Muscle energy techniques

Front cover
Muscle Energy Techniques with DVD-ROM
Copyright page
Table of Contents
Contributors
Foreword
	References
Preface
Acknowledgements
The Website
1 Muscle Energy Techniques
	Chapter Contents
	What is MET?
		Variables
	MET – an evolving approach
	Adaptation leading to  somatic dysfunction
		Repetitive lumbar injury – an example of failed adaptation
			Grieve’s decompensation model
		A therapeutic formula: reduce adaptive load and enhance function
		Functional independence
		STAR and TART assessments
			STAR (Dowling 1998)
			TART (Chase 2009)
				Differences?
				Are these features of somatic dysfunction real?
	Definitions of PNF and MET
	Muscle Energy Technique  (MET) & Proprioceptive Neuromuscular Facilitation (PNF): similarities  and differences
		MET-PNF similarities
		MET-PNF differences
		Different MET approaches
			A note on terminology
		The addition of respiratory and visual synkinesis
	Muscle types and MET
		Change of muscle type
		Stress implications for different muscle types
			Which muscles belong in which groupings?
				Postural and phasic muscle lists
			Joints, muscles and MET – identifying sources of pain (Kaltenborn 1985; Kuchera and Kuchera 1992)
				Muscles and joints: causes and effects – Janda’s view
				Mitchell’s ‘short muscle paradigm’ view
				Greenman’s view
				Mense’s view
			More on joints and MET
		Viscoelasticity in relation to MET/PNF contractions and stretching
		Possible neurological effects of MET
		Distraction as a means of increasing stretch tolerance
		Analgesia following sustained isometric contractions
			Possible mechanisms
			Possible features of hypoalgesia following isometric contractions
			Stretching increases stretch tolerance
		MET in tissue remodelling and mechanotransduction
			An example of mechanotransduction
	Summary
	References
2 The history of Muscle Energy Technique
	Chapter Contents
	Fred L. Mitchell Sr.’s approach to osteopathy
		The origin of the development  of MET
			Ruddy’s influence
	Further development of MET
		PNF and MET
		Kimberly and Mitchell Sr.
	The meaning and recognition of MET
		First tutorial
		MET after the death of Fred  Mitchell Sr.
		Lewit and MET
		Janda and Mitchell
	The model of MET and research findings in recent years
	References
3 MET: efficacy and research
	Chapter Contents
	Efficacy and effectiveness
		Muscle energy for pain and restricted motion of the spine
			Effect on range of motion
			Effect on spinal pain
		Muscle energy for myofascial extensibility
			Immediate effects of isometric contraction stretching techniques
			Applications of isometric contraction stretching techniques over longer periods
			Studies on muscles other than hamstrings
				Chronic shoulder dysfunction
				Eccentric isotonic MET (see also Chapter 8b)
			Direction of contraction
			Duration of contraction
			Force of contraction
			Number of contraction phases
			Duration of post-contraction stretch
			Frequency of application
			Post-exercise
			Heat and cold
			Muscle pain
			Conclusion
	Research into the mechanisms of therapeutic effect
		Mechanisms for increasing myofascial extensibility
			Reflex muscle relaxation
			Viscoelastic or muscle property change
			Stretch tolerance
		Mechanisms for improving  spinal function
			Increase in range of motion
			Reduction in pain
			Tissue fluid drainage
			Improvement of proprioception and  motor control
		Diagnostic issues
	References
4 How to use MET
	Chapter Contents
	Palpation skills
		Ease and bind/loose and tight
		Three-dimensional patterns
		Clinical possibilities
		Palpating balance
		Test for palpation of ease and bind during assessment of adductors of the thigh (see Fig. 4.1A, B)
		Goodridge’s ease–bind palpation exercise, part 1 (Goodridge 1981)
		Goodridge’s ease–bind palpation exercise, part 2
			MET exercise
		Basic MET exercise using post-isometric relaxation (PIR) in  an acute context
		Basic MET exercise using postisometric relaxation (PIR) followed by stretch, in  a chronic context
			Modification of Janda’s approach
			The differences between Janda’s and Lewit’s use of PIR
		Reciprocal inhibition
		Basic exercise in MET using reciprocal inhibition in acute and chronic contexts
	MET – some common errors and contraindications
		Possible patient errors during MET
		Practitioner errors in application  of MET
		Contraindications and side-effects of MET
			Side-effects will be limited if MET is used in ways that:
		Breathing and MET
		Degree of effort with isometric contraction
	More on MET variations
		Strength testing – Mitchell’s (1979) view
		Janda’s contrary view on the accuracy of muscle testing
		Strain-transmission and stretching
			Conclusion
			Mitchell and Janda and ‘the weakness factor’
			Should you stretch short/tight  muscles before facilitating tone  in inhibited antagonists?
