MET: Muscle Energy Technique

MUSCLE ENERGY TECHNIQUE
Radhika Chintamani

CONTENTS
 Definition
 History
 Principles
 Mechanism
 Variations
 Summary

 Muscle Energy Technique (MET): is a manual therapy that
uses the gentle muscle contractions of the patient to relax and
lengthen muscles and normalize joint motion.
Definition

 Muscle Energy Technique is One such approach – which targets the
soft tissues primarily, making a major contribution towards joint.
 The most general (and descriptively accurate) term of which was that
used by chiropractor Craig Liebenson (1989, 1990) when he described
‘muscle energy’ techniques as ‘active muscular relaxation techniques’.
 MET was first described by T. J. Ruddy (1961), who termed his
approach ‘resistive duction’, and Fred Mitchell Snr (1967).
 Largely due to the work of experts in physical medicine such as Karel
Lewit (1999), MET has evolved and been refined, and now crosses all
interdisciplinary boundaries.
Introduction

1. T. J. Ruddy:
 Developed MET in 1940’s and 1950’s
 An orthopedic Physician
 He described it as one of the treatment method involving patient-
induced, rapid, pulsating contractions against resistance which he
termed ‘rapid resistive duction’.
 Pulsed MET: Ruddy’s method called for a series of rapid, low
amplitude muscle contractions against resistance, at a rate a little
faster than the pulse rate.
 As a rule, at least initially, these patient-directed pulsating
contractions involve an effort towards the barrier, using antagonists to
shortened structures.
 Effects include improved local oxygenation, venous and lymphatic
circulation, as well as a positive influence on both static and kinetic
posture, because of the effects on proprioceptive and interoceptive
afferent pathways.
 Best used as self treatment

2. Fred Mitchell Snr:
 Worked on the basis of Ruddy’s work of MET
 Fred Mitchell Snr gave MET its inception into osteopathic
work in 1958.
 After Fred Mitchell Snr his son Fred Mitchell Jnr continued
the work on MET done by his father and formulated MET s
‘patient uses his/her muscles, on request, from a
precisely controlled position in a specific direction, against
a distinctly executed counterforce’.
History

3. Philip Greenman:
 In 1996; Philip Greenamn worked on documentation of the
mechanism of MET and stated that; function of any
articulation of the body which can be moved by voluntary
muscle action, either directly or indirectly, can be
influenced by muscle energy procedures
 He also stated that; MET 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.
History

4. Sandra Yale:
 In 1991; Osteopathic Physician described potentials of using
MET in fragile and severely ill patients.
 He gave the theory as; MET’s are particularly effective in
patients who have severe pain from acute somatic
dysfunction, such as those with a whiplash injury from a
car accident, or a patient with severe muscle spasm from
a fall. They can be used in older patients who may have
severely restricted motion from arthritis, or who have
brittle osteoporotic bones.
History

5. Edward Stiles:
 In 1984a and 1984b ;
 Basic science data suggests the musculoskeletal system plays
an important role in the function of other systems. Research
indicates that segmentally related somatic and visceral
structures may affect one another directly, via viscerosomatic
and somaticovisceral reflex pathways. Somatic dysfunction may
increase energy demands, and it can affect a wide variety of
bodily processes; vasomotor control, nerve impulse patterns (in
facilitation), axionic flow of neurotrophic proteins, venous and
lymphatic circulation and ventilation. The impact of somatic
dysfunction on various combinations of these functions may be
associated with myriad symptoms and signs. A possibility which
could account for some of the observed clinical effects of
manipulation.
History

6. J. Goodridge and W. Kuchera (1977):
 J. Goodridge : Modern osteopathic refinements of MET –
the emphasis on very light contractions.
 William Kuchera: Localization of force is more important
than intensity. Localization depends on palpatory
proprioceptive perception of movement (or resistance to
movement) at or about a specific articulation and
monitoring and confining forces to the muscle group or
level of somatic dysfunction involved are important for
achieving desirable changes.
 “Poor results are most often due to improperly
localized forces, often with excessive patient effort. “
History

7. Knott and Voss : 1968
 Improvised PNF technique which was developed in
1940s, PNF method tended to stress the importance of
rotational components in the function of joints and
muscles, and employed these using resisted (isometric)
forces, usually involving extremely strong contractions.
Initially, the focus of PNF related to the strengthening of
neurologically weakened muscles, with attention to the
release of muscle spasticity following on from this, as
well as to improving range of motion at intervertebral
levels (Kabat 1959, Levine et al 1954)
History

A. Fundamentals Principles of MET are:
1. Post isometric relaxation/ Post contraction inhibition
technique: automatic relaxation of a muscle after isometric
contraction of it.
2. Reciprocal Inhibition: automatic relaxation of a agonist
muscle when antagonist muscle is isometrically contracted.
By: Libenson
 Liebenson suggests that there is evidence that the
receptors responsible for PIR lie within the muscle and
not in the skin or associated joints .

