Hip Inflare Hip Outflare Anterior Hip Rotation Posterior Hip Rotation
MET emerged initially from osteopathic traditions and has travelled exceptionally well through all manual therapy disciplines. The evolution of these methods cross fertilized with the pioneering manual medicine approaches as taught by the East European giants Vladimir Janda, MD, and Karel Lewitt, MD, who were collaborators with the osteopathic developers of MET. Today, another East European giant, Leon Chaitow, ND, DO, has emerged. Together their bodies of work form a basis for a segment of my own manual therapy practice. Muscle Energy Techniques are a class of soft tissue manipulation methods that incorporate precisely directed and controlled, patient initiated, isometric and/or isotonic muscle contractions, designed to improve musculoskeletal function and reduce pain.
The mixture of tightness and weakness seen in the muscle imbalance process alters body segment alignment and changes the equilibrium point of a joint. Normally, the equal resting tone of the agonist and antagonistic muscles allows the joint to take up a balanced position where the joint surfaces are evenly loaded and the inert tissues of the joint are not excessively stressed. However if the muscles on one side of the joint are tight and the opposing muscles relax, the joint will be pulled out of alignment towards the tight muscles. Such alignment changes produce weight bearing stresses on joint surfaces, and result also in shortened soft tissues (muscles) chronically contracting over time.
The function of any articulation (joint) of the body, which can be moved by voluntary muscle action, either directly or indirectly, can be influenced by muscle energy procedures. A basic tenant of the muscle energy modality is that muscles cause and/or maintain both non-painful (early) and painful (later) somatic dysfunctions.
Two major aspects of MET are their ability to relax an overactive muscle and their ability to enhance stretch of a shortened muscle or its associated fascia when connective tissue or viscoelastic changes have occurred. Muscle energy techniques can be used to lengthen a shortened, contractured or spastic muscle; to strengthen a physiologically weakened muscle or group of muscles; to reduce localized edema, to relieve passive congestion, and to mobilize an articulation with restricted mobility.
There currently exist at least nine different MET protocols that are characterized by: type of contraction and physiological mechanism utilized, chronic or acute setting, and stretch or no stretch. The particular choice of MET will be based on: indications, contraction starting point, modus operandi (agonist or antagonist), force of contraction, duration of contraction, action following contraction, and number of repetitions.
The protocol I describe and demonstrate for correcting rotational malalignment of the hip is based on a method that effectively reverses the action of the origin and insertion of the contracting muscles. This technique results in the exertion of a rotational force that is exactly opposite that of the rotational malalignment we are attempting to correct. (see MET links)
The demonstrated techniques are self-care techniques given to the clients following a corrective treatment session, and are intended as a form of ‘home exercise’ or ‘home work’.
Most manual practitioners will agree that muscle energy techniques are among the most valuable tools that any manual clinician can have in his or her tool box. Why?
1) METs have a wide application.
Crosses all interdisciplinary boundries.
Can be applied to muscle hypertonicity and muscle tightness.
Equally effective when applied to joint dysfunction and joint capsule adhesions.
Effective for any type of client from high-level athlete on down.
2) METs can be applied in a gentle manner, but still
Provides effective correction of dysfunction. Especially muscle hypertonicity and joint dysfunction.
Method of joint manipulation that is well tolerated by the apprehensive patient.
MET has been shown to be equally effective as thrust techniques.
3) METs actively involve the patient in the process.
Empowers the patient to perform self-care/treatment.
Self-care techniques transfer responsibility to the patient.
The patient is an active participant not a passive recipient of treatment.
Dovetails with other active release techniques.
4) METs are effective.
Clinically based research indicates patients benefit to a greater degree than when these methods are not included.
Chaitow, Leon. Muscle Energy Techniques, Advanced Soft Tissue Techniques. Elsevier Limited, 1999, 2006.
Schamberger, Wolf. The Malalignment Syndrome, Implications for Medicine and Sport. Elsevier Science Limited, 2002.