly allocated into three equal groups. Group A received MET combined with the PT program, which included therapeutic ultrasound and isometric neck strengthening exercises. Group B received SCS combined with the same PT program, and Group C received the same PT program alone, for three sessions per week for four consecutive weeks. In addition, postural corrections and ergonomic advice were given to all three groups. The outcome measures were assessed pre- and post-treatment and included pain intensity, PPT, CROM, and neck disability, which were evaluated using the visual analogue scale, pressure threshold meter, CROM device, and neck disability index (Arabic version), respectively. Results. A 3×2 mixed model multivariate analysis of variance (MANOVA) test demonstrated significant improvement (p < 0.01) and significant between-group differences for post-treatment mean values (p < 0.05) in all the outcome measures in the three groups. Additionally, significant differences were found for post-treatment mean values in the pairwise comparison in favor of Group A and Group B as compared to Group C (p < 0.05) in all the outcome measures. Conclusion. Both techniques combined with PT are more effective than PT alone for patients with upper trapezius MPS.
Key words:
muscle energy technique, myofascial pain syndrome, physical therapy, strain counterstrain
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Effectiveness of muscle energy technique along with strengthening exercise among college students with lower cross syndrome

Aswin Kumaraguru, Anitha.A, Shenbaga Sundaram Subramanian, Karthick.K, Jeslin. G.N, Neha Lakshmanan, Dinesh Sampath Kumar, Sivaraghav Sathish Kumar

Aswin Kumaraguru et al. – Effectiveness of muscle energy technique along with strengthening exercise among college students with lower cross syndrome –  Fizjoterapia Polska 2025; 25(2); 290-293

DOI: https://doi.org/10.56984/8ZG00E1MU5D

Abstract
Aim. Poor posture, prolonged sitting, and a sedentary lifestyle are common among students, causing muscle imbalances, increased lordosis, and a lateral shift in the center of gravity. These conditions affect muscle strength and can cause lower cross syndrome. This study aims to assess the effectiveness of MET and strengthening exercises in college students with lower cross syndrome.
Material and methods. It is a double-blinded study in which subjects diagnosed with lower cross syndrome were recruited after giving consent. Subjects were allocated into the METs group (n = 20) and the conventional group (n = 20). The baseline evaluation for anterior pelvic tilt was done using Kinovea software. The curl-up test and squat test for abdominal and gluteal muscle strength were recorded.
Results. Statistical analyses, using mean and standard deviation, revealed significant improvements in anterior pelvic tilt, abdominal curl, and squats post-intervention in the METs group compared to the conventional group (p < 0.0001 for all). Post-intervention values were 10.30 ± 1.45, 42.05 ± 2.44, and 36.70 ± 3.23, respectively.
Conclusion. Results prove that the subjects of the METs group improved their anterior pelvic tilt, abdominal strengthening, and gluteal strengthening more than those of the conventional group.
Key words
low back pain, anterior pelvic tilt, muscle energy technique, strengthening exercise, Thomas test, Kinovea software, curl up test
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Muscle energy technique versus Maitland’s mobilization on shoulder pain and disability after neck dissection surgeries

Marwa Mahdy Abd Elhameed, Hagar Reda Shawky El-Habiby, E.M. Othman, Sherif Bahaa El-Din Zayed, Shaimaa M. A. Elsayeh, Dr. Heba Mohamed Mohamady

Marwa Mahdy Abd Elhameed, Hagar Reda Shawky El-Habiby, E.M. Othman, Sherif Bahaa El-Din Zayed, Shaimaa M. A. Elsayeh, Dr. Heba Mohamed Mohamady – Muscle energy technique versus Maitland’s mobilization on shoulder pain and disability after neck dissection surgeries –  Fizjoterapia Polska 2024; 24(4); 396-401

