Middle Eastern Journal of Disability Studies

Abstract
Background & Objectives: Multiple sclerosis (MS) is a disease with an unknown cause that affects the central nervous system by destroying the myelin sheath around the nerves, disrupting the effective transmission of nerve impulses. Among the complications caused by this disorder are lack of coordination, balance disorders, and stability in maintaining posture while standing and walking. One of the important points in creating stability and balance, especially in a stationary state, is the problem of muscle timing. In MS, muscle contraction is delayed, leading to unbalanced movements. Muscles with spasms also experience tissue shortening. Various methods have been proposed to release the muscles and increase the range of motion. One is the muscle–energy method. This method facilitates neuromuscular relaxation and increases muscle length using post–isometric relaxation and reciprocal inhibition mechanisms. Through the muscle energy technique, the length of the muscle can be brought close to the natural length over time, and subsequently, the necessary force in the muscles to maintain the posture will increase, leading to greater balance in both dynamic and static conditions. Considering that spastic disorders are prevalent in people with MS, this research aimed to study the effect of muscle–energy technique on the performance of people with MS, especially their balance.
Methods: The current quasi–experimental research employed a causal–comparative method with a pretest–posttest design. Using G power software, the sample size was estimated at 20, considering the test power of 0.8, effect size of 0.5, type I error of 0.05, and confidence interval of 0.95. The samples were 25–40 years old, with BMI within 20–25 kg/m² , and obtained EDSS (the Expanded Disability Status Scale) scores between 1 and 4. The samples were randomly divided into two groups of 10 people: control and intervention. The muscle–energy protocol was performed for the intervention group in eight weeks, 3 times a week. The training protocol was used on six flexor and extensor muscle groups of the knee, thigh, and ankle. The 14–step Berg test was used in the pretest and posttest stages to measure balance. This test is a standard test for checking functional balance, which includes 14 balance tests. The score of each test is between 0 and 4. If the total score of the patient is less than or equal to 20, the patient needs a wheelchair, and if the total score of the patient is between 20 and 40, the patient will need help in walking. Patients whose score is more than 40 can walk independently. The obtained information was analyzed using SPSS software version 26. The significance level was set at the 95% level or p≤0.05. The Shapiro–Wilk test, independent t test, and paired t test were used to check the normal distribution of data, the difference between groups, and between pretest and posttest scores.
Results: According to the pretest and posttest scores in the experimental group, their balance scores increased by 5.1, which caused a significant difference in the dependent t test (p≤0.001). However, in the control group, the result was not significant. An independent t test was used to investigate the difference between the groups. The results indicated a significant difference between these groups in the Berg Balance test (p=0.002). Thus, it can be concluded that the implementation of the muscle–energy technique on the muscles of the lower limbs significantly affects the balance of patients with MS.
Conclusion: In general, the intervention of muscle energy on the lower limbs affects the balance of patients with multiple sclerosis. The advantages of the muscle–energy technique include non–invasiveness and low risk, the release of spasmed muscles in the lower limb, greater range of motion, and natural muscle length, as well as increased balance. Therefore, it is recommended that, in addition to therapeutic interventions, experts use protocols such as the muscle–energy technique, especially in the lower limbs, in patients with MS to improve the level of preparation in controlling posture and balance.