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PHYSIO_REHAB_AP
Muscle
Energy
Technique
By- Dr. Anjali Parmar
History
Father of MET- Fred L. Mitchel
Dr. TJ Ruddy was the 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.
Dr.Phillip Greenman believed that any
articulation which can be moved by
voluntary muscle action can be
influenced by muscle energy techniques
(MET); MET can be used for lengthening
strengthening, decreasing local edema.
Dr. Sandra Yale stated that MET was
safe enough for use with fragile and
severely ill, or on a spasm from fall
Muscle Energy
Tchnique
Muscle energy techniques are soft
tissue manipulation methods that
incorporate precisely directed and
controlled, patient initiated,
isometric and or isotonic
contraction, designed to improve
musculoskeletal function and
reduce pain
Uses Indication Contraindication Precaution
Lengthen shortened,
contracted or
spastic muscles
Strengthen a
physiological
weakened muscle or
group of muscles
Reduce local
oedema
Relieve passive
congestion
To mobilize
articulation with
restricted mobility
Shortened,
contracted or
spastic muscles
Weaknedmuscle or
groupof muscle
Malpositioning of
bony element
Restoration of joint
motion associated
with articular
dysfunction
Acute
musculoskeletal
injuries
Unstable or fused
joints
Unsetor unstable
fractures
Unknown
pathology
Stress fractures
Strains, infections
or diseases causing
musculoskeletal
pain
Osteoporosis or
tumors in the area
of treatment
01 02 03 04
TYPES OF MUSCLE CONTRACTION
Generate force without changing
the length of the muscle
ISOMETRIC
Change in length of the muscles
resulting in a movement without a
change in the muscle tension
ISOTONIC
Muscle contracts and shortens at a
constant speed, or constant angular speed.
To perform Isokinetic muscle contractions
requires specialist equipment – known as an
Isokinetic Dynamometer.
This increases the load when it senses the
muscle is speeding up, ensuring that the
speed of movement is held constant
throughout.
ISOKINETIC
Principle of MET
Post
Isometric
Relaxation
Reciprocal
Inhibition
POST ISOMETRIC
RELAXATION
It is assumed effect of reduced tone
experienced by a muscle or group of
muscle after brief periods of
following an isometric contraction.
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
RECIPROCAL
INHIBITION
When a muscle is isometrically contracted, its
antagonist will be inhibited, and will
demonstrate reduced tone immediately
following this.
Thus, the antagonist of a shortened muscle, or
group of muscles, may be isometrically
contracted in order to achieve a degree of
ease and additional movement potential in the
shortened tissues.
Isometric contraction of a muscle
Stimulates the same muscle by alpha motor
neurons where as 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
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: Liebenson
Liebenson suggests that there is evidence that the receptors
responsible for PIR lie within the muscle and not in the skin or
associated joints .
Principle of MET
B Key points of 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 antagonist 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).
Principle of MET
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).
Principle of MET
1. Stretch the Muscle: Move the tight muscle to the point where it just starts to
hurt or you feel resistance.
2. Contract the Muscle: The patient gently tightens the muscle against the
therapist's resistance for 5-10 seconds.
3. Relax the Muscle: The patient then relaxes the muscle.
4. Move to New Position: After relaxation, the therapist gently moves the
muscle a little further, removing all slack but not stretching it.
5. Repeat: This process is repeated 2-3 times.
For the hamstrings specifically:
- The patient uses 10-20% of their effort when tightening the muscle.
1. Lewit's Postisometric
relaxation technique
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1.Minimal Force Contraction:
- When using minimal force to resist (isometric contraction), only a few muscle fibers are
active while the others are inhibited.
2.Gentle Movement Without Stretching:
- During relaxation, the muscle is gently moved to its new limit without stretching, which
avoids triggering the stretch reflex.
- The stretch reflex can be triggered even by a gentle, non-painful stretch.
3. Connection Between Tension and Pain:
- This method shows that there is a close link between muscle tension and pain.
- It also shows a link between muscle relaxation and pain relief (analgesia).
Mechanism of PIC
1. Midrange Position:
- Position the shortened muscle halfway between fully stretched and fully relaxed.
2. Isometric Contraction:
- The patient contracts the muscle as hard as they can for 5-10 seconds, while the effort is
fully resisted.
3. Release and Stretch:
- After releasing the effort, quickly stretch the muscle to its new limit without bouncing and
hold for 10 seconds.
4. Relaxation:
- The patient relaxes for 20 seconds.
5. Repeat:
- Repeat this procedure 3-5 times.
2. Janda's Postfacilitation stretch
method
1. Isometric Contraction:**
- When a muscle contracts isometrically, it activates the same muscle through alpha motor
neurons.
2. Inhibition of Antagonist Muscle:**
- This contraction also inhibits the opposing muscle (antagonist) through gamma motor
neurons.
3. Neurological Loop:
- This process, called antagonist relaxation due to agonist firing, involves a local neurological
loop with the Golgi tendon organs.
4. Reciprocal Inhibition:
- For example, when the hamstrings contract, their antagonist muscles are inhibited, reducing
their muscle tone.
