Treatment of ERS and FRS Dysfunction

In general, muscle energy techniques used to treat non-neutral (Type II) dysfunction are designed to normalize muscle tone in the intersegmental muscles of the vertebral segment. This is accomplished by positioning the vertebral segment at the three-dimensional barrier to motion and then performing isometric contractions of the hypertonic muscle that is limiting further motion. The gentle muscle contractions help to reset gamma gain in the muscle spindle of the hypertonic muscle. The resetting of gamma gain allows the muscle to lengthen without abnormal resistance and the vertebral segment to move unimpeded through its normal range of motion. The restoration of normal muscle tone and segmental mobility is thought to lead to resolution of the impaired or altered function at the involved vertebral segment.

Muscle Energy Technique for an ERSL Dysfunction:

The motion restriction with this dysfunction is flexion, right rotation and right side bending. The patient is positioned in right side lying. The clinician stands in front of the patient. The patient rotates their chest toward the table (producing right rotation). The patient’s left arm should be off the edge of the table so that the patient can reach toward the floor and aid the production of right trunk rotation to the rotational barrier at the dysfunctional segment. The clinician must palpate the spinous processes of the dysfunctional segment to determine when the barrier to motion is reached. The clinician supports the patient’s knees on his/her right thigh and palpates the dysfunctional segment. The clinician flexes the patient’s hips until the flexion motion barrier at the dysfunctional segment is encountered. While maintaining the patient’s knees on his/her thigh, the clinician allows the patient’s feet to drop toward the floor (producing right side bending) until the barrier to right side bending at the dysfunctional segment is encountered. Once the flexion, rotation and side bending barriers are engaged, the clinician resists the patient’s effort to lift their feet toward the ceiling. This will produce a contraction of the muscles responsible for left side bending of the spine (the muscles thought to be maintaining the dysfunction). The contraction should be held for 3 to 6 seconds. Upon relaxation, the new flexion, right rotation and right side bending barriers to segmental motion should be engaged. The muscle contraction should be repeated at the new three-dimensional barrier. This muscle contraction and repositioning sequence should be repeated 3 to 5 times. The dysfunctional segment should be re-evaluated after the 3 to 5 repetitions.
Right sidelying position
(ERS treatment)
Right sidelying with right trunk rotation
Right sidelying with right trunk rotation and trunk flexion
Right sidelying with right trunk rotation, trunk flexion, and right trunk sidebending (feet to floor)
Right sidelying with right trunk rotation, trunk flexion, and right trunk sidebending (feet to floor)