MUSCLE ENERGY

TECHNIQUE

 MET

 Dr. TJ Ruddy was the first osteopathic doctor to use muscle energy in
the 1940’s and 1950’s, he referred to it as resistive duction, which he
defined as a series of muscle contractions against resistance; used
techniques mainly in the C‐spine.
 Dr. Fred Mitchell, has been titled the Father of muscle energy, he
took Dr. Ruddy’s principles and incorporated them into manual
medicine to any body region/articulation.
 Dr. Phillip Greenman believed that any articulation which can be
moved by voluntary muscle action can be influenced by muscle
energy techniques (MET); MET can be used for lengthening
strengthening, decreasing local edema.
 Dr. Sandra Yale stated that MET was safe enough for use with fragile
and severely ill, or on a spasm from fall.
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Muscle Energy Technique
 DEFINITION

 Muscle energy techniques are a class of soft tissue
manipulation methods that incorporate precisely
directed and controlled, patient initiated, isometric
and or isotonic contraction, designed to improve
musculoskeletal function and reduce pain.

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 USES

 Lengthen a shortened, contracted or spastic muscles
 Strengthen a physiologically weakened muscle or
group of muscles
 Reduce local oedema
 Relieve passive congestion
 To mobilize articulation with restricted mobility

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 INDICATION

 Shortened, contracted or spastic muscles
 Weakned muscle or group of muscle
 Malpositioning of bony element
 Restoration of joint motion associated with articular
dysfunction

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 CONTRINDICATIONS

 Acute musculoskeletal injuries
 Unstable or fused joints
 Unset or unstable fractures

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 PRECAUTIONS

 Unknown pathology
 Stress fractures
 Strains, infections or diseases causing
musculoskeletal pain
 Osteoporosis or tumors in the area of treatment

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TYPES OF CONTRACTION


ISOTONIC
IC IS
R O
ET LY
M TI
O C
IS

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PRINCIPLES OF MET


POST
ISOMETRIC
RELAXATION RECIPROCAL
INHIBITION

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POST ISOMETRIC RELAXATION

 It is assumed effect of reduced tone experienced by a
muscle or group of muscle after brief periods of
following an isometric contraction.

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 

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RECIPROCAL INHIBITION

 When a muscle is isometrically contracted, its antagonist
will be inhibited, and will demonstrate reduced tone
immediately following this.
 Thus, the antagonist of a shortened muscle, or group of
muscles, may be isometrically contracted in order to
achieve a degree of ease and additional movement
potential in the shortened tissues.

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 

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 ELEMENTS

Patient active muscle contraction:
1. From controlled motion
2. In a specific direction
3. Met by practitioner applied distinct
counterforce
4. Involving a controlled intensity of
contraction

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COMMON ERRORS
PATIENT
 PRACTITIONER
ERROR ERROR

Inaccurate control
Strong
of joint,
contraction, in
counterforce,
wrong direction
direction, moving

Contraction is not
Instruction, fails
sustained, not
to maintain
relaxed, starting
stretch
and finishingMuscle Energy Technique 15
 BREATHING AND MET

 Inhale as slowly build up an isometric contraction
 hold 7-10 seconds
 Release breadth as they slowly cease contraction
 Inhale and exhale fully once more, following
cessation of all efforts

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 BARRIER

 Soft tissue
 Fluid restriction
 Hypertonicity
 Fibrotic tissue
 Bony tissue
 Pain

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 Key points

1. Force may exactly match the effort of the patient (so
producing an isometric contraction) allowing no movement
to occur – and possibly producing reciprocal inhibition and
post isometric relaxation.
2. The operator’s force may overcome the effort of the patient,
thus moving the area or joint in the direction opposite to
that in which the patient is attempting to move it (this is an
isotonic eccentric contraction, also known as an isolytic
contraction when performed rapidly).
3. The operator may partially match the effort of the patient,
thus allowing, the patient’s effort (and so producing an
isotonic concentric, isokinetic, contraction).
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 Key points

 Effort 20% of strength, or more, or less
 The length of time the effort is held – 7–10 seconds,
or more, or less
 three repetitions are thought to be optimal
 What sort of resistance is offered (for example by the
operator, by gravity, by the patient, or by an
immovable object).

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 VARIATIONS. 1

1. ISOMETRIC contraction – using reciprocal inhibition (acute
setting, without stretching)
 Indications: Relaxing acute muscular spasm
Mobilizing restricted joints
Preparing joint for manipulation
 Contraction starting point: Resistance barrier
 Method
 Forces
 Duration of contraction: 7-10 seonds
 Action following contraction: New restriction barrier without
stretch
 Repetitions: 3 times
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 VARIATIONS. 2

2. ISOMETRIC contraction – using post isometric relaxation
(acute setting, without stretching)
 Indication: Relaxing acute muscular spasm
Mobilizing restricted joints
Preparing joint for manipulation
 Contraction starting point: Resistance barrier
 Method
 Forces
 Duration of contraction: 7-10 seconds
 Action following contraction: New restriction barrier without stretch
 Repetitions: 3 times

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 VARIATIONS. 3

3. ISOMETRIC contraction – using post isometric relaxation (chronic
setting, with stretching, also known as post facilitation stretching)
 Indication: Stretching chronic restricted, fibrotic, contracted soft
tissues
 Contraction starting point: Short of the resistance barrier
 Method: Short of the resistance barrier
 Forces
 Duration of contraction: 7-10 seconds
 Action following contraction: 5 sec rest – New barrier – stretch for 30
to 60 sec
 Repetitions: 3 times

