When working with client who are rehabbing a serious injury, I have found that muscle guarding is quite often a factor in limited range of motion (ROM).  I have recently seen this in cases of rotator cuff injuries, as well as neck strains.

The technique that I most often turn to in this situation is Muscle Energy Technique (MET).  With gentle activation of the guarding muscles, you can utilize the post-isometric relaxation (PIR) response to “turn off” the guarding muscles and increase the client’s ROM.

I usually start with the client in the mid-rage of their ROM and instruct them to use very gentle force (about 10% of their maximum) against my resistance for about 10 seconds.  At the very end of the 10 seconds, I will slowly decrease my resistance while the client is still pressing against my hand, allowing the client to move their joint further.  After a brief, 5-second hold in the new position, I have the client move against my resistance in the opposite direction following the same steps and repeat this back-and-forth MET for about 10 repetitions.

For example, a client with guarding in shoulder external rotation will attempt to externally rotate their shoulder against my gentle resistance for 10 seconds.  After 8 seconds, I will decrease my resistance slightly, allowing the client to overcome my force and take the arm into a few more degrees of external rotation.  I then repeat these steps against internal rotation to activate the antagonistic muscle groups.

By allowing the client to slightly move the joint at the end of the resistance, they begin to overcome the fear of movement, all the while working within their pain tolerance.