This process helps reduce the muscle tone of the antagonist muscle, aiding in relaxation and
movement.
3. Reciprocal Inhibition technique
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4. Strengthening Variation
1.this is like Isokinetic Contraction (Progressive Resisted Exercise):
- The patient starts with a weak effort and quickly progresses to a maximal
contraction of the affected muscles.
- The therapist provides resistance as the joint or area moves through a full
range of motion.
2. Limited Range with Good Muscle Tone:
- A limited range of motion with good muscle tone is often preferable to a
normal range with limited power.
- Strengthening weak muscles in areas with permanent mobility limitations
is important.
4. Strengthening Variation
3. Benefits of Isokinetic Contractions:
- Strengthen muscle fibers.
- Improve coordination of muscle fibers.
- Result in progressively stronger muscular efforts due to neuromuscular
recruitment.
4. Execution of Isokinetic Contractions:
- Each contraction should last no more than 4 seconds to maximize benefits
and minimize fatigue.
- Avoid prolonged contractions.
5. Application:
- Best used on small joints, such as those in the extremities.
- More challenging to apply to spinal joints during full muscular resistance.
5. Isolytic MET
Isotonic Contractions:
The patient uses isotonic contractions where the muscle changes length while under tension
during resistance from the therapist.
Stretching and Breaking Down Fibrotic Tissue:
The technique involves stretching the muscle and sometimes breaking down fibrotic tissues.
The therapist applies slightly more force than the patient to reduce adhesions in the muscle.
Gradual Increase in Effort:
The patient starts with about 20% of their possible strength for the first contraction, which
lasts 3-4 seconds.
The therapist resists and overcomes this effort.
Progressive Effort Increase:
If the first effort is painless, the patient increases the effort for the next contraction.
This process continues, with the patient using more force each time, aiming for maximum
contraction effort.
Aim:
The goal is to progressively increase the force of the muscle contractions while the therapist
overcomes these efforts to improve muscle function and reduce adhesions.
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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.'.
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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).
7. Isokinetic MET
Isokinetic Contraction (Progressive Resisted Exercise):
The patient starts with a weak effort and quickly progresses
to a maximal contraction of the affected muscles.
Resistance is introduced to the practitioner’s effort to move a
joint or area through a full range of motion.
Counterforce Adjustment:
The counterforce is increased during the contraction to match
the muscle’s increasing force as it shortens.
Benefits:
Improves efficient and coordinated use of muscles.
Enhances the tonus (resting tension) of the muscle.
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8. Joints and MET
Joint and Muscle Connection:
The methods have a significant impact on joints because
joints cannot be considered separately from the muscles that
support and move them.
Importance of Muscle Function:
Proper muscle function is crucial for joint health and
movement.
9. Self MET
Self-Treatment (Autotherapy):
Patients can learn to apply this treatment to themselves at home.
Passive Stretching:
They use their hand to passively stretch the tight muscle.
Counter Pressure:
The hand provides counter pressure during the muscle's voluntary
contraction (while inhaling).
Preventing Muscle Shortening:
During relaxation, the hand holds the muscle to prevent it from
shortening.
Increasing Range of Motion:
During exhalation, the hand takes up any slack to increase the range of
motion.
Patient active muscle contraction:
1. From controlled motion
2. In a specific direction
3. Met by practitioner applied distinct counterforce
4. Involving a controlled intensity of contraction
ELEMENTS
COMMON ERRORS
PATIENT ERROR
Strong contraction, in
wrong direction
Contraction is not
sustained, not
relaxed, starting and
finishing
PRACTITIONER ERROR
Inaccurate control of
joint, counterforce,
direction, moving
Instruction, fails to
maintain stretch
BARRIER
Soft tissue
Fluid restriction
Hypertonicity
Fibrotic tissue
Bony tissue
Pain
Breath & MET
Inhale as slowly build up an isometric
contraction
Hold 7-10 seconds
Release breadth as they slowly cease
contraction
Inhale and exhale fully once more, following
cessation of all efforts
Application
Isometric Contraction:
1.
The therapist's force matches the patient's effort, resulting in
no movement. This can lead to reciprocal inhibition and post-
isometric relaxation.
Isotonic Eccentric (Isolytic) Contraction:
2.
The therapist's force overcomes the patient's effort, moving
the area or joint in the opposite direction of the patient's
movement. This is an isotonic eccentric contraction, also called
isolytic when performed rapidly.
Isotonic Concentric (Isokinetic) Contraction:
3.
The therapist partially matches the patient's effort, allowing
movement. This results in an isotonic concentric or isokinetic
contraction.
Key Factors:
Effort Level: Patients exert around 20% of their strength or
adjust as needed.
Duration: Effort is held for 7-10 seconds or adjusted based
on need.
Repetitions: Three repetitions are considered optimal.
Resistance: Resistance can be provided by the operator,
gravity, the patient, or an immovable object.
