NEUROMUSCULAR TECHNIQUE (NMT)

Utilising the nervous system to normalise muscle tone

and reset reflex patterns

MUSCLE ENERY TECHNIQUES (MET)

A type of NMT
A form of soft tissue treatment where muscles are actively used, on request, from a
controlled position, in a specific direction and against a specific counterforce.
The key defining element is the use of an isometric (static) contraction before subsequent
stretching of restricted tissues
Variables
o Degree of force
o Length of time
o Direction of force (towards or away from the barrier)
o Degree of movement following the contraction
o How many repetitions
Uses the energy of the clients muscle (rather than the force of the therapist) to create a
beneficial change
Can be used as a standalone treatment or incorporated into massage although useful to
prepare the area with general massage first
Basic elements of MET involve the identification of a resistance barrier, the initiation of an
isometric contraction using minimal effort, in a defined direction and for a limited period,
followed after relaxation of a movement towards a new barrier or into a stretch
AIM OF USING METS

Aim is to use affected muscles or their antagonists in order to achieve

the release of tense, tight, shortened muscles which are often painful
and limited in movement
Two therapeutic objectives:
Pain modification
Enhanced mobility

All METs are based on principals of POST

ISOMETRIC RELAXATION (PIR) and
RECIPROCAL INHIBITION (RI)

Both induce a state of deeper relaxation in a

muscle.
In the relaxed state, the muscle can be
more easily and safely stretched and
lengthened.

MET VARIATIONS

IN addition to PIR and RI, there are a variety

of MET techniques used for different
purposes within treatment. There are:

Pulsed MET/Ruddys
Slow Eccentric Isotonic Stretch (SEIS)
Rapid Isotonic Eccentric Stretch
(SIES)/Isolytic
Isokinetic (a variation of Isotonic
Concentric)

BASIC PIR MET PROTOCOL

1. Position the client so that both you and he are comfortable. Take the muscle to be stretched to a resistance barrier. This barrier is the point at which
you and the client will start to feel a stretch. This entire procedure should be pain free.

2. Ask the client to contract the dysfunctional muscle using a maximum of 20-30% 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.

3. After about 7 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.
THE BASIC RI PROTOCOL IS EXACTLY THE SAME BUT INSTEAD OF CONTRACTING THE DYSFUCNTIONAL MUSCLE, THE CLIENT CONTRACTS
THE OPPOSING MUSCLE/ANTAGONIST

Basic principles of PIR

Following a mild isometric contraction, a muscle becomes inhibited

and more relaxed for about five seconds afterwards. While in this
relaxed state, it can be stretched to a new resting length.
Occurs due to Golgi Tendon Organs which lie near origins and
insertions of the muscles and report to the CNS. An isometric which
has been maintained for some seconds results in a report to the CNS
to release and relax due to excessive load
PIR is helpful for a strong and healthy muscle which is tight however,
may overload injured/repairing tissues and so is less safe where there
has been an acute injury

Basic principles of RI

Isometric contraction of an antagonist in order to inhibit the agonist

before agonist is stretched
Reciprocal Inhibition obliges a muscle to relax due to the increased
tome in the antagonist. This happens due to the CNS preventing the
agonist and antagonist contracting at the same time
A tight or acutely injured muscle can be inhibited in this way and
stretched more easily by contracting the opposing muscle.
Action is instant so RI ends the moment the contraction ends so
stretch must be carried out immediately
Client can stretch the muscle themselves neuromuscular system
will respond to any damage before they stretch too far
Better technique to use if there has been a recent or acute injury

Both PIR and RI are useful for treating muscular spasm, stiff, short and contracted muscles and loosening stiff joints.
Also useful in preparing a joint for subsequent manipulation

Ruddys Method / Pulsed MET

What
Minute, repetitive contractions,
usually of antagonist in order to
inhibit agonist after which the
agonist is stretched
Patients effort is greater than
therapists effort
Why
Useful to facilitate and
strengthen weakened
antagonists
Has additional circulatory,
drainage and proprioceptive
benefits

How
Dysfunctional tissue held at
barrier and patient makes
rapid, minute, repetitive
contractions towards the
barrier
Contraction of opposing muscle
to restricted tissue
Inhibits agonist
Should be light with no
perceptible motion being
permitted due to firm
resistance offered by
practitioner

Slow Eccentric Isotonic Stretch (SEIS)

What
Application of a slow, resisted
stretch to the antagonist of the
dysfunctional tissue after which
the agonist is stretched
Therapists effort overcomes
patients effort

Why
You are eccentrically contracting
and toning the antagonist of the
dysfunctional muscle
Useful in toning weak muscles

How
Client tries to concentrically
contract the antagonist while the
therapist applies resistance to
eccentrically move the joint in
the opposite direction
Low resistance and slow
movements should be used

Rapid Isotonic Eccentric Stretch/

Isolytic

What
Rapid elongation of the
dysfunctional tissue at the same
time the patient is contracting it
Therapists effort is greater than
patients effort
Should not be used with acute
injury
Why

Controlled tissue damage

Breaks down adhesions and
fibrosis within muscle tissue
It is in contrast with SEIS which
does not damage tissue

How

Client tries to concentrically

contract the antagonist while the
therapist applies resistance to
eccentrically move the joint in
the opposite direction
Fast movements should be used
Patients should be warned that
the procedure can be
uncomfortable

Isokinetic

What
Variation on isotonic concentric
contractions (the concentric
version of SEIS)
Rapidly and repeatedly moving a
joint in a variety of directions
while partially resisted
Therapists effort is less than the
clients effort
Why
Muscle gradually becomes
shorter as it works against
resistance
Useful for toning weak muscles
and building strength of all
muscles used in joint function

How
Forcibly and with maximum
available effort, the patient aims
to move the joint through its full
range of movement while being
partially restricted by
counterpressure

Advantages of MET

Economical in terms of time and physical effort

Results are rapid
Reduced discomfort
Increased mobility
Proprioceptive features
Increased motor control and motor learning as it
involves the active and precise recruitment of muscle
activity

Final Points

Active and Passive ROM should be checked beforehand for purposes of comparison
Identify feather barrier must be identified to be most effective
No pain should be produced during or after
If an individual cannot generate a controlled contraction, MET is not appropriate
MET should not be used to release a protective spasm
Only work where there is tissue restriction they cannot make muscles any longer or
more elastic than they should normally be.
In order to maintain effects of MET, client needs to maintain regular stretching
exercises afterwards