DOI: https://doi.org/10.56984/8ZG01A8C7L3

Abstract
Background. A substantial number of patients who undergo various neck dissection procedures experience shoulder dysfunction and pain, which can significantly complicate or disrupt daily routines, social engagements, and overall Quality of Life (QOL). Muscle Energy Techniques (MET) and mobilization have been demonstrated to effectively reduce shoulder pain and disability.
Objective. The objective of this study was to examine the therapeutic benefits of MET and mobilization in improving shoulder pain and disability following neck dissection surgeries and compare these two techniques’ efficacies.
Design. The present study employed a randomized, single-blind, controlled trial
Methods. Thirty patients between the ages of 25 and 70 (13 men and 17 women) with shoulder dysfunction following six months’ post-neck dissection surgeries were enrolled in the study. Patients were equally randomized into two groups of 15per each: Group A received the Muscle Energy Technique (MET), and Group B underwent Maitland’s Mobilization. Both groups participated in identical conventional physiotherapy regimens. Both interventions were administered at a frequency of three sessions per week over four weeks. Visual Analogue Scale (VAS) for pain assessment, Shoulder Pain, and Disability Index (SPADI), in addition to shoulder range of motion (flexion, abduction, and lateral rotation), were measured before and after four weeks of intervention.
Results. Following four weeks of intervention, both groups exhibited significant improvements in VAS, SPADI, and shoulder flexion, abduction, and lateral rotation, with p values ≤ 0.001. A comparison between the groups showed a statistically significant difference in all measured outcomes, favoring Group A, with p-values < 0.001.
Conclusion. The Muscle Energy Technique (MET) and Maitland’s Mobilization were effective therapeutic strategies for alleviating shoulder pain and disability following neck dissection surgeries. However, the results showed that MET outperformed Maitland’s Mobilization strategies.
Keywords
disability, muscle energy technique, Maitland’s mobilization, neck dissection, shoulder pain
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Revelation of muscle energy technique and positional release technique in mitigating low back pain, disability, and hyperlordosis in patients with low back pain: A comprehensive review

Jency Thangasheela Gnanasigamani, VinodhKumar Ramalingam, Franklin Saju Madhavadian Kurusumuthu

Jency Thangasheela Gnanasigamani, VinodhKumar Ramalingam, Franklin Saju Madhavadian Kurusumuthu – Revelation of muscle energy technique and positional release technique in mitigating low back pain, disability, and hyperlordosis in patients with low back pain: A comprehensive review –  Fizjoterapia Polska 2024; 24(4); 271-281

DOI: https://doi.org/10.56984/8ZG01A8M4N1

Abstract
Background. Low back pain, often known as LBP, is a complicated ailment that has many associated risks, including those related to age, gender, lifestyle, social and psychological background, physical demands of work, social support, pain perception, and much more. Its frequency steadily rises with age and is typically nonspecific or mechanical in nature, with axially abnormal loading that might cause ache in the lower lumbar region. Strain-counter strain (SCS) or positional release technique (PRT) and muscle energy technique (MET) are identified as eligible management for LBP; however, in which way both techniques help to control LBP is to be evaluated.
Objectives. To discuss the potential role of MET and PRT in reducing LBP and to find the space between previous and current practice of MET and PRT in correcting the lordosis angle in the lumbar region and disability in LBP patients.
Methods. English-language articles were searched online, using the PEDro, PubMed, and Google Scholar databases. Keywords were MET, PRT, LBP, and lumbar lordosis. The articles were published from 2001 to 2022, of which 100 were found to be relevant and 20 to meet the inclusion criteria. They included LBP-related articles with MET and PRT techniques of management, excluding those not related to lumbar lordosis or to those two techniques.
Conclusion. Based on the 20 articles reviewed, it was concluded that MET and PRT played a significant role in decreasing participants’ LBP pain, lordosis angle, and functional impairment.
Keywords
low back pain, muscle energy technique, positional release technique, lordosis angle, functional impairment
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Effects of muscle energy technique overhold relax on pain and range of motion in patients with post-surgical elbow stiffness

Junior Sundresh, Kalidasan Varathan, Shenbaga Sundaram Subramanian, Arul Pragassame, Thabbashvinny A.P. Suresh, Makesh Babu Subramanian, Ayman Abdullah Alhammad, Nayef Hamad E Alhatlani, Fadwa Alhalaiqa, Riziq Allah Mustafa Gaowzeh, Kavitha Ramanathan

Junior Sundresh et al. – Effects of muscle energy technique overhold relax on pain and range of motion in patients with post-surgical elbow stiffness –  Fizjoterapia Polska 2024; 24(3); 242-248

DOI: https://doi.org/10.56984/8ZG020AHBC

Abstract:
Background. An elbow joint that can move and is stable is important for work, play, and sports. Stiffness in the elbow after surgery is common and can make it difficult to perform daily activities. This is a significant problem for therapy. Therapeutic exercises, especially stretching exercises, are a crucial part of physiotherapy for alleviating elbow stiffness. Muscle Energy Technique (MET) is a manual therapy that uses mild isometric contractions to utilize the muscles’ energy to help with limited limb movement. On the other hand, Proprioceptive Neuromuscular Facilitation (PNF) is one of the best ways to improve motor performance and speed up recovery by increasing the range of motion and flexibility. The goal is to determine how MET over Hold‑Relax affects pain and range of motion when rehabilitating stiffness in the elbow after surgery.
Methods. A quasi-experimental study was conducted on 12 patients post-elbow fracture fixation. Group A was given MET, while Group B received the Hold-Relax Technique three times a week for three consecutive weeks after the immobilization period. As baseline treatment, both groups received active ROM exercises. Pain (Visual Analog Scale) and ROM (goniometer) were assessed pre- and post-3 weeks.
Results. In the third week, the two treatment groups showed a statistically significant difference in all parametric values (P < 0.05). However, Group B Hold-Relax’s mean difference and paired and unpaired t-test values were greater compared to Group A MET at the end of the third week.
Conclusion. This study concludes that implementing PNF stretch (Hold-Relax) in conjunction with conventional treatment techniques in post-surgical stiffness is beneficial in enhancing the subject’s quality of life by reducing pain and restoring ROM. Hence, PNF (Hold-Relax) can be the best treatment option in physiotherapy practice.
Keywords:
elbow stiffness, muscle energy technique, Hold-Relax, pain, range of motion
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Muscle energy techniques versus myofascial release on scoliosis in adolescent girls: A randomized controlled trial