VARIATIONS
ISOMETRIC ISOTONIC ISOKINETIC
PIR
ACUTE
(Without
stretch)
RI
CHRONIC
(With
stretch)
concentric
muscle
contraction
slow eccentric
muscle
contraction
eccentric
muscle
contraction combination of
isomonic and
isometric
muscle
contraction
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
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
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
3. Isometric contraction- using PIR with 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: Agonist is used in isometric contraction thus treating affected
muscle via PIR allowing an easier stretch to be performed.
D. Force: subject's effort; initially: 20%
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 10-30sec (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
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 .
F. Action following contraction: Rest interval of 5 sec followed by stretch
held for 10-30sec (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
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
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
https://drive.google.com
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w
A8sCZ_lY/view?usp=drive_link
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
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
To Improve Treatment
Efficacy:
Respiratory Synkesis
Visual Synkinesis
Respiratory Synkesis
Inhale
During Contraction
Exhale
During Release, Newer
Range Positioning or
Stretching Maneouvers.
Visual Synkinesis
Inhale
Look towards the direction
of muscle contract.
Exhale
Look towards the direction
of muscle relaxation.
Neck extensor
PRI
Positioning: The patient is typically positioned lying down or sitting
comfortably.
1.
Isometric Contraction: The patient contracts the neck extensors by gently
pushing the head backward against resistance provided by the therapist's
hand.
2.
Intensity: The patient exerts around 20-30% of their maximum effort during
the contraction.
3.
Duration: The contraction is held for about 7-10 seconds.
4.
Relaxation: After the contraction, the patient relaxes the neck muscles
completely.
5.
Stretching: The therapist then applies a gentle stretch to the neck extensors,
taking the muscle into a slightly deeper stretch.
6.
Hold: The stretch is held for about 10-20 seconds to allow the muscles to relax
further.
7.
Repetition: This process may be repeated 2-3 times to maximize the
effectiveness of the post-isometric relaxation technique.
8.
https://drive.google.com/file/d/15xaNZxoAPZJ4Y3L
SElvjfnn3YF_majXO/view?usp=drive_link
shoulder flexion range
is decreased
Positioning:
The patient is positioned comfortably, typically in a seated or lying position, with the
shoulder in a neutral or slightly extended position.
Isometric Contraction:
The therapist guides the patient to perform an isometric contraction of the shoulder
extensor muscles by pushing against the therapist's resistance for about 5-10 seconds.
Relaxation:
After the contraction, the patient relaxes the shoulder muscles completely.
Stretching:
The therapist then applies a gentle stretch to the shoulder extensor muscles, taking care not
to cause discomfort or pain.
Hold and Repeat:
The stretch is held for about 10-30 seconds, allowing for post-isometric relaxation to occur.
This process may be repeated for 2-3 times to maximize the effectiveness of the technique.
Benefits:
Post-isometric relaxation helps to increase flexibility and range of motion in the shoulder
extensor muscles.
It can also help alleviate muscle tension and reduce the risk of injury
https://drive.google.com/file/d/15xaNZxoAPZJ4Y3L
SElvjfnn3YF_majXO/view?usp=drive_link
Positioning:
1.
The patient is typically positioned lying on their side or supine, depending on the
therapist's preference and the specific needs of the patient.
Isometric Contraction:
2.
The therapist guides the patient to perform an isometric contraction of the quadratus
lumborum muscle by pushing against the therapist's resistance for about 5-10 seconds.
Relaxation:
3.
After the contraction, the patient relaxes the quadratus lumborum muscle completely.
Stretching:
4.
The therapist then applies a gentle stretch to the quadratus lumborum muscle, usually
by side-bending the trunk away from the contracted side or by performing a passive
stretch in a seated position.
Hold and Repeat:
5.
The stretch is held for about 10-30 seconds, allowing for post-isometric relaxation to
occur and for the muscle to lengthen.
This process may be repeated for 2-3 times to maximize the effectiveness of the
technique.
Benefits:
6.
Post-isometric relaxation helps to increase flexibility and range of motion in the
quadratus lumborum muscle, which can help alleviate lower back pain and improve
overall movement patterns.
quadratus
lumborum
https://drive.google.com/file/d/1xv40G9PzLlKlTJ56_qB6AFR-
hUsTgcvQ/view?usp=drive_link
https://drive.google.com/file/d/16Pn2bAdeRsYx_Cm
LBnCaZ7blJo9NttvY/view?usp=drive_link
Positioning:
The patient is positioned comfortably, usually lying on their stomach or standing,
with the arms extended overhead or by their sides.
Isometric Contraction:
The therapist guides the patient to push against their resistance for around 5-10
seconds, engaging the latissimus dorsi muscles.
Relaxation:
After the contraction, the patient completely relaxes the latissimus dorsi muscles.
Stretching:
The therapist then gently stretches the latissimus dorsi muscle, usually by
extending the arm or bending the trunk to the side, ensuring there's no pain.
Hold and Repeat:
The stretch is held for about 10-30 seconds, allowing the muscle to relax and
lengthen further.
The process can be repeated for 2-3 times to enhance flexibility and reduce
muscle tension.
Benefits:
Post-isometric relaxation helps improve the flexibility and range of motion of the
latissimus dorsi muscles.
