MUSCLE ENERGY

TECHNIQUES

Dr Venus Pagare

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 History
• Father of MET

• Dr. Fred L. Mitchell

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• 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.
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• Active technique as patient contributes
corrective force

• Activating force is classified as intrinsic : patient

is responsible for dosage applied
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 Basic Elements
1. Patient-active muscle contraction
2. Controlled joint position
3. Muscle contraction in a specific direction
4. Operator-applied distinct counterforce
5. Controlled contraction intensity

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 Barrier Concept
Physiologic barrier

Elastic barrier

Anatomic barrier

Restrictive barrier
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• 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
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 Principles of MET

Post isometric relaxation (PIR)

Reciprocal inhibition (RI)

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 Post-isometric Relaxation
• After a muscle is contracted, it is automatically in a
relaxed state for a brief, latent period

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 Method
For hypertonic muscle

• Taken to the lengthen position

• 20% of strength contraction for 5-7 seconds
• 3-5 times

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 Reciprocal Inhibition
When one muscle is contracted, its antagonist is
automatically inhibited.

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 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

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• 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.
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 Isometric Technique

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• A concentric isotonic contraction occurs when
muscle tension causes origin and insertion to
approximate.

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 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.
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• 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.

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 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

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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

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 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

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 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
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 Key points
Accurately assess the resistant barrier

Engage each motion barrier in same fashion

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 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
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 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

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 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
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 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

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 Successful Muscle Energy Technique

Control

Balance

Localization

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 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
muscles and fascia
• Mobilize restricted joint(s)
• Movement restriction due to muscle tightness
• Muscle hyperactivity
• Acute injuries
• Myofascial restricitions, muscle imbalance
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 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
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not or will not follow directions
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 REFERENCES
Greenman’s Principle of manual medicine.
4th edition. Lisa DeStefano

Muscle Energy Techniques.

2nd edition. Leon Chaitow
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