Amira. H. Mohammed, Safy. E. Abo-Ali, Sahar M. Abdelmutilibe, Sara. A. Elsamahy, Nashwa. E. Elsherif, Malak. A. Elmahdy, Samah. M. Sheha

 

Amira. H. Mohammed, Safy. E. Abo-Ali, Sahar M. Abdelmutilibe, Sara. A. Elsamahy, Nashwa. E. Elsherif, Malak. A. Elmahdy, Samah. M. Sheha – Muscle energy techniques versus myofascial release on scoliosis in adolescent girls: A randomized controlled trial –  Fizjoterapia Polska 2024; 24(1); 54-59

DOI: https://doi.org/10.56984/8ZG2EF864D

Abstract
Background. Adolescent idiopathic scoliosis (AIS) is a complicated 3D structural spine condition occurring in children aged 10 to skeletal maturity. The study aimed to examine the impact of muscle energy technique and/or myofascial release on adolescent idiopathic scoliosis for large sample. Also, it aimed to compare the muscle energy techniques versus myofascial release on idiopathic scoliosis.
Methods. A total of 50 girls with idiopathic non-bony structural scoliosis of the thoracic spine were included in this trial. They were randomly divided into two equal-sized (n = 25 for each group). For three months, group A (Muscle energy technique Group), which received Scientific Exercises Approach to Scoliosis exercises in addition to Muscle energy technique; and group B (Myofascial release Group), which received the same Scientific Exercises Approach to Scoliosis exercises conducted to group A in addition to myofascial release. The primary outcome was a standing radiological evaluation of coronal Cobb´s angle.
Results. According to this study’s findings, a highly significant difference was discovered in the mean values of Cobb´s angle between pre and post-treatment in muscle energy technique group. When the mean values of Cobb´s angle was compared before and after treatment for myofascial release group, it was reveals a significant change.
Conclusions. After treatment for three months, both groups improved significantly, with muscle energy technique group outperforming the myofascial release group by a large margin. So, muscle energy technique was more effective than myofascial release in reducing the abnormal thoracic curvature in adolescent idiopathic scoliosis.
Trial registration. The study was registered with Clinicaltrials.gov under the identifier NCT05120089.
Keywords
myofascial release, muscle energy technique, scoliosis
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Muscle Energy Technique versus Static Stretch on Forward Head Posture in patients with Mechanical Neck pain: Randomized controlled trial

Haidy S. Roshdy, Maher A. Elkeblawy, Soheir S. Rezkallah, Mohmed M. Elkeblawy

Haidy S. Roshdy, Maher A. Elkeblawy, Soheir S. Rezkallah, Mohmed M. Elkeblawy – Muscle Energy Technique versus Static Stretch on Forward Head Posture in patients with Mechanical Neck pain: Randomized controlled trial. Fizjoterapia Polska 2020; 20(5); 208-214

Abstract
Background. Mechanical neck pain (MNP) is one of the most common disorders that originates from poor postural habits and bad ergonomics. Forward head posture (FHP) was highly correlated to MNP. Muscle energy technique (MET) and stretching are easy widespread therapeutic techniques that are known for their effects in improving tissue extensibility, relieving pain and promoting function.
Objective. A randomized controlled trial was designed to compare the effect of MET versus static stretching in terms of FHP, pain and disability in patients with MNP.
Methods. Thirty participants (3 males and 27 females, 18-30 years old) were randomly allocated into one of 3 groups: group (A) received MET+ hydrocollator pack+ postural education, group (B) received stretching and strengthening exercises+ hydrocollator pack+ postural education, group (C) control group received hydrocollator pack+ postural education, 3 sessions /week for 4 weeks. Evaluation was done pre-treatment, post-treatment and after 6-weeks of follow-up. Results: There were significant improvement (p<0.05) in all tested variables in all groups post-treatment except disability in control group. There was significant improvement of pain in all groups, disability in experimental groups and FHP in stretching group only at the follow-up. There were no significant differences between groups in all measured variables.
Conclusion. MET has equal effect to that of static stretching regarding pain and function even after 6-weeks of follow-up. Stretching showed better improvement in FHP correction that persists. Postural education is effective in pain management and seems to have a role in preserving long-term outcome.
Key words:
Forward Head Posture, Mechanical Neck Pain, Muscle Energy Technique, Static stretching, Visual Analogue Scale, Neck Disability Index, Craniovertebral angle
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Muscle energy technique versus core stability exercises on asymptomatic lumbar hyperlordosis in adults: A Randomized controlled trial