			Strength testing methodology
		Ruddy’s methods – ‘pulsed MET’
		Isotonic concentric strengthening MET methods
		Isotonic eccentric alternatives
			Example of a slow eccentric isotonic  stretch (SEIS)
		Strengthening a joint complex with isokinetic MET
		Reduction of fibrotic changes  with isolytic (rapid isotonic eccentric) MET
		Summary of choices for MET in treating muscle problems
		Joints and MET
		Self-treatment
			How often should self-treatment be prescribed?
		When should MET be applied to  a muscle?
		Evaluation
	Muscle maps
	References
5 Sequential assessment and MET treatment  of main postural muscles
	Chapter Contents
	Clinical research evidence
		MET and myofascial pain
		MET and muscles in clinical settings
			Shoulder range of motion, impingement and dysfunction
			Low-back and sacroiliac pain
			MET – with other modalities – for example in treatment of fibromyalgia
	Objectives of manual treatment
	Evaluating muscle shortness and strength
	Important notes on assessments and use of MET
		What’s short? What’s tight? Postural muscle assessment sequence checklist
	Sequential assessment and MET treatment of postural muscles
		1. Assessment of gastrocnemius (01) and soleus (02) (Fig. 5.1A, B)
			Assessment of tight soleus (02)
			Squat screening test
			MET treatment of shortened gastrocnemius and soleus (see Fig. 5.1A, B)
		2. Assessing for shortness in medial hamstrings (03) (semi-membranosus, semi-tendinosus as well as gracilis) and short adductors (04) (pectineus, adductors brevis, magnus and longus) (Figs 5.3 and 5.4)
			Screening short adductors (04) from medial hamstrings (03)
			MET treatment of shortness in short and long adductors of the thigh
			Caution and alternative treatment position (Fig. 5.5)
		3. Assessment and treatment of hip flexors – rectus femoris (05), iliopsoas (06) (see also Box 5.4 and Fig. 5.6A)
			Mitchell’s Strength Test
			What if one psoas is inhibited, and the other tight?
			Alternative psoas strength test and toning exercise (Norris 1999) (Fig. 5.7B)
			MET treatment for shortness of rectus femoris
			Alternative rectus femoris MET treatment, using slow eccentric isotonic stretching (SEIS) of the hamstrings (in chronic, not acute, settings)
			MET treatment of psoas
				Method A Prone (Fig. 5.9A, B)
				Method B (Fig. 5.10A)
			MET treatment of psoas
				Method C (Fig. 5.11A, B)
			Self-treatment of psoas
				Method A
				Method B (Fig. 5.12)
		4. Assessment and treatment of hamstrings (07) (Fig. 5.13A, B)
			Methodology
				Hamstring test A
				Hamstring test B (Fig. 5.13C)
				Janda’s hip extension test (see Fig. 5.14)
					Commentary on hip extension test
				Alternative observational test
			Method A. MET for shortness of lower hamstrings using agonists
			Method B. MET treatment of lower hamstrings using antagonists (Fig. 5.13C)
			Method C. Co-contraction MET method of hamstring treatment
			Method D. Simultaneous toning of hamstring antagonists (quadriceps) and preparation for stretch of shortened hamstrings using SEIS
			MET for shortness of the upper hamstrings
		5. Assessment and treatment  of tensor fascia lata (TFL) (08)  (see also Box 5.5)
			Lewit’s (1999) TFL palpation
			Janda’s (1996) Observation assessment – hip abduction test (Fig. 5.16)
			Method A. Supine MET treatment of shortened TFL (Fig. 5.17)
			Method B. Greenman alternative supine MET treatment of shortened TFL (Fig. 5.18)
			Method C. Isolytic variation
			Method D. Side-lying MET treatment  of TFL
			Additional methods
			Self-treatment and maintenance
		6. Assessment and treatment of piriformis (09) (see also Boxes 5.6 and 5.7)
			Test A1. Piriformis stretch test
			Test A2. Alternative: FAIR test = flexion, adduction, internal rotation
			Test B. Piriformis palpation test (Fig. 5.20)
			Piriformis strength test
			MET treatment of piriformis
				Method A: Supine
				Method B: Supine, with full hip flexion and external rotation
				Method C: Prone (see Fig. 5.21B)
				Method D: Side-lying – ischaemic compression together with MET
		7. Assessment and treatment of quadratus lumborum (10) (see also  Box 5.8)
