One of the most debilitating and emotionally frustrating ailments is limited range of motion. That occurs when the hands, arms, hips and legs are supposed to move freely within a “normal” range and area, but they can’t. They are held captive by muscle spasms, trigger points, constricted tendons and inflamed joints. When this continues over time and becomes chronic, you have to alter your daily activities. And this doesn’t merely limit your ability to play a sport or go for a long walk, but restricts your capacity for opening cabinets and reaching for things on shelves. This limited range of motion causes pain, emotional turmoil and loss of zest for life. But an old technique, nearly lost in today’s healthcare practices, can help enormously.
The Lost Art
Back in the day, osteopathic medicine was cool. It was aligned with naturalistic medicine and preventive care. It treated the external body through bodywork methods and internally with diet and medicines. It was holistic. My father is a retired doctor of osteopathy (DO); the old guard (that included him) has been replaced by a new guard. During their education, they take an elective in the bodywork method of spinal manipulation and muscle energy technique, but they soon forget what they’ve learned.
When I press my colleagues in this field on why they no longer (or ever) offered this modality to patients, they often say it takes too much time, they have too many patients to see and that people want drugs — not therapy. I disagree. This is not the case for all DOs, so ask yours (if you have one) about the method known as Muscle Energy Technique, or MET.
Depending on which history you ascribe to, osteopathic medicine was the first Western mainstream medical system in the United States to employ somatic manipulative diagnosis and treatment. That is, it palpated (touched) the body to assess muscle tension and imbalances, to maneuver the limbs to assess range of motion, and to correct spinal misalignment with manipulation techniques and fixed muscle and joint dysfunction with stretching and controlled force.
Legend has it that the first osteopath learned spinal manipulation from a Chinese doctor working on the railroads. This makes sense: Traditional Chinese medicine (TCM) has hundreds of such techniques in its Tui Na curriculum. And chiropractic, it is said, is a breakaway system from osteopathic medicine, focusing almost exclusively on spