Muscle Energy Technique (MET)

MUSCLE ENERGY
TECHNIQUES
Dr Venus Pagare
MET Venus Pagare5/5/2014

History
• Fatherof MET
• Dr. Fred L. Mitchell

• Muscle energy technique is a manual
medicinetreatment procedure that involves
voluntary contraction of patientmuscle in:
–a preciselycontrolled direction
–at varyinglevelsof intensity
–againsta distinctlyexecutedcounterforce
appliedby theoperator.

• Activetechniqueas patient contributes
correctiveforce
• Activating force is classified as intrinsic : patient
is responsiblefor dosage applied

Basic Elements
1. Patient-activemusclecontraction
2. Controlled joint position
3. Muscle contraction in a specific direction
4. Operator-applied distinct counterforce
5. Controlled contraction intensity

Barrier Concept
Physiologic barrier
Elastic barrier
Anatomic barrier
Restrictive barrier

• Barrier: 1st sign of palpated or sensed resistance to
freemovements
• When motion is lost withinrange, barrier that
preventsmovement in direction of motionlossis
defined as “restrictive barrier”
• MET works to moverestrictivebarrier as far into
the directionof motion loss as possible

Principles of MET
Postisometric relaxation (PIR)
Reciprocal inhibition (RI)

Post-isometric Relaxation
• After a muscle is contracted,it is automatically in a
relaxed statefor a brief,latent period

Method
For hypertonicmuscle
• Taken to the lengthenposition
• 20%of strength contraction for 5-7 seconds
• 3-5 times

Reciprocal Inhibition
When one muscleis contracted, itsantagonist is
automaticallyinhibited.

Types of contractions in MET
• Isometric contraction : hypertonicshortened
muscle
• Isotonic contraction : inhibited weakened muscles
–Concentric contraction: mobilizea joint against
its motion barriers
–Eccentric contraction
–Isolytic contraction : fibrosed muscle

• During an isometric contraction, distancebetween
origin and the insertionof muscle is maintained at
a constantlength.
• A fixed tension developsin muscleas patient
contractsmuscleagainst an equal counterforce
applied by operator
• Preventingshortening of muscle from origin to
insertion.

Isometric Technique

• A concentricisotonic contractionoccurs when
muscle tension causes origin and insertionto
approximate.

Isolytic
• Non-physiological event
• Patientattempts concentriccontractionbut an
external force is applied by operatorin opposite
direction
• Useful in cases with marked degree of fibrotic
change.

• Used cautiously to lengthena severely
contractured or hypertonic muscle as ruptureof
musculotendinous junctionand insertionof tendon
into bone or muscle fibers can occur.

USES
• Lengthen a shortened, contractured,or spastic
muscle
• Strengthen a physiologically weakened muscle /s
• Reduce pain
• Stretch tight fascia
• Reduce localized edema
• Mobilizean articulationwith restrictedmobility

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 counterforceMET Venus Pagare5/5/2014

Guidelines
• 3-5 repetitions for 7-10 secondseach
• 20-50% of muscle strength
• Isometric contraction should not be too hard
• Aftersustained but lightcontraction, a momentary
pauseshould occur
• Isotonic contractions requiresforceful contraction

Breathing during met
• Inhale slowlyas isometric contraction buildsup
• Hold the breath during 7-10 sec
• Releasethe breath as they slowlyceasethe
contraction
• Inhale and exhale fully once more following
cessationof all efforts

Key points
Accuratelyassesstheresistant barrier
Engageeachmotionbarrier in samefashion

Isometric v/s Isotonic Procedures
Isometric Isotonic
Careful positioning Careful positioning
Lightto moderatecontraction Hardto maximalcontraction
Unyieldingcounterforce Counterforcepermits
controlledmotion
Relaxation after contraction Relaxation after contraction
Repositioning Repositioning

Errors By Patient
Contractionis toohard
Contractinwrongdirection
ContractiOnisnotsustainedfor longenough
Individualdoesn’trelaxcompletely aftercontraction
Startingor finishingcontractiontoohastilyMET Venus Pagare5/5/2014

Errors By Therapist
Inaccuratecontrolof jointpositioninrelationto
barrierto movement
Counterforce : incorrectdirection
Inadequate patient instructions
Movingto a new joint position toosoonafter
contraction

Not waiting forrefractoryperiodfollowingan
isometriccontraction beforemuscle can be
stretched to a newresting length
Not maintainingstretchpositionforappropriate
period of time

Successful Muscle Energy Technique
Control
Balance
Localization

MET Indications
Wheneversomatic dysfunctionis presentand/orwhenever
there is a need to
• Normalizeabnormal neuromuscular relationships
• Improve local circulationand respiratory function
• Lengthenand/ornormalizerestricted/hypertonic
muscles and fascia
• Mobilize restricted joint(s)
• Movementrestrictiondue to muscletightness
• Musclehyperactivity
• Acute injuries
• Myofascial restricitions,muscleimbalanceMET Venus Pagare5/5/2014

MET Contraindications
 Appliedthoughtfully
 Avoidin :
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 directionsMET Venus Pagare5/5/2014

REFERENCES
Greenman’s Principle of manual medicine.
4th edition. Lisa DeStefano
Muscle Energy Techniques.
2nd edition. Leon Chaitow

Muscle Energy Technique (MET)

Muscle Energy Technique (MET)

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