			Quadratus lumborum test A (Fig. 5.23, see also Fig. 5.16)
			Quadratus lumborum test B
			Treatment of shortened QL
				Method A. MET for shortness in quadratus lumborum (‘banana’) (Fig. 5.24)
				Method B. Quadratus lumborum side-lying MET (Fig. 5.25)
				Method C. Quadratus lumborum gravity-induced MET – self-treatment
				Method D. Quadratus lumborum MET
		8. Assessment and treatment of pectoralis major (11) and latissimus dorsi (12)
			Latissimus and pectoral test A
			Latissimus and pectoral test B
			Assessment of shortness in pectoralis major (Fig. 5.28)
			Assessment for strength of pectoralis major
			Method A. MET treatment of short pectoralis major (Fig. 5.29A, B)
			Method B. Pectoralis major MET (Fig. 5.30)
			Method C. Slow eccentric isometric contraction (SEIS) MET treatment of pectoralis major
				MET treatment of short pectoralis minor  (Fig. 5.31)
			Latissimus dorsi (12) test for shortness
			Method A. MET treatment of shortened latissimus dorsi
			Method B. MET of shortened latissimus dorsi (Fig. 5.32)
		9. Assessment and treatment of upper trapezius (13)
			Upper trapezius shortness test A  (Fig. 5.33)
			Upper trapezius shortness test B
			Upper trapezius shortness test C
			Method A. MET treatment of chronically shortened upper trapezius (Fig. 5.35 A–C)
			Method B. MET treatment of acutely shortened upper trapezius, with visual synkinesis
				Cervical mobility and MET
		10. Assessment and treatment of scalenes (14) (see also Box 5.9)
			Assessment A: Scalene observation – the paradoxical breathing assessment
			Assessment B: Scalene functional observation and palpation
			MET treatment of short scalenes  (Fig. 5.37A–C)
		11. Assessment for shortness of sternocleidomastoid (15) (see also Box 5.10)
			Functional SCM test
			MET treatment of shortened SCM (Fig. 5.38)
		12. Assessment and treatment  of levator scapulae (16)
			Test A (spring test) for levator scapula shortness
			Test B for levator scapula shortness (observation)
			Test C for levator dysfunction
			MET treatment of levator scapula (Fig. 5.39)
			Facilitation of tone in lower shoulder fixators using pulsed MET (Ruddy 1962)
				Method A
				Method B
			Pulsed MET treatment for eye muscles (Ruddy 1962)
		13. Assessment and treatment of shortness in infraspinatus (17)
			Infraspinatus shortness test A
			Infraspinatus shortness test B (Fig. 5.40)
			Assessment for infraspinatus weakness
			MET treatment of infraspinatus (Fig. 5.41)
		14. Assessment and treatment  of subscapularis (18)
			Subscapularis shortness test A
			Subscapularis shortness test B (Fig. 5.42A)
			Assessment of weakness in subscapularis
			MET treatment of subscapularis
		15. Assessment for shortness  of supraspinatus (19)
			Supraspinatus shortness test
			Assessment for supraspinatus weakness
			MET treatment of supraspinatus (Fig. 5.43)
		16. Assessment and treatment  of flexors of the arm (20)
			Biceps tendon shortness test A
			Biceps tendon shortness test B
			Biceps tendon shortness test C
			MET treatment for shortness in biceps tendon
			Flexors of the forearm – MET treatment
			Biceps brachii – assessment and MET treatment
		17. Assessment and treatment of paravertebral muscles (21)
			Paravertebral muscle shortness test A
			Paravertebral muscle shortness test B
			Interpretation of paravertebral muscle shortness tests A and B
			Paravertebral muscle shortness test C – the ‘breathing wave’ (Fig. 5.47)
			MET treatment of erector spinae muscle – seated
			MET transverse stretching of paraspinal musculature
				‘C’ bend & ‘S’ bend techniques (Figs. 5.48 & 5.49)
			Thoracolumbar dysfunction
			MET treatment of thoracolumbar dysfunction
			Assessment for shortness in erector spinae muscles of the neck (22)
			Assessment of weakness of deep neck flexors
			Toning the deep neck flexors using slow eccentric isotonic stretching (SEIS; see Ch. 4)
			MET treatment of short neck extensor muscles
			MET treatment methods for joint problems
	References
6 MET and the treatment of joints
	Chapter Contents
	Joints and MET
		Opinion or evidence?
