MET Flashcards
Stretching: Definition and Purpose
A general term used to describe any
therapeutic maneuver designed to increase
mobility of soft tissues and subsequently
improve ROM by elongating (lengthening)
structures that have adaptively shortened and
have become hypomobile over time
Contracture
adaptive shortening of the muscle-tendon
unit & other STs results in sig resistance to AROM, PROM
& limitation of ROM & may compromise ADL’s.
– Types of contracture
• Myostatic contracture – motor-tendon unit with ↓ROM
• Pseudomyostatic contracture – due to CNS lesion
• Arthrogenic and periarticular contractures -
• Fibrotic contracture and irreversible contractures
Interventions to Increase Mobility of Soft Tissues
Manual or Mechanical Stretching – Utilizes an external force
Passive Stretching
– No patient assistance
Assisted Stretching – Patient assistance
Self-Stretching
– Patient performs the stretch
Neuromuscular Facilitation and Inhibition Techniques
Muscle Energy Techniques (MET – that’s us!)
Joint Mobilization/Manipulation
Soft Tissue Mobilization and Manipulation
Neural Tissue Mobilization (Neuromeningeal Mobilization)
ndications for Stretching Exercises
Adhesions, Contractures, Scar Tissue Limit ROM
Potential for Structural Deformity d/t Limited ROM
Muscle Weakness, Shortening of Muscles
Part of a Total Fitness Program
Pre and Post Vigorous Exercise
Contraindications for Stretching Exercises
Bony Block Non-Union Fracture Acute Inflammation or Infection Sharp or Acute Pain With Elongation Hematoma or Tissue Trauma Hypermobility Hypomobility Provides Stability or Neuro- muscular Control
Potential Benefits and Outcomes for Stretching Exercises
Increased Flexibility and ROM
General Fitness
Other Potential Benefits – Injury prevention
– Reduced post-exercise soreness – Enhanced performance
Properties of Soft Tissue: Response to Immobilization and Stretch
Elasticity
Viscoelasticity
plasticity
Contractile and Non-Contractile Tissue Changes – Elasticity = ability to return to the pre-stretch state
– Viscoelasticity = initial stretch resistance, once sustained it allows the change in length & return back
• Only non-contractile connective tissue
– Plasticity = tendency to assume a new & greater
length after a stretch.
Mechanical Properties of Contractile Tissue
Contractile Elements of Muscle
Mechanical Response of the Contractile Unit to
Stretch and Immobilization
– Response to stretch
– Response to immobilization and remobilization • Morphological changes
• Immobilization in a shortened position - contracts
• Immobilization in a lengthened position- keeps new
length
Neurophysiological Properties of Contractile Tissue
Muscle Spindle -muscle sensory organ for tissue length and velocity changes
Golgi Tendon Organ –Neurophysiological to monitor tension
Procedural Guidelines for Application of Stretching Interventions
Examination and Evaluation of the Patient
– Test AROM & PROM for hypomobility
– Identify the involved tissues
– Evaluate the irritability of the tissues involved
– Assess strength of the tissues, do they have the capacity to control the new ROM’s safely ?
– Set outcome goals
Preparation for stretching
– Review goals, explain procedure & obtain consent
– Select techniques
– Warm up the tissues with local heat or active low- intensity exercises or ultrasound
– Patient is comfortable position
– No restrictive clothing
– Explain the need to be relaxed & geared to your tolerance
‘Barrier’ talk
Application of Manual Stretching Procedures – Move slowly to the point of tissue restriction
– Start with a low intensity in slow manner – Gradually release the stretch
– Review how patient tolerated the stretch.
- Physiologic barrier: end of voluntary or AROM
- elastic barrier: end of PROM
- Anatomic barrier: end of ROM due to bone or soft tissue.
- Restrictive barrier- due to injury?
Barrier= 1st sign of palpated or sensed resistance to free movements.
Restrictive barrier: when motion is lost within range, barrier that prevents movement in direction of motion loss.
-can be due to congestion, oedema, pain, chronic fibrosis
-MET works to move restrictive barrier as far into direction of motion loss as possible.
After stretch procedures:
– Apply cold to the stretched tissues & allow to cool in the lengthened position to minimize post- stretch soreness (10-15 minutes Hunting reflex of Lewis)
– Patient should perform AROM and strengthening exercises through the gained ROM immediately after stretching (can it be used at home functionally?)
– Are antagonists balanced with agonists in new ROM so adequate joint control & stability?
Precautions for stretching:
– Common errors and potential problems • Nonselective or poorly balanced stretching activities • Insufficient warm-up • Ineffective stabilization • Use of ballistic stretching • Excessive intensity • Abnormal biomechanics • Insufficient information about age-related difference
What is MET
“Muscle Energy Techniques (METs) is the terminology used for a broad class of manual therapy techniques directed at improving musculoskeletal function, and improving pain”.
“Historically, the concept emerged as a form of osteopathic manipulative diagnosis and treatment in which the patient’s muscles are actively used on request, from a precisely controlled position, in a specific direction, and against a distinctly executed physician counterforce”
