MET Student[1]

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Muscle Energy Techniques

By:

Nathan L. Uhl, D.C.©2008 Uhl Publications



Ov er v iew

Muscle energy techniques (MET) are a class of soft tissue osteopathic (originally)manipulation methods that incorporateprecisely directed and controlled, patientinitiated, isometric and/or isotoniccontractions, designed to impro v e

musculoskeletal function and reduce pain.Muscle energy can be used with precision torelease and realign spinal joints from the atlas

to the sacroiliac.



Ov er v iew

MET methods ha v e transferred to almost allother manual therapeutic settings.

Chiropractic Physical therapy Massage therapy Athletic training O ther



Ov er v iew

MET PIONEERS

T.J. Ruddy

Fred Mitchell SnrKarel LewitPhilip GreenmanSandra YaleEdward StilesJ. Goodridge and W. KucheraO thers




Contraindications

Suspected Pathology (until confirmed dx)Joint hypermobility/instability (modifications)

FractureTumorInfection in immediate underlying tissue

O thers?




Side Effects

Muscle energy techniques are quite safeWith PIR, posttreatment soreness and

stiffness can occur (esp. with inexperience)With PFS, the patient often feels posttreatmentsoreness, but should dissipate within minutes tohours




Common Errors1. The patient is not positioned properly, and as a result, pain or

discomfort may occur, or at best, the technique is ineffecti v e.2. The patient contracts too aggressi v ely, and thus stabilization of the

body part is not appropriate.

3. The patient does not hold the contraction long enough to obtainthe most effecti v e release.4. The lengthening of the muscle by the practitioner begins before

the patient is able to completely relax, thus leading to increasedpain and discomfort.

5. The lengthening of the muscle by the practitioner after the

contraction is too aggressi v e, leading to pain and discomfort.6. In PFS technique, the practitioner fails to maintain the stretch forlong enough. This does not allow the connecti v e tissue to lengthenaccordingly.




Basic Guidelines

Instruct the patients to pro v ide minimal contractionswhen instructed to (20%)Make e v ery attempt to a v oid pain or discomfort

when applying a PIR techniqueWhen performing PFS techniques, do not stretch tooaggressi v ely, instead take muscles only up to thebarrier and apply a gentle stretch beyond that point

When possible, ha v e the patient assist in the stretchby contracting the antagonist muscle group



Post Isometric Relaxation

PIR




Postisometric Relaxation

PIR technique, as described by Lewit, is amethod of reducing or relaxing muscle tone inacute situations, in muscles that demonstratemuscle hypertonicity and with musclescontaining trigger points.

Lewit K. Manipulative Therapy in Rehabilitation of the Motor System . 2nd ed. London: Butterworth-Heinnemann; 1996.




Postisometric Relaxation

Basic Principles1. Patient positioning: position of maximal comfort

and lengthening2. Engaging the barrier:3. Use of an isometric contraction:4. Use breathing and eye mo v ements:

5. Feel the release and lengthen the muscle:



Postfacilitation Stretch

PFS





Described by Janda to lengthen chronicallyshortened muscles is called postfacilitation stretchtechnique. Much more v igorous approach than the

PIR technique. Tight muscles requiring not only arelaxation of the muscle spindle but also alengthening of the fascial structures. This techniquerequires more than relaxation; it also requires anactual stretching of the muscle and connecti v e tissuerather than simply the taking of the muscle to a newbarrier.Janda V. Postural and Phasic Muscles in the Pathogenesis of Low Back Pain. Proceedings of the 11 th Congress ISRD, Dublin:1960:553-554.





Patient position at start of contraction:

Force of the isometric contraction and thelength of the stretch:





The differences between Janda s PFS andLewit s PIR techniques: PIR starts at the barrier and PFS starts in the

midrange PFS uses a stronger contraction than PIR PFS takes the tissues beyond the barrier and

attempts to place a stretch on the structures,whereas PIR takes the tissues to a new barrier of resistance





PIR PFS

Location

Contraction

Length of contraction

Stretch

Length of stretch

Relaxation




Resources

Muscle Energy Techniques 3 rd Ed. / by LeonChaitow. Churchill Li v ingstone (Else v ier) 2007

Soft-Tissue Manipulation: a practitioner s guideto the diagnosis and treatment of soft-tissuedysfunction and reflex acti v ity / by Leon Chaitow.Healing Arts Press 1988

Functional Soft Tissue Examination andTreatment by Manual Methods by Hammer.

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