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MUSCLE ENERGY TECHNIQUE

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Ashley Lamb

on 23 October 2014

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Transcript of MUSCLE ENERGY TECHNIQUE

WHAT IS MET?
The key features of MET
Lengthen contracted or spastic muscle
Strengthen physiologically weakened muscles
Reduce localised oedema
Improve ROM of joints with restricted mobility
Physiological rationale behind the technqiue
Is there any evidence?
"There is little evidence supporting and validating its use, as well as limited evidence to substantiate the theories used to explain its effects" (Ballantyne et al, 2003).
Clinical Studies
Shoulder
Elbow
SIJ
LBP
Thoracic Spine
The history of MET
Ruddy (Osteopath)
"The patient presses against a precisely executed counterforce"
MUSCLE ENERGY TECHNIQUE (MET)
Rachel Thitchener, Edwina Powe, Ashley Lamb
WHO USES MET?
MET vs PNF
Biological Basis
References:
A form of soft tissue treatment in which the patient actively contracts a muscle from a precisely controlled position in a
specific direction
against a distinctly executed counter force
by the therapist.

The use of an isometric contraction before subsequent stretching of restricted tissues
1. Post-isometric relaxation
2. Reciprocal inhibition
3. Pain modification
4. Viscoelastic properties
DEMONSTRATION OF THE TECHNIQUE...

1. Target muscle is stretched to a position until resistance barrier is felt
held for 5-15 seconds.
2. Patient slowly resists (20 -25% of maximum strength) which is matched by
the therapist to produce an isometric muscle contraction
held for 5-10 seconds.
3. Patient relaxes whilst therapist finds new resistance barrier
relaxed for 5 seconds
4. New barrier is found
held for 5-15 seconds
5. Whole procedure repeated 3 times.
References:
References:

Protective spasm
Acute MSK injuries
Fractures
Unstable/fused joints
Patient unable to generate controlled contraction
Pain should not be produced
Shortened, contractured or spastic muscle
Scoliosis
Sciatica
SIJ pain
Back pain
Cervical pain
Shoulder pain
"The Effect of Muscle Energy Technique on Hamstring Extensibility: The Mechanism of Altered Flexibility"

Ballantyne et al, 2003
“Mechanisms underlying improved muscle flexibility following static stretch, contract-relax or MET remains obscure and may be a result of biomechanical or neurophysiological changes or an increase in tolerance to stretching
” (Ballantyne et al, 2003).

"A Comparison of Post-Isometric Relaxation (PIR) and Reciprocal Inhibition (RI) Muscle Energy Techniques Applied to Piriformis"
Wright, P. & Drysdale, I., 2008
MET applied to the piriformis (agonist) vs MET applied to the IR of the hip (antagonists)
Result: both groups demonstrated significant improvements in ROM, but no significant difference between groups.
Conclusions

MET vs Corticosteroid injections
Kucksen et al, 2013
MET and Posterior Shoulder Tightness
Moore et al, 2011
MET and LBP Postnatally
El-Brandrawy et al, 2014
MET and Lumbopelvic pain
Selkow et al, 2009
MET and Gross Thoracic Rotation

Lenehan et al, 2003
Dr Fred Mitchell Snr (Osteopath)
Described 5 types of pelvic dysfunction which could be treated with 2 thrust techniques
Dr Fred Mitchell Jnr (Osteopath)
Described methods where the patient was required to use their own muscle energy to actively participate
If a joint is not used to its full ROM...
Dr Fred Mitchell Snr & Dr Frank Mitchell Jnr
Function will lessen

Risk suffering strains and injuries
The patient uses their own muscle energy whilst the therapist presents a stationary surface. The patient will contract their muscle against in order to stretch the muscle and joint to its full potential
'Muscular cooperation technique" - 1948
MET
Focus on lengthening specific muscles
Lengthen contracted or spastic muscle
Mobilises ROM of joints with restricted mobility
Based on recruitment of postural muscles that are more susceptible to shortening and may require stretching
Slower transition between stretch and resistance components
20-25% of maximum strength
Uses isometric muscle contractions
PNF
Stimulates patterns of movements to oppose motion in multiple planes at the same time
Manual resistance technique
Used for stroke victims, children with cerebral palsy and various orthopaedic conditions
Rapid transition from stretch to resistance
75%+ of maximal strength
Uses patient - specific concentric, eccentric and isometric muscle contractions
Physiotherapists/ Physiotherapy students
Osteopaths
Chiropractors
Rehabilitation therapists
Sports rehabilitation therapists
Occupation therapists
Podiatrists
Doctors
MET TRAINING COURSES
No APA MET courses

