Muscle Energy Techniques (MET's) - massage with motion is often one of the best tools a therapist has available
What are METs and how and when should they be used?
The purpose of today's blog is to explain the role of muscle energy techniques (METs) and to provide you with a clear understanding of when and why to employ this type of treatment.
Manual therapists usually have a toolbox of various techniques at their disposal to help release and relax muscles, which will then assist the client's body to promote the healing mechanisms. METs, first described by Mitchell in 1948, are one such tool that if used correctly can have a major influence on the client's well-being.
Definition: Muscle energy techniques (METs) 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.
METs are unique in their application in that the clirnt provides the initial effort and the practitioner just facilitates the process. The primary force comes from the contraction of the client's soft tissues (muscles), which is then utilized to assist and correct the presenting musculoskeletal dysfunction. This treatment method is generally classiffed as a direct form of technique as opposed to indirect, since the use of muscular effort is from a controlled position, in a specific direction, and against a distant counterforce that is usually offered by the therapist.
Some of the Benefits of METs
When teaching the concept of METs, one of the benefits I emphasize is their use in normalizing joint range, rather than in improving flexibility. This might sound counterintuitive; what I am saying is if, for example, your client cannot rotate their neck (cervical spine) to the right as far as they can to the left, they have a restriction of the cervical spine in a right rotation.
The normal rotational range of the cervical spine is 80 degrees, but let’s say the client can only rotate 70 degrees to the right. This is where METs come in. After an MET has been employed on the tight restrictive muscles, hopefully the cervical spine will then be capable of rotating to 80 degrees—the patient has made all the effort and you, the practitioner, have encouraged the cervical spine into further right rotation. You have now improved the joint range to “normal.” This is not stretching in the strictest sense—even though the overall flexibility has been improved, it is only to the point of achieving what is considered to be a normal joint range.
Depending on the context and the type of MET employed, the objectives of this treatment can include:
Restoring normal tone in hypertonic muscles
Strengthening weak muscles
Preparing muscles for subsequent stretching
Increasing joint mobility
Restoring Normal Tone in Hypertonic Muscles
Through the simple process of METs, we as manual therapists try to achieve a relaxation in the hypertonic shortened muscles. If we think of a joint as being limited in its ROM, then through the initial identification of the hypertonic structures, we can employ the techniques to help achieve normality in the tissues. Certain types of massage therapy can also help us achieve this relaxation effect, and generally an MET is applied in conjunction with massage therapy. I personally feel that massage with motion is one of the best tools a therapist has.
Strengthening Weak Muscles
METs can be used in the strengthening of weak or even flaccid muscles, as the clients are asked to contract the muscles prior to the lengthening process. The therapist should be able to modify the MET by asking the client to contract the muscle that has been classiffed as weak, against a resistance applied by the therapist (isometric contraction), the timing of which can be varied. For example, the patient can be asked to resist the movement using approximately 20–30% of their maximum capability for 5–15 seconds. They are then asked to repeat the process five to eight times, resting for 10–15 seconds between repetitions. The client's performance can be noted and improved over time.
Preparing Muscles for Subsequent Stretching
In certain circumstances, what sport your client participates in will be determined by what ROM they have at their joints. Everybody can improve their flexibility, and METs can be used to help achieve this goal. Remember that the focus of METs is to try to improve the normal ROM of a joint.
If you want to improve the client's flexibility past the point of normal, a more aggressive MET approach might be recommended. This could be in the form of asking the client to contract a bit firmer than the standard 10–20% of the muscle’s capability. For example, we can ask the client to contract using, say, 40–70% of the muscle’s capability. This increased contraction will help stimulate more motor units to fire, in turn causing an increased stimulation of the Golgi tendon organ (GTO). This will then have the effect of relaxing more of the muscle, allowing it to be lengthened even further. Either way, once an MET has been incorporated into the treatment plan, a flexibility program can follow.
Increasing Joint Mobility
One of my favorite sayings when I teach muscle testing courses is: “A stiff joint can become a tight muscle, and a tight muscle can become a stiff joint.” Does this not make perfect sense?
When you use an MET correctly, it 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 client to contract the muscles; this subsequently causes a relaxation period, allowing a greater ROM to be achieved within that specific joint.
This trigger point therapy blog is intended to be used for information purposes only and is not intended to be used for medical diagnosis or treatment or to substitute for a medical diagnosis and/or treatment rendered or prescribed by a physician or competent healthcare professional. This information is designed as educational material, but should not be taken as a recommendation for treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.
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