Muscle energy technique (MET) is a type of osteopathic manipulative medicine (OMM) developed by Fred Mitchell, Sr, D.O., in 1948, designed to improve musculoskeletal function through mobilizing joints and stretching tight muscles and fascia, to reduce pain, and to improve circulation and lymphatic flow. These methods are unique in OMM as they are “active” techniques, requiring the patient to perform isometric contractions. MET is contraindicated in individuals with poor energy, fractures, significant joint disease, or recent surgery. MET is characterized by a patient-induced skeletal muscle contraction against an operator’s resistance in a controlled direction and position. More specifically, isometric MET entails the following steps:

Isolation of the target joint and/or muscle barrier through joint positioning, generally to a pathologic barrier.

This is followed by active muscle contraction by the patient in a specific direction, generally away from the restriction, for a specified period against provider-applied counterforce. Conventionally, the amount of force generated by the patient should be the maximum amount comfortably tolerated by both the patient and practitioner.

Relaxation of the contracted muscle.

Passive movement of the patient’s anatomy toward a new pathologic barrier

Repeat steps 1 to 4 as tolerated until physiologic pain sufficiently relieved and/or the achievement of the desired range of motion.

Within this framework, different protocols have been developed with varied specifics for each step, including duration and strength of contraction, duration of rest, and the number of repetitions. For example, the Greenman method proposes a five-to-seven second relaxation step and three-to-five repetitions overall.

The goal of this therapy is to induce relaxation of a muscle or muscle group, the hypertonicity of which is proposed to be the source of pain and/or loss of mobility in a body part and/or joint. The primary theories behind this phenomenon entail post-isometric relaxation – the reduction in tone of an agonist muscle following isometric contraction, and reciprocal inhibition – the reduction in tone of an antagonist muscle after its agonist has undergone isometric contraction. Both of these phenomena are well understood on a cellular level.