It can also relieve muscle tightness and discomfort in the back and shoulder area.
latissimus dorsi
https://drive.google.com/file/d/168-
rRlhE6FmVK9Z5RM25RX0v6tNWDK4W/view?usp=drive_link
Positioning:
The patient is positioned comfortably, usually lying on their stomach or standing,
with the arms extended overhead or by their sides.
Isometric Contraction:
The therapist guides the patient to push against their resistance for around 5-10
seconds, engaging the latissimus dorsi muscles.
Relaxation:
After the contraction, the patient completely relaxes the latissimus dorsi muscles.
Stretching:
The therapist then gently stretches the latissimus dorsi muscle, usually by
extending the arm or bending the trunk to the side, ensuring there's no pain.
Hold and Repeat:
The stretch is held for about 10-30 seconds, allowing the muscle to relax and
lengthen further.
The process can be repeated for 2-3 times to enhance flexibility and reduce
muscle tension.
Benefits:
Post-isometric relaxation helps improve the flexibility and range of motion of the
latissimus dorsi muscles.
It can also relieve muscle tightness and discomfort in the back and shoulder area.
quadriceps
https://drive.google.com/file/d/16PCMdoeAtcRghsSBiWLdWQ
5VYKTX7CJe/view?usp=drive_link
Positioning:
1.
The patient lies on their back or sits comfortably with the leg extended.
Isometric Contraction:
2.
The therapist guides the patient to contract the rectus femoris muscle by pushing
the thigh downwards against the therapist's resistance for about 5-10 seconds.
Relaxation:
3.
After the contraction, the patient relaxes the muscle completely.
Stretching:
4.
The therapist then gently stretches the rectus femoris muscle by flexing the hip
joint, bringing the knee towards the chest while keeping the opposite leg flat on
the surface.
Hold and Repeat:
5.
The stretch is held for about 10-30 seconds, allowing for post-isometric relaxation
to occur.
This process may be repeated for 2-3 times to enhance flexibility and reduce
muscle tension.
Benefits:
6.
Post-isometric relaxation helps increase the flexibility and range of motion in the
rectus femoris muscle.
It can also alleviate tightness and discomfort in the muscle, promoting better
movement and function.
rectus femoris
https://drive.google.com/file/d/16anuS9bXQ0fLFwbPtkpgmMy
o4fLiH538/view?usp=drive_link
shoulder horizontal abductors-
Middle Trapezius., Lower Trapezius, Rhomboid Major., Rhomboid Minor.
Positioning:
1.
The patient is positioned comfortably, typically in a seated or lying position, with the arm
at the side and the shoulder in a neutral position.
Isometric Contraction:
2.
The therapist guides the patient to perform an isometric contraction of the shoulder
horizontal abductors by pushing against the therapist's resistance for about 5-10
seconds.
Relaxation:
3.
After the contraction, the patient relaxes the shoulder muscles completely.
Stretching:
4.
The therapist then applies a gentle stretch to the shoulder horizontal abductor muscles,
moving the arm away from the body, taking care not to cause discomfort or pain.
Hold and Repeat:
5.
The stretch is held for about 10-30 seconds, allowing for post-isometric relaxation to
occur.
This process may be repeated for 2-3 times to maximize the effectiveness of the
technique.
Benefits:
6.
Post-isometric relaxation helps to increase flexibility and range of motion in the shoulder
horizontal abductor muscles.
It can also help alleviate muscle tension and improve overall shoulder function.
https://drive.google.com/file/d/1qZfZ8DaSiKxVj4gp6c3aTdQxp
1sxksYS/view?usp=drive_link
Positioning:
The patient is typically positioned lying on their back with both knees bent and one leg is on
other knee.
Isometric Contraction:
The therapist guides the patient to perform an isometric contraction of the piriformis muscle
by pushing the knee of the affected side against the therapist's resistance for about 5-10
seconds.
Relaxation:
After the contraction, the patient relaxes the piriformis muscle completely.
Stretching:
The therapist then applies a gentle stretch to the piriformis muscle by externally rotating
and abducting the hip of the affected side, while keeping the knee bent.
Hold and Repeat:
The stretch is held for about 10-30 seconds, allowing for post-isometric relaxation to occur.
This process may be repeated for 2-3 times to maximize the effectiveness of the technique.
Benefits:
Post-isometric relaxation helps to increase flexibility and reduce tension in the piriformis
muscle.
It can also alleviate symptoms associated with piriformis syndrome, such as sciatica and hip
pain.
piriformis
https://drive.google.com/file/d/15yl6cuHW9D65d5qn8-
jz_XACnYgEu3bm/view?usp=drive_link
https://drive.google.com/file/d/15xzjB9wTxCEbtQM
_srAhxa9BhRwKm1Uf/view?usp=drive_link
T
hankyo
u
Contact
information:
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E-Mail :
physio4health22.gmail.com

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Muscle Energy Technique (MET) with variant and techniques.

