-MET is a type of osteopathic manipulative treatement used in osteopathic therapy, physical therapy, massage therapy and occupational therapy. - A form of diagnosis and treatment in which the patient's muscles are actively used on request, from a precisely controlled position, in a specific direction, and against a distinctly executed physician counterforce. 1.Dr. TJ Ruddy:  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.2.Dr. Fred Mitchell, Sr.: 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. -He believed that pelvis was the key to musculoskeletal system.

1. Dr. Gulwish Sadique :
(MPT-Musculoskeletal)
Asst.Professor
Rama University

2. INTRODUCTION

3. -MET is a type of osteopathic manipulative treatement
used in osteopathic therapy, physical therapy, massage
therapy and occupational therapy.
- A form of diagnosis and treatment in which the
patient's muscles are actively used on request, from a
precisely controlled position, in a specific direction,
and against a distinctly executed physician
counterforce.

4. HISTORY OF MET

5. 1.Dr. TJ Ruddy:
-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.

6. 2.Dr. Fred Mitchell, Sr.: 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.
-He believed that pelvis was the key to musculoskeletal
system.

7. 3.Dr. Phillip Greenman:
Believed that any articulation which can be moved by
voluntary muscle action can be it influenced by
muscle energy techniques (MET); MET
can be used for: lengthening strengthening,
decreasing local edema .

8. 4.Dr. Sandra Yale:
stated that MET was safe enough for
use with fragile and severely ill, or on a spasm from fall

9. EFFECTS OF MET

10. There are two main effects when performing muscle
energy :
 Physiological properties
-structure of the muscle fibers-
Intrafusal and Extrafusal muscle fibers
 Neurological properties
- Muscle spindle
- Motor neurons : Afferent and Efferent motor neurons

11. Location of MS and GTO

12. Function Of GTO

13. Structure of the Muscle fibre

14. INDICATIONS

15.  It uses isometric or isotonic contractions as a way of
1.Lengthening tight muscle;
2.Strengthening weak muscle;
3.Mobilising joints
4.Releasing the trigger points
5.Relieving congestion in the tissues (circulatory
functions and helps to reduce Odema)

16. CONTRA-INDICATIONS

17.  Acute musculoskeletal injuries
 Unstable or fused joints.
 Unset or unstable fractures,
 Avulsion Injuries,
 Severe osteoporosis
 Open wounds, or
 Metastatic disease.
Additionally, because these techniques require active
patient participation, they are inappropriate for any
patient that is unable to cooperate

18. PRECAUTIONS

19. 1.Unknown pathology
2.Stress fractures
3.Strains, infections or diseases causing
musculoskeletal pain
4.Osteoporosis or tumors in the area of treatment.

20. TREATMENT PRINCIPLES

21.  1.Isometric contraction – most commonly used.
 Distance between the origin and insertion of the
muscle is maintained with a fixed amount of tension in
the muscle.
 Resets the muscle proprioceptors as the muscle
lengthens.
Two forms of isometric MET –
 1.Post-Isometric Relaxation (PIR) and
 2.Reciprocal Inhibition (RI).

22.  2.a.Concentric Isotonic Contraction
-Origin and Insertion of the muscle approximate.
-Useful in building muscle strength.
-Contraction occurs when the therapist’s counterforce
is weaker than the contractile force allowing some
movement to occur in the direction of the muscle
force, therefore shortening and strengthening the
muscle.

23. 
 2.b.Eccentric Isotonic Contraction (Isolytic)
- Origin and Insertion of the muscle are separated.
-Resistance overcomes the tension in the muscle so the
muscle lengthens.
-Occurs when the therapist’s counterforce is stronger
than the contractile force of the muscle and stretching
and lengthening occur in the muscle tissue.
-This results in a change to the muscles shortened
structure and improves elasticity and circulation.

24. THE PHYSIOLOGY OF
HOW THE MET TECHNIQUES WORK?

25. 1.POST ISOMETRIC RELAXATION-
 PIR refers to the subsequent reduction in tone of the
agonist muscle after isometric contraction.
 This occurs due to stretch receptors -Golgi tendon
organs(GTO), located in the tendon of the agonist
muscle.
 These receptors react to over- stretching of the muscle
by inhibiting further muscle contraction.

