MUSCLE ENERGY
TECHNIQUE (MET)
Dr. Jyoti Chauhan
INTRODUCTION
Muscle energy technique is a manual therapy procedure
which involves the voluntary contraction of a muscle in a
precisely controlled direction at varying levels of
intensity against a distinct counterforce applied by the
operator.
INTRODUCTION
Father of MET – Dr. Fred L.Mitchell
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 position
3. Muscle contraction in specific direction
4. Operator applied distinct counterforce
5. Controlled contraction intensity
BARRIER CONCEPT
Physiological Barrier
Elastic Barrier
Anatomic Barrier
Restrictive Barrier
Barrier: first sign of palpated or sensed resistance to free
movements
When motion is lost within range, barrier that prevents
movement in direction of motion loss defined as
“restrictive barrier”.
MET works to move restrictive barrier as far into the
direction of motion loss as possible.
PRINCIPLES EMPLOYED
Reciprocal Inhibition (RI)
Autogenic (post-isometric) Inhibition (PIR)
POST ISOMETRIC RELAXATION
After a muscle is contracted, it is automatically in a
relaxed state for a brief , latent period.
AUTOGENIC (POST-ISOMETRIC)
INHIBITION
Afferents from both Golgi tendon receptors and gamma
afferents from muscle spindle receptors feed back to the cord.
Gamma efferents return to the intrafusal fibers resetting their
resting length.
This changes the resting length of the extrafusal fibers of the
muscle.
After an isometric contraction, a hypertonic muscle can be
passively lengthened to a new resting length.
METHOD
For hypertonic muscle:
⚫ Taken to the lengthen position
⚫ 20% of strengthen contraction for 5-7 seconds
⚫ 3-5 times
RECIPROCAL INHIBITION
When one muscle is contracted, its antagonist is
automatically inhibited.
RECIPROCAL INNERVATION&
INHIBITION
When an agonist muscle contracts and shortens, its
antagonist must relax and lengthen so that motion can
occur under the influence of the agonist muscle.
The contraction of the agonist reciprocally inhibits its
antagonist allowing smooth motion.
The harder the agonist contracts, the more inhibition in
the antagonist, causing relaxation.
TYPES OF CONTRACTIONS IN MET
Isometric: hypertonic shortened muscle
Isotonic contraction
⚫ Concentric contraction: mobilize a joint against its motion
barriers
⚫ Eccentric contraction
⚫ Isolytic contraction: fibrosed muscle
ISOMETRIC CONTRACTION
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
ISOMETRIC CONTRACTION
Primarily reduce the tone in a hypertonic muscle and
reestablish its normal resting length.
Shortened and hypertonic muscles are frequently identified as
the major component of restricted motion of an articulation.
Length and tone are governed by the fusiform motor system to
the intrafusal fibers.
The gamma system is the neurological control for this system.
Works on a reflex arc.
CONCENTRIC ISOTONIC CONTRACTION
A concentric isotonic contraction occurs when muscle
tension causes origin and insertion to approximate.
IMPROVED TONE & PERFORMANCE
The second principle of isotonic MET is increasing the tonus
and improving the performance of a muscle that is too weak
for its musculoskeletal function.
As a series of reps of isotonic contraction occur in the muscle,
against progressive resistance, extrafusal muscle fiber
participation in the contraction increases.
Isotonic MET procedures reduce hypertonicity in a shortened
antagonist and increase the strength of the agonist.
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
Used cautiously to lengthen a severely contracted or
hypertonic muscle as rupture of musculotendinous junction
and insertion of tendon into bone or muscles can occur.
USES
Uses:
Lengthen a shortened, contracted, or spastic muscle.
Strengthen a weakened muscle or group of muscles.
Reduces pain
Stretch tight fascia
To reduce localized edema.
Relieve passive congestion.
To mobilize an articulation with restricted mobility.
OVERALL EFFECT
These muscle contractions affect the surrounding fascia,
connective tissue ground substance interstitial fluids, and alter
muscle physiology by reflex mechanisms.
Fascial length and tone is altered by muscle contraction.
Alteration in fascia influences biomechanical function,
biochemical, and immunological functions.
The contraction produces metabolic processes to occur and the
patient may experience soreness within 12-36 hours after
treatment.
ELEMENTS OF MUSCLE ENERGY
PROCEDURES
1.Patient-active muscle contraction
2.Controlled Joint Position
3.Controlled contraction intensity
4.Direction specific muscle contraction
5.Operator applied specific 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
motion
Relaxation after contraction Relaxation after contraction
Repositioning 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
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 MET
Control
Balance
Localization
MET INDICATIONS
Whenever 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 muscle and
fascia
⚫ Mobilize restricted joints
⚫ Movement restriction due to muscle tightness
⚫ Muscle hyperactivity
⚫ Acute injuries
⚫ Myofascial restrictions, muscle imbalance
MET CONTRAINDICATIONS
Avoid in:
⚫ Fracture
⚫ Severe sprain
⚫ Severe strain
⚫ Open wounds
⚫ Metabolic bone or other disease e.g., osteoporosis
⚫ Uncooperative, unresponsive, unconscious patients or those
that can not or will not follow directions
MUSCLE ENERGY TECHNIQUE LAB
The Principles of diagnosis and treatment are:
⚫ To evaluate ROM in all planes
⚫ To evaluate strength of all muscle groups
⚫ To treat restricted ROM by isometric technique at the
restrictive barrier
⚫ If weakness is detected, to treat by a series of concentric
isotonic contractions
REFERENCES
Greenman’s Principle of manual medicine, 4th edition.
Lisa DeStefano
Muscle energy techniques, 2nd edition, Leon Chaitow
