Muscle energy technique is a school of manual therapy for diagnosis and management of somatic dysfunction using patient’s own muscular effort to the benefit of therapeutic intervention.

In its core MET involves facilitation of the stretching of myofascia by neural inhibition. Based on this simple theme various techniques have evolved.

MET is incorporated to physiotherapy from osteopathic and chiropractic system of treatment. MET was developed by Fred Mitchell sr. between 1945 and 1950. Other stalwarts in the field of MET are TJ Rudy, Lewit, Janda and Leon Chaitow.

Physiological basis:

  1. Post isometric relaxation
  2. Reciprocal inhibition
  3. Endocannabinoid release

 

Post isometric relaxation

Reciprocal inhibition

 

 

 

Endocannabinoid release

More recently a third mechanism is proposed for the effectiveness of MET.MET is said to improve range of motion by “increased tolerance to stretch”. There is a possibility of involvement of endocannabinoid mediated analgesia.

THERAPEUTIC ELEMENTS

  1. Active muscle contraction of the patient, which is towards (antagonist) or away (agonist) from the restriction barrier.
  2. The therapist applies a distinct counterforce which may be lesser, equal or greater than the force of the patient.
  3. The muscle is taken beyond tissues barrier.

PIR Vs RI:

PIR works better in chronic setting whereas RI is best for acute condition, but both can be used in either case.

Variations of the MET theme:

  1. Strength of contraction:  Lewit recommends 10-20% of maximum voluntary contraction where as Janda’s method insists on a maximum contraction.
  2. Resistance: can be isometric, concentric, eccentric (isolytic) or isokinetic (strengthening)
  3. Duration: varies from 5 to 20 sec. Rudy recommends a series of pulsed contraction, while others use continuous contraction.
  4. Eye movement:  when spinal muscles are involved facilitation is achieved by looking towards the direction of contraction and stretch.
  5. Breathing: exhalation is used during stretch to facilitate relaxation.
  6. Starting position: Start at the barrier for acute conditions. Start slightly at ease for chronic conditions.
  7. Choice of resistance: Agonist (PIR) or antagonist (RI) can be contracted.

Uses:

  1. Restoration of mobility
  2. Retraining of global movement pattern
  3. Reduction of edema and stretching of myofascial fibrosis
  4. Restoration of stability

 

Joint mobilization by MET

 

Apart from stretching the shortened muscles MET can also be effectively used to mobilize the joints. In such a scenario no stretching is used, only active movement and/or isometric contraction is used to take the joint to a new barrier.