Journal of Osteopathic Medicine, 2026/02, 126(2):103–108. doi: 10.1515/jom-2024-0131, type of study: article

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Keywords:

article [2634]
MET [640]
muscle energy technique [180]
rib [70]

Abstract:

The muscle energy technique for a superiorly subluxed rib, introduced by Fred Mitchell Sr., DO, and later adapted by Philip Greenman, DO, is an effective treatment for a superior rib one somatic dysfunction. Although muscle energy techniques involve various reflexes, Mitchell and Greenman emphasized the postisometric relaxation variation. However, aligning this technique with general postisometric relaxation principles requires certain assumptions to be made about involved nerve reflexes. By analyzing similarly paired muscles to the anterior and middle scalenes as well as the neurologic mechanisms of muscle energy, the most plausible explanation for this technique involves the crossed-extensor reflex or postisometric relaxation with assumptions. This article examines the reflexes at play and the clinical implications for refining muscle energy applications.