MET, which allows patients to actively contract their muscles in a direction precisely controlled by the therapist during treatment, was created by Kabat in the 1940s, primarily for actively moving muscles, and named this technique proprioceptive neuromuscular facilitation (PNF). In the 1950s, Fred applied this technique to move the patient’s joints and named it the muscle energy technique.
Clinical applications.
1.Reducing the tension of over-tensioned muscles and lengthening the shortened fascia in the muscles.
2.Increase the extensibility of the tissues around the joints and reduce their sensitivity.
3.Strengthening of weak muscles and muscle groups.
4.Rebuild the normal movement pattern.
5.Increase the range of motion of joints with restricted movement.
6.Help the integration of sensation and movement, and restore sensation to the patient’s habitual contraction site.
7.Avoid pain during treatment by cross-inhibition and stimulation of mechanoreceptors.
Treatment principles.
1. The most important principle of using MET is painlessness. Even mild pain should be stopped. Find the resistance that the patient feels comfortable with and can counteract by adjusting the force. (If the patient still feels pain, use RI (reciprocal inhibition). For example if resistance internal and external rotation of the shoulder joint is causing pain, try resistance inversion, flexion or abduction of the shoulder joint.)
2. Use MET preferentially on over-tensioned or contracted muscles.
3.Keep the muscle in the starting medium length position, which is the position of the normal state length of the muscle and the most comfortable position.
4, therapists usually apply moderate resistance, the patient only needs 10-20% of the force against.
5, acute injury patients need to resist the therapist’s resistance for 5-10 seconds each time, usually repeated 3-5 times, while chronic injury patients can last longer and can be repeated 20 times.
6.For some unconscious muscles in a state of high tension, gentle tapping on the contracting muscles can restore their consciousness.
Contraction – relaxation (CR)
Purpose: To relax hypertonic muscles, restore muscle sensation, and assess muscle weakness and pain.
Position: The therapist places the patient’s elbow in the resting position, i.e., in a neutral position of extension and flexion, or feels the presence of resistance barriers.
Movement: The therapist holds the patient’s forearm and immobilizes the elbow, telling the patient “Don’t let me drive you” and then gradually pulls on the elbow joint. The patient resists the resistance for 5-10 seconds, making sure the patient is not holding his or her breath and repeating 3-5 times.
Reciprocal inhibition (RI)
Purpose: Used for acute injuries to suppress pain and to be able to consolidate the relaxation effect achieved by CR.
Position: The therapist extends the patient’s elbow joint until resistance is felt or the patient feels pain.
Movement: The therapist says to the patient “don’t let me drive you”, pushes the forearm and tries to flex the elbow joint. Hold for 5-10 seconds and repeat the movement 3-5 times.
Isometric contraction followed by relaxation (PIR)
Purpose: To lengthen the shortened muscles and associated fascia, as well as lower the trigger point to the finger flexors.
Position: The patient is placed in a supine position with the elbow extended, forearm rotated back and wrist to the side of the bed.
Movement: The therapist slowly and gently straightens the patient’s fingers until pain is elicited or the therapist feels resistance from the muscles and fascia, at which point the therapist tells the patient “don’t let me drive you” and allows the patient to fight the resistance for 5-10 seconds, then attempts to hyperextend the patient’s fingers, see figure below. Hold for a few seconds until the patient is completely relaxed.
Once the patient is completely relaxed, the therapist slowly and gently presses the patient’s finger until pain or resistance is felt from the muscles and fascia. Repeat 3-5 times.
Contraction-Relaxation-Antagonist Contraction (CRAC) (using gastrocnemius as an example)
Purpose:To distract adhesions, lengthen connective tissue, and reduce excessive muscle tone.
Position:The patient is in supine position. The therapist places one hand on the patient’s knee, the other hand holds the heel, and the forearm rests on the sole of the foot.
Movement: The patient actively performs dorsiflexion of the foot while the therapist touches the bottom of the foot with the forearm. Tell the patient “Don’t let me drive you”. The therapist tilts the body weight to the side of the patient’s head while pressing the patient’s sole with the forearm, trying to get him or her to dorsiflex further, while the patient is in this position against the therapist’s movements. Hold for 5 seconds and then relax, then allow the patient to actively dorsal extend the foot, knowing that resistance barriers are felt. Repeat 3-5 times.
Centrifugal contraction (EC) to the biceps brachii
Purpose: To loosen adhesions and lengthen connective tissue. Note that it can only be used in chronic cases. Patients in very poor health and those who have undergone arthroplasty should not do the centrifugal contraction.
Position: The therapist extends the patient’s elbow joint until the patient causes pain or feels resistance from the muscles and fascia.
Movement: The therapist extends the patient’s elbow by telling the patient “Don’t let me drive you”. The therapist can use moderate force, causing the patient to exert about 50% of maximum force against it and hold for 5-10 seconds. Then tell the patient to “continue to resist the resistance, but let me drive you slowly”. The therapist gradually places the patient’s elbow in the hyperextended position, maintaining the patient’s resistance throughout this process. Repeat 3-5 times, gradually increasing the pain-free range of motion each time.