Muscle Energy Techniques

Front cover
......Page 1
Back cover
......Page 2
Contents
......Page 7
Contributors
......Page 9
Forward
......Page 11
Preface
......Page 13
Acknowledgements
......Page 15
The route to dysfunction
......Page 17
History
......Page 19
Key points about modern MET
......Page 25
Variations on the MET theme......Page 28
Lewit's postisometric relaxation method 
......Page 29
Janda's postfacilitation stretch method
......Page 30
Isotonic eccentric MET
......Page 31
Why fibrosis occurs naturally
......Page 32
Putting it together
......Page 33
Tendons
......Page 34
Joints and MET
......Page 36
References
......Page 37
2. PATTERNS OF FUNCTION AND DYSFUNCTION
......Page 39
Constructing a credible story
......Page 41
Questions
......Page 42
Box 2.2 Myer's fascial trains
......Page 43
Viewing symptoms in context
......Page 47
The role of the emotions in musculoskeletal dysfunction
......Page 48
Korr's 'orchestrated movement' concept
......Page 49
Van Buskirk's nociceptive model
......Page 50
Isaccson's 'functional unit'
......Page 54
Fascial considerations
......Page 55
Fascial properties
......Page 56
Slow stretching is best
......Page 57
Postural (fascial) patterns
......Page 58
Cervicothoracic (CT) area
......Page 59
Example of sport-induced compensation
......Page 60
Lewit and 'tight-loose' thinking
......Page 61
The evolution of musculoskeletal dysfunction
......Page 62
Fitness, weakness, strength and hypermodbility influences
......Page 64
Characteristics of altered movement
......Page 65
Postural and phasic muscles
......Page 66
Characteristics of postural and phasic muscles
......Page 68
Rehabilitation implications
......Page 69
Stabilisers and mobilisers
......Page 70
Global and local muscles
......Page 71
Easing the confusion
......Page 72
Box 2.7 Patterns of imbalance
......Page 73
Upper crossed syndrome
......Page 75
Chain reaction leads to facial and jaw pain
......Page 76
Patterns of change with inappropriate breathing
......Page 77
More hyperventilation effects
......Page 78
Goldthwaite's postural overview
......Page 79
Identification and normalisation of patterns of dysfunction
......Page 80
Segmental facilitation
......Page 81
How to recognise a facilitated area
......Page 82
What causes a trigger point to develop?
......Page 83
Fibromyalgia and trigger points
......Page 84
Summary of trigger point characteristics
......Page 85
Figure 2.21 A selection of the most commonly found examples of representations of trigger point sites and their reference (or target) areas
......Page 86
Integrated neuromuscular inhibition (INIT)
......Page 88
References
......Page 89
3. HOW TO USE MET
......Page 93
Ease and bind
......Page 94
Goodridge's ease-bind palpation exercise, part 1
......Page 95
Goodridge's ease-bind palpation exercise, part 2
......Page 96
MET exercise
......Page 97
Basic exercises in MET using postisometric relaxation (PIR) followed by stretch, in a chronic context
......Page 98
Basic exercise in MET using reciprocal inhibition in acute and chronic contexts
......Page 99
Practitioner errors in application of MET
......Page 100
Contraindications and side-effects of MET
......Page 101
Degree of effort with isometric contraction
......Page 102
Janda's view
......Page 103
Strength testing methodology
......Page 104
Ruddy's methods- 'pulsed MET'
......Page 105
Isotonic eccentric alternatives
......Page 106
Strengthening a joint complex with isokinetic MET
......Page 107
Summary of choices for MET in treating muscle problems
......Page 108
Joints and MET
......Page 109
Self-treatment
......Page 110
Evaluation
......Page 111
2. Isometric contraction- using postisometric relaxation (in an acute setting, without stretching)
......Page 112
4. Isometric contraction- using reciprocal inhibition (chronic setting, with stretching)
......Page 113
5. Isotonice concetric contraction (for toning or rehabilitation)
......Page 116
6. Isotonic eccentric contraction (isolytic, for reduction of fibrotic change, to introduce controlled microtrauma)
......Page 118
7. Isotonic eccentric contraction (slowly performed) for strengthening weak postural muscles and preparing their antagonists for stretching
......Page 120
8. Isokinetic (combined isotonic and isometric contractions)
......Page 122
References
......Page 123
4. MET: EFFICACY AND RESEARCH
......Page 125
Myofascial extensibility
......Page 126
Immediate effects of contract-relax techniques
......Page 127
Long-term effects of contract-relax techniques
......Page 129
Agonist contract-relax versus contract-relax
......Page 130
Duration of contraction
......Page 131
Duration of post-contraction stretch
......Page 132
Other factors
......Page 133
Effect on range of motion
......Page 134
Effect on spinal pain
......Page 135
Reflex muscle relaxation
......Page 136
Viscoelastic or muscle property change
......Page 138
Stretch tolerance
......Page 141
Decrease in pain
......Page 142
Other possible effects
......Page 143
Application to spinal dysfunction
......Page 144
References
......Page 145
Clinical research evidence
......Page 149
MET results in treatment of fibromyalgia
......Page 150
Objectives of manual treatment
......Page 151
Evaluating muscle shortness
......Page 152
Important notes on assessments and use of MET
......Page 153
Box 5.1 'Acute' and 'Chronic'
......Page 154
Stretching- what is happening?
