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Muscle Energy Technique - Overview

MET is a 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.
Clinical Uses
1) To lengthen a shortened, contractured, or spastic muscle
2) To strengthen a physiologically weakened muscle or group of
muscles
3) To reduce localized edema and relieve passive congestion
4) To mobilize an articulation with restricted mobility
Types
Isometric Technique is used primarily in the vertebral axis to overcome
short, hypertonic muscle that functions as a biomechanical tether,
preventing motion, and through the law of reciprocal innervation,
inhibits its antagonist. Through complex
neurological mechanisms, including the spindle, golgi tendon
apparatus, and spinal cord and cortical reflexes, the following
phenomena occurs. After an isometric contraction, a hypertonic,
shortened muscle can be stretched to a new resting length. When this
hypertonic agonist is relaxed, it no longer contributes inhibition to its
antagonists, resulting in more equal tone & balance.
Isotonic Contractions are frequently used in the extremities. In the
presence of an inhibited, weakened muscle group, a series on
concentric isotonic contractions can be made against progressively
increasing resistance, resulting in increased strength of the muscle.
Concurrently, increasing strength of repetitive actions of a muscle
throughout its range concentrically will also inhibit its antagonist,
resulting in more symmetrical muscle tone.
Elements of Muscle Energy Procedures
1) Patient active muscle contraction
2) Controlled joint position
3) Muscle contraction in specific direction
4) Operator-applied distinct counterforce
5) Controlled contraction intensity

Muscle Energy Technique - Example


Example
Assume there is restriction of elbow movement into full extension, that
is, the elbow is flexed. One etiology for restricted elbow extension is
hypertonicity and shortening of the biceps brachii muscle. The operator
might choose an isometric muscle energy technique to treat this
condition as follows:
1) Patient sits comfortably on the treatment table with the operator
standing in front.
2) Operator grasps patient's elbow with one hand and distal forearm
with the other.
3) Operator extends the elbow until the first extension barrier is felt.
4) Operator instructs the patient to attempt to bring the forearm to the
shoulder by using a few ounces of force in a sustained manner.
5) Operator provides equal counterforce to the patient's effort.
6) After 3-7 seconds of contraction, the patient is instructed to stop
contracting and relax.
7) Operator waits until the patient is completely relaxed after the
contracting effort and extends the elbow to a new resistant barrier.
8) Steps 2 through 7 are repeated three to five times until full
extension is restored.
Muscle Energy Technique - Example
Alternative Option
The restriction of elbow extension might also be the result of length
and strength imbalance between the biceps muscle as the elbow flexor
and the triceps muscle as the elbow extender. A weak triceps could
prevent full elbow extension. The operator might choose an isotonic
muscle energy technique to treat this condition as follow:
1) Patient sitting on table with operator in front.
2) Operator grasp shoulder and distal forearm and takes elbow into full

flexion.
3) Patient is instructed to extend th elbow with as much effort as
possible, perhaps several pounds.
4) The operator provides a yielding counterforce that allows the elbow
to lowly but steadily extend throughout its maximal range.
5) Operator returns elbow to full flexion and the patient repeats the
contraction of the triceps to extend the elbow, but this time the
operator provides increasing resistance to elbow extension.
6) Several repetitive efforts are accomplished with the operator
providing increasing resistance each time and with the patient
endeavoring to take the elbow through full extension with each effort.
7) Approximately three or five repetitions are usually necessary to
achieve full elbow extension.
In any of these muscle energy procedures, it is important to accurately
assess the resistant barrier. With an isometric technique, the first
barrier sensed must be the point where the careful joint position is
held by the operator. If the operator "crashes into" the muscle
resistant barrier in positioning the joint, an increase in the muscle hyp
ertonicity will result, just the opposite of the desired therapeutic effort.
Second, when using these procedures in a joint with multiple planes of
movement available, each motion barrier must be engaged in the
same fashion. In the vertebral column with motion restriction around
and along three different axes, precision in the engagement of the
restrictive barrier is essential for therapeutic effectiveness.