2. • Muscle energy techniques are a class of soft
tissue osteopathic (originally) manipulation
methods that incorporate precisely directed
and controlled, patient initiated, isometric
and/or isotonic contractions, designed to
improve musculoskeletal function and reduce
pain
3. • MET was developed in 1948 by Fred Mitchell,
Sr, D.O
• MET uses a muscle’s own energy in the form
of gentle isometric contractions to relax the
muscles via autogenic or reciprocal inhibition
and lengthen the muscle.
• As compared to static stretching which is a
passive technique in which the therapist does
all the work, MET is an active technique in
which the patient is also an active participant.
4. • MET is based on the concepts of Autogenic
Inhibition and Reciprocal Inhibition.
• If a sub-maximal contraction of the muscle is
followed by stretching of the same muscle it is
known as Autogenic Inhibition MET
• if a sub maximal contraction of a muscle is
followed by stretching of the opposite muscle
then this is known as Reciprocal Inhibition
MET.
5. • Autogenic and reciprocal inhibition both occur
when certain muscles are inhibited from
contracting due to the activation of the Golgi
tendon organ (GTO) and the muscle spindles.
• These two musculotendinous proprioceptors
located in and around the joints and muscles
respond to changes in muscle tension and
length, which helps manage muscular control
and coordination.
6. • The GTO, located between the muscle belly
and its tendon, senses increased tension when
the muscle contracts or stretches. When the
muscle contracts, the GTO is activated and
responds by inhibiting this contraction (reflex
inhibition) and contracting the
opposing (antagonist) muscle group. This
process is known as autogenic inhibition
7. Mechanism
• The GTO response plays an important role in flexibility.
• When the GTO inhibits the (agonist) muscle’s
contraction and allows the antagonist muscle to
contract more readily, the muscle can be stretched
further and easier.
• Autogenic inhibition is often seen during static
stretching, such as during a low-force, long-duration
stretch. After 7 to 10 seconds, muscle tension increases
and activates the GTO response, causing the muscle
spindle in the stretched muscle to be inhibited
temporarily, which makes it possible to stretch the
muscle further.
8. • The muscle spindle is located within the
muscle belly and stretches along with the
muscle itself. When this occurs, the muscle
spindle is activated and causes a reflexive
contraction in the agonist muscle (known as
the stretch reflex) and relaxation in the
antagonist muscle. This process is known
as reciprocal inhibition.
9. • Types of MET:
• Autogenic Inhibition MET
– Post Isometric Relaxation (PIR)
– Post Facilitation Stretching (PFS)
• Reciprocal Inhibition MET
10. • Autogenic Inhibition MET
• As already mentioned Autogenic Inhibition
METs work on the principle of autogenic
inhibition.
• The two major and well-known types of MET
that are based on the concept of autogenic
inhibition are Post Isometric Relaxation
(PIR)and Post facilitation Stretching (PFS)
11. • Post Isometric Relaxation (PIR)
• Post Isometric Relaxation is a technique that
was later developed by Karel Lewitt.
• PIR is the effect of the decrease in muscle
tone in a single or group of muscles, after a
brief period of submaximal isometric
contraction of the same muscle. PIR works on
the concept of autogenic inhibition.
12. PIR technique
• The hypertonic muscle is taken to a length just short of
pain, or to the point where resistance to movement is first
noted.
• A submaximal (10-20%) contraction of the hypertonic
muscle is performed away from the barrier for between 5
and 10 seconds and the therapist applies resistance in the
opposite direction. The patient should inhale during this
effort.
• After the isometric contraction, the patient is asked to relax
and exhale while doing so. Following this, a gentle stretch is
applied to take up the slack till the new barrier.
• Starting from this new barrier, the procedure is repeated
two or three times.
13. • Post Facilitation Stretch (PFS)
• Post Facilitation Stretch (PFS) is a technique
developed by Janda . This technique is more
aggressive than PIR but is also based on the
concept of autogenic inhibition.
•
14. PFS technique is performed as follows
• The hypertonic and shortened muscle is placed
between a fully stretched and a fully relaxed
state.