  • 2. History Father of MET- Fred L. Mitchel Dr. TJ Ruddy was the 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. Dr.Phillip Greenman believed that any articulation which can be moved by voluntary muscle action can be influenced by muscle energy techniques (MET); MET can be used for lengthening strengthening, decreasing local edema. Dr. Sandra Yale stated that MET was safe enough for use with fragile and severely ill, or on a spasm from fall
  • 3. Muscle Energy Tchnique Muscle energy techniques are soft tissue manipulation methods that incorporate precisely directed and controlled, patient initiated, isometric and or isotonic contraction, designed to improve musculoskeletal function and reduce pain
  • 4. Uses Indication Contraindication Precaution Lengthen shortened, contracted or spastic muscles Strengthen a physiological weakened muscle or group of muscles Reduce local oedema Relieve passive congestion To mobilize articulation with restricted mobility Shortened, contracted or spastic muscles Weaknedmuscle or groupof muscle Malpositioning of bony element Restoration of joint motion associated with articular dysfunction Acute musculoskeletal injuries Unstable or fused joints Unsetor unstable fractures Unknown pathology Stress fractures Strains, infections or diseases causing musculoskeletal pain Osteoporosis or tumors in the area of treatment 01 02 03 04
  • 5. TYPES OF MUSCLE CONTRACTION Generate force without changing the length of the muscle ISOMETRIC Change in length of the muscles resulting in a movement without a change in the muscle tension ISOTONIC Muscle contracts and shortens at a constant speed, or constant angular speed. To perform Isokinetic muscle contractions requires specialist equipment – known as an Isokinetic Dynamometer. This increases the load when it senses the muscle is speeding up, ensuring that the speed of movement is held constant throughout. ISOKINETIC
  • 7. POST ISOMETRIC RELAXATION It is assumed effect of reduced tone experienced by a muscle or group of muscle after brief periods of following an isometric contraction. 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
  • 8. RECIPROCAL INHIBITION When a muscle is isometrically contracted, its antagonist will be inhibited, and will demonstrate reduced tone immediately following this. Thus, the antagonist of a shortened muscle, or group of muscles, may be isometrically contracted in order to achieve a degree of ease and additional movement potential in the shortened tissues. Isometric contraction of a muscle Stimulates the same muscle by alpha motor neurons where as 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
  • 9. 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: Liebenson Liebenson suggests that there is evidence that the receptors responsible for PIR lie within the muscle and not in the skin or associated joints . Principle of MET
  • 10. B Key points of 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 antagonist 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). Principle of MET
  • 11. 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). Principle of MET
  • 12. 1. Stretch the Muscle: Move the tight muscle to the point where it just starts to hurt or you feel resistance. 2. Contract the Muscle: The patient gently tightens the muscle against the therapist's resistance for 5-10 seconds. 3. Relax the Muscle: The patient then relaxes the muscle. 4. Move to New Position: After relaxation, the therapist gently moves the muscle a little further, removing all slack but not stretching it. 5. Repeat: This process is repeated 2-3 times. For the hamstrings specifically: - The patient uses 10-20% of their effort when tightening the muscle. 1. Lewit's Postisometric relaxation technique h t t p s : / / d r i v e . g o o g l e . c o m / f i l e / d / 1 6 t C b N D T W F L B _ x Z i J m N B o d A t 7 o 5 i 3 0 T q f / v i e w ? u s p = d r i v e _ l i n k
  • 13. 1.Minimal Force Contraction: - When using minimal force to resist (isometric contraction), only a few muscle fibers are active while the others are inhibited. 2.Gentle Movement Without Stretching: - During relaxation, the muscle is gently moved to its new limit without stretching, which avoids triggering the stretch reflex. - The stretch reflex can be triggered even by a gentle, non-painful stretch. 3. Connection Between Tension and Pain: - This method shows that there is a close link between muscle tension and pain. - It also shows a link between muscle relaxation and pain relief (analgesia). Mechanism of PIC
  • 14. 1. Midrange Position: - Position the shortened muscle halfway between fully stretched and fully relaxed. 2. Isometric Contraction: - The patient contracts the muscle as hard as they can for 5-10 seconds, while the effort is fully resisted. 3. Release and Stretch: - After releasing the effort, quickly stretch the muscle to its new limit without bouncing and hold for 10 seconds. 4. Relaxation: - The patient relaxes for 20 seconds. 5. Repeat: - Repeat this procedure 3-5 times. 2. Janda's Postfacilitation stretch method
  • 15. 1. Isometric Contraction:** - When a muscle contracts isometrically, it activates the same muscle through alpha motor neurons. 2. Inhibition of Antagonist Muscle:** - This contraction also inhibits the opposing muscle (antagonist) through gamma motor neurons. 3. Neurological Loop: - This process, called antagonist relaxation due to agonist firing, involves a local neurological loop with the Golgi tendon organs. 4. Reciprocal Inhibition: - For example, when the hamstrings contract, their antagonist muscles are inhibited, reducing their muscle tone. This process helps reduce the muscle tone of the antagonist muscle, aiding in relaxation and movement. 3. Reciprocal Inhibition technique h t t p s : / / d r i v e . g o o g l e . c o m / f i l e / d / 1 6 q _ h 5 D c Y S R P _ j V s O A r s G 3 C H v g y C H V N M 9 / v i e w ? u s p = d r i v e _ l i n k
  • 16. 4. Strengthening Variation 1.this is like Isokinetic Contraction (Progressive Resisted Exercise): - The patient starts with a weak effort and quickly progresses to a maximal contraction of the affected muscles. - The therapist provides resistance as the joint or area moves through a full range of motion. 2. Limited Range with Good Muscle Tone: - A limited range of motion with good muscle tone is often preferable to a normal range with limited power. - Strengthening weak muscles in areas with permanent mobility limitations is important.
