This is an excerpt from Therapeutic Stretching by Jane Johnson.
Muscle Energy Technique
Popularly known simply as MET, muscle energy technique is a form of stretching commonly used by sports massage therapists, sports therapists, osteopaths and some physiotherapists, chiropractors and fitness professionals. There is no standardized definition of this technique, which involves the active contraction of a muscle by the client against a resistive force provided by a second party (i.e., the therapist). Originating as an osteopathic technique in the late 1950s and early 1960s, there are today numerous variations and applications of this method of stretching.
MET is believed to be particularly helpful in lengthening postural muscles, which are prone to shortening. Theoretically, the active contraction performed by the client against the resistance produced by the therapist is an isometric contraction and may therefore be helpful in strengthening muscles. Also, contraction of one muscle group decreases tone in the opposing muscle group, and MET may therefore be beneficial in helping to overcome cramping. There is some debate about the degree of force a client should use when contracting a muscle before it is stretched, although low levels of contraction are advocated, certainly no more than 25 percent of the client's maximum force capacity. This is especially important should the technique be used in early stages of rehabilitation after injury, when levels as low as 5 percent may be the most appropriate. MET is sometimes used with a pulsing motion (known as pulsed MET), which advocates claim helps reduces localized oedema. MET is therefore used in the following circumstances:
- To stretch muscles, especially those considered to be postural rather than phasic
- To strengthen muscles
- To relax muscles, especially useful for treating cramping muscles
- To help regain correct muscle function
- To reduce localized oedema
A disadvantage of this technique is that it may be applied in many ways, and training is required to learn how and when to use each. For further information, please see Muscle Energy Techniques (L. Chaitow, Churchill Livingstone 2001),where eight variations on the basic MET technique are described, along with information on how and when they might be used, and on which the basic MET protocol described here is based. Facilitated Stretching (E. McAtee and J. Charland, Human Kinetics 1999) is also a good source of starting positions for performing MET stretches.
Basic MET Protocol
A basic MET protocol is as follows:
1. Position the client so that both you and he are comfortable. Take the muscle to be stretched to a resistance barrier, that point where both you and the client can feel an increase in the resistance of the client's tissues to further elongation. This barrier is the point at which you will start to stretch. Tell the client to let you know as soon as you reach this barrier, a point where he may feel an ever so slight stretch. This entire procedure should be pain free.
2. Ask the client to contract his muscle (i.e., the one in which he feels the mild stretch) using a maximum of 25 percent of his muscle force, whilst you resist this contraction. Maintain the body part that is being stretched in a static position so the effect is an isometric contraction of the muscle you are about to stretch. It is important that it is the client who sets the level of contraction against which you resist, not the other way around. That is, clients should never be resisting your force; you should be resisting theirs. Remember, too, that when used as part of rehabilitation, clients should be instructed to use very low levels of contraction, perhaps as low as 5 percent of their maximal force.
3. After about 10 seconds ask the client to relax, and within the next 3 to 5 seconds, gently ease the body part further into the stretch so you find a new barrier position. Maintain this position for a few seconds before repeating the procedure up to two more times.
You may meet therapists who ask a client to contract a muscle for more than 10 seconds, or who wait a couple of seconds before performing the stretch; many hold the client's limb in the final stretch position for some time, encouraging a gentle relaxation of soft tissues. There are many variants on MET stretching, and I encourage you to experiment to discover what works for you.
Getting Started With MET
One of the reasons for including a brief description of MET is that the examples of passive stretches provided in chapters 5, 6 and 7 are all starting positions from which to apply the basic MET protocol described here. For example, if you wanted to apply this basic MET to the calf using this protocol, you would follow these steps:
1. Start with your client in either of the passive stretch positions shown here.
2. Ask your client to use 25 percent of her force to push her toes into your thigh (a) or hand (b), plantar flexing her ankles and isometrically contracting her calf muscles.
3. Resist this contraction for 10 seconds. Then, once the client relaxes, gently dorsiflex her foot and ankle within the next 3 to 5 seconds to reach a new resistance barrier.
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