MUSCLE ENERGY

TECHNIQUE

Dr. Nistara S. Chawla

MIAP, CSTMT
MPT Neurology
Introduction
• Muscle energy technique is a
manual therapy treatment
procedure that involves voluntary
contraction of patient’s muscle in:
• a precisely controlled direction
• at varying levels of intensity
• Against a distinctly executed
counterforce applied by the
therapist
History
• The term “Muscle Energy” was
given by Fred L. Mitchell, Sr. D.
O. to the techniques he
developed in the 1950s, first to
treat mechanical problems in the
pelvis.
History
• First Fred used the patient’s muscles
to restore physiologic movement to
the pelvis.
• He then expanded the concept to
include treatment of all joints except
the cranial sutures.
• Next he developed techniques for the
spine using isometric and isotonic
contractions of the patient’s muscles
to treat vertebral dysfunctions.
Basics of MET
• MET is an active technique as
patient contributes corrective
force
• Activating force is classified as
intrinsic : patient is
responsible for dosage applied
Basics of MET
• Designed to improve
musculoskeletal function
through mobilizing joints
and stretching tight
muscles and fascia, to
reduce pain, and to
improve circulation and
lymphatic flow.
Basic elements of MET
1. Active muscle contraction by the
patient
2. Controlled joint position
3. Muscle contraction in a specific
direction
4. Operator-applied distinct
counterforce
5. Controlled contraction intensity
Barrier Concept
• Physiologic barrier
• Elastic barrier
• Anatomic barrier
• Restrictive barrier
 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
Barrier Concept
Principles of MET
• Post-isometric relaxation
• Reciprocal inhibition
Post-isometric Relaxation
• After a muscle is contracted, it
is automatically in a relaxed
state for a brief, latent period.
Method For hypertonic muscle:
• Taken to the lengthen position
• 20%of strength contraction for
5-7 seconds
• 3-5 times
Video Time
https://www.youtube.com/watch?v=QOTR-
J2LJ3k&t=146s
Reciprocal Inhibition
• When one muscle is contracted, its antagonist is
automatically inhibited.
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
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
• This prevents shortening of muscle
from origin to insertion.
Concentric Contraction
• A concentric isotonic
contraction occurs when
muscle tension causes
origin and insertion to
approximate.
Isolytic Contraction
• Non-physiological event
• Patient attempts concentric
contraction but an external
force is applied by therapist
in the opposite direction
• Useful in cases with
marked degree of fibrotic
change.
Isolytic Contraction
• Used cautiously to lengthen
a severely contractured or
hypertonic muscle as
rupture of musculo-
tendinous junction and
insertion of tendon into
bone or muscle fibres can
occur.
Uses of MET
• Lengthen a shortened,
contractured or spastic muscle
• Strengthen a physiologically
weakened muscle/s
• Reduce pain
• Stretch tight fascia
• Reduce localized oedema
• Mobilize an articulation with
restricted mobility
Elements of MET Procedures
• Patient : active muscle
contraction
• Controlled joint position
• Controlled contraction
intensity
• Muscle contraction in a
specific direction
• Therapist-applied distinct
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 Hard to maximal
contraction contraction
Unyielding counterforce Counterforce permits
controlled motion
Relaxation after Relaxation after
contraction contraction
Repositioning Repositioning
Possible errors by the 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
Errors By Therapist continued..
• Not waiting for refractory
period following an
isometric contraction
before muscle can be
stretched to a new resting
length
• Not maintaining stretched
position for appropriate
period of time
Successful MET
• Control
• Balance
• Localization
MET Indications
• 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
• Myofascial restrictions, muscle
imbalance
MET Contra-indications
• Fracture
• Severe Sprain
• Severe Strain
• Open wounds
• Metabolic bone or other
disease eg. osteoporosis
• Uncooperative, unresponsive, unconscious
patients or those who can not or will not follow
directions
That’s All For Today!