		What makes joints stiff?
		Age, disease and MET
		End-of-range, end-feel, restrictions to normal motion
			Kaltenborn’s (1985) description of normal end-feel variations
			Kaltenborn’s definition of abnormal  end-feel variations
		Lewit’s anaesthetised patients
		Muscles or joints?
		MET mechanisms in treatment  of joints
	Evidence for MET
		Examples of joint ROM increases following MET
			Ideal length of contraction for increasing joint ROM
		Burns and Wells (2006): Cervical  ROM study
		Selkow et al (2009): MET and lumbopelvic pain
		Wilson et al (2003): Acute low-back pain and MET (see Ch. 7)
			MET versus HVLA thrust
		Brodin (1987): MET treatment of chronic low-back pain
			MET approaches used in the Brodin study
		MET treatment of joints damaged by haemophilia
	Preparing joints for HVLA manipulation using MET
		Avoid wrestling
	Basic criteria for treating joint restriction with MET (Fig. 6.1A–F)
		Precise focus of forces – example  of lumbar dysfunction
		Focus rather than force
		Harakal’s cooperative isometric technique (Harakal 1975)  (see Fig. 6.2A–D)
		Grieve (1984) and MET for the  low back
			Grieve’s low-back approach (Fig. 6.3)
			Discussion of Grieve’s method
			Additional choices
			Method (Fig. 6.3)
		What if it hurts?
	MET for thoracic spinal dysfunction
		T3 restriction: MET  protocol summary
			Reminders
	Cervical application of MET
		General procedure using MET for cervical restriction
		Localised cervical restriction assessment and MET treatment
		Greenman’s exercise in cervical palpation and use of MET
		Exercise in cervical palpation  (Fig. 6.4A, B)
		MET treatment of the cervical area to treat translation restriction
	MET in joint treatment
		Spencer shoulder sequence incorporating MET
		Treating muscles, for  shoulder restrictions
			A. Assessment and MET treatment of shoulder extension restriction (Fig. 6.5A)
			B. Assessment and MET treatment of shoulder flexion restriction (Fig. 6.5B)
			C. Articulation and assessment of circumduction with mild compression  (Fig. 6.5C)
			D. Articulation and assessment of circumduction with traction (Fig. 6.5D)
			E. Assessment and MET treatment of shoulder abduction restriction (Fig. 6.5E)
			F. Assessment and MET treatment  of shoulder adduction restriction (Fig. 6.5E)
			G. Assessment and MET treatment of internal rotation restriction (Fig. 6.5F)
			Variable directions of effort
		Modified PNF ‘spiral stretch’ techniques
			Spiral MET method 1. Shoulder ‘spiral’ stretch into extension to increase the range of motion in flexion, adduction and external rotation (Fig. 6.6A)
			Spiral MET method 2. Shoulder ‘spiral’ stretch into flexion to increase the range of motion in extension, abduction and internal rotation (Fig. 6.6B)
		MET treatment of acromioclavicular and sternoclavicular dysfunction
			Acromioclavicular dysfunction (Fig. 6.7A, B)
			Assessment and MET treatment of restricted abduction in the sternoclavicular joint (‘Shrug’ test)
			MET treatment of restricted abduction in the sternoclavicular joint (Fig. 6.8B)
			Assessment (‘prayer’ test) and MET treatment of restricted horizontal flexion of the upper arm (sternoclavicular restriction)
			MET treatment of restricted horizontal flexion of the upper arm  (sternoclavicular restriction)
		MET for rib dysfunction (Greenman 1996, Goodridge & Kuchera 1997)
			Preferred approach
			Terminology
			Rib treatment guidelines
			Rib palpation test: rib 1 (Fig. 6.10)
			Rib palpation test: ribs 2–10: patient seated (Fig. 6.11)
			Rib palpation test: ribs 11 and 12 (Fig. 6.12)
			General principles of MET  for rib dysfunction
			MET treatment for elevated 1st rib, patient seated (Fig. 6.13A)
			MET treatment for elevated 1st rib, patient supine (Fig. 6.13B)
			MET treatment for elevated 2nd to 10th  ribs (Fig. 6.14)
			MET treatment for depressed 1st to 5th ribs, patient supine (Fig. 6.15)
			MET treatment for elevated 11th–12th  ribs (Fig. 6.16)
			MET treatment for depressed 11–12th  ribs (Fig. 6.17)
		General mobilisation
			Lower thorax and diaphragm attachment release using MET (Fig. 6.18)
			General thoracic release using MET (Lenehan et al 2003) (see Fig. 1.3)
		Assessment and MET treatment  of sacroiliac (SI) and iliosacral  (IS) restrictions
			Which spinal and SIJ tests do American practitioners use?
