THE PHYSIOLOGY AND APPLICATION OF MUSCLE ENERGY TECHNIQUES by Gill Webster DARM RMT SMTO

Osteopaths and other Manipulative Therapists developed Muscle Energy Techniques (METs) beginning with Fred Mitchell (1909-74), in the 1950s, who started with the pelvis. They are a gentle but highly effective treatment of musculoskeletal dysfunction. MET uses isometric or isotonic contractions as a way of lengthening tight muscle; strengthening weak muscle; mobilising joints and relieving congestion in the tissues. Good quality results require skilled application and an accurate diagnosis of muscle condition. THE PHYSIOLOGY OF HOW THE TECHNIQUES WORK Isometric contraction is contraction of the muscle against a counterforce so that no movement occurs. Two forms of isometric MET are Post-Isometric Relaxation (PIR) and Reciprocal Inhibition (RI). PIR refers to the subsequent reduction in tone of the agonist muscle after isometric contraction. This occurs due to stretch receptors called Golgi tendon organs that are located in the tendon of the agonist muscle. These receptors react to overstretching of the muscle by inhibiting further muscle contraction. This is naturally a protective reaction, preventing rupture and has a lengthening effect due to the sudden relaxation of the entire muscle under stretch. In more technical terms, a strong muscle contraction against equal counterforce triggers the Golgi tendon organ. The afferent nerve impulse from the Golgi tendon organ enters the dorsal root of the spinal cord and meets with an inhibitory motor neurone. This stops the discharge of the efferent motor neurones impulse and therefore prevents further contraction, the muscle tone decreases, which in turn results in the agonist relaxing and lengthening (see Figure 1). The Golgi tendon organs react to both passive and active movements and therefore passive mobilisation of a joint may sometimes have as good an effect on relaxing the muscles as direct massage. RI refers to the inhibition of the antagonist muscle when isometric contraction occurs in the agonist. This happens due to stretch receptors within the agonist muscle fibres muscle spindles. Muscle spindles work to maintain constant muscle length by giving feedback on the changes in contraction, in this way muscle spindles play a part in proprioception. In response to being stretched, muscle spindles discharge nerve impulses, which increase contraction, thus preventing over-stretching. The spindles discharge impulses which excite the afferent nerve fibres or the agonist muscle, they meet with the excitatory motor neurone of the agonist muscle (in the spinal cord) and at the same time inhibit the motor neurone of the antagonist muscle which prevents it from contracting (see Figure 2). This results in the relaxation of the antagonist therefore is called reciprocal inhibition. When the agonist stops contracting against force, the muscle spindles stop discharging and the muscle relaxes, this has the same effect as post isometric relaxation.

Figure 1: Post-isometric relaxation neurological effects of an isometric contraction on the golgi tendon organs of a skeletal muscle (taken from Muscle Energy Techniques by Leon Chaitow)

Figure 2: Reciprocal Inhibition neurological effects of an isometric contraction on the muscle spindles of a skeletal muscle, resulting in relaxation of its antagonist (taken from Muscle Energy Techniqes by Leon Chaitow)

In brief, when the agonist muscle contracts against equal force (isometrically) two stretch receptors respond. Firstly muscle spindles react to the stretch of the muscle and respond by inhibiting the antagonist (RI), secondly Golgi tendon organs respond to the stretch on the tendon, they act by inhibiting further contraction of the agonist muscle (PIR), as this occurs the muscle spindles also cease to discharge effectively relaxing the agonist. Concentric Isotonic Contraction occurs when the therapists counterforce is weaker than the contractile force allowing some movement to occur in the direction of the muscle force, therefore shortening and strengthening the muscle. This technique is used to strengthen physiologically weak muscles. Eccentric Isotonic Contraction occurs when the therapists counterforce is stronger than the contractile force of the muscle and stretching and lengthening occur in the muscle tissue. This is effective in short, fibrotic muscles allowing a controlled microtrauma to the muscle. This results in a change to the muscles shortened structure and improves elasticity and circulation.