26.  This is naturally a protective reaction, preventing
rupture and has a lengthening effect due to the sudden
relaxation of the entire muscle under stretch.
 The afferent nerve impulse from the Golgi tendon
organ enters the dorsal root of the spinal cord and
meets with an inhibitory motor neuron.

27.  This stops the discharge of the efferent motor neurone’s
impulse and therefore prevents further contraction, the
muscle tone decreases, which in turn results in the
agonist relaxing and lengthening.
 The Golgi tendon organs react to both passive and
active movements and therefore passive mobilisation of
a joint may sometimes have as good an effect on
relaxing the muscles.

28. PIR

29.  2.RECIPROCAL INHIBITION
 RI refers to the inhibition of the antagonist muscle
when isometric contraction occurs in the agonist.
 This happens due to stretch receptors within the
agonist muscle fibres – Muscle Spindles.
 Muscle spindles work to maintain constant muscle
length by giving feedback on the changes in
contraction.

30.  Due to stretch muscle spindles discharge nerve
impulses, which increase contraction, thus preventing
over-stretching.
 The spindles discharge impulses which excite the
afferent nerve fibres or the agonist muscle, they meet
with the excitatory motor neurone of the agonist
muscle (in the spinal cord) and at the same time
inhibit the motor neurone of the antagonist muscle
which prevents it from contracting.

31.  Results in the relaxation of the antagonist therefore is
called reciprocal inhibition.
 When the agonist stops contracting against force, the
muscle spindles stop discharging and the muscle
relaxes.

32. RI

33. TECHNIQUES ACCORDING TO THE
CONTRACTIONS

34. 1.Isometric‐ Utilizing Autogenic Inhibition
-Operator Push through the barrier of restriction, utilizing
autogenic inhibition of the target muscle.
-Frequency: 3‐5 reps
-Intensity: Operator and patient’s forces are matched.
Patient provides on effort at 20% of their strength
increasing to no more than 50% on subsequent contractions.
-Duration: 4‐10 seconds initially, increasing up to 30 seconds
in subsequent contractions.

35. Isometric‐ Utilizing Reciprocal Inhibition
-Operator push through the barrier of restriction,
utilizing reciprocal inhibition which causes relaxation
the target muscle.
-Frequency: 3‐5 reps
-Intensity: Operator and patient’s forces are matched.
Patient provides on effort at 20% of their strength incre
asing to no more than 50% subsequent contractions.
-Duration: 4‐10 seconds initially, increasing up to 30
seconds in subsequent contractions.

36. Isotonic Concentric‐ Utilizing Autogenic Inhibition
 Target muscle is allowed to contract with some
resistance from the operator. This technique utilizes
autogenic inhibition of the target muscle.
Frequency: 5‐7 reps .
-Intensity: Patient’s force is greater than operator’s
resistance.Patient utilizes maximum effort and
force is built slowly, not suddenly.
-Duration- 3-4 seconds.

37. Isotonic Eccentric‐Utilizing Reciprocal Inhibition
 Target muscle is prevented from contracting by
superior operator force, utilizing reciprocal inhibition
which causes relaxation of the target muscle.
 Frequency: 3‐5 reps as long as tolerable .
 Intensity: Operator’s force is greater than patient’s
force.
Patient utilizes maximal force initially and subsequent
contractions build towards patient’s maximal force.
 Duration: 2‐4 seconds

38. FACTORS

39.  Common Patient Errors
- Contraction too hard
-Contraction in Wrong Direction
-Contraction for too short a time
-Does not relax fully following contraction

40.  Common Operator Errors
-Inaccurate control of joint position
-Counterforce in the incorrect direction
-Not giving the patient accurate instructions
-Moving the joint to a new position too soon after the
contraction stops

41.  Good results of MET depend on: accurate diagnosis,
appropriate levels of force, and sufficient localization.
 Poor results of MET are attributed to: inaccurate
diagnosis, improperly localized force, or forces that are
too strong.

