MET: Muscle Energy Technique

Muscle energy technique, a manual therapy technique with a long term history and 8 variations which can be used in various condition to treat muscle as well as joints. This slide show consists of detailed history, variations/types and summary of MET in detail.

1. MUSCLE ENERGY TECHNIQUE
Radhika Chintamani

2. CONTENTS
Definition
History
Principles
Mechanism
Variations
Summary

3. Muscle Energy Technique (MET):
is a manual therapy that
uses
the gentle muscle contractions of the patient to relax and
lengthen
muscles and normalize joint motion.
Definition

4. Muscle Energy Technique is One such approach – which targets the
soft tissues primarily, making a major contribution towards joint.
The most general (and descriptively accurate) term of which was that
used by chiropractor Craig Liebenson (1989, 1990) when he described
‘muscle energy’ techniques as ‘active muscular relaxation techniques’.
MET was first described by T. J. Ruddy (1961), who termed his
approach ‘resistive duction’, and Fred Mitchell Snr (1967).
Largely due to the work of experts in physical medicine such as Karel
Lewit (1999), MET has evolved and been refined, and now crosses all
interdisciplinary boundaries.
Introduction

5. 1.T. J. Ruddy:
Developed MET in 1940’s and 1950’s
An orthopedic Physician
He described it as one of the treatment method involving patient-
induced, rapid, pulsating contractions against resistance which he
termed ‘rapid resistive duction’.
Pulsed MET: Ruddy’s method called for a series of rapid, low
amplitude muscle contractions against resistance, at a rate a little
faster than the pulse rate.
As a rule, at least initially, these patient-directed pulsating
contractions involve an effort towards the barrier, using antagonists to
shortened structures.
Effects include improved local oxygenation, venous and lymphatic
circulation, as well as a positive influence on both static and kinetic
posture, because of the effects on proprioceptive and interoceptive
afferent pathways.
Best used as self treatment

6. 2. Fred Mitchell Snr:
Worked on the basis of Ruddy’s work of MET
Fred Mitchell Snr gave MET its inception into osteopathic
work in 1958.
After Fred Mitchell Snr his son Fred Mitchell Jnr continued
the work on MET done by his father and formulated MET s
‘patient uses his/her muscles, on request, from a
precisely controlled position in a specific direction, against
a distinctly executed counterforce’.
History

7. 3. Philip Greenman:
In 1996; Philip Greenamn worked on documentation of the
mechanism of MET and stated that; function of any
articulation of the body which can be moved by voluntary
muscle action, either directly or indirectly, can be
influenced by muscle energy procedures
He also stated that; MET can be used to lengthen a
shortened, contractured or spastic muscle; to strengthen
a physiologically weakened muscle or group of muscles;
to reduce localized edema, to relieve passive
congestion, and to mobilize an articulation with restricted
mobility.
History

8. 4. Sandra Yale:
In 1991; Osteopathic Physician described potentials of using
MET in fragile and severely ill patients.
He gave the theory as; MET’s are particularly effective in
patients who have severe pain from acute somatic
dysfunction, such as those with a whiplash injury from a
car accident, or a patient with severe muscle spasm from
a fall. They can be used in older patients who may have
severely restricted motion from arthritis, or who have
brittle osteoporotic bones.
History

9. 5. Edward Stiles:
In 1984a and 1984b ;
Basic science data suggests the musculoskeletal system plays
an important role in the function of other systems. Research
indicates that segmentally related somatic and visceral
structures may affect one another directly, via viscerosomatic
and somaticovisceral reflex pathways. Somatic dysfunction may
increase energy demands, and it can affect a wide variety of
bodily processes; vasomotor control, nerve impulse patterns (in
facilitation), axionic flow of neurotrophic proteins, venous and
lymphatic circulation and ventilation. The impact of somatic
dysfunction on various combinations of these functions may be
associated with myriad symptoms and signs. A possibility which
could account for some of the observed clinical effects of
manipulation.
History

