7 MET and ART Flashcards
What is Muscle Energy?
Voluntary contraction of patient muscle in controlled direction (away from barrier) with varying levels of intensity and against a distinctly executed counterforce
Direct and Active Technique
4 Types of Muscular Contraction
Isometric: Contraction of muscle with no change in distance between origin and insertion
Concentric Isotonic: Contraction of muscle with approximation of origin and insertion
Eccentric Isotonic: Contraction of muscle with separation of origin and insertion
Isolytic (Non-physiologic): Attempted concentric contraction with external force causing separation of origin and insertion
Post-Isometric Relaxation
Most Common Form of MET
Muscle Contraction –> Increased tension in GTO –> Inhibition of Muscle Contraction
Joint Mobilization using Muscle Force
Physiologic Basis
Force of Contraction
Hypertonicity across joint can cause distortion of articular relationships and motion loss
Maximal muscle contraction that can be comfortably resisted by physician (30-50 lb of pressure depending on joint)
Respiratory Assistance
Muscular forces involved are generated by simple act of breathing
Physician usually applies fulcrum against which the respiratory forces can work
Oculocephalogyric Reflex
Eye movements reflexivley affect cervical and truncal musculature as body attempts to follow the lead provided by eye motion
Force of contraction is exceptionally gentle
Reciprocal Inhibition
Gentle contraction initiated in agonist muscle, reflex relaxation of that muscle’s antagonist group
Force of contraction in ounces, not pounds of pressure
Crossed Extensor Reflex
Used in extremities where the muscle requiring treatment is in area so severely injured it is directly unmanipulable or inaccessible
Learned cross pattern locomotion reflexes engrammed into the CNS. Flexor muscle in one extremity is contracted voluntarily, flexor in contralateral extremity relaxes and extensor contracts
Isokinetic Strengthening
Reestablish normal tone and strength in muscle weakened by reflex hypertonicity of opposing muscle group
Asymmetry of ROM exists, also potential for asymmetry in muscle strength. Shortening of antagonist muscle, attend to that first. Agonists spontaneously increase strength if shortened or hypertonic fibers are lengthened first
Isokinetic contractions (length change, typically concentric contractions, occurs at constant, controlled slow rate)
Isolytic lengthening
Lengthen a muscle shortened by contracture and fibrosis
Vibration used has some effect on myotratic units in addition to mechanical and circulatory effects
Maximal contraction that can be comofrtably resisted by physician
Using muscle force to move one region of body to achieve movement of another bone or region
Often more effective to move one structure by moving another body structure adjacent to it
Muscular force used to move first structure and that body part’s response to muscle force is transmitted to yet another part of body
Isometric vs Isotonic
- Careful positioning
- Light - Moderate contraction
- Unyielding counterforce
- Relaxation after contraction
- Repositioning
- Careful positioning
- Hard to maximal contraction
- Counterforce permits controlled motion
- Relaxation after contraction
- Repositioning
MET Indications
Balance muscle tone
Strengthen reflexively weakened musculature
Improve symmetry of articular motion
Enhance circulation of body fluids
Lengthen shortened, contractured, or spastic muscle group
MET Sequence
- Positions body parts at position of initial resistance
- Patient instructed in intensity, duration, direction of contraction
- Direct patient to contract appropriate musculature
- Physician uses counterforce in opposition to and equal to patient’s contraction
- Physician maintains forces until appropriate patient contraction perceived (3-5 seconds)
- Patient relaxes while physician simultaneously matches decrease in force
- Physician allows patient to relax and senses tissue relaxation with his or her own proprioceptors
- Physician takes up slack permitted by procedure
- Repeat steps 1-8 3-5 times until best possible increase in motion obtained
- Reevalute original dysfunction
Factors influencing successful muscle energy
Patient
Physician
- Contract too hard, contract in wrong direction, sustain contraction for too short a time, do not relax appropriately following contraction
- Not controlling joint position in relation to barrier movement, not providing counterforce in correct direction, not giving accurate instructions, moving to new joint position too soon after patient stops contracting
