Muscle Energy Technique (MET)....Ppt new

It is type of manual therapy, widely used in osteopathy, that uses muscle energy in the form of gentle isometric contraction to relax the muscles via autogenic or reciprocal inhibition and lengthen the muscle.

1. MUSCLE ENERGY TECHNIQUE Dr. PRIYANKA S. (PT) (ASSISTANT PROFESSOR)

2. Contents Description Definition Principles of MET Types (Mechanism) Indication Contraindication

3. Description MET was invented in 1948 by Fred Mitchell,sr , It is type of manual therapy, widely used in osteopathy, that uses muscle energy in the form of gentle isometric contraction to relax the muscles via autogenic or reciprocal inhibition and lengthen the muscle

4. Definition MET is an Osteopathic manipulation technique , that incorporate precisely directed and controlled, patient initiated, isotonic or isometric contractions, design to improve musculoskeletal function and reduce pain.

5. Principles 1. The therapist’s force may exactly match the effort of the patient allowing no movement to occur ( isometric contraction).This isometric contraction is combination of : Post isometric relaxation (PIR) of agonist of the muscle being contracted. Reciprocal inhibition (RI) of antagonist of the muscle being contracted .

6. 2. The therapist 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 (isotonic eccentric contraction , also known as an isolytic contraction). 3. The effort of the patient is 20% of strength. 4.Length of time held is 7-10 seconds.

7. Restrictive barrier Physiological barrier Elastic barrier Anatomic barrier Restrictive barrier MET works to move restrictive barrier as far into the direction of motion loss as possible .

8. Types Of MET Autogenic inhibition MET Post isometric rehabilitation ( PIR) Post facilitation stretching (PFS) 2. Reciprocal inhibition (RI)

9. Post isometric rehabilitation ( PIR) A submaximal (10-20%) contraction of the hypertonic muscle is performed away from the barrier between 5 to 10 seconds. Therapist applies resistance in the opposite direction. The patient should inhale during this action. After isometric contraction, the patient is asked to relax and exhale. Following this, a gentle stretch is applied to take up the slack till new barrier. Starting from new barrier the process is repeated 2 to 3 times

10. Mechanism of action for PIR Strong muscle contraction excites golgi tendon organs This causes inhibition of motor neurons to the muscle When muscle contraction stops the muscle relaxes and lengthens as a result

11. Isometric contraction of muscle Inhibition of antagonist and induced intrafibral stretch of agonist. Reduces muscle tone of agonist as well as antagonist

12. Post facilitation stretch (PFS) The hypertonic and shortened muscle is placed between a fully stretched and a fully flexible state. The patient is asked to tighten the agonist using maximum effort for 5 to 10 seconds Therapist resists the patients force. The patient is then asked to relax and release the effort,

13. whereas the therapist involves a rapid stretch to a new barrier and is held for 10 seconds. Relaxes for 20 seconds Process repeated 3 to 5 times Rather than starting from barrier , the muscle is placed between a fully stretched and a fully relaxed state before every repetition.

14. Reciprocal Inhibition ( RI) The manufactured muscle is placed in a mid range position. The patient pushes towards the restriction or barrier whereas the therapist completely opposes the effort (isometric) or allows a movement towards it ( isotonic). This following by relaxation of the patient along with exhalation. Therapist applies a passive stretch to the new barrier. The procedure is repeated 3 to 5 times 10-20% of maximum muscle contraction

15. Mechanism Isometric contraction of a muscle Stimulates the same muscle by alpha motor neurons , inhibits its antagonist by gamma motor neurons Antagonist relaxation due to agonist firing which due neurological loop involving golgi tendon organ.

16. MET INDICATIONS Lengthen a shortened, contractured or spastic mucle Strengthens physiologically weakened muscle Reduce pain Stretch tight fascia Reduces localized edema Mobilize an articulation with restricted mobility

17. MET CONTRAINDICATIONS Fracture Severe sprain Severe strain Open wounds Osteoporosis or metabolic bone diseases Non –cooperative Unconscious

18. Mechanism in summary Muscle and joint mechanoreceptors , which includes centrally mediated pathways including periaqueductal gray matter in midbrain and noradrenergic helps in descending inhibitory pathways. Muscle increases range as muscle extensibility is increased , reflex relaxation and viscoelastic changes which increases stretch tolerance.

19. Reference Leon Chaitow , “Muscle Energy Technique”-3 rd Edition

20. THANK YOU