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APPLICATION OF THE TECHNIQUES MET methods have many possible variations that will affect the results. For example, the muscle length at starting position; the effort of the client or therapist; the duration of the contraction; whether the contraction is pulsed or single; the number of repetitions of the contraction; whether the position changes with each repetition, i.e. moving to tissue tension; the direction of effort, i.e. whether it is an eccentric or concentric contraction; client breathing and eye movements in the direction of the force; type of resistance, i.e. gravity, therapist or immovable object. These variables need to be combined and controlled depending on the particular needs of the case. Example 1: Isotonic contraction using Post-Isometric Relaxation 1a In the condition of acute muscular spasm or to mobilise a restricted joint, this PIR can be used. The therapist takes the agonist muscle to its barrier of tension and holds the position; the therapist provides equal resistance to the client contracting the agonist muscle with about 20% of their strength, for 7-10 seconds. Client relaxes for around 5 seconds, and then as they exhale, the therapist takes muscle to the new restriction barrier, without stretching past it, and the process is repeated 3 to 5 times. 1b In the condition of chronic, fibrotic muscular spasm, the following PIR technique can be used. The therapist takes the agonist muscle to a comfortable location before its barrier of tension and holds the position; therapist provides equal resistance to the client contracting the agonist muscle with about 30% of their strength, for 7-10 seconds. Client relaxes for around 5 seconds, then as they exhale, the therapist takes muscle to new restriction barrier with an additional gentle stretch past it (without pain), to a new starting point. For safety, and to reduce contraction further, the client can assist in assuming this position. This position can also be held for 10-60 seconds before the next isometric contraction occurs, the process is then repeated 3 to 5 times. Example 2: Isotonic contraction using Reciprocal Inhibition 2a In the condition of acute muscular spasm or to mobilise a restricted joint this RI method can be used. It is also a safe substitute when there is pain involved in treating the agonist muscle in the PIR technique. It is exactly as described in 1a except applied to the antagonist muscle instead of the agonist. 2b In the condition of chronic, fibrotic muscular spasm, the following RI method can be used. It is also a safe substitute when there is pain involved in treating the agonist muscle in the PIR technique. It is exactly as described in 1b except applied to the antagonist muscle instead of the agonist. Example 3: Concentric Isotonic Contraction (Used for toning and rehabilitation to strengthen physiologically weak muscles.) The therapist begins with the muscle in resting length (comfortable mid-range) and allows the client to contract the affected muscle with some force as they provide a constant amount of resistance, for 3-4 seconds. This can be repeated 3-5 times, building the strength used by the client as appropriate. Example 4: Eccentric Isotonic Contraction (Used to induce a controlled microtrauma to shortened, fibrotic musculature.) Contraction begins from the restriction barrier, the client contracts the muscle but allows their contraction to be overcome by the effort of the therapist, who forces the muscle to stretch past its original barrier. Contraction should not be longer than 4 seconds and this can be repeated 4-5 times (the client should not experience excessive discomfort). This technique would never be used on head and neck muscles, on frail, pain-sensitive clients or those with osteoporosis. IN CONCLUSION The key requirements for good results are the diagnosis of muscular activity, appropriate level of effort, appropriate duration of contraction and safe movements to new tissue tensions with client assistance if required. METs may be ineffective if excessive force is applied, if it is not possible to localise muscular effort to the precise region of the dysfunction, or if underlying pathological conditions prevent long-term relief. Muscle Energy Techniques have been proven to be effective in most cases even in fragile or infirm clients. Pathology such as arthritis or osteoporosis can benefit although application of the technique should be appropriate to client fitness and health, vigorous methods should only be used on the physically fit. Essentially these techniques are a very effective tool for the Massage Therapist, with skilled application neither the client nor the therapist should be under strain and muscle balance, joint mobility and pain relief can be achieved. Simple guidelines to follow if using MET: No pain should be caused by met Keep contractions light (20-30% of strength) Communicate effectively and ensure client is not experiencing discomfort at any time Client can help to locate tissue tension or restriction barrier Never over-stretch
BIBLIOGRAPHY Berne, Robert M., Levy, Matthew N., Principles of Physiology, Second Edition, Mosby, 1996 Chaitow, Leon, Muscle Energy Techniques, Second Edition, Churchill Livingston, 2001

Gill Webster practises in Bridge of Allan, Stirling in Advanced Remedial Massage, Remedial & Sports Massage, Swedish Massage and Reiki. Tel. 01786 834757 Email. gill@webster8378.fsnet.co.uk - 20 -