Muscle Energy Technique - Overview

MET is a manual medicine treatment procedure that involves the voluntary contraction of patient muscle in a precisely controlled

direction, at varying levels of intensity, against a distinctly executed counterforce applied by the operator.

Clinical Uses1) To lengthen a shortened, contractured, or spastic muscle

2) To strengthen a physiologically weakened muscle or group of muscles

3) To reduce localized edema and relieve passive congestion 4) To mobilize an articulation with restricted mobility

TypesIsometric Technique is used primarily in the vertebral axis to overcome

short, hypertonic muscle that functions as a biomechanical tether, preventing motion, and through the law of reciprocal innervation,

inhibits its antagonist. Through complexneurological mechanisms, including the spindle, golgi tendon apparatus, and spinal cord and cortical reflexes, the following

phenomena occurs. After an isometric contraction, a hypertonic, shortened muscle can be stretched to a new resting length. When this hypertonic agonist is relaxed, it no longer contributes inhibition to its

antagonists, resulting in more equal tone & balance.

Isotonic Contractions are frequently used in the extremities. In the presence of an inhibited, weakened muscle group, a series on

concentric isotonic contractions can be made against progressively increasing resistance, resulting in increased strength of the muscle. Concurrently, increasing strength of repetitive actions of a muscle throughout its range concentrically will also inhibit its antagonist,

resulting in more symmetrical muscle tone.

Elements of Muscle Energy Procedures1) Patient active muscle contraction

2) Controlled joint position3) Muscle contraction in specific direction4) Operator-applied distinct counterforce

5) Controlled contraction intensity

Muscle Energy Technique - Example

Example

Assume there is restriction of elbow movement into full extension, that is, the elbow is flexed. One etiology for restricted elbow extension is

hypertonicity and shortening of the biceps brachii muscle. The operator might choose an isometric muscle energy technique to treat

this condition as follows:

1) Patient sits comfortably on the treatment table with the operator standing in front.

2) Operator grasps patient's elbow with one hand and distal forearm with the other.

3) Operator extends the elbow until the first extension barrier is felt.

4) Operator instructs the patient to attempt to bring the forearm to the shoulder by using a few ounces of force in a sustained manner.

5) Operator provides equal counterforce to the patient's effort.

6) After 3-7 seconds of contraction, the patient is instructed to stop contracting and relax.

7) Operator waits until the patient is completely relaxed after the contracting effort and extends the elbow to a new resistant barrier.

8) Steps 2 through 7 are repeated three to five times until full extension is restored.

Muscle Energy Technique - Example

Alternative Option

The restriction of elbow extension might also be the result of length and strength imbalance between the biceps muscle as the elbow flexor

and the triceps muscle as the elbow extender. A weak triceps could prevent full elbow extension. The operator might choose an isotonic

muscle energy technique to treat this condition as follow:

1) Patient sitting on table with operator in front.

2) Operator grasp shoulder and distal forearm and takes elbow into full flexion.

3) Patient is instructed to extend th elbow with as much effort as possible, perhaps several pounds.

4) The operator provides a yielding counterforce that allows the elbow to lowly but steadily extend throughout its maximal range.

5) Operator returns elbow to full flexion and the patient repeats the contraction of the triceps to extend the elbow, but this time the

operator provides increasing resistance to elbow extension.

6) Several repetitive efforts are accomplished with the operator providing increasing resistance each time and with the patient

endeavoring to take the elbow through full extension with each effort.

7) Approximately three or five repetitions are usually necessary to achieve full elbow extension.

In any of these muscle energy procedures, it is important to accurately assess the resistant barrier. With an isometric technique, the first

barrier sensed must be the point where the careful joint position is held by the operator. If the operator "crashes into" the muscle resistant

barrier in positioning the joint, an increase in the muscle hyp ertonicity will result, just the opposite of the desired therapeutic effort. Second,

when using these procedures in a joint with multiple planes of movement available, each motion barrier must be engaged in the

same fashion. In the vertebral column with motion restriction around and along three different axes, precision in the engagement of the

restrictive barrier is essential for therapeutic effectiveness.