MUSCLE ENERGY TECHNIQUES (MET)

OVERVIEW- ▪ MET are a class of soft tissue

osteopathic (originally) manipulation methods that incorporate precisely directed and controlled, patient initiated, isometric / isotonic contractions, designed to improve musculoskeletal function & reduce pain.

▪ Muscle energy can be used with precision to release & re-align spinal joints from the atlas to the sacroiliac.

▪ MET methods have transferred to almost all other manual therapeutic settings.▪ Chiropractic▪ Physical therapy▪ Massage therapy▪ Athletic training▪ Other

Procedure that involves voulantry contraction of patient’s muscle in a precisely controlled direction, at varying levels of intensity.

DEFINATION OF MUSCLE ENERGY-

USES OF MUSCLE ENERGY--Use to lengthen a shorted, contractured or spastic muscle to strengthen a physiologically weakened muscle or group of muscles.-To reduce localised edema.-Relieve passive congestion.-Mobilize an articulation with restricted mobility, trigger points , & myofacial states.

MUSCLE MAKE-UP -Muscle is made up of extrafusal & intrafusal fibers.> extrafusal- during rest, some contracts while others rests, so whole muscle dosen’t contract.>intrafusal- monitor length 7 tone of muscle - innervated by gamma fibers

-Golgi tendon apparatus *lies with extrafusal fibers *sensitive to muscle tension *as muscle contracts -> tension builds up in GTA -> GTA inhibit alpha motor neuron output ->> muscle relaxes.

GOLGI TENDON REFLEX-

Basic Concepts> Using the intrinsic power of muscles to

achieve a variety of effects, involving isometric and isotonic contractions

> 2 fundamental neurophysiological principles-> Post contraction Inhibition▪ After a muscle is contracted, automatically goes

into a relaxed state for a brief period

-> Reciprocal Inhibition▪ When one muscle is contracted, its antagonist is

automatically inhibited

Basic Concepts - ▪ Patients contractions in conjunction with therapists

effort result in:1.Isometric contraction▪ Therapist Force applied = Patient Force applied

2.Isotonic Eccentric contraction▪ Therapist Force applied > Patient Force applied

3.Isotonic Concentric contraction▪ Therapist Force applied < Patient Force applied

Basic Concepts -▪ Operator – Direct Method▪ Patient contracts agonist muscle▪ Chronic conditions

▪ Operator – Indirect Method▪ Patient contracts atagonist muscle▪ Acute conditions

2 TYPES OF MET-1- ISOMETRIC MUSCLE ENERGY TECHNIQUES- >reduce tone in hypertonic muscle >re-establish normal resting length

2- ISOTONIC MUSCLE ENERGY TECHNIQUES- >reciprocal innervations/ inhibitions -when agonist ms. contracts> antagonists must relax >so that the action is carried out by agonists muscle.

SURROUNDING TISSUES-▪ MET also influences the surrounding fasciae, connective tissues

and interstitial fluids >> alters muscle physiology.▪When ms. contracts > length & tone alters > influnces

biomechanical, biochemical & immunologic functions.▪ Ms. Contraction requires energy > metabolic process results in

CO2, lactic acid, other metabolic wastes that must be transported and metabolized.

NEUROLOGICAL PROPERTIES –

▪ MUSCLE SPINDLES – located thorought muscle, provides continuous feedback, enables CNS to control activity of ms.

> sensitive to ms. change > rate of length change > change in tension GOLGI TENDON ORGANS – located within tendon of muscle, provide

constant feedback to CNS, sensitive to – tension developed in ms. fibre > prevents ms. To develop too much tension. > prevents tearing of muscle - lengthening reaction

APPLICATIONS OF MUSCLE ENERGY TECHNIQUES

INDICATIONS OF MET-

Lengthen shortened ,contractured , & spastic muscle.

strengthen weakened muscle or group of muscle.

malposition of bony elements.

Restoration of joint motion assosiated with joint

dysfunction.

PRECAUTIONS OF MET –Unknown pathologyStress fracturesStrains infections and diseases

causing musculoskeletal pain osteoporosis or tumors in the area

of treatment.

CONTRAINDICATIONS OF MET –

Acute musculoskeletal injuries.Unset or unstable fractures.Unstable or fused joints. - GOOD RESULTS OF MET DEPENDS ON – accurate diagnosis,

appropriate levels of force, and sufficient localization. - POOR RESULTS OF MET DEPENTS ON – inaccurate diagnosis,

improperly localised force, or forces that are too strong.

TECHNIQUES SEPERATED BY TYPE OF CONTRACTIONS- PATIENT-DIRECT :- isometric utilization autogenic

inhibition ( pt. attempts to push through the barrier of restriction

utilizing autogenic inhibition of target muscle) frequency : 3-5 rep. intensity : operator’s & pt.’s forces are matched duration : 4-10 sec initially. Increasing upto 30 sec in

subsequent contractions.Isometric patient- direct (hamstring ms. Gp.) - patient : supine, flx affected hip completely, knee ext as far

as possible, back of lower leg is resting on shoulder of PTh. who stands facing pt.

- action : pt. attempts to flex knee (causing downward pressure on PTh’s shoulder with back of lower leg engaging hamstrings isometrically for 4-10 sec, repeat this.

THERAPIST’S DIRECT –

Isometrics utilizing reciprocal inhibition – therapist attempts to push through the barrier of restriction, utilising reciprocal inhibition which causes relaxation of the target muscle.

- Frequency : 3-5 reps.

- Intensity : therapist’s and patient’s forces are matched

- Duration : 4-10 sec initially , increasing up to 30 sec after subsequent contractions.

Isometric therapist’s - direct (hamstring ms. Gp.)

- patient : supine, flx affected hip completely, knee ext as far as possible, back of lower leg is resting on shoulder of PTh. who stands facing pt.

- Action : pt. contracts quadriceps isometrically for 4-10 sec relaxing hamstrings, and the therapist engages the barrier.

Variations of MET▪ Lewit’s Post-isometric Relaxation▪ Hypertonic muscle is taken to a length

short of pain / resistance▪ Patient contracts (10-25%) muscle for

5 – 10 seconds while therapist supplies equal force

▪ Patient relaxes and muscle is taken to new range of motion

▪ Starting from gained ROM, repeated 2-3 times

▪ Janda’s Post-facilitation Stretch▪ Affected muscle is placed in a midrange

position▪ Patient contracts (90-100%) for 5 – 10

seconds▪ Rapid stretch to new ROM and hold for

10 seconds▪ Relax for 20 seconds and repeated 3 – 5

times

▪ Sensations of warmth and weakness may be experienced for a short time with this method

▪ Reciprocal Inhibition Method

- Affected muscle is placed in mid-range

- Patient contracts isometrically or isotonically for 5 – 10 seconds

- Muscle is passively lengthened

- Repeated 2 – 3 times

DIFFERENCE B/W THE TWO- JANDA’S PFS LEWIT’S PIR

STARTS AT MIDRANGE AT BARRIER

TYPE OF CONTRACTION STRONGER LESS STRONGER THAN PFS

ACTION ON TISSUES

TAKES TISSUE BEYOND THE BARRIER, ATTEMPTS

TO PLACE STRETCH ON STRUCTURES

TAKES TISSUES TO A NEW BARRIES OF RESISTANCE.