THE PHYSIOLOGY AND APPLICATION OF MUSCLE ENERGY TECHNIQUES

by Gill Webster DARM RMT SMTO

Osteopaths and other Manipulative Therapists developed Muscle Energy Techniques (METs) beginning with Fred Mitchell
(1909-74), in the 1950s, who started with the pelvis. They are a gentle but highly effective treatment of musculoskeletal
dysfunction. MET uses isometric or isotonic contractions as a way of lengthening tight muscle; strengthening weak muscle;
mobilising joints and relieving congestion in the tissues. Good quality results require skilled application and an accurate
diagnosis of muscle condition.

THE PHYSIOLOGY OF HOW THE TECHNIQUES WORK

Isometric contraction is contraction of the muscle against a counterforce so that no movement occurs. Two forms of
isometric MET are Post-Isometric Relaxation (PIR) and Reciprocal Inhibition (RI).

PIR refers to the subsequent reduction in tone of the agonist

muscle after isometric contraction. This occurs due to stretch
receptors called Golgi tendon organs that are located in the
tendon of the agonist muscle. These receptors react to over-
stretching of the muscle by inhibiting further muscle
contraction. This is naturally a protective reaction, preventing
rupture and has a lengthening effect due to the sudden
relaxation of the entire muscle under stretch. In more technical
terms, a strong muscle contraction against equal counterforce
triggers the Golgi tendon organ. The afferent nerve impulse
from the Golgi tendon organ enters the dorsal root of the spinal
cord and meets with an inhibitory motor neurone. This stops the
discharge of the efferent motor neurone’s impulse and therefore
prevents further contraction, the muscle tone decreases, which
in turn results in the agonist relaxing and lengthening (see
Figure 1). The Golgi tendon organs react to both passive and Figure 1: Post-isometric relaxation – neurological effects of an
active movements and therefore passive mobilisation of a joint isometric contraction on the golgi tendon organs of a skeletal
may sometimes have as good an effect on relaxing the muscles muscle
(taken from Muscle Energy Techniques by Leon Chaitow)
as direct massage.

RI refers to the inhibition of the antagonist muscle when

isometric contraction occurs in the agonist. This happens due to
stretch receptors within the agonist muscle fibres – muscle
spindles. Muscle spindles work to maintain constant muscle
length by giving feedback on the changes in contraction, in this
way muscle spindles play a part in proprioception. In response
to being stretched, muscle spindles discharge nerve impulses,
which increase contraction, thus preventing over-stretching. The
spindles discharge impulses which excite the afferent nerve
fibres or the agonist muscle, they meet with the excitatory
motor neurone of the agonist muscle (in the spinal cord) and at
the same time inhibit the motor neurone of the antagonist
muscle which prevents it from contracting (see Figure 2). This
results in the relaxation of the antagonist therefore is called
reciprocal inhibition. When the agonist stops contracting against Figure 2: Reciprocal Inhibition – neurological effects of an
force, the muscle spindles stop discharging and the muscle isometric contraction on the muscle spindles of a skeletal
relaxes, this has the same effect as post isometric relaxation. muscle, resulting in relaxation of its antagonist
(taken from Muscle Energy Techniqes by Leon Chaitow)

In brief, when the agonist muscle contracts against equal force (isometrically) two stretch receptors respond. Firstly muscle
spindles react to the stretch of the muscle and respond by inhibiting the antagonist (RI), secondly Golgi tendon organs
respond to the stretch on the tendon, they act by inhibiting further contraction of the agonist muscle (PIR), as this occurs
the muscle spindles also cease to discharge – effectively relaxing the agonist.

Concentric Isotonic Contraction occurs when the therapist’s counterforce is weaker than the contractile force allowing
some movement to occur in the direction of the muscle force, therefore shortening and strengthening the muscle. This
technique is used to strengthen physiologically weak muscles.

Eccentric Isotonic Contraction occurs when the therapist’s counterforce is stronger than the contractile force of the
muscle and stretching and lengthening occur in the muscle tissue. This is effective in short, fibrotic muscles allowing a
controlled microtrauma to the muscle. This results in a change to the muscles shortened structure and improves elasticity
and circulation.

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APPLICATION OF THE TECHNIQUES
MET methods have many possible variations that will affect the results. For example, the muscle length at starting position;
the effort of the client or therapist; the duration of the contraction; whether the contraction is pulsed or single; the number
of repetitions of the contraction; whether the position changes with each repetition, i.e. moving to tissue tension; the
direction of effort, i.e. whether it is an eccentric or concentric contraction; client breathing and eye movements in the
direction of the force; type of resistance, i.e. gravity, therapist or immovable object. These variables need to be combined
and controlled depending on the particular needs of the case.

Example 1: Isotonic contraction using Post-Isometric Relaxation

1a In the condition of acute muscular spasm or to mobilise a restricted joint, this PIR can be used. The therapist takes the
agonist muscle to its barrier of tension and holds the position; the therapist provides equal resistance to the client
contracting the agonist muscle with about 20% of their strength, for 7-10 seconds. Client relaxes for around 5 seconds,
and then as they exhale, the therapist takes muscle to the new restriction barrier, without stretching past it, and the
process is repeated 3 to 5 times.
1b In the condition of chronic, fibrotic muscular spasm, the following PIR technique can be used. The therapist takes the
agonist muscle to a comfortable location before its barrier of tension and holds the position; therapist provides equal
resistance to the client contracting the agonist muscle with about 30% of their strength, for 7-10 seconds. Client
relaxes for around 5 seconds, then as they exhale, the therapist takes muscle to new restriction barrier with an
additional gentle stretch past it (without pain), to a new starting point. For safety, and to reduce contraction further,
the client can assist in assuming this position. This position can also be held for 10-60 seconds before the next
isometric contraction occurs, the process is then repeated 3 to 5 times.

Example 2: Isotonic contraction using Reciprocal Inhibition

2a In the condition of acute muscular spasm or to mobilise a restricted joint this RI method can be used. It is also a safe
substitute when there is pain involved in treating the agonist muscle in the PIR technique. It is exactly as described in
1a except applied to the antagonist muscle instead of the agonist.
2b In the condition of chronic, fibrotic muscular spasm, the following RI method can be used. It is also a safe substitute
when there is pain involved in treating the agonist muscle in the PIR technique. It is exactly as described in 1b except
applied to the antagonist muscle instead of the agonist.

Example 3: Concentric Isotonic Contraction

(Used for toning and rehabilitation to strengthen physiologically weak muscles.)
The therapist begins with the muscle in resting length (comfortable mid-range) and allows the client to contract the affected
muscle with some force as they provide a constant amount of resistance, for 3-4 seconds. This can be repeated 3-5 times,
building the strength used by the client as appropriate.

Example 4: Eccentric Isotonic Contraction

(Used to induce a controlled microtrauma to shortened, fibrotic musculature.)
Contraction begins from the restriction barrier, the client contracts the muscle but allows their contraction to be overcome
by the effort of the therapist, who forces the muscle to stretch past its original barrier. Contraction should not be longer than
4 seconds and this can be repeated 4-5 times (the client should not experience excessive discomfort). This technique would
never be used on head and neck muscles, on frail, pain-sensitive clients or those with osteoporosis.

IN CONCLUSION
The key requirements for good results are the diagnosis of muscular activity, appropriate level of effort, appropriate
duration of contraction and safe movements to new tissue tensions with client assistance if required. METs may be
ineffective if excessive force is applied, if it is not possible to localise muscular effort to the precise region of the
dysfunction, or if underlying pathological conditions prevent long-term relief.
Muscle Energy Techniques have been proven to be effective in most cases even in fragile or infirm clients. Pathology such
as arthritis or osteoporosis can benefit although application of the technique should be appropriate to client fitness and
health, vigorous methods should only be used on the physically fit.
Essentially these techniques are a very effective tool for the Massage Therapist, with skilled application neither the client
nor the therapist should be under strain and muscle balance, joint mobility and pain relief can be achieved.
Simple guidelines to follow if using MET:
• No pain should be caused by met
• Keep contractions light (20-30% of strength)
• Communicate effectively and ensure client is not experiencing discomfort at any time
• Client can help to locate tissue tension or restriction barrier
• Never over-stretch
BIBLIOGRAPHY
Berne, Robert M., Levy, Matthew N., Principles of Physiology, Second Edition, Mosby, 1996
Chaitow, Leon, Muscle Energy Techniques, Second Edition, Churchill Livingston, 2001
Gill Webster practises in Bridge of Allan, Stirling in Advanced Remedial Massage, Remedial & Sports Massage,
Swedish Massage and Reiki. Tel. 01786 834757 Email. gill@webster8378.fsnet.co.uk

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