......Page 155
Sequential assessment and MET treatment of postural muscles
......Page 156
Assessment of tight soleus 
......Page 157
MET treatment of shortened gastrocnemius and soleus
......Page 158
Screening short adductors from medial hamstrings
......Page 159
MET treatment of hortness in short and long adductors of the thigh
......Page 160
3. Assessment and treatment of hip flexors- rectus femoris, Iliopsoas
......Page 161
Psoas strength test and toning exercise
......Page 162
Box 5.4 Notes on psoas
......Page 164
MET treatment for shortness of rectus femoris
......Page 165
MET treatment of psoas
......Page 166
Self-treatment of the psoas
......Page 169
Methodology
......Page 170
Method A. MET for shortness of lower hamstrings
......Page 172
MET for shortness of upper hamstrings
......Page 173
Lewit's TFL palpation
......Page 174
Observation assessment- hip abduction test
......Page 175
Method B. Greenman alternative supine MET treatment of shortened TFL
......Page 176
Additional TFL methods
......Page 177
Test B. Piriformis palpation test
......Page 178
Method A. Side-lying
......Page 179
Box 5.6 Notes on piriformis
......Page 180
Method C......Page 181
Box 5.8 Notes on quadratus lumborum
......Page 182
Quadratus lumborum test B
......Page 183
Method B. Quadratus lumborum side-lying MET
......Page 184
Method C. Quadratus lumborum gravity-induced MET- self-treatment
......Page 185
Latissimus and pectoral test B
......Page 186
Method A. MET treatment of short pectoralis major
......Page 187
Method C. Pectoralis major MET
......Page 189
Latissimus dorsi test for shortness
......Page 190
Method B. MET of shortened latissimus dorsi
......Page 191
Upper trapezius shortness test A
......Page 192
Upper trapezius shortness test B
......Page 193
Method A. MET treatment of chronically shortened upper trapezius
......Page 194
Assessment B. Scalene observation
......Page 196
MET tretment of short scalenes
......Page 197
MET treatment of shortened SCM
......Page 199
Box 5.10 Notes on sternocleidomastoid
......Page 200
Test B for levator scapula shortness (observation)
......Page 201
MET treatment of levator scapula
......Page 202
Infraspinatus shortness test A
......Page 203
Assessment for infraspinatus weakness
......Page 204
Subscapularis shortness test A
......Page 205
Assessment for supraspinatus weakness
......Page 206
MET treatment for shortness in biceps tendon
......Page 207
Flexors of the forearm- MET treatment
......Page 208
Paravertebral muscle shortness test B
......Page 209
MET treatment of erector spinae muscle
......Page 210
Assessment for shortness in erector spinae muscles of the neck
......Page 211
MET treatment of short neck extensor muscles
......Page 212
References
......Page 213
Joints and MET
......Page 215
Evidence
......Page 216
MET treatment of low-back pain
......Page 217
MET treatment of joints damaged by haemophilia
......Page 218
Preparing joints for manipulation using MET
......Page 219
Joint mobilisation using MET
......Page 220
Basic criteria for treating joint restriction with MET
......Page 221
Focus rather than force
......Page 223
No stretching as a feature of joint MET application
......Page 224
Grieve's low-back approach
......Page 225
Discussion of Grieve's method
......Page 226
Method
......Page 227
Upper cervical dysfunction assessment and MET treatment
......Page 228
Stiles' comments regarding whiplash injury and MET
......Page 229
Greenman's exercise in cervical palpation and MET application
......Page 230
Exercise in cervical palpation
......Page 231
MET in joint treatment
......Page 232
Spencer shoulder sequence incorporating MET
......Page 233
A. Assessment and MET treatment of shoulder extension restriction
......Page 234
D. Articulation and assessment of circumduction with traction
......Page 235
G. Assessment and MET treatment of internal rotation restriction
......Page 236
Spiral MET method 1. Shoulder 'spiral' stretch into extension to increase the ROM in flexion, adduction and external rotation......Page 237
Spiral MET method 2. Shoulder 'spiral' stretch into flexion to increase the ROM in extension, abduction and internal rotation 
......Page 238
Acromioclavicular dysfunction
......Page 239
MET treatment of restricted abduction in the sternoclavicular joint
......Page 240
MET treatment of restricted horizontal flexion of the upper arm (sternoclavicular restriction)
......Page 241
Terminology
......Page 242
Rib palpation test: rib 1
......Page 243
Rib palpation test: ribs 11 and 12
......Page 244
MET method for elevated ribs
......Page 245
MET method for depressed ribs
......Page 246
MET treatment for elevated 11-12th ribs
......Page 247
Assessment and MET treatment of sacroiliac (SI) and iliosacral (IS) restrictions
......Page 248
Supine functional SI assessments
......Page 249
Box 6.2 The sacroiliac joint during gait
......Page 250
Prone functional SI assessment
......Page 251
Test A: pelvic balance
......Page 252
Test F: seated spinal rotation
......Page 253
Test H: landmarks
......Page 254
MET treatment of iliac outflare
......Page 256
MET treatment of anterior iliac rotation
......Page 257
MET for treatment of posterior iliac rotation
......Page 258
MET TMJ method 3
......Page 259
TMJ self-treatment exercise 1
......Page 260
References
......Page 261
7. INTEGRATED NEUROMUSCULAR INHIBITION TECHNIQUE (INIT)
......Page 263
STAR palpation
......Page 264
Trigger point treatment methods
......Page 265
Ischaemic compression validation
......Page 266
Ischaemic compression in trigger point deactivation
......Page 267
Strain/counterstrain (SCS) briefly explained
......Page 268
INIT method
......Page 269
References
......Page 270
Clinical progression of care
......Page 273
Method
......Page 274
Proprioceptive neuromuscular facilitation
......Page 275
The neurodevelopmental basis for muscle imbalance
......Page 276
Experiment in postural correction
......Page 277
Developmental influences
......Page 278
The key role of coactivation of antagonists in producing and maintaining upright posture
......Page 279
Functional screening tests
......Page 280
Experiment in facilitation of an inhibited muscle chain
......Page 281
Brugger's facilitation method for inhibited muscle chains in the extremities
......Page 283
Conclusion
......Page 284
References
......Page 288
9. MET IN THE PHYSICAL THERAPY SETTING
......Page 289
Classification models
......Page 290
Further refinement of classification
......Page 291
Misconceptions in the literature
......Page 293
Appendix A: Reviews of the studies
......Page 294
Clinical utilisation of muscle energy technique
......Page 296
Stage 1: Pain modulation
......Page 297
Stage 2: Pain modulation and addressing impairments
......Page 298
Assessing impairment: segmental-specific strengthening
......Page 299
Isolation of effort: three-finger stacking
......Page 300
Progressing the process
......Page 302
Parameters
......Page 303
Appendix B: Segmental strengthening programme
......Page 304
Appendix C: Patient positions
......Page 305
Summary
......Page 307
Appendix D: Unstable surfaces
......Page 308
References
......Page 311
Marrying assessement and treatment
......Page 315
Summary
......Page 316
'Wellness' and therapeutic (clinical) modes of massage
......Page 317
Example: Massage including MET to stretch the quadriceps muscles
......Page 318
MET as part of a general massage application
......Page 319
Case study
......Page 322
References
......Page 325
11. MET IN THE TREATMENT OF ATHLETIC INJURIES
......Page 327
Adaptation of athletes
......Page 328
Dysfunction in sports
......Page 330
Spine measurements
......Page 331
Hip region measurements
......Page 333
Lower extremity measurements
......Page 337
Upper extremities
......Page 338
Dynamic flexibility versus static stretching
......Page 339
Warm-up
......Page 341
Recovery techniques
......Page 343
Acute injury care
......Page 345
Prevention of injury using MET, INIT and other techniques
......Page 347
Chronic injury and long-term rehabilitation using MET
......Page 348
Case A: Sub-acute low-back strain
......Page 349
Case B: Acute hamstring strain
......Page 350
Case C: Shoulder tendonitis (subacromial long head of biceps)
......Page 352
References
......Page 353
INDEX......Page 357