MET emerged initially from osteopathic traditions and has shown to fit well with most all manual therapy disciplines. These methods were integrated with innovative manual medicine approaches as taught by the East European giants Vladimir Janda, MD, Karel Lewitt, MD, and Leon Chaitow, ND, DO, who were collaborators with the osteopathic developers of MET. 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 combination of tightness and weakness observed in muscle imbalance modifies body segment alignment and alters the equilibrium point of a joint. Typically, the equivalent resting tone of the agonist and antagonistic muscles permits the joint to take up a position where the joint surfaces are evenly loaded and the inert tissues of the joint are not overly stressed. However, if the muscles on one side of the joint are facilitated and the opposing muscles inhibited, the result will be misalignment towards the tight muscles. Such alignment changes create weight bearing stresses on joint surfaces, and result also in shortened soft tissues (muscles) chronically contracting over time.
As put forward by Chaitow, 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
- Isometric Contraction- using reciprocal inhibition (in an acute setting, without stretching)
- Isometric Contraction- using post-isometric relaxation (in an acute setting, without stretching)
- Isometric Contraction- using reciprocal inhibition (in a chronic setting, with stretching)
- Isokinetic (combined isotonic and isometric contractions)
- Isotonic Concentric (for toning or rehabilitation)
- Isotonic Eccentric Contraction (performed slowly, for strengthening weak postural muscles and preparing their agonists for stretching)
- Isotonic Eccentric Contraction (isolytic, for reduction of fibrotic change, to introduce controlled microtrauma)