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y Techniques
duration of symptoms will determine which
variation of MET is suitable.
l Therapist guides muscle to point of
resistance (point of bind) before releasing
slightly from that position (especially if
the tissue is tender).
l Client isometrically contracts affected
muscle (PIR) or the antagonist (RI) to
approximately 10 to 20 per cent of its
strength capabilities against resistance.
l Client holds contraction for 10 to
12 seconds.
l Client relaxes fully by taking a deep final stretch held Diagram 2: reciprocal inhibition (RI)
breath in and, as they breathe out, the for approximately 20
therapist passively guides the specific joint to 30 seconds. therefore more appropriate for rehabilitation.
that lengthens the hypertonic muscle into MET is quite a mild form Most conditions involving muscle
a new position, effectively normalising of stretching when compared shortening will occur in postural muscles,
joint ROM. to other techniques, such as since these are composed predominantly of
l Process repeated until no further progress proprioceptive neuromuscular slow twitch fibres, therefore a milder form of
is made (normally three to four times) and facilitation (PNF), and MET is stretching is perhaps more suitable.
Assessment of the
2 Case study lateral hamstrings
James* is a 24-year-old male who plays rugby at Pictures 1 and 2 demonstrate a specific test
a high standard. he has an ongoing right-sided that I used to determine whether the client’s
hamstring injury that has not responded to (not pictured) lateral hamstrings were tight,
conventional treatment. he has had some soft and involved a technique that individually
tissue work on his problematic hamstring with isolated and tested the lateral (biceps femoris)
advice on a stretching programme. and medial hamstrings (semitendinosus and
having initially carried out a thorough semimembranosus).
assessment to consider other differential the therapist applies an internal rotation
diagnoses for the cause, rather than purely and adduction, while the client’s leg is taken
treating the presenting pain, I found no into passive flexion, which isolates the biceps
dysfunction present in the lumbar spine, femoris. If the motion feels restrictive, the
pelvis, hip or lower limb. James presented with therapist needs to determine whether the range
pain in his right hamstring, located more on of motion is less than the original hip flexion
the lateral, central aspect, and he identified test, and if it is, then the lateral hamstring
the aggravating factor as the movement of can be identified as short. When this test
‘rotation’ when he played rugby. he was was carried out on James, it had the effect of
relatively pain free when running in a straight ‘reproducing’ his symptoms, which indicated
line, but if he rotated, changed direction or that the biceps femoris is the muscle that is
passed a ball, then symptoms would worsen. responsible for his specific symptoms.
their hip while the therapist encourages passive hip flexion. this John Gibbons, sports osteopath, lecturer, author, and regular speaker/contributor
involves the client contracting the hip flexors, which causes a to Fht, owns peak sporting performance at oxford university sports. his new
reciprocal inhibition in the hamstrings and promotes relaxation, book, Muscle energy techniques, a practical guide for physical therapists, will be
thereby helping achieve an increased roM and new position. available in september 2011 from lotus publishing (www.lotuspublishing.co.uk),
*The client’s name has been changed. physique and amazon. t. 07850 176600 www.peaksport.co.uk