1. 5/26/2016copyright 2006 www.brainybetty.com 1 Muscle Energy Techniques By: Nathan L. Uhl, D.C. ©2008 Uhl Publications

2. Overview Muscle energy techniques (MET) are a class of soft tissue osteopathic (originally) manipulation methods that incorporate precisely directed and controlled, patient initiated, isometric and/or isotonic contractions, designed to improve musculoskeletal function and reduce pain. Muscle energy can be used with precision to release and realign spinal joints from the atlas to the sacroiliac.

3. Overview MET methods have transferred to almost all other manual therapeutic settings. –Chiropractic –Physical therapy –Massage therapy –Athletic training –Other

4. Overview MET PIONEERS T.J. Ruddy Fred Mitchell Snr Karel Lewit Philip Greenman Sandra Yale Edward Stiles J. Goodridge and W. Kuchera Others

5. 5/26/2016copyright 2006 www.brainybetty.com 5 Contraindications Suspected Pathology (until confirmed dx) Joint hypermobility/instability (modifications) Fracture Tumor Infection in immediate underlying tissue Others?

6. 5/26/2016copyright 2006 www.brainybetty.com 6 Side Effects Muscle energy techniques are quite safe With PIR, posttreatment soreness and stiffness can occur (esp. with inexperience) With PFS, the patient often feels posttreatment soreness, but should dissipate within minutes to hours

7. 5/26/2016copyright 2006 www.brainybetty.com 7 Common Errors 1.The patient is not positioned properly, and as a result, pain or discomfort may occur, or at best, the technique is ineffective. 2.The patient contracts too aggressively, and thus stabilization of the body part is not appropriate. 3.The patient does not hold the contraction long enough to obtain the most effective release. 4.The lengthening of the muscle by the practitioner begins before the patient is able to completely relax, thus leading to increased pain and discomfort. 5.The lengthening of the muscle by the practitioner after the contraction is too aggressive, leading to pain and discomfort. 6.In PFS technique, the practitioner fails to maintain the stretch for long enough. This does not allow the connective tissue to lengthen accordingly.

8. 5/26/2016copyright 2006 www.brainybetty.com 8 Basic Guidelines Instruct the patients to provide minimal contractions when instructed to (20%) Make every attempt to avoid pain or discomfort when applying a PIR technique When performing PFS techniques, do not stretch too aggressively, instead take muscles only up to the barrier and apply a gentle stretch beyond that point When possible, have the patient assist in the stretch by contracting the antagonist muscle group

9. Post Isometric Relaxation PIR

10. 5/26/2016copyright 2006 www.brainybetty.com 10 Postisometric Relaxation PIR technique, as described by Lewit, is a method of reducing or relaxing muscle tone in acute situations, in muscles that demonstrate muscle hypertonicity and with muscles containing trigger points. –Lewit K. Manipulative Therapy in Rehabilitation of the Motor System. 2 nd ed. London: Butterworth- Heinnemann; 1996.

11. 5/26/2016copyright 2006 www.brainybetty.com 11 Postisometric Relaxation Basic Principles 1.Patient positioning: position of maximal comfort and lengthening 2.Engaging the barrier: 3.Use of an isometric contraction: 4.Use breathing and eye movements: 5.Feel the release and lengthen the muscle:

12. Postfacilitation Stretch PFS

13. 5/26/2016copyright 2006 www.brainybetty.com 13 Postfacilitation Stretch Described by Janda to lengthen chronically shortened muscles is called postfacilitation stretch technique. Much more vigorous approach than the PIR technique. Tight muscles requiring not only a relaxation of the muscle spindle but also a lengthening of the fascial structures. This technique requires more than relaxation; it also requires an actual stretching of the muscle and connective tissue rather than simply the taking of the muscle to a new barrier. Janda V. Postural and Phasic Muscles in the Pathogenesis of Low Back Pain. Proceedings of the 11 th Congress ISRD, Dublin: 1960:553-554.

14. 5/26/2016copyright 2006 www.brainybetty.com 14 Postfacilitation Stretch Patient position at start of contraction: Force of the isometric contraction and the length of the stretch:

15. 5/26/2016copyright 2006 www.brainybetty.com 15 Muscle Energy Techniques The differences between Janda’s PFS and Lewit’s PIR techniques: –PIR starts at the barrier and PFS starts in the midrange –PFS uses a stronger contraction than PIR –PFS takes the tissues beyond the barrier and attempts to place a stretch on the structures, whereas PIR takes the tissues to a new barrier of resistance

16. 5/26/2016copyright 2006 www.brainybetty.com 16 Muscle Energy Techniques PIRPFS Location Contraction Length of contraction Stretch Length of stretch Relaxation

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21. 5/26/2016copyright 2006 www.brainybetty.com 21 Resources Muscle Energy Techniques 3 rd Ed. / by Leon Chaitow. Churchill Livingstone (Elsevier) 2007 Soft-Tissue Manipulation: a practitioner’s guide to the diagnosis and treatment of soft-tissue dysfunction and reflex activity / by Leon Chaitow. Healing Arts Press 1988 Functional Soft Tissue Examination and Treatment by Manual Methods by Hammer.