muscle energy technique (met)

MUSCLE ENERGY TECHNIQUES

Dr Venus Pagare

History

• Father of MET

• Dr. Fred L. Mitchell

• Muscle energy technique is a manual medicine treatment procedure that involves voluntary contraction of patient muscle in:

–a precisely controlled direction–at varying levels of intensity–against a distinctly executed counterforce applied by the operator.

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• Active technique as patient contributes corrective force

• Activating force is classified as intrinsic : patient is responsible for dosage applied

Basic Elements

1. Patient-active muscle contraction

2. Controlled joint position3. Muscle contraction in a specific

direction4. Operator-applied distinct

counterforce5. Controlled contraction intensity

Barrier Concept

Physiologic barrier

Elastic barrier

Anatomic barrier

Restrictive barrier

• Barrier: 1st sign of palpated or sensed resistance to free movements

• When motion is lost within range, barrier that prevents movement in direction of motion loss is defined as “restrictive barrier”

• MET works to move restrictive barrier as far into the direction of motion loss as possible

Principles of MET

Post isometric relaxation (PIR)

Reciprocal inhibition (RI)

Post-isometric Relaxation

• After a muscle is contracted, it is automatically in a relaxed state for a brief, latent period

Method

For hypertonic muscle

• Taken to the lengthen position

• 20% of strength contraction for 5-7 seconds

• 3-5 times

Reciprocal Inhibition

When one muscle is contracted, its antagonist is automatically inhibited.

Types of contractions in MET

• Isometric contraction : hypertonic shortened muscle

• Isotonic contraction : inhibited weakened muscles–Concentric contraction: mobilize a joint against its motion barriers–Eccentric contraction–Isolytic contraction : fibrosed muscle

• During an isometric contraction, distance between origin and the insertion of muscle is maintained at a constant length.

• A fixed tension develops in muscle as patient contracts muscle against an equal counterforce applied by operator

• Preventing shortening of muscle from origin to insertion.

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Isometric Technique

• A concentric isotonic contraction occurs when muscle tension causes origin and insertion to approximate.

Isolytic• Non-physiological event

• Patient attempts concentric contraction but an external force is applied by operator in opposite direction

• Useful in cases with marked degree of fibrotic change.

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• Used cautiously to lengthen a severely contractured or hypertonic muscle as rupture of musculotendinous junction and insertion of tendon into bone or muscle fibers can occur.

USES

• Lengthen a shortened, contractured, or spastic muscle

• Strengthen a physiologically weakened muscle /s

• Reduce pain• Stretch tight fascia• Reduce localized edema• Mobilize an articulation with

restricted mobility

Elements of Muscle Energy Procedures

1. Patient : active muscle contraction

2. Controlled joint position

3. Controlled contraction intensity

4. Muscle contraction in a specific direction

5. Operator-applied distinct counterforce

Guidelines

• 3-5 repetitions for 7-10 seconds each

• 20-50% of muscle strength• Isometric contraction should not be

too hard• After sustained but light

contraction, a momentary pause should occur

• Isotonic contractions requires forceful contraction

Breathing during met• Inhale slowly as isometric

contraction builds up

• Hold the breath during 7-10 sec

• Release the breath as they slowly cease the contraction

• Inhale and exhale fully once more following cessation of all

efforts

Key points

Accurately assess the resistant barrier

Engage each motion barrier in same fashion

Isometric v/s Isotonic Procedures

Isometric Isotonic

Careful positioning Careful positioning

Light to moderate contraction

Hard to maximal contraction

Unyielding counterforce

Counterforce permits controlled

motionRelaxation after

contractionRelaxation after

contractionRepositioning Repositioning

Errors By Patient

Contraction is too hard

Contract in wrong direction

ContractiOn is not sustained for long enough

Individual doesn’t relax completely after contraction

Starting or finishing contraction too hastily

Errors By Therapist

Inaccurate control of joint position in relation to barrier to movement

Counterforce : incorrect direction

Inadequate patient instructions

Moving to a new joint position too soon after contraction

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Not waiting for refractory period following an isometric contraction

before muscle can be stretched to a new resting length

Not maintaining stretch position for appropriate period of time

Successful Muscle Energy Technique

Control

Balance

Localization

MET IndicationsWhenever somatic dysfunction is present

and/or whenever there is a need to• Normalize abnormal neuromuscular

relationships• Improve local circulation and respiratory

function• Lengthen and/or normalize

restricted/hypertonic muscles and fascia• Mobilize restricted joint(s)• Movement restriction due to muscle

tightness• Muscle hyperactivity• Acute injuries• Myofascial restricitions, muscle imbalance

MET Contraindications Applied thoughtfully Avoid in : Fracture Severe Sprain Severe Strain Open wounds Metabolic bone or other

disease eg.

osteoporosis Uncooperative, unresponsive,

unconscious patients or those

that can not or will not follow directions

REFERENCES

Greenman’s Principle of manual medicine.

4th edition. Lisa DeStefano

Muscle Energy Techniques. 2nd edition. Leon Chaitow