				The most commonly reported findings for assessment of spinal somatic dysfunction were:
				The most commonly used spinal treatment methods were:
				Assessment of pelvic landmark asymmetry employed during palpation were the following:
				For assessment of sacroiliac joint motion  the following methods were most  frequently employed:
				In treatment of pelvic and sacroiliac  dysfunction, the following methods were most frequently employed:
				Validity of such tests?
			Form and force assessment
				Active straight leg raise (ASLR) test
				ASLR test supine: functional SI assessments (form/force closure) (Vleeming et al 1995, 1996, 1997, Barker et al 2004, Lee 1997, 2000, 2010) (Fig. 6.20A, B)
				A variation on the ASLR Test
				ASLR test prone: functional SIJ assessment (form/force closure) (Vleeming et al 1995, 1996, 1997, Barker et al 2004, Lee 1997, 2000, 2010)  (Fig. 6.21A, B)
				Modified Trendelenburg Test
			Tests and MET treatment for pelvic and sacroiliac joint dysfunction
				Standing flexion (iliosacral) test
				Seated flexion (sacroiliac) test
				Paravertebral ‘fullness’ assessment
				Confirmation of iliosacral dysfunction: standing hip flexion test
			What type of iliosacral dysfunction exists?
				Landmark test
					Rotations
					Flares
			MET treatment of iliac inflare (Fig. 6.24A, B)
			MET treatment of iliac outflare (Fig. 6.25)
			MET treatment of anterior iliac rotation: Method 1 patient prone (Fig. 6.26A)
			MET treatment of anterior iliac rotation: Method 2 patient supine (Fig. 6.26B)
			MET for treatment of posterior iliac  rotation (Fig. 6.27)
			‘Shotgun’ method of pelvic stabilisation and pubic dysfunction
				‘Shotgun’ method 1 (see Fig. 6.28A)
				‘Shotgun’ method 2 (see Fig. 6.28B)
				‘Shotgun’ method 3
				‘Shotgun’ method 4
			MET treatment for sacroiliac dysfunction: keeping it simple
			Clinical questions when confronted with SI dysfunction and pain
		MET for sacroiliac dysfunction
			Method A (see Fig. 6.29A)
			Method B (see Fig. 6.29B)
			Method C (see Fig. 6.29C)
			Method D (see Fig. 6.29D)
			Method E (see Fig. 6.29E)
		MET treatment for temporomandibular joint  (TMJ) dysfunction
			MET TMJ method 1 (Fig. 6.30A)
			MET TMJ method 2 (Fig. 6.30B)
			MET TMJ method 3 (Fig. 6.30C)
			TMJ self-treatment isometric  concentric exercise
	References
7 Muscle Energy Techniques in cases of spinal injury or pathology
	Chapter Contents
	Introduction
	Patient preference
		Patients with acute radiculopathy
		Patients with neurologic deficit
		Post-surgical patients
		Patients with osteopenia  or osteoporosis
		Patients with central  pain hypersensitivity
	Conclusion
	References
8a Manual resistance techniques in rehabilitation
	Chapter Contents
	Clinical progression of care
	Postisometric relaxation  (PIR) techniques
		Method
	Proprioceptive neuromuscular facilitation (see also Ch. 1)
	The environmental basis for muscle imbalance
		Experiment in postural correction (Figs 8a.4, 8a.5)
			Brügger’s relief position
		Developmental influences
		The key role of coactivation of antagonists in producing and maintaining upright posture
		Functional screening tests
		Experiment in facilitation of an inhibited muscle chain
			Investigation
		Brügger’s facilitation method  for inhibited muscle chains in  the extremities
	Conclusion
	References
8b MET in post-surgical rehabilitation
	Chapter Contents
	Introduction
	Clinical post-surgical situations
	Muscle physiology relevant to the post-surgical environment
	Need for functional muscle re-education after surgery in the immediate and late post-surgical period
	Why MET in the post-surgical condition/rehabilitation?
