muscle energy technique (met)
DESCRIPTION
TRANSCRIPT
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.
04/09/2023 MET Venus Pagare
• 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.
04/09/2023 MET Venus Pagare
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.
04/09/2023 MET Venus Pagare
• 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
04/09/2023 MET Venus Pagare
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