  • 17. 4. Strengthening Variation 3. Benefits of Isokinetic Contractions: - Strengthen muscle fibers. - Improve coordination of muscle fibers. - Result in progressively stronger muscular efforts due to neuromuscular recruitment. 4. Execution of Isokinetic Contractions: - Each contraction should last no more than 4 seconds to maximize benefits and minimize fatigue. - Avoid prolonged contractions. 5. Application: - Best used on small joints, such as those in the extremities. - More challenging to apply to spinal joints during full muscular resistance.
  • 18. 5. Isolytic MET Isotonic Contractions: The patient uses isotonic contractions where the muscle changes length while under tension during resistance from the therapist. Stretching and Breaking Down Fibrotic Tissue: The technique involves stretching the muscle and sometimes breaking down fibrotic tissues. The therapist applies slightly more force than the patient to reduce adhesions in the muscle. Gradual Increase in Effort: The patient starts with about 20% of their possible strength for the first contraction, which lasts 3-4 seconds. The therapist resists and overcomes this effort. Progressive Effort Increase: If the first effort is painless, the patient increases the effort for the next contraction. This process continues, with the patient using more force each time, aiming for maximum contraction effort. Aim: The goal is to progressively increase the force of the muscle contractions while the therapist overcomes these efforts to improve muscle function and reduce adhesions. h t t p s : / / d r i v e . g o o g l e . c o m / f i l e / d / 1 6 s - 4 6 - M y s l W q a p p g Y K Q e i O G O V Y b 6 4 v C U / v i e w ? u s p = d r i v e _ l i n k
  • 19. 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.'. h t t p s : / / d r i v e . g o o g l e . c o m / f i l e / d / 1 7 - c S X z 1 P Z t w z B z c R Y j O p N N q J b s f S 1 w i j / v i e w ? u s p = d r i v e _ l i n k
  • 20. 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).
  • 21. 7. Isokinetic MET Isokinetic Contraction (Progressive Resisted Exercise): The patient starts with a weak effort and quickly progresses to a maximal contraction of the affected muscles. Resistance is introduced to the practitioner’s effort to move a joint or area through a full range of motion. Counterforce Adjustment: The counterforce is increased during the contraction to match the muscle’s increasing force as it shortens. Benefits: Improves efficient and coordinated use of muscles. Enhances the tonus (resting tension) of the muscle. h t t p s : / / d r i v e . g o o g l e . c o m / f i l e / d / 1 6 r w B d A x 8 u 8 E w B 9 W N 4 x 4 d E d x C X 2 w S b n F g / v i e w ? u s p = d r i v e _ l i n k
  • 22. 8. Joints and MET Joint and Muscle Connection: The methods have a significant impact on joints because joints cannot be considered separately from the muscles that support and move them. Importance of Muscle Function: Proper muscle function is crucial for joint health and movement.
  • 23. 9. Self MET Self-Treatment (Autotherapy): Patients can learn to apply this treatment to themselves at home. Passive Stretching: They use their hand to passively stretch the tight muscle. Counter Pressure: The hand provides counter pressure during the muscle's voluntary contraction (while inhaling). Preventing Muscle Shortening: During relaxation, the hand holds the muscle to prevent it from shortening. Increasing Range of Motion: During exhalation, the hand takes up any slack to increase the range of motion.
  • 24. Patient active muscle contraction: 1. From controlled motion 2. In a specific direction 3. Met by practitioner applied distinct counterforce 4. Involving a controlled intensity of contraction ELEMENTS
  • 25. COMMON ERRORS PATIENT ERROR Strong contraction, in wrong direction Contraction is not sustained, not relaxed, starting and finishing PRACTITIONER ERROR Inaccurate control of joint, counterforce, direction, moving Instruction, fails to maintain stretch
  • 26. BARRIER Soft tissue Fluid restriction Hypertonicity Fibrotic tissue Bony tissue Pain Breath & MET Inhale as slowly build up an isometric contraction Hold 7-10 seconds Release breadth as they slowly cease contraction Inhale and exhale fully once more, following cessation of all efforts
  • 27. Application Isometric Contraction: 1. The therapist's force matches the patient's effort, resulting in no movement. This can lead to reciprocal inhibition and post- isometric relaxation. Isotonic Eccentric (Isolytic) Contraction: 2. The therapist's force overcomes the patient's effort, moving the area or joint in the opposite direction of the patient's movement. This is an isotonic eccentric contraction, also called isolytic when performed rapidly. Isotonic Concentric (Isokinetic) Contraction: 3. The therapist partially matches the patient's effort, allowing movement. This results in an isotonic concentric or isokinetic contraction.