42. SIMPLE GUIDELINES TO
FOLLOW MET

43.  No pain should be caused byMET
 Keep contractions light (20-30% of strength)
 Communicate effectively and ensure patient is not
experiencing discomfort at any time
 Client can help to locate tissue tension or restriction
barrier
 Never over-stretch

44. RELATED ARTICLES FOR
RESULTS WHILE USING THE
TECHNIQUE(MET)

45.  1.Fiona Ballantyne,Gary Fryer et al- The Effect Of Muscle
Energy Technique On Hamstring Extensibility: The
Mechanism Of Altered Flexibility
 Purpose – To investigate the effectiveness of MET in
increasing passive knee extension.
40 asymptomatic subjects -control or experimental groups.
Hamstring muscle stretched to the onset of discomfort by
passive knee extension.
Knee range of motion -recorded with digital photography and
passive torque recorded with a hand-held dynamometer.

46. The experimental group received MET to the
hamstring muscle, after which the resistance to stretch
and the ROM were again measured. The knee was
extended to the original passive torque and the angle
at the knee recorded. If the onset of discomfort was
not produced at this angle, the knee was further
extended and the new angle was recorded.
 Results-significant increase in ROM observed at the
knee (p<0.019) following a single application of MET to
the experimental group. No change was observed in
the control group.

47.  When an identical torque was applied to the hamstring
both before and after the MET, no significant difference
in range of motion of the knee was found in the
experimental group.
 Conclusions-MET produced an immediate increase in
passive knee extension. This observed change in ROM
is possibly due to an increased tolerance to stretch as
there was no evidence of viscoelastic change.

48.  2.Effect of Muscle Energy Technique on Pain in
Individuals with Non-Specific Lumbopelvic Pain: A
Pilot Study. Noelle M. Selkow et al
 20 subjects with LPP ,randomized into two groups (MET
or control) after magnitude of pain was determined.
MET of the hamstrings and iliopsoas consisted of 4- 5
second hold/relax periods, while the control group
received a sham treatment. Tests for current and worst
pain, and pain with provocation were administered at
baseline, immediately following intervention and 24
hours after intervention.

49.  VAS for worst pain reported in the past 24 hours
decreased for the MET group (4.3mm±19.9, p=.03) and
increased for the sham (control) group (17.1mm±21.2,
p=.03).
 Subjects receiving MET demonstrated a decrease in
VAS worst pain over the past 24 hours, thereby
suggesting that MET may be useful to decrease LPP
over 24 hours.

50. 3.The Effects of Muscle Energy Technique on Cervical Range
of Motion by -Kimberly, Rousselle, John
To determine if a 4 week treatment period of (MET)
would significantly increase cervical flexion, extension,
side bending, and rotation in asymptomatic persons
with limited range of motion (ROM).
18 subjects for the study following screening for neck
ROM limitation. These subjects were then randomly
assigned to either a control or MET group. A series of
six, mixed, two-way analyses variance (ANOVA) were
used to test for significant cervical ROM increases.

51.  The two factors examined were Group (MET vs.
control) and Test (pre vs. post). Significant interactive
effects for both left and right rotation were found
(both F's > 4.8 and p's < 0.05) indicating a significantly
greater ROM in the MET group. Treatment groups
showing an increase between pre-test and post-test.
These results support MET as an effective technique
for increasing cervical range of motion.

52. REFERENCES
 Text book of THE PHYSIOLOGY AND APPLICATION OF MUSCLE
ENERGY TECHNIQUES by Gill Webster.
 John Gibbons-text book of Muscle Energy, Issue 97 July 2011
 Short-Term Effect of Muscle Energy Technique on Pain in Individuals
with Non-Specific Lumbopelvic Pain: A Pilot Study Noelle M. Selkow,
Terry GriNdSTaff,Spine Journal
 Grubb ER, Hagedorn EM, Book of Muscle Energy Technique.
 A comparison of two muscle energy techniques for increasing flexibility of
the hamstring muscle group.Madeleine Smith,B.Clin.Sc, Gary Fryer
Journal of Body work and movement therapiesOctober 2008, Pages 312–317

53.  Text book of Grieve’s Modern Manual Therapy by DG
Lee.
 Textbook of Human Physiology by AK Jain,3 rd Edition
 The Effects of Muscle Energy Technique on Cervical Range of
Motion by -Kimberly, Rousselle, John Journal of
Manual & Manipulative Therapy Volume 2, Number 4,
1994 , pp. 149-155.

54. THANK YOU