Muscle energy techniques are a form of manual therapy that uses active muscle contraction to relax muscles through various mechanisms. It is often used in treatment plans for neck pain, but how does it compare to other forms of manual therapy?
Nonspecific neck pain affects a large part of the general population and exceeds socio-economic boundaries, which affect 80% of people in the course of their lives. It is often of a multifactorial nature and can be acute or chronic.
Most non-specific neck pain responds to conservative treatment (as soon as warning signals have been ruled out), but there is no consensus on which treatment is the best . From a medical point of view, NSAIDs and analgesics are used most frequently, the main treatment being physiotherapy.
Take your knowledge of the neck to the next level
There are many treatment options in the physiotherapy toolkit to combat neck pain. Manual therapy is often high on the list for many clinicians, for example muscle energy techniques (MET). But what is the evidence for the use of MET, is it more or less effective than other forms of manual therapy?
A new systematic review published in Healthcare (Basel) with the aim to compare the clinical effects of MET with other manual therapies or rehab treatments for acute and chronic neck pain and to compare these clinical effects Answer question.
Methods
Although this systematic review was in accordance with the PRISMA guidelines, it was not pre-registered on PROSPERO, which means that the transparency and the room for potential reporting errors within the results are reduced. It also means there are fewer opportunities to try and replicate results in order to assess other forms of bias.
The literature search was carried out at the beginning of 2020 and used five databases; Pubmed, Medline, PEDro, Cochrane Database and Google Scholar. According to best practice, this is more than sufficient.
The keywords used were "muscle energy technique AND / OR neck pain AND / or upper trapezius trigger point, MET AND / OR neck pain AND / OR upper trapezius trigger points.
All clinical study types published between 2010 and 2020 in English or Italian were included. Participants had to be at least 18 years old and the study results had to include one of the following; Neck pain, disability, joint function and quality of life.
Two authors rated the risk of bias using the Cochrane Domain-Based Evaluation Framework and the methodological quality using the PEDro scale. Any disagreement about the inclusion or quality of articles was resolved through discussion until consensus was reached.
Results
A total of 21 studies were included in the qualitative analysis, of which 15 examined acute non-specific neck pain and six examined chronic non-specific neck pain. A total of 913 participants were included in the review (527 women and 386 men) with an average age of 32 years (18-55).
The average methodological quality of the studies included in the review was 6.9 / 10 on the PEDro scale. The risk of bias was low for five of the studies and high for 17 whereby the most common source of potential bias was performance bias.
Brief summary of the muscle energy techniques for non-specific neck pain
MET could be a therapeutic treatment option for both acute and chronic neck pain
Treatment regimens using MET are little reported making it difficult to recommend protocols
MET is most effective when used in conjunction with other conventional rehabilitation techniques
There is little evidence for the sole use of MET in the treatment of non-specific neck pain
Acute neck pain
In a study, MET was compared with triggerpointing of the trapezius in two groups of 15 participants. Trigger pointing was more effective in relieving pain, while MET was more effective in increasing ROM. This was also shown in another study by Kirthika et al. which also comprised two groups of 15 participants. However, a larger study with 52 patients showed that MET is no more effective than myofascial release.
Nagrale et al., A single-blinded RCT with 64 participants and the most robust study examining MET in conjunction with other manual therapies, showed that MET was most effective when used in conjunction with myofascial release techniques. This is essentially the picture of the other included studies; there is little evidence that MET alone is used in the treatment of acute non-specific neck pain.
Chronic neck pain
The image of MET as a treatment that should be used in conjunction with other treatment techniques, if at all, also continues for the treatment of chronic pain. In a study by Jeong et al. there was no difference between MET, passive stretching and massage when it comes to improving pain, freedom of movement or stiffness.
A similar result was obtained in a study by Sadria et al. found comparing two groups of 32, one receiving MET and the other myofascial release. When it comes to comparing exercise and MET, studies including exercise and MET were more effective, but studies were poor at reporting what was meant by exercise which made it very difficult to draw firm conclusions.
Summary
Overall studies examining MET do not seem to have enough force and rigor to draw firm conclusions about its effectiveness. When used to treat nonspecific neck pain, it should be used in conjunction with guideline treatment, if at all. It should not be used as the sole treatment, we can be sure of that.