  • 28. Key Factors: Effort Level: Patients exert around 20% of their strength or adjust as needed. Duration: Effort is held for 7-10 seconds or adjusted based on need. Repetitions: Three repetitions are considered optimal. Resistance: Resistance can be provided by the operator, gravity, the patient, or an immovable object.
  • 29. VARIATIONS ISOMETRIC ISOTONIC ISOKINETIC PIR ACUTE (Without stretch) RI CHRONIC (With stretch) concentric muscle contraction slow eccentric muscle contraction eccentric muscle contraction combination of isomonic and isometric muscle contraction
  • 30. 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 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
  • 31. 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
  • 32. 3. Isometric contraction- using PIR with 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: Agonist is used in isometric contraction thus treating affected muscle via PIR allowing an easier stretch to be performed. D. Force: subject's effort; initially: 20% 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 10-30sec (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
  • 33. 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 . F. Action following contraction: Rest interval of 5 sec followed by stretch held for 10-30sec (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
  • 34. 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
  • 35. 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 https://drive.google.com /file/d/16uh_78hKBffkBTut9cDZym w A8sCZ_lY/view?usp=drive_link
  • 36. 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
  • 37. 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
  • 38. To Improve Treatment Efficacy: Respiratory Synkesis Visual Synkinesis
  • 39. Respiratory Synkesis Inhale During Contraction Exhale During Release, Newer Range Positioning or Stretching Maneouvers.
  • 40. Visual Synkinesis Inhale Look towards the direction of muscle contract. Exhale Look towards the direction of muscle relaxation.
  • 41. Neck extensor PRI Positioning: The patient is typically positioned lying down or sitting comfortably. 1. Isometric Contraction: The patient contracts the neck extensors by gently pushing the head backward against resistance provided by the therapist's hand. 2. Intensity: The patient exerts around 20-30% of their maximum effort during the contraction. 3. Duration: The contraction is held for about 7-10 seconds. 4. Relaxation: After the contraction, the patient relaxes the neck muscles completely. 5. Stretching: The therapist then applies a gentle stretch to the neck extensors, taking the muscle into a slightly deeper stretch. 6. Hold: The stretch is held for about 10-20 seconds to allow the muscles to relax further. 7. Repetition: This process may be repeated 2-3 times to maximize the effectiveness of the post-isometric relaxation technique. 8. https://drive.google.com/file/d/15xaNZxoAPZJ4Y3L SElvjfnn3YF_majXO/view?usp=drive_link
  • 42. shoulder flexion range is decreased Positioning: The patient is positioned comfortably, typically in a seated or lying position, with the shoulder in a neutral or slightly extended position. Isometric Contraction: The therapist guides the patient to perform an isometric contraction of the shoulder extensor muscles by pushing against the therapist's resistance for about 5-10 seconds. Relaxation: After the contraction, the patient relaxes the shoulder muscles completely. Stretching: The therapist then applies a gentle stretch to the shoulder extensor muscles, taking care not to cause discomfort or pain. Hold and Repeat: The stretch is held for about 10-30 seconds, allowing for post-isometric relaxation to occur. This process may be repeated for 2-3 times to maximize the effectiveness of the technique. Benefits: Post-isometric relaxation helps to increase flexibility and range of motion in the shoulder extensor muscles. It can also help alleviate muscle tension and reduce the risk of injury https://drive.google.com/file/d/15xaNZxoAPZJ4Y3L SElvjfnn3YF_majXO/view?usp=drive_link
  • 43. Positioning: 1. The patient is typically positioned lying on their side or supine, depending on the therapist's preference and the specific needs of the patient. Isometric Contraction: 2. The therapist guides the patient to perform an isometric contraction of the quadratus lumborum muscle by pushing against the therapist's resistance for about 5-10 seconds. Relaxation: 3. After the contraction, the patient relaxes the quadratus lumborum muscle completely. Stretching: 4. The therapist then applies a gentle stretch to the quadratus lumborum muscle, usually by side-bending the trunk away from the contracted side or by performing a passive stretch in a seated position. Hold and Repeat: 5. The stretch is held for about 10-30 seconds, allowing for post-isometric relaxation to occur and for the muscle to lengthen. This process may be repeated for 2-3 times to maximize the effectiveness of the technique. Benefits: 6. Post-isometric relaxation helps to increase flexibility and range of motion in the quadratus lumborum muscle, which can help alleviate lower back pain and improve overall movement patterns. quadratus lumborum https://drive.google.com/file/d/1xv40G9PzLlKlTJ56_qB6AFR- hUsTgcvQ/view?usp=drive_link https://drive.google.com/file/d/16Pn2bAdeRsYx_Cm LBnCaZ7blJo9NttvY/view?usp=drive_link
