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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
patients 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
dosent 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 pathology
Stress fractures
Strains 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 : operators & 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 PThs shoulder with back of lower leg
engaging hamstrings isometrically for 4-10 sec, repeat this.
THERAPISTS 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 : therapists and patients forces are matched
- Duration : 4-10 sec initially , increasing up to 30 sec after
subsequent contractions.
Isometric therapists - 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.

Lewits 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
Jandas 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-
JANDAS PFS LEWITS 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.

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