Hanaa Kenawy Atta, Abeer Mohamed ElDeeb, Hamada Ahmed Hamada, Yasser Mohamed Aneis

Hanaa Kenawy Atta, Abeer Mohamed ElDeeb, Hamada Ahmed Hamada, Yasser Mohamed Aneis – Muscle energy technique versus core stability exercises on asymptomatic lumbar hyperlordosis in adults: A Randomized controlled trial. Fizjoterapia Polska 2020; 20(4); 50-56

Abstract
Purpose. This study aimed to evaluate and compare the impact of muscle energy technique and core stability exercises on lumbar lordosis angle, pelvic inclination angle, and lumbar range of motion (ROM) in adults with asymptomatic hyperlordosis. Materials and methods. Sixty subjects with documented lumbar hyper-lordosis, aged 18-30, had a lumbar lordosis angle > 58.5 ° with a body mass index of ˂ 29.9 kg/m2, were assigned randomly into three groups. Group (A) underwent muscle energy technique in addition to postural correction exercises, group (B) received core stability exercises along with postural correction exercises, while group (C) got a postural correction exercise only. The intervention was administered for 12 weeks, three days a week. Plain X-ray and double inclinometers were used respectively for the assessment of lumbar lordosis and pelvic inclination angles and lumbar flexion and extension ROM. Results. All groups reported a substantial decrement in both lumbar lordotic and pelvic inclination angles as well as a marked increment in lumbar flexion and extension ROM following intervention relative to baseline. Differences between groups were noteworthy with respect to lumbar lordotic angle, pelvic angle of inclination and lumbar flexion ROM with significant enhancements in favor of group A and B compared to group C, however, there was no difference between groups regarding lumbar extension ROM. Conclusions. Both muscle energy technique and core stability exercises are equally effective in correcting hyperlordosis and pelvic tilting, as well as in increasing lumbar flexion and extension ROM through improving lumbopelvic stability and pelvic symmetry in adults with asymptomatic hyperlordosis.

Key words:
Muscle energy technique, core stability exercises, hyperlordosis

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Effect of Manual therapy over conventional treatment among chronic degenerative joint disease of the knee – A Prospective Comparative study

A D Gopalswami, S.Senthil Kumar, S. Venkatesan

A D Gopalswami, S.Senthil Kumar, S. Venkatesan – Effect of Manual therapy over conventional treatment among chronic degenerative joint disease of the knee – A Prospective Comparative study. Fizjoterapia Polska 2019; 19(3); 82-90

Abstract
Background. Degenerative Joint Disease (DJD) of knee is a musculoskeletal disorder that affects about 22% to 39% of population in India. The physical impairments among DJD patients poses a significant challenge to clinicians in order to manage and restore their functional capabilities. The disease has been well managed with conventional physiotherapy and exercises. The potential benefits of such physiotherapy lasted for short term.
Aim. Thus, the primary aim was to find the efficacy of less explored methods of treating muscular deficits such as Muscle Energy Techniques (MET) and structured exercise program. The primary objectives of the study were to analyze the effectiveness of MET and joint mobilization in relieving pain severity, improving knee joint ROM and muscle strength.
Material and methods. One hundred patients diagnosed to have tibiofemoral joint degeneration with a grade 2 or 3 on Kellgren and Lawrence scale, were allocated in to Experimental Group (EG) and Comparative Group (CG). EG had received manual therapy in the form of joint mobilization, MET, strengthening exercises and patient education whereas CG had received the referred treatment program (Interferential therapy) along with strengthening exercises and patient education for a period of two weeks.
Results. The analyses of outcome variables for Pain (VAS), knee joint Range of Motion (ROM), Muscle Power and Isometric muscle strength of Quadriceps and Hamstrings was done. Choice of statistical tests (Wilcoxon signed rank test and Mann Whitney U test) was used based on the type of variables.
Conclusions. In a disease specific program, inclusion of manual therapy as a part of treatment regimen would be an effective management for knee osteoarthritis patients. Such an intervention may possibly delay or reduce the need for joint replacement.

Key words:
Degenerative Joint Disease, Manual therapy, Muscle energy technique, Exercise program

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