Muscle Energy Techniques (METs) describes a broad class of manual therapy techniques directed at improving
musculoskeletal
The human musculoskeletal system (also known as the human locomotor system, and previously the activity system) is an organ system that gives humans the ability to move using their muscular and skeletal systems. The musculoskeletal system provid ...
function or joint function, and improving pain. METs are commonly used by manual therapists,
physical therapist
Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease prevention ...
s,
occupational therapist
Occupational therapists (OTs) are health care professionals specializing in occupational therapy and occupational science. OTs and occupational therapy assistants (OTAs) use evidence-based practice, scientific bases and a Holism, holistic perspec ...
,
chiropractors
Chiropractic () is a form of alternative medicine concerned with the diagnosis, treatment and prevention of mechanical disorders of the musculoskeletal system, especially of the spine. It is based on several pseudoscientific ideas.
Many ch ...
,
athletic trainer
An athletic trainer is a certified and licensed health care provider who practices in the field of sports medicine. Athletic training has been recognized by the American Medical Association
The American Medical Association (AMA) is an American ...
massage therapist
Massage is the rubbing or kneading of the body's soft tissues. Massage techniques are commonly applied with hands, fingers, elbows, knees, forearms, feet, or a device. The purpose of massage is generally for the treatment of body stress or pa ...
s. Muscle energy requires the patient to actively use his or her muscles on request to aid in treatment. Muscle energy techniques are used to treat somatic dysfunction, especially decreased
range of motion
Range of motion (or ROM) is the linear or angular distance that a moving object may normally travel while properly attached to another.
In biomechanics and strength training, ROM refers to the angular distance and direction a joint can move be ...
, muscular hypertonicity, and pain.
Historically, the concept emerged as 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 physician counterforce. It was first described in 1948 by Fred Mitchell, Sr,
D.O.
Doctor of Osteopathic Medicine (DO or D.O., or in Australia DO USA) is a medical degree conferred by the 38 osteopathic medical schools in the United States. DO and Doctor of Medicine (MD) degrees are equivalent: a DO graduate may become lice ...
Pathophysiology
Injury can occur as a result of trauma, accidents, overuse, strain/sprain, etc., not all of which should be treated with muscle energy. These techniques are most appropriate for the following injury patterns:
* Decreased range of motion secondary to muscular spasticity, rigidity, hypertonicity or hypotonicity. Hypertonicity often follows overuse and can result in altered joint position, increased irritability and decreased elasticity. This injury pattern is often accompanied by a non-specific muscle ache in the area of injury.
* Interneuronal injury—when dysfunction occurs at one joint or segment, the related agonist muscles are also affected. If uncorrected, the
antagonistic muscles
An antagonist is a character in a story who is presented as the main enemy or rival of the protagonist and is often depicted as a villain.isometric contraction, the following physiologic changes occur:
*
Golgi tendon organ
The Golgi tendon organ (GTO) (also called Golgi organ, tendon organ, neurotendinous organ or neurotendinous spindle) is a proprioceptor – a type of sensory receptor that senses changes in muscle tension. It lies at the interface between a mus ...
activation directly inhibits agonist muscles.
* A reflexive reciprocal inhibition occurs at the antagonistic muscles.
* As the patient relaxes, agonist and antagonist muscles remain inhibited, allowing the joint to be moved further into the restricted range of motion.
Despite the many claims made regarding the efficacy of these techniques, there are only two peer-reviewed studies that have shown that muscle energy techniques can significantly decrease disability and improve functionality in patients with disorders such as low back pain.
Indications and contraindications
Muscle energy techniques can be employed to reposition a dysfunctional joint and treat the affected musculature. Indications include, but are not limited to: muscular shortening,
low back pain
Low back pain or wiktionary:lumbago#Etymology, lumbago is a common musculoskeletal disorders, disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can var ...
, pelvic imbalance,
edema
Edema (American English), also spelled oedema (British English), and also known as fluid retention, swelling, dropsy and hydropsy, is the build-up of fluid in the body's tissue (biology), tissue. Most commonly, the legs or arms are affected. S ...
, limited range of motion, somatic dysfunction, respiratory dysfunction,
cervicogenic headache
Cervicogenic headache is a type of headache characterized by chronic hemicranial pain referred to the head from either the cervical spine or soft tissues within the neck. The main symptoms of cervicogenic headaches include pain originating in the ...
s, and many others.
These techniques are inappropriate when a patient has injuries such as
fractures
Fracture is the appearance of a crack or complete separation of an object or material into two or more pieces under the action of stress (mechanics), stress. The fracture of a solid usually occurs due to the development of certain displacemen ...
,
avulsion injuries
Avulsion in general refers to a tearing away. Specifically, it can refer to:
* Avulsion fracture, when a fragment of bone tears away from the main mass of bone as a result of physical trauma
* Avulsion injury, in which a body structure is detac ...
, severe
osteoporosis
Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to more porous bone, and consequent increase in Bone fracture, fracture risk.
It is the most common reason f ...
, open wounds, or has metastatic disease. Additionally, because these techniques require active patient participation, they are inappropriate for any patient that is unable to cooperate.
Techniques
Muscle energy techniques can be applied to most areas of the body. According to one textbook, each technique requires eight essential steps:
# Perform and obtain an accurate structural diagnosis.
# Engage the restrictive barrier in as many planes as possible.
# Physician and patient engage in an unyielding counterforce where the patient's force matches the physician's force.
# The patient's isometric contraction has the correct amount of force, the correct direction of effort (away from the restrictive barrier), and the correct duration (5-10 seconds).
# Complete relaxation occurs after the muscular effort.
# The patient is repositioned into the new restrictive barrier in as many planes as possible.
# Steps 3–6 are repeated approximately 3–5 times or until no further improvement in range of motion is observed.
# The structural diagnosis is repeated to evaluate if the dysfunction has resolved or improved.
Types
There are several different types of muscle energy techniques:
#Post-Isometric relaxation: Treat by engaging the restrictive barrier in all planes.
# Reciprocal inhibition: Treat by contracting the antagonistic muscles, which causes the agonist muscle to relax through the reciprocal inhibition reflex arc.
# Joint mobilization using muscle force: Use muscle contraction to restore range of motion in a joint.
# Oculocephalogyric reflex: Treat cervical/truncal muscles by using extraocular muscle contraction.
# Respiratory assistance: Use the patient's voluntary respiratory motions to treat a somatic dysfunction. Commonly used in treating inhalation rib dysfunctions.
# Crossed extensor reflex: Use crossed extensor reflex to treat muscular injuries. For example, contraction of a muscle on the right side leads to relaxation of the same muscle on the left side.
Effectiveness
A 2015 Cochrane review concluded that Muscle Energy Technique is not effective for patients with
low back pain
Low back pain or wiktionary:lumbago#Etymology, lumbago is a common musculoskeletal disorders, disorder involving the muscles, nerves, and bones of the back, in between the lower edge of the ribs and the lower fold of the buttocks. Pain can var ...
, and that the quality of the research testing the effectiveness of MET is poor.