10. 6. J. Goodridge and W. Kuchera (1977):
J. Goodridge : Modern osteopathic refinements of MET –
the emphasis on very light contractions.
William Kuchera: Localization of force is more important
than intensity. Localization depends on palpatory
proprioceptive perception of movement (or resistance to
movement) at or about a specific articulation and
monitoring and confining forces to the muscle group or
level of somatic dysfunction involved are important for
achieving desirable changes.
“Poor results are most often due to improperly
localized forces, often with excessive patient effort. “
History

11. 7.Knott and Voss : 1968
Improvised PNF technique which was developed in
1940s, PNF method tended to stress the importance of
rotational components in the function of joints and
muscles, and employed these using resisted (isometric)
forces, usually involving extremely strong contractions.
Initially, the focus of PNF related to the strengthening of
neurologically weakened muscles, with attention to the
release of muscle spasticity following on from this, as
well as to improving range of motion at intervertebral
levels (Kabat 1959, Levine et al 1954)
History

12. A.Fundamentals Principles of MET are:
1.Post isometric relaxation/ Post contraction inhibition
technique: automatic relaxation of a muscle after isometric
contraction of it.
2.Reciprocal Inhibition: automatic relaxation of a agonist
muscle when antagonist muscle is isometrically contracted.
By: Libenson
Liebenson suggests that there is evidence that the
receptors responsible for PIR lie within the muscle and
not in the skin or associated joints .

13. B Key points of Modern MET:
1. The operator’s force may exactly match the effort of the patient
(isometric contraction) allowing no movement to occur – and
producing as a result a physiological neurological response (via the
Golgi tendon organs) involving a combination of:
— reciprocal inhibition of the antagonist of the muscle being
contracted, as well as
— post isometric relaxation of the muscle which are being contracted.
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 (eccentric contraction).
3. The operator may partially match the effort of the patient, thus
allowing, although slightly retarding, the patient’s effort (concentric
contraction).
Principles

14. C Requirements of MET: By Greenman
He suggested that the lesion should be control, balance and
localisation.
A patient/active muscle contraction, which
— commences from a controlled position
— is in a specific direction (towards or away from a restriction barrier)
The operator applies distinct counterforce (to meet, not meet, or to
overcome the patient’s force)
The degree of effort is controlled (sufficient to obtain an effect but
not great enough to induce trauma or difficulty in controlling the
effort).
Principles

15. D.Components of MET: By Greenman
There is a patient-active muscle contraction
— from a controlled position
— in a specific direction
— met by practitioner applied distinct counterforce
— involving a controlled intensity of contraction.
Principles

16. MET
has as one of its objectives the induced relaxation of
hypertonic
musculature and
Ability
to enhance stretch of a shortened muscle or its associated
fascia
when connective tissue or viscoelastic changes have occurred.

17. Mechanism is described in two aspects on the basis of two
types of MET usually used;
a.Post Isometric Relaxation technique
b.Reciprocal Inhibition technique
Mechanism

18. 1.POST ISOMETRIC RELAXATION
TECHNIQUE:
Isometric contraction of muscle
Inhibition of antagonist and induced
intrafibral stretch of agonist
Reduced muscle tone of both
agonist as well as antagonist
Thus; shortened agonist muscle on
isometric contraction achieves a
degree of ease due to intrafibral
stretch induced by isometric
contraction along with an additional
movement.
Mechanism

19. 2. RECIPROCAL INHIBITION:
Isometric contraction of a muscle
Stimulates the same muscle by alpha
motor neurons whereas inhibits its
antagonist by gamma motor neuron locally.
This is known as antagonist relaxation due
to agonist firing which happens locally due
to a neurological loop involving Golgi
tendon Organs.
Thus, Reducing muscle tone of antagonist
Mechanism

20. 1.Lewit’s Postisometric relaxation technique
2.Janda’s post tfacilitation stretch method
3.Reciprocal inhibition variation
4.Strengthening variation
5.Isolytic MET
Major Variations Of MET