B Key points of Modern MET:
1. The operator’s force may exactly match the effort of the patient
(isometric contraction) allowing no movement to occur – and
producing as a result a physiological neurological response (via the
Golgi tendon organs) involving a combination of:
— reciprocal inhibition of the antagonist of the muscle being
contracted, as well as
— post isometric relaxation of the muscle which are being contracted.
2. The operator’s force may overcome the effort of the patient, thus
moving the area or joint in the direction opposite to that in which the
patient is attempting to move it (eccentric contraction).
3. The operator may partially match the effort of the patient, thus
allowing, although slightly retarding, the patient’s effort (concentric
contraction).
Principles

C Requirements of MET: By Greenman
 He suggested that the lesion should be control, balance and
localisation.
 A patient/active muscle contraction, which
— commences from a controlled position
— is in a specific direction (towards or away from a restriction barrier)
 The operator applies distinct counterforce (to meet, not meet, or to
overcome the patient’s force)
 The degree of effort is controlled (sufficient to obtain an effect but
not great enough to induce trauma or difficulty in controlling the
effort).
Principles

D. Components of MET: By Greenman
 There is a patient-active muscle contraction
 — from a controlled position
 — in a specific direction
 — met by practitioner applied distinct counterforce
 — involving a controlled intensity of contraction.
Principles

 MET has as one of its objectives the induced relaxation of
hypertonic musculature and
 Ability to enhance stretch of a shortened muscle or its associated
fascia when connective tissue or viscoelastic changes have occurred.

 Mechanism is described in two aspects on the basis of two
types of MET usually used;
a. Post Isometric Relaxation technique
b. Reciprocal Inhibition technique
Mechanism

1. POST ISOMETRIC RELAXATION
TECHNIQUE:
 Isometric contraction of muscle
 Inhibition of antagonist and induced
intrafibral stretch of agonist
 Reduced muscle tone of both
agonist as well as antagonist
 Thus; shortened agonist muscle on
isometric contraction achieves a
degree of ease due to intrafibral
stretch induced by isometric
contraction along with an additional
Mechanism

2. RECIPROCAL INHIBITION:
 Isometric contraction of a muscle
 Stimulates the same muscle by alpha
motor neurons whereas inhibits its
antagonist by gamma motor neuron locally.
 This is known as antagonist relaxation due
to agonist firing which happens locally due
to a neurological loop involving Golgi
tendon Organs.
 Thus, Reducing muscle tone of antagonist
Mechanism

1. Lewit’s Postisometric relaxation technique
2. Janda’s post tfacilitation stretch method
3. Reciprocal inhibition variation
4. Strengthening variation
5. Isolytic MET
Major Variations Of MET

 Hypertonic muscle is taken to a length
just short of pain, or to the point where
resistance to movement is first noted.
 Patient gently contracts the affected
agonist muscle away from the barrier for
5-10 seconds against equal effort by the
therapist
 Degree of effort by patient=10-20%
 Muscle is taken into new barrier with all
slack removed but no stretch and relaxed
 Repeat the procedure for 2-3 times.
1. Lewit’’s Postisometric relaxation
technique

Key element in this technique is precise positioning as
well as taking out slack using the barrier as the
starting and ending points of each contraction

Mechanism of PIC
 During resistance using minimal force (isometric contraction) only a
very few fibers are active, the others being inhibited
 During relaxation (in which the shortened musculature is taken gently to
its new limit without stretching) the stretch reflex is avoided – a reflex
which may be brought about even by passive and non-painful stretch.
 He concludes that this method demonstrates the close connection
between tension and pain, and between relaxation and analgesia.