• The patient is asked to contract the agonist using
a maximum degree of effort for 5–10 seconds
while the therapist resists the patient's force.
• The patient is then asked to relax and release the
effort, whereas the therapist applies a rapid
stretch to a new barrier and is held for 10
seconds.
15. CONTINUE
• The patient relaxes for approximately 20
seconds and the procedure is repeated
between three to five times and five times
more.
• Instead of starting from a new barrier, the
muscle is placed between a fully stretched and
a fully relaxed state before every repetition
16. Reciprocal Inhibition MET
• Reciprocal Inhibition MET is different from the
above two techniques in that it involves the
contraction of one muscle followed by
stretching of the opposite muscle, because
contrary to PIR and PFS, Reciprocal Inhibition
MET as the name implies is based on the
concept of Reciprocal Inhibition.
17. • The affected muscle is placed in a mid-range
position.
• The patient pushes towards the
restriction/barrier whereas the therapist
completely resists this effort (isometric) or
allows a movement towards it (isotonic).
• This is followed by relaxation of the patient
along with exhalation, and the therapist
applies a passive stretch to the new barrier.
• The procedure is repeated between three to
five times and five times more.
18. Indication
• Relaxation and lengthening of the muscles
• Improve range of motion (ROM) in joints.
• Guard against future injury of muscles and
joints.
• It is mainly used by individuals who have a
limited ROM due to facet joint dysfunction in
the neck and back, and for broader areas such
as shoulder pain, scoliosis, sciatica
asymmetrical legs, hips or arms, or to treat
chronic muscle pain, stiffness or injury
19. • Muscle energy techniques can be employed to
reposition a dysfunctional joint and treat the affected
musculature. Indications include, but are not limited
to: muscular shortening, low back pain, pelvic
imbalance, edema, limited range of motion, somatic
dysfunction, respiratory dysfunction, cervicogenic
headaches and many others.
• These techniques are inappropriate when a patient has
injuries such as fractures, avulsion injuries,
severe osteoporosis, open wounds, or has metastatic
disease. Additionally, because these techniques require
active patient participation, they are inappropriate for
any patient that is unable to cooperate.
20. Key points about modern MET
• The practitioner/therapist's force may exactly
match the effort of the patient (so producing an
isometric contraction) allowing no movement
to occur - and possibly producing as a result a
physiological neurological
• Response (via the Golgi tendon organs)involving
a combination of reciprocal inhibition of the
antagonist(s) of the muscle(s) being contracted,
as well as post isometric relaxation of the
muscle(s) which are being contracted
21. • The practitioner / therapist'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, known, when
performed rapidly, as an isolytic contraction).
A slowly performed isotonic eccentric stretch
has the effect of toning the muscle being
stretched in this way, while inhibiting its
antagonist(s), allowing it/them to be more
easily stretches
22. • The practitioner / therapist may partially
match the effort of the patient, thus allowing,
whilst slightly retarding, the patient's effort
(and so producing a toning effect by means of
the isotonic concentric, isokinetic,
contraction).
23. • Whether the contraction should commence
with the muscle or joint held at the resistance
barrier or short of it - a factor decided largely
on the basis of the degree of chronicity or
acuteness of the tissues involved How much
effort the patient uses - say, 20% of strength,
or more, or less.
• The length of time the effort is held in 7-10
seconds, or more, or less
24. • Whether, instead of a single maintained
contraction, to use a series of rapid, low
amplitude contractions (Ruddy's rhythmic
resisted reduction method, also known as
pulsed muscle energy technique)
• The number of times the isometric
contraction (or its variant) is repeated - three
repetitions are thought to be optimal
25. • The direction in which the effort is made
towards the resistance barrier or away from it,
thus involving either the antagonists to the
muscles or the actual muscles (agonists)
which require 'release' and subsequent
stretching (these variations are also known as
'direct'and 'indirect' approaches.
26. • Whether to incorporate a held breath and/ or
specific eye movements (respiratory or visual
synkinesis) to enhance the effects of the
contraction. These tactics are desirable if
possible
