Isometric resistance

In active techniques, the patient assists the physician by actively contracting certain muscles under the guidance of the physician. There are two forms of active myofascial techniques. Active direct techniques are those in which the patient is asked to contract the involved muscle. These techniques use the Golgi tendon organ reflex to result in relaxation of the involved muscle(s). In these techniques, the physician applies isometric resistance to the contraction. (Isometric resistance The physician apphes resistance to the patient s contraction such that little shortening of the muscle is permitted but a great increase in muscle tension results.)... 

Unyielding counterforce (operator force = patient force) in the form of isometric resistance is necessary to activate the Golgi tendon reflex. Inaccuracy could lead to coimterpro-ductive force. 

FIG. 26-8 Active direct myofascial technique to suboccipital region with isometric resistance. 

FIG. 37-13 Active direct myofasciai technique for tho-racoiumbar muscies. Patient pushes arm toward fioor whiie physician gives isometric resistance. 

Note An assistant creating an isometric resistive force against the lateral aspect of the knee as the extremity is being pivoted laterally back to its original position will increase the effectiveness of the exercise. 

Please see the isometric resistance modification of the Spencer techniques in Chapter 88. 

Other restricted motions of the wrist or hand may be treated in a similar fashion by taking the joint to the barrier to motion, having the patient push against isometric resistance toward the freedom of motion, relax, and repeat the process three times. Any muscle energy technique may be followed by a passive stretch. 

For example, in the case of restricted motion in extension, the patient is first placed in a position of maximum comfortable extension. The patient then tries to move his arm into flexion while the physician applies a mild isometric resistive force. This position is held for 4 seconds, then the patient relaxes. The physician increases the patient s arm extension and the maneuver is repeated. 

The patient is instructed to push his leg downward toward the table. The physician provides isometric resistance for 3 to 5 seconds. 

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