21. Hypertonic
muscle is taken to a length
just
short of pain, or to the point where
resistance
to movement is first noted.
Patient
gently contracts the affected
agonist
muscle away from the barrier for
5-10
seconds against equal effort by the
therapist
Degree
of effort by patient=10-20%
Muscle
is taken into new barrier with all
slack
removed but no stretch and relaxed
Repeat
the procedure for 2-3 times.
1.Lewit’’s Postisometric relaxation
technique

22. Key element in this technique is precise positioning as
well as taking out slack using the barrier as the
starting and ending points of each contraction

23. Mechanism of PIC
During
resistance using minimal force (isometric contraction) only a
very
few fibers are active, the others being inhibited
During
relaxation (in which the shortened musculature is taken gently to
its
new limit without stretching) the stretch reflex is avoided – a reflex
which
may be brought about even by passive and non-painful stretch.
He
concludes that this method demonstrates the close connection
between
tension and pain, and between relaxation and analgesia.

24. Shortened
muscle is placed in a midrange position about halfway
between
a fully stretched and a fully relaxed state
The
patient contracts the muscle isometrically, using a maximum degree
of
effort for 5-10 seconds: effort is resisted completely
Release
of effort
Rapid
stretch is applied at a new barrier without any bounce and held for
10
seconds
Subject
relaxes for 20 seconds
Repeat
the procedure for 3-5 times
2. Janda’s Postfacilitation stretch
method

25. Isometric contraction of a muscle
Stimulates the same muscle by alpha
motor neurons whereas inhibits its
antagonist by gamma motor neuron
locally.
This is known as antagonist
relaxation due to agonist firing which
happens locally due to a neurological
loop involving Golgi tendon Organs.
Thus, Reducing muscle tone of
antagonist
3. Reciprocal Inhibition technique
Reciprocal Inhibition of Hams

26. 4. Strengthening Variation
• It
is also called as isokinetic contraction (also known as progressive resisted
exercise),
in which patient starts with a weak effort but rapidly progresses to a
maximal
contraction of the affected muscle(s), introducing a degree of resistance
to
the operator’s effort to put the joint, or area, through a full range of motion.
•It
is also felt that a limited range of motion, with good muscle tone, is preferable
(to
the patient) to having a normal range with limited power.
•Thus
the strengthening of weak musculature in areas of permanent limitation of
mobility
is seen as an important contribution in which isokinetic contractions may
assist.

•Isokinetic
contractions not only strengthen the fibres which are involved, but also
have
a training effect which enables them to operate in a more coordinated manner.

27. •Because
of neuromuscular recruitment, there is a progressively
stronger
muscular effort as this method is repeated.
•Isokinetic
contractions, and ccompanying mobilisation of the region,
should
take no more than 4 seconds at each contraction in order to
achieve
maximum benefit with as little fatiguing as possible.
•Prolonged
contractions should be avoided.
•The
simplest, safest, and easiest-to-handle use of isokinetic methods
involves
small joints, such as those in the extremities. Spinal joints may
be
more difficult to mobilise while muscular resistance is being fully
applied.

28. 5. Isolytic MET
• In
this type of MET, isotonic contractions are used by the muscle during
resistance
application by the therapist. The technique involves stretching, and
sometimes
the breaking down of fibrotic tissues present in the affected muscles.
•Adhesions
of this type are reduced by the application of force by the operator
which
is just greater than that being exerted by the subject.
•Limited
degrees of effort are called for by the subject in this technique.
•The
patient should be instructed to use about 20% of possible strength on the first
contraction,
which is resisted and overcome by the operator, in a contraction
lasting
3–4 seconds. This is then repeated, but with an increased degree of effort on
the
part of the patient (assuming the first effort was relatively painless). This
continuing
increase in the amount of force employed in the contracting
musculature
may be continued until, hopefully, a maximum contraction effort is
possible,
again to be overcome by the operator.