The Australian Physiotherapy and Pilates institute
Advanced manual therapy association
Paramount college of Natural Medicine
Physiowise (Private practice)
INDICATIONS
Restriction of soft tissue or joint causing decreased ROM or pain
Weakened muscles
Oedema
Chronic pain
CONDITIONS WHERE MET MAY BE USED
CONTRAINDICATIONS
Safe
Pain free
Effective
Mechanism poorly understood
Limited evidence
USEFUL ADJUNCT TO OTHER THERAPIES
Precautions
Unknown pathology
Stress fractures
Osteoporosis
Tumors
Overstretching
1948
1960's
1930's
Study Summary
Safe
Gentle
Painfree
Quick
Cost effective
Patient centered
Reduces pain
Restores function
Increases ROM
What can we take from the evidence?
What can't we take from the evidence?
Is it appropriate for symptomatic patients?
Can it be used over a long period of time?
Is it superior to other non-invasive treatments?
What is it actually doing to the structures it is used on?
Are there exact treatment parameters that should be used for specific populations?
So should we use it?
Al Araji, G. (2006). A study Investigating the effects of osteopathic muscle energy technique on the viscoelasticity of skeletal muscle.

Ballantyne F, Fryer G, McLaughlin P. (2003). The effect of muscle energy technique on hamstring extensibility: the mechanism of altered flexibility. Journal of Osteopathic Medicine, 6(2), 59-63. DOI: 10.1016/S1443-8461(03)80015-1

Calcutt, M. (2012). Muscle Energy Technique. Retrieved online from: http://www.massageclinic.com.au/service/muscle-energy-technique/ 7/10/14
El-Bandrawy, A.M., Mohamed, M.A., Mamdouh, A.M. (2014). Effect of muscle energy technique on pain perception and functional disability of women with postnatal low back pain. British Journal of Medicine & Medical Research, 4 (33), 5253-5261. DOI : 10.9734/BJMMR/2014/6999
Farquharson, C. (2010). MET VERSUS PNF WHAT, WHEN AND HOW. SportEX Dynamics, (25).

Gill Webster. The Physiology and Application of Muscle Energy Techniques. Retrieved from: http://www.snowdonia-sports-medicine.com/articles.php 7/10/14

Grubb, E. R., Hagedorn, E. M., Inoue, N., Leake, M. J., Lounsberry, N. L., Love, S. D., ... & Waters, C. M. (2010). Muscle Energy. University of Kenucky, At, 690. Retrieved from: https://www.mc.uky.edu/athletic_training/docs/ModalityProject_MuscleEnergy_Spring2010.pdf 16/10/14

John Gibbons, 2011. Muscle Energy Techniques. Retrieved from: http://www.fht.org.uk/mainwebsite/resources/document/st%20met.pdf 14/10/14

Kucuksen, S., Yilmaz, H., Salli, A., Ugurlu, H. (2013). Muscle energy technique versus corticosteroid injection for management of chronic lateral epicondylitis: randomised controlled trial with 1-year follow up. Archives of Physical Medicine, 94 (11). 2068-2074. doi: 10.1016/j.apmr.2013.05.022.

Lenehan, K.L., Fryer, G., & McLaughlin, P. (2003) The effect of muscle energy technique on gross trunk range of motion. Journal of Osteopathic Medicine, 6 (1). 13 -18. DOI: 10.1016/S1443-8461(03)80004-7

Moore, S.D. Laudner, K.G. McLoda, T.A. Shaffer, M.D. (2011). The immediate effects of muscle energy technique on posterior shoulder tightness: a randomised controlled trial. Journal of Orthopedic Sports Physical Therapy, 41(6), 400-407. doi: 10.2519/jospt.2011.3292.

Schenk, R., Adelman, K., & Roussell, J. (1994). The effects of muscle energy technique on cervical range of motion. Journal of Manual & Manipulative Therapy, 2 (4), 149-155. DOI: http://dx.doi.org/10.1179/jmt.1994.2.4.149

Schenk, R., MacDiarmid, A., & Rousselle, J. (1997). The effects of muscle energy technique on lumbar range of motion. Journal of Manual and Manipulative Therapy, 5 (4). 179-183. DOI: http://dx.doi.org/10.1179/jmt.1997.5.4.179

Selkow, N.M., Grindstaff, T.L., Cross, K.M., Pugh, K., Hertel, J., Saliba, S. (2009). Short-term effect of muscle energy technique on pain in individuals with non-specific lumbopelvic pain: a pilot study. Journal of Manual & Manipulative Therapy, 17 (1), 14-18. Retrieved from: http://jmmtonline.com/documents/v17n1/selkow.pdf

Wright, P. & Drysdale, I., (2008). A comparison of post-isometric relaxation (PIR) and reciprocal inhibition (RI) muscle energy techniques applied to piriformis. International Journal of Osteopathic Medicine, 11(4), 158-159. DOI: 10.1016/j.ijosm.2008.08.015.
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