Muscle Energy Technique (MET)

1. MUSCLE ENERGY TECHNIQUES Dr Venus Pagare MET Venus Pagare 11-Sep-13

2. History Father of MET Dr. Fred L. Mitchell MET Venus Pagare 11-Sep-13

3. 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. MET Venus Pagare 11-Sep-13

4. Active technique as patient contributes corrective force Activating force is classified as intrinsic : patient is responsible for dosage applied MET Venus Pagare 11-Sep-13

5. 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 MET Venus Pagare 11-Sep-13

6. Barrier Concept Physiologic barrier Elastic barrier Anatomic barrier Restrictive barrier MET Venus Pagare 11-Sep-13

7. Barrier: 1 st 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 MET Venus Pagare 11-Sep-13

8. MET Venus Pagare 11-Sep-13

9. Principles of MET Post isometric relaxation (PIR) Reciprocal inhibition (RI) MET Venus Pagare 11-Sep-13

10. Post-isometric Relaxation A fter a muscle is contracted, it is automatically in a relaxed state for a brief, latent period MET Venus Pagare 11-Sep-13

11. Method For hypertonic muscle Taken to the lengthen position 20% of strength contraction for 5-7 seconds 3-5 times MET Venus Pagare 11-Sep-13

12. Reciprocal Inhibition When one muscle is contracted, its antagonist is automatically inhibited. MET Venus Pagare 11-Sep-13

13. 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 MET Venus Pagare 11-Sep-13

14. 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. MET Venus Pagare 11-Sep-13

15. Isometric Technique MET Venus Pagare 11-Sep-13

16. A concentric isotonic contraction occurs when muscle tension causes origin and insertion to approximate. MET Venus Pagare 11-Sep-13

17. 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. MET Venus Pagare 11-Sep-13

18. 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. MET Venus Pagare 11-Sep-13

19. USES L engthen 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 MET Venus Pagare 11-Sep-13

20. 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 MET Venus Pagare 11-Sep-13

21. 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 MET Venus Pagare 11-Sep-13

22. 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 MET Venus Pagare 11-Sep-13

23. Key points Accurately assess the resistant barrier Engage each motion barrier in same fashion MET Venus Pagare 11-Sep-13

24. 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 MET Venus Pagare 11-Sep-13

25. Errors By Patient Contraction is too hard C ontract in wrong direction ContractiOn is not sustained for long enough Individual doesn’t relax completely after contraction Starting or finishing contraction too hastily MET Venus Pagare 11-Sep-13

26. 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 MET Venus Pagare 11-Sep-13

27. 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 MET Venus Pagare 11-Sep-13

28. Successful Muscle E nergy T echnique Control Balance Localization MET Venus Pagare 11-Sep-13

29. 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 MET Venus Pagare 11-Sep-13

30. 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 not or will not follow directions MET Venus Pagare 11-Sep-13

31. REFERENCES Greenman’s Principle of manual medicine. 4 th edition. Lisa DeStefano Muscle Energy Techniques. 2 nd edition. Leon Chaitow MET Venus Pagare 11-Sep-13

32. MET Venus Pagare 11-Sep-13