29. 6. Ruddy’s Pulsed MET
• 1940s
and 50s, osteopathic physician T. J. Ruddy developed a method which
utilised
a series of rapid pulsating contractions against resistance, which he
termed
‘rapid resistive duction’.
•Ruddy’s
method (Ruddy 1962) called for a series of muscle contractions against
resistance,
at a rhythm a little faster than the pulse rate. This approach can be
applied
in all areas where isometric contractions are suitable, and is particularly
useful
for self-treatment following instruction from a skilled practitioner.
•Ruddy
used these techniques in the cervical spine and around the orbit in his
practice
as an ophthalmologist–otorhinolaryngologist.’.

30. 6. Ruddy’s Pulsed MET
The
introduction of a pulsating muscle energy procedure such as Ruddy’s,
involving
these weak antagonists, therefore offers the opportunity for:
1.Proprioceptive
re-education
2.Strengthening
facilitation of the weak antagonists
3.Further
inhibition of tense agonists
4.Enhanced
local circulation and drainage
5.In
Liebenson’s words, ‘reeducation of movement patterns on a reflex,
subcortical
basis’ (Liebenson 1996).

31. 7. Isokinetic MET
•Isokinetic
contraction (also known as progressive resisted exercise). In this
the
patient, starting with a weak effort but rapidly progressing to a maximal
contraction
of the affected muscle(s), introduces a degree of resistance to the
practitioner’s effort to put a joint, or area, through a full range of motion.
•‘The
counterforce is increased during the contraction to meet changing
contractile
force as the muscle shortens and its force increases.’ These are, he
says,
especially valuable in improving efficient and coordinated use
of
muscles, and in enhancing the tonus of the resting muscle.

32. 7. Isokinetic MET
•In
dealing with paretic muscles, isotonics (in the form of progressive
resistance
exercise) and isokinetics, are the quickest and most efficient road to
rehabilitation.
i.To
tone weak phasic (stabiliser) muscles, perform concentric isotonic
exercises
using full strength, rapidly (4 seconds maximum).
ii.To
tone weak postural (mobiliser) muscles, slowly perform eccentric
isotonic
(i.e. isolytic,) exercises using increasing degrees of effort. In
order
to tone postural fibres, slow speed, eccentric resistance is most
effective
(Norris 1999).

33. 8. Joints and MET
The
impact of these methods on joints is clearly profound since it is
impossible
to consider joints independently of the muscles which support and
move
them.

34. 9. Self MET
•Receptive
patients are taught how to apply this treatment to themselves, as
autotherapy,
in a home programme. They passively stretched the tight muscle
with
their own hand.
•This
hand next provided counter pressure to voluntary contraction of the tight
muscle
(during inhalation) and then held the muscle from shortening, during
the
relaxation phase.
•Finally,
it supplied the increment in range of motion (during exhalation) by
taking
up any slack that had developed.

35. Summary of Variation: MET
1.
Isometric contraction- using RI(without stretch):
A.
Indications:
Relaxing
acute muscular spasm or contraction
Mobilising
restricted joints
Preparing
joint for manipulation.
B.
Contraction starting point: at easy restriction barrier
C.
Mode: Antagonist is used in contraction thus treating affected muscle via
reciprocal
inhibition method.
D.
Force: subject’s effort; initially: 20% and gradually increase to 50%.
E.
Duration of contraction: initially: 7-10sec and gradually increase to 20sec
F.
Action following contraction: Rest interval followed by the area taken to a
new
barrier without stretch and repeated.
G.
Repetitions: 3-5times until no further gain in ROM

36. Summary of Variation: MET
2.
Isometric contraction- using PIR(without stretch):
A.
Indications:
Relaxing
acute muscular spasm or contraction
Mobilising
restricted joints
Preparing
joint for manipulation.
B.
Contraction starting point: at restriction barrier
C.
Mode: Agonist is used in the isometric contraction thus treating affected
muscle.
D.
Force: subject’s effort; initially: 20% and gradually increase to 50%.
E.
Duration of contraction: initially: 7-10sec and gradually increase to
20sec
F.
Action following contraction: Rest interval followed by the area taken to
a
new barrier without stretch and repeated.
G.
Repetitions: 3-5times until no further gain in ROM

