Muscle Energy Technique

Muscle Energy Technique (MET) is a manual therapy that uses the gentle muscle contractions of the client to relax and lengthen muscles and normalize joint motion. Post Isometric Relaxation (PIR) – Muscle to relax after an isometric contraction (Basis of MET).

To define it specifically, it is "a direct manipulative procedure that uses a voluntary contraction of the patient's muscles against a distinctly controlled counterforce from a precise position and in a specific direction". It is considered an active technique, as opposed to a passive technique where only the therapist does the work.

'Uses his/her muscles, on request, from a precisely controlled position in a specific direction, against a distinctly executed counterforce'

'...manual medicine treatment procedure that involves the voluntary contraction of patient muscle in a precisely controlled direction, at varying levels of intensity, against a distinctly executed counterforce applied by the operator'

There are two types of MET:

1.       Post-Isometric Relaxation (PIR) The therapist stretches and lengthens a muscle as it relaxes right after a client contraction. This lengthens, relaxes and realigns the muscle fibres.

2.       Reciprocal Inhibition (RI) It is a law of body dynamics that when you contract a muscle the opposing or reciprocal muscle must relax. That is the way the brain is wired and the principle that makes this technique work. The therapist has the client's muscle perform a contraction against resistance which relaxes the opposing muscle.

Restricted movement that can cause conditions like back pain, headache, scoliosis, sciatica, etc.

Postural deformities

Muscle Energy Technique is derived from Osteopathics (the study of the musculoskeletal system) by Dr. Fred Mitchell, Sr. and his son Dr. Fred Mitchell, Jr. The theory behind MET suggests that if a joint isn't used to its full range of motion, its function will lessen and it will be at risk of suffering strains and injuries. This form of muscular therapy makes use of a patient's own muscle energy (the force); while the therapist presents a stationary surface (or anti-force) the patient will contract their muscle against in order to stretch the muscle and joint to its full potential.

Muscle energy techniques can be applied safely to almost any joint in the body. Many athletes use MET as a preventative measure to guard against future muscle and joint injury. However, its mainly used by individuals who have a limited range of motion due to back, neck and shoulder pain, scoliosis, sciatica, unsymmetrical legs, hips or arms (for example when one is longer or higher than the other), or to treat chronic muscle pain, stiffness or injury. MET has circulatory functions and helps to reduce Oedema

Treatment Principles

Isometric contraction – staple MET technique

·         Distance between the origin and insertion of the muscle is maintained with a fixed amount of tension in the muscle

·         Resets the muscle proprioceptors as the muscle lengthens

Concentric Isotonic Contraction

·         Origin and Insertion of the muscle approximate

·         Useful in building muscle strength

Eccentric Isotonic Contraction (Best for Shortened Thickened Fibrotic type muscles)

·         Origin and Insertion of the muscle are separated

·         Resistance overcomes the tension in the muscle so the muscle lengthens

"Isolytic"

·         Non-physiological situation where a concentric contraction occurs with the application of an external force by the operator

·         Must be used cautiously as this type of contraction can cause damage to the muscle

Approximate 3-5 reps

Each rep approx 5 sec (can range to 15 sec depending on patient

Depend upon

·         Clinical Experience

·         Chronic or acute state

·         Results of previous treatment or contraction

Type	Contraction	Indication
Isometric	Light	·         shortened mono-articular muscles ·         decreased segmental ROM ·         myofascial trigger points
	Moderate/Strong	·         shortened poly-articular muscles ·         fibrotic muscles ·         antagonist relaxation
Isotonic	Light/Moderate	·         functionally weak muscle ·         poor proprioception
	Strong	·         weak atrophied muscle ·         antagonist relaxation
Isolytic	Moderate*	·         fibrotic adhesions

*MET is best used in conjunction with other methods such as MFR, inhibition, soft tissue therapy*

Common Patient Errors

·         Contraction too hard

·         Contraction in Wrong Direction

·         Contraction for too short a time

·         Does not relax fully following contraction

Common Operator Errors

·         Inaccurate control of joint position

·         Counterforce in the incorrect direction

·         Not giving the patient accurate instructions

·         Moving the joint to a new position too soon after the contraction stops