  • 44. Positioning: The patient is positioned comfortably, usually lying on their stomach or standing, with the arms extended overhead or by their sides. Isometric Contraction: The therapist guides the patient to push against their resistance for around 5-10 seconds, engaging the latissimus dorsi muscles. Relaxation: After the contraction, the patient completely relaxes the latissimus dorsi muscles. Stretching: The therapist then gently stretches the latissimus dorsi muscle, usually by extending the arm or bending the trunk to the side, ensuring there's no pain. Hold and Repeat: The stretch is held for about 10-30 seconds, allowing the muscle to relax and lengthen further. The process can be repeated for 2-3 times to enhance flexibility and reduce muscle tension. Benefits: Post-isometric relaxation helps improve the flexibility and range of motion of the latissimus dorsi muscles. It can also relieve muscle tightness and discomfort in the back and shoulder area. latissimus dorsi https://drive.google.com/file/d/168- rRlhE6FmVK9Z5RM25RX0v6tNWDK4W/view?usp=drive_link
  • 45. Positioning: The patient is positioned comfortably, usually lying on their stomach or standing, with the arms extended overhead or by their sides. Isometric Contraction: The therapist guides the patient to push against their resistance for around 5-10 seconds, engaging the latissimus dorsi muscles. Relaxation: After the contraction, the patient completely relaxes the latissimus dorsi muscles. Stretching: The therapist then gently stretches the latissimus dorsi muscle, usually by extending the arm or bending the trunk to the side, ensuring there's no pain. Hold and Repeat: The stretch is held for about 10-30 seconds, allowing the muscle to relax and lengthen further. The process can be repeated for 2-3 times to enhance flexibility and reduce muscle tension. Benefits: Post-isometric relaxation helps improve the flexibility and range of motion of the latissimus dorsi muscles. It can also relieve muscle tightness and discomfort in the back and shoulder area. quadriceps https://drive.google.com/file/d/16PCMdoeAtcRghsSBiWLdWQ 5VYKTX7CJe/view?usp=drive_link
  • 46. Positioning: 1. The patient lies on their back or sits comfortably with the leg extended. Isometric Contraction: 2. The therapist guides the patient to contract the rectus femoris muscle by pushing the thigh downwards against the therapist's resistance for about 5-10 seconds. Relaxation: 3. After the contraction, the patient relaxes the muscle completely. Stretching: 4. The therapist then gently stretches the rectus femoris muscle by flexing the hip joint, bringing the knee towards the chest while keeping the opposite leg flat on the surface. Hold and Repeat: 5. The stretch is held for about 10-30 seconds, allowing for post-isometric relaxation to occur. This process may be repeated for 2-3 times to enhance flexibility and reduce muscle tension. Benefits: 6. Post-isometric relaxation helps increase the flexibility and range of motion in the rectus femoris muscle. It can also alleviate tightness and discomfort in the muscle, promoting better movement and function. rectus femoris https://drive.google.com/file/d/16anuS9bXQ0fLFwbPtkpgmMy o4fLiH538/view?usp=drive_link
  • 47. shoulder horizontal abductors- Middle Trapezius., Lower Trapezius, Rhomboid Major., Rhomboid Minor. Positioning: 1. The patient is positioned comfortably, typically in a seated or lying position, with the arm at the side and the shoulder in a neutral position. Isometric Contraction: 2. The therapist guides the patient to perform an isometric contraction of the shoulder horizontal abductors by pushing against the therapist's resistance for about 5-10 seconds. Relaxation: 3. After the contraction, the patient relaxes the shoulder muscles completely. Stretching: 4. The therapist then applies a gentle stretch to the shoulder horizontal abductor muscles, moving the arm away from the body, taking care not to cause discomfort or pain. Hold and Repeat: 5. The stretch is held for about 10-30 seconds, allowing for post-isometric relaxation to occur. This process may be repeated for 2-3 times to maximize the effectiveness of the technique. Benefits: 6. Post-isometric relaxation helps to increase flexibility and range of motion in the shoulder horizontal abductor muscles. It can also help alleviate muscle tension and improve overall shoulder function. https://drive.google.com/file/d/1qZfZ8DaSiKxVj4gp6c3aTdQxp 1sxksYS/view?usp=drive_link
  • 48. Positioning: The patient is typically positioned lying on their back with both knees bent and one leg is on other knee. Isometric Contraction: The therapist guides the patient to perform an isometric contraction of the piriformis muscle by pushing the knee of the affected side against the therapist's resistance for about 5-10 seconds. Relaxation: After the contraction, the patient relaxes the piriformis muscle completely. Stretching: The therapist then applies a gentle stretch to the piriformis muscle by externally rotating and abducting the hip of the affected side, while keeping the knee bent. Hold and Repeat: The stretch is held for about 10-30 seconds, allowing for post-isometric relaxation to occur. This process may be repeated for 2-3 times to maximize the effectiveness of the technique. Benefits: Post-isometric relaxation helps to increase flexibility and reduce tension in the piriformis muscle. It can also alleviate symptoms associated with piriformis syndrome, such as sciatica and hip pain. piriformis https://drive.google.com/file/d/15yl6cuHW9D65d5qn8- jz_XACnYgEu3bm/view?usp=drive_link https://drive.google.com/file/d/15xzjB9wTxCEbtQM _srAhxa9BhRwKm1Uf/view?usp=drive_link