37. Summary of Variation: MET
3.
Isometric contraction- using PIR with stretch:
A.
Indications:
Stretching
chronic or subacute restricted, fibrotic, contracted soft tissues
(fascia,
muscle) or tissues housing active myofascial trigger points.
B.
Contraction starting point: Short of restriction barrier
C.
Mode: Agonist is used in isometric contraction thus treating affected
muscle
via RI allowing an easier stretch to be performed.
D.
Force: subject’s effort; initially: 30% and gradually increase to 50%.
E.
Duration of contraction: initially: 7-10sec and gradually increase to 20sec
F.
Action following contraction: Rest interval of 5 sec followed by stretch held
for
10-60sec (painless) without stretch and relaxation followed by
repeatition
Stretching chronic or subacute restricted, fibrotic, contracted
soft
tissues (fascia, muscle) or tissues housing active myofascial trigger
points..
G.
Repetitions: 3-5times until no further gain in ROM

38. Summary of Variation: MET
4.
Isometric contraction- using RI with stretch:
A.
Indications:
Stretching
chronic or subacute restricted, fibrotic, contracted soft tissues
(fascia,
muscle) or tissues housing active myofascial trigger points
This
approach is chosen if contraction of the agonist is contraindicated because
of
pain.
B.
Contraction starting point: A little Short of restriction barrier
C.
Mode: Antagonist is used in isometric contraction thus treating affected muscle
via
RI allowing an easier stretch to be performed.
D.
Force: subject’s effort; initially: 30% and gradually increase to 50%.
E.
Duration of contraction: initially: 7-10sec and gradually increase to 20sec
F.
Action following contraction: Rest interval of 5 sec followed by stretch held for
10-60sec
(painless) without stretch and relaxation followed by repetition
Stretching
chronic or subacute restricted, fibrotic, contracted soft tissues
(fascia,
muscle) or tissues housing active myofascial trigger points..
G.
Repetitions: 3-5times until no further gain in ROM

39. Summary of Variation: MET
5.
Isotonic concentric contraction (for toning rehab):
A.
Indications:
Tonic
weakened musculature
B.
Contraction starting point: In a mid-range easy position
C.
Mode: Contracting muscle is allowed to do so against some
resistance
applied by the therapist
D.
Force: subject’s effort: greater than therapists resistance
E.
Duration of contraction: 3-4 seconds
F.
Repetitions: 5-7 times

40. Summary of Variation: MET
6.
Isotonic eccentric contraction (for reducing fibrotic changes in the
muscle):
A.
Indications:
Stretching
tight fibrotic musculature
B.
Contraction starting point: At restriction barrier
C.
Mode: Muscle to be stretched is contracted and is rapidly prevented
by
doing so by therapist, so that the contraction is overcome and
reversed
so that contracting muscle is stretched.
D.
Force: therapist’s effort: greater than subject
E.
Duration of contraction: 2-4 seconds
F.
Repetitions: 3-5 times

41. Summary of Variation: MET
7.
Isotonic eccentric contraction (isolytic, for strengthening weak
postural
muscles):
A.
Indications:
Strengthening
weakened postural muscles
B.
Contraction starting point: At restriction barrier
C.
Mode: Muscle to be stretched is contracted and is rapidly prevented
by
doing so by therapist, so that the contraction is slowly overcome
and
reversed so that contracting muscle is stretched.
D.
Force: therapist’s effort: greater than subject
E.
Duration of contraction: 5-7 seconds
F.
Repetitions: 3-5 times

42. Summary of Variation: MET
8.
Isokinetic (combined isotonic and isometric contractions):
A.
Indications:
Toning
weakened musculature
Building
strength in all muscles involved in particular joint
function
Training
and balancing effect on muscle fibres.
B.
Contraction starting point: Easy mid range position
C.
Mode: Patient resists with moderate and variable effort at first,
progressing
to maximal effort subsequently, as practitioner/
therapist
puts joint rapidly through as full a range of movements
as
possible.
D.
Force: therapist’s effort: greater than subject
E.
Duration of contraction: up to4 seconds
F.
Repetitions: 2-4 times

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