	Slow Eccentric Isotonic Stretching (SEIS)/Isolytic Contraction (ILC) as a form of Active Stretching technique in the post-operative phase
	Clinical evidence and clinical case settings
		Methodology
		Clinical application
		Clinical examples
			Scenario 1
				Distal end radius
			Scenario 2
				Supracondylar Humerus
			Scenario 3
				Upper end tibia
	Further scope
	Conclusion
	References
9 MET in the physical therapy setting
	Chapter Contents
	Classification models
		Staging classification and indexing
		Further refinement of classification
	MET studies
		Positive reliability study
		Misconceptions in the literature
	Clinical utilisation of Muscle Energy Technique
		Staging
			Clinical correlation: LBP and ankle sprains
			Stage 1: Pain modulation
				Example
			Stage 2: Pain modulation and  addressing impairments
			Addressing impairments:  segmental-specific strengthening
			Positioning for segmental-specific strengthening
				Isolation of effort: three-finger stacking
			Progressing the process
				The importance of rest
				Parameters
	Summary and Conclusion
	Appendix A: Reviews of studies
		Faas et al (1993)
		Cherkin et al (1998)
	Appendix B: Segmental strengthening programme
		Part 1: Neuromuscular re-education
		Part 2: Hypertrophy
		Part 3: Endurance phase
	References
10 MET in a massage therapy setting
	Chapter Contents
	Marrying assessment  and treatment
		Soft tissues
		Joints
		Laxity
		Summary
	Integrating muscle energy methods into the massage session
		‘Wellness’ and therapeutic (clinical) modes of massage
		Example: Massage including MET to stretch the hip flexor tissues
	MET in a typical  massage setting
		MET as part of a general  massage application
		Case study
			Patient prone
			Patient side-lying
			Patient supine
	Summary
	References
11 MET in treatment of athletic injuries
	Chapter Contents
	Adaptation of athletes
	Dysfunction in sports
	Screening for dysfunction
		Pre-season screen
		Spine measurements
		Hip region measurements
		Abdominal strength  and coordination
			Diaphragmatic control
			Function
				Strengthening
				Endurance training
		Lower extremity measurements
		Upper extremities
		Manual assessment of  connective tissues
	Corrective/preventative strategies
		Dynamic flexibility versus  static stretching
		Warm-up
		Recovery techniques
	Muscle Energy Techniques (MET) and integrated neuromuscular inhibition techniques (INIT) in sports injuries
		Prevention of injury using MET, INIT and other techniques
			Indications
		Acute injury care with MET and other therapies
		INIT/MET in acute settings
			Indications
		Chronic injury and long-term rehabilitation using MET
			Indications
	MET using isotonic, isometric and isokinetic contractions for strengthening weak postural muscles
		Case A: Sub-acute low-back strain
			Treatment
		Case B: Shoulder tendonitis (subacromial long head of biceps)
			Treatment
	Summary
	References
	Further reading
12 Integrated neuromuscular inhibition technique (INIT) and myofascial pain
	Chapter Contents
	Local facilitation
	Locating trigger points
		STAR palpation
		Drag palpation
	Trigger point treatment methods
	The stretching effect of isometric contractions
	Hypothesis
	Selye’s concepts
	Ischaemic compression validation
	Ischaemic compression in trigger point deactivation
		Effects of sustained or intermittent compression?
	An alternative methodology
	Associated methods
		Strain/counterstrain (SCS)  briefly explained
		INIT method
			Discussion
		Validation of INIT
	Summary
	References
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	N
	O
	P
	Q
	R
	S
	T
	U
	V
	W