 Shortened muscle is placed in a midrange position about halfway
between a fully stretched and a fully relaxed state
 The patient contracts the muscle isometrically, using a maximum degree
of effort for 5-10 seconds: effort is resisted completely
 Release of effort
 Rapid stretch is applied at a new barrier without any bounce and held for
10 seconds
 Subject relaxes for 20 seconds
 Repeat the procedure for 3-5 times
2. Janda’s Postfacilitation stretch
method

 Isometric contraction of a muscle
 Stimulates the same muscle by alpha
motor neurons whereas inhibits its
antagonist by gamma motor neuron
locally.
 This is known as antagonist
relaxation due to agonist firing which
happens locally due to a neurological
loop involving Golgi tendon Organs.
 Thus, Reducing muscle tone of
antagonist
3. Reciprocal Inhibition technique
Reciprocal Inhibition of Hams

4. Strengthening Variation
• It is also called as isokinetic contraction (also known as progressive resisted
exercise), in which patient starts with a weak effort but rapidly progresses to a
maximal contraction of the affected muscle(s), introducing a degree of resistance
to the operator’s effort to put the joint, or area, through a full range of motion.
•It is also felt that a limited range of motion, with good muscle tone, is preferable
(to the patient) to having a normal range with limited power.
•Thus the strengthening of weak musculature in areas of permanent limitation of
mobility is seen as an important contribution in which isokinetic contractions may
assist.
•Isokinetic contractions not only strengthen the fibres which are involved, but also
have a training effect which enables them to operate in a more coordinated manner.

•Because of neuromuscular recruitment, there is a progressively
stronger muscular effort as this method is repeated.
•Isokinetic contractions, and ccompanying mobilisation of the region,
should take no more than 4 seconds at each contraction in order to
achieve maximum benefit with as little fatiguing as possible.
•Prolonged contractions should be avoided.
•The simplest, safest, and easiest-to-handle use of isokinetic methods
involves small joints, such as those in the extremities. Spinal joints may
be more difficult to mobilise while muscular resistance is being fully
applied.

5. Isolytic MET
• In this type of MET, isotonic contractions are used by the muscle during
resistance application by the therapist. The technique involves stretching, and
sometimes the breaking down of fibrotic tissues present in the affected muscles.
•Adhesions of this type are reduced by the application of force by the operator
which is just greater than that being exerted by the subject.
•Limited degrees of effort are called for by the subject in this technique.
•The patient should be instructed to use about 20% of possible strength on the first
contraction, which is resisted and overcome by the operator, in a contraction
lasting 3–4 seconds. This is then repeated, but with an increased degree of effort on
the part of the patient (assuming the first effort was relatively painless). This
continuing increase in the amount of force employed in the contracting
musculature may be continued until, hopefully, a maximum contraction effort is
possible, again to be overcome by the operator.

6. Ruddy’s Pulsed MET
• 1940s and 50s, osteopathic physician T. J. Ruddy developed a method which
utilised a series of rapid pulsating contractions against resistance, which he
termed ‘rapid resistive duction’.
•Ruddy’s method (Ruddy 1962) called for a series of muscle contractions against
resistance, at a rhythm a little faster than the pulse rate. This approach can be
applied in all areas where isometric contractions are suitable, and is particularly
useful for self-treatment following instruction from a skilled practitioner.
•Ruddy used these techniques in the cervical spine and around the orbit in his
practice as an ophthalmologist–otorhinolaryngologist.’.

6. Ruddy’s Pulsed MET
The introduction of a pulsating muscle energy procedure such as Ruddy’s,
involving these weak antagonists, therefore offers the opportunity for:
1. Proprioceptive re-education
2. Strengthening facilitation of the weak antagonists
3. Further inhibition of tense agonists
4. Enhanced local circulation and drainage
5. In Liebenson’s words, ‘reeducation of movement patterns on a reflex,
subcortical basis’ (Liebenson 1996).

7. Isokinetic MET
•Isokinetic contraction (also known as progressive resisted exercise). In this
the patient, starting with a weak effort but rapidly progressing to a maximal
contraction of the affected muscle(s), introduces a degree of resistance to the
practitioner’s effort to put a joint, or area, through a full range of motion.
•‘The counterforce is increased during the contraction to meet changing
contractile force as the muscle shortens and its force increases.’ These are, he
says, especially valuable in improving efficient and coordinated use
of muscles, and in enhancing the tonus of the resting muscle.

7. Isokinetic MET
•In dealing with paretic muscles, isotonics (in the form of progressive
resistance exercise) and isokinetics, are the quickest and most efficient road to
rehabilitation.
i. To tone weak phasic (stabiliser) muscles, perform concentric isotonic
exercises using full strength, rapidly (4 seconds maximum).
ii. To tone weak postural (mobiliser) muscles, slowly perform eccentric
isotonic (i.e. isolytic,) exercises using increasing degrees of effort. In
order to tone postural fibres, slow speed, eccentric resistance is most
effective (Norris 1999).

8. Joints and MET
The impact of these methods on joints is clearly profound since it is
impossible to consider joints independently of the muscles which support and
move them.

9. Self MET
•Receptive patients are taught how to apply this treatment to themselves, as
autotherapy, in a home programme. They passively stretched the tight muscle
with their own hand.
•This hand next provided counter pressure to voluntary contraction of the tight
muscle (during inhalation) and then held the muscle from shortening, during
the relaxation phase.
•Finally, it supplied the increment in range of motion (during exhalation) by
taking up any slack that had developed.

Summary of Variation: MET
1. Isometric contraction- using RI(without stretch):
A. Indications:
 Relaxing acute muscular spasm or contraction
 Mobilising restricted joints
 Preparing joint for manipulation.
B. Contraction starting point: at easy restriction barrier
C. Mode: Antagonist is used in contraction thus treating affected muscle via
reciprocal inhibition method.
D. Force: subject’s effort; initially: 20% and gradually increase to 50%.
E. Duration of contraction: initially: 7-10sec and gradually increase to 20sec
F. Action following contraction: Rest interval followed by the area taken to a
new barrier without stretch and repeated.
G. Repetitions: 3-5times until no further gain in ROM

2. Isometric contraction- using PIR(without stretch):
A. Indications:
 Relaxing acute muscular spasm or contraction
 Mobilising restricted joints
 Preparing joint for manipulation.
B. Contraction starting point: at restriction barrier
C. Mode: Agonist is used in the isometric contraction thus treating affected
muscle.
E. Duration of contraction: initially: 7-10sec and gradually increase to
20sec
F. Action following contraction: Rest interval followed by the area taken to
a new barrier without stretch and repeated.

3. Isometric contraction- using PIR with stretch:
A. Indications:
 Stretching chronic or subacute restricted, fibrotic, contracted soft tissues
(fascia, muscle) or tissues housing active myofascial trigger points.
B. Contraction starting point: Short of restriction barrier
C. Mode: Agonist is used in isometric contraction thus treating affected
muscle via RI allowing an easier stretch to be performed.
F. Action following contraction: Rest interval of 5 sec followed by stretch held
for 10-60sec (painless) without stretch and relaxation followed by
repeatition Stretching chronic or subacute restricted, fibrotic, contracted
soft tissues (fascia, muscle) or tissues housing active myofascial trigger
points..

4. Isometric contraction- using RI with stretch:
A. Indications:
 Stretching chronic or subacute restricted, fibrotic, contracted soft tissues
(fascia, muscle) or tissues housing active myofascial trigger points
 This approach is chosen if contraction of the agonist is contraindicated because
of pain.
B. Contraction starting point: A little Short of restriction barrier
C. Mode: Antagonist is used in isometric contraction thus treating affected muscle
via RI allowing an easier stretch to be performed.
F. Action following contraction: Rest interval of 5 sec followed by stretch held for
10-60sec (painless) without stretch and relaxation followed by repetition
Stretching chronic or subacute restricted, fibrotic, contracted soft tissues
(fascia, muscle) or tissues housing active myofascial trigger points..

5. Isotonic concentric contraction (for toning rehab):
A. Indications:
 Tonic weakened musculature
B. Contraction starting point: In a mid-range easy position
C. Mode: Contracting muscle is allowed to do so against some
resistance applied by the therapist
D. Force: subject’s effort: greater than therapists resistance
E. Duration of contraction: 3-4 seconds
F. Repetitions: 5-7 times

6. Isotonic eccentric contraction (for reducing fibrotic changes in the
muscle):
A. Indications:
 Stretching tight fibrotic musculature
B. Contraction starting point: At restriction barrier
C. Mode: Muscle to be stretched is contracted and is rapidly prevented
by doing so by therapist, so that the contraction is overcome and
reversed so that contracting muscle is stretched.
D. Force: therapist’s effort: greater than subject

7. Isotonic eccentric contraction (isolytic, for strengthening weak
postural muscles):
A. Indications:
 Strengthening weakened postural muscles
B. Contraction starting point: At restriction barrier
C. Mode: Muscle to be stretched is contracted and is rapidly prevented
by doing so by therapist, so that the contraction is slowly overcome
and reversed so that contracting muscle is stretched.

8. Isokinetic (combined isotonic and isometric contractions):
A. Indications:
 Toning weakened musculature
 Building strength in all muscles involved in particular joint
function
 Training and balancing effect on muscle fibres.
B. Contraction starting point: Easy mid range position
C. Mode: Patient resists with moderate and variable effort at first,
progressing to maximal effort subsequently, as practitioner/
therapist puts joint rapidly through as full a range of movements
as possible.
E. Duration of contraction: up to4 seconds

MET: Muscle Energy Technique

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