Mathematical analysis of applied loads on skeletal muscles during manual therapy

Context: Because of the lack of accurate values for mechanically applied forces in osteopathic manipulative treatment, osteopathic physicians must apply mechanical forces intuitively. However, excessive loading and high velocity maneuvers carry risks for patients. Objective: To determine the loads required to produce compression, shear, extension, and twist on biceps muscle during manual therapy. Methods: A mathematical analysis valid for the in vivo state of biceps muscle was performed to determine the loads produced in a simple elastic biceps muscle model and a more realistic viscoelastic biceps muscle model. Results: Loads of 7% lesser pressure were needed to produce 10% deformation of biceps muscle using the viscoelastic model, compared with the elastic model. In the viscoelastic model, there was stress relaxation of 18% of maximum pressure when muscle was deformed by 10% over 60 seconds and maintained in that state for 200 seconds. With quick maneuvers, the viscoelasticity effect was decreased. Conclusion: The biceps muscle is 15 times stiffer in the direction parallel to the muscle fibers than in the direction perpendicular to the fibers. The results of the present study may be used by osteopathic physicians to adjust their manual techniques to match viscoelastic properties of specific tissues. Because biceps muscle is viscoelastic, the results obtained with the viscoelastic model would be more useful than the results obtained with the elastic model for determining viscoelastic loads on this muscle.