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 VARIATIONS. 4

4. ISOMETRIC contraction – using reciprocal inhibition (chronic setting,
with stretching)
 Indication: Stretching chronic restricted, fibrotic, contracted soft tissues
 Contraction starting point: Short of the resistance barrier
 Method
 Forces
 Duration of contraction: 7-10 seconds can increase upto 15sec
 Action following contraction: 5 sec rest – New barrier – stretch for 30 to
60 sec
 Repetitions: 3 times

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 VARIATIONS. 5

5. ISOTONIC concentric contraction (for toning or
rehabilitation)
 Indication: Toning weakened muscle
 Contraction starting point: Mid range easy position
 Method
 Forces
 Duration of contraction: 3-4 seconds
 Repetitions: 5-7 times

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 VARIATIONS. 6

6. Isotonic eccentric contraction (ISOLYTIC for reduction
of fibrotic change, to introduce controlled microtrauma)
 Indication: Stretching tight fibrotic musculature
 Contraction starting point: At the resistance barrier
 Method
 Forces
 Duration of contraction: 2-4 seconds
 Repetitions: 3-5 times

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 VARIATIONS. 7

7. ISOTONIC ECCENTRIC CONTRACTION (slowly
performed for strengthening weak postural muscles and
preparing their antagonists for stretching)
 Indication: Strengthening weakened muscle, Preparing
tight antagonist to inhibited muscles for stretching
 Contraction starting point: At the restriction barrier
 Method
 Forces
 Duration of contraction: 5-7 seconds
 Repetitions: 3 times
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 VARIATIONS. 8

8. ISOKINETIC (combined isotonic and isometric
contractions)
 Indication: Toning weakened musculature
Building strength
Training and balancing effect of muscle fibers
 Contraction starting point: Easy mid range position
 Method
 Forces
 Duration of contraction: up to 4 seconds
 Repetitions: 2-4 times
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 PULSED MET

 T.J. Ruddy
 Series of muscle contraction against resistance, at a
rhythm little faster than pulse rate.
 Towards barrier rapid contraction by patient
 2 contraction per seconds.
 Upto 20 mini contraction.

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LEWIT’S POST ISOMETRIC
RELAXATION

 Hypertonic muscles
 Patient contract muscle away from barrier and
therapist ressist in opposite direction
 Hold for 5-10 seconds
 Taken in new barrier by stretching

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 JANDA’S POST
FASCILITATION STRETCH

 Shortened muscle is placed in mid range
 Isometric contraction away from barrier
 5-10 second hold and ressisted by therapist
 On release of effort rapid stretch id given to achieve
a new barrier
 Hold for 10 seconds
 Repeat

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 INTEGRATED NEUROMUSCULAR
INHIBITION TECHNIQUE

 Chitow described an integrated sequence in which,
after location of an active trigger points, this receives
ischemic compression, followed by positional
release, followed by imposition of isometric
contraction which is either stretched subsequently
(post- fascilitation stretch) or simultaneously isolytic
stretch.
 This method is effectively deactivates trigger points.

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 TECHNIQUE

 Locate the trigger points
 Inhibitory pressure
 SCS
 20 -30 second hold
 Isometric contraction and hold for 7-10 seconds
 Post isometric relaxation
 Gently stretch

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 

RECENT EVIDENCE

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EFFECTS OF MUSCLE ENERGY TECHNIQUE ON PAIN AND
DISABILITY IN SUBJECTS WITH SI JOINT DYSFUNCTION

Deepali Sharma , Siddhartha Sen

International Journal of Physiotherapy and Research
2014, Vol 2(1):305-11

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 
 METHOD: 20 men and women of Unilateral back
pain experiencing around or near sacral sulcus and
Positive muscle length tests for piriformis, Erecter
Spinae, Quadratus Lumborum.
Group A: MET and mobilizatioN
Group B: mobilization of SI joint.
Outcome was measured on first day and then after 1
and 2 week from each subjects pain and disability by
VAS and modified oswestry disability questionnaire
(MODI).
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 
 CONCLUSION: MET was more effective than
mobilization to reducing pain and improving
functions.

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 The Immediate Effects of Muscle Energy
Technique on Posterior Shoulder Tightness: A
Randomized Controlled Trial

STEPHANIE D. MOORE, KEVIN G. LAUDNER,
TODD A. MCLODA, MICHAEL A. SHAFFER
Journal of orthopaedic & sports physical therapy |
volume 41 | number 6 | June 2011

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 
 OBJECTIVES: To compare a muscle energy technique
(MET) for the glenohumeral joint (GHJ) horizontal abductors
and an MET for the GHJ external rotators to improve GHJ
range of motion (ROM) in baseball players.
 METHOD: 61 Division I baseball players
GROUP 1: MET for the GHJ horizontal abductors (n = 19),
GROUP 2: MET for the GHJ external rotators (n = 22)
GROUP 3: control (n = 20).
Pre-intervention and post-intervention GHJ horizontal
adduction and
internal rotation ROM measured.

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 
 CONCLUSION: A single application of an MET for
the GHJ horizontal abductors provides immediate
improvements in both GHJ horizontal adduction and
internal rotation ROM in asymptomatic collegiate
baseball players. Application of MET for the
horizontal abductors may be useful to gain ROM in
overhead athletes.

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