Muscle Energy Technique (MET)

• At the end of this lecture students can learn about muscle energy technique for back muscles
• They can also learn the principle of the technique
• Additionally the application of the technique of Hip flexors (Iliopsoas)Erector spinae
• Also Indication, contraindication

Introduction to Muscle Energy Technique (MET)

• MET is a manual medicine procedure and a gentle form of manipulative therapy.
• MET is effective for treating movement restrictions of the spine and extremities.
• Osteopathic MET is a versatile technique traditionally used for muscular strain, local edema, and joint dysfunction.
• Spinal joint dysfunction involves local tenderness, tissue texture change, asymmetry, limitation of segmental motion and altered end-feel.

Lower Crossed Syndrome

• Also known as pelvic crossed syndrome or distal crossed syndrome and 'Unterkreuz syndrome'.
• Lower Crossed Syndrome (LCS) results from muscle strength imbalances in the lower segment.
• Muscle imbalances can occur when muscles are constantly shortened or lengthened.
• LCS is characterized by specific patterns of muscle weakness and tightness crossing between the dorsal and ventral sides of the body.

Clinically Relevant Anatomy

• LCS involves weakness in trunk muscles like rectus abdominis, internal and external obliques, and transversus abdominis.
• Weakness also affects the gluteal muscles: gluteus maximus, medius, and minimus.
• Inhibited muscles are often substituted by activation of superficial muscles.
• Overactivity and tightness exist in thoracolumbar extensors: erector spinae, multifidus, quadratus lumborum, and latissimus dorsi.
• Overactivity and tightness exist in hip flexors: iliopsoas and tensor fasciae latae.
• Hamstrings compensate for anterior pelvic tilt or an inhibited gluteus maximus.

Muscle Energy Technique (MET) for Lower Cross Syndrome

• LCS presents as postural dysfunction which features tight hip flexors and erector spinae muscles.
• It also presents as weak abdominal and gluteal muscles
• This imbalance may cause musculoskeletal problems, like lower back pain, poor posture, and decreased functional capacity.
• MET is a manual therapy technique effective for addressing muscular imbalances associated with LCS.
• MET improves muscle length, strength, and coordination through patient's voluntary muscle contractions against resistance from a therapist.

Key Muscle Groups Involved in Lower Cross Syndrome

• Tight muscles: Hip flexors (Iliopsoas) and Erector spinae
• Weak muscles: Abdominal muscles, as well as Gluteal muscles (Gluteus maximus, medius, and minimus) and Rectus abdominis, obliques, transverse abdominis.

MET Techniques for Lower Cross Syndrome

• Hip Flexor Lengthening
• Position: Patient supine, one hip and knee flexed to 90 degrees.
• Technique: Apply gentle pressure to the patient's knee.
• Therapist resist the patient's attempt to extend the hip.
• After a brief isometric contraction, therapist releases the pressure for increased hip extension.
• Erector Spinae Lengthening
  • Position: High sitting with back towards the practitioner, legs hanging, hands clasped behind the neck.
  • Therapist Position: Stand behind the patient.
  • Theapist Passes a hand across the front of the patient's chest and grasps the upper arm
  • Technique:
    • Identify Barrier
    • Patient should inhale and return to an upright position against firm resistance (20% isometric contraction) for 5-7 seconds.
    • Patient should exhale and slowly release
    • Patient should Inhale and exhale again
    • While exhaling, take the patient further in all directions of restriction, towards the new barrier.
    • Stretch for 30 seconds.
    • Repeat.

Clinical Considerations

• Patient Assessment: Thoroughly assess to identify muscle imbalances and trigger points contributing to LCS.
• Pain Management: Pain-relieving modalities should be used before MET if the patient has significant pain.
• Postural Correction: Educate the patient on proper posture and ergonomic principles to avoid recurrence of LCS.
• Home Exercise Program: Prescribe exercises strengthening weak muscles and stretching tight muscles.

Indications for MET in Back Muscles

• Limited Back Range of Motion: Improves flexion, extension, lateral flexion and rotation of the spine.
• Reduce muscle tension and deactivate trigger points in back muscles, such as the erector spinae, quadratus lumborum, and piriformis.

Further Indications for MET in Back Muscles

• Low Back Pain: Alleviates back pain caused by muscle tension, disc herniation, or facet joint dysfunction.
• Postural Dysfunction: Corrects postural imbalances, improving spinal alignment.
• Sciatica: Reduces sciatic pain by relieving muscle tension and improving nerve function.

Contraindications for MET in Back Muscles

• Avoid in the acute phase of injury.
• Avoid in cases of ligamentous or joint instability.
• Caution advised with severe osteoporosis.
• Avoid in acute phases of rheumatoid arthritis due to potential symptom exacerbation.
• Avoid in patients with neurological conditions affecting muscle control.