Muscle Energy Techniques
First described in 1948 by Fred Mitchell, Sr, DO, muscle energy techniqueses are a form of osteopathic manipulative diagnosis and treatment in which the patient's muscles are actively used on request, from a precisely controlled position, in a specific direction, and against a distinctly executed counterforce.
Muscle energy techniques (MET) are unique in their application as the patient is providing the initial effort and the practitioner is just facilitating the process. The primary force is from the contraction of the patient's soft tissues (muscles) that are then utilised to assist and correct the presenting musculoskeletal dysfunction. Muscle energy techniques are generally classified as a direct form of technique as opposed to indirect as the use of muscular effort is from a controlled position, in a specific direction, against a distant counter force, this is usually offered by the practitioner. One of the benefits of MET is that they are used to normalise joint range rather than to improve ones flexibility. For example, if your patient cannot rotate their neck (cervical) to the right as far as the left then you have a restriction of the cervical spine in right rotation. The normal range of rotation for the cervical is 80 degrees, lets say they can rotate to the right only 70 degrees then this is where MET comes in. After the MET technique has been employed of the tight restrictive muscles, hopefully the cervical spine is now capable of rotating to 80 degrees, the patient has made all the effort and the practitioner has encouraged the cervical spine into further right rotation.
The objectives of MET can include, depending on the context and the variation of MET employed: the restoration of normal tone in hypertonic muscles; the strengthening of weak muscles; preparation of muscle for subsequent stretching; improved joint mobility; improved local circulation, and improved musculoskeletal function.
MET can be used in the strengthening of weak or even flaccid muscles as the patient is asked to contract the muscles prior to the lengthening process. The therapist should be able to modify the MET by asking the patient to contract the muscle that has been classified as weak against a resistance applied by the therapist (isometric contraction), this can be varied in its timing. Depending upon the sport that the patient participates in will in certain circumstances depend on what range of motion they have at their joints.
Everybody can improve their flexibility and MET can be used to help achieve flexibility. Remember that the focus of MET is to try and improve 'normal' range of motion. If you want to improve the patient's flexibility past the point of 'normal' then a more aggressive MET approach might be recommended. This might be in the form that the patient is asked to contract a bit firmer than the standard 10-20% of the muscles capability. Once an MET has been incorporated into the treatment plan, then a flexibility programme could follow. MET is one of the best ways to improve the mobility of the joint, even though you are relaxing the muscles initially.
The focus of the MET is to get the patient to contract the muscles; this then causes a relaxation period, allowing the 'new' range of motion to be achieved within that specific joint. If you have applied some soft tissue techniques to the dysfunctional area, then there has to be an improvement of circulation. As you get the patient to contract for 10 seconds and relax, then to repeat the process a few times then this approach will automatically encourage blood flow into that area.
For further information on muscle energy techniques, read Muscle Energy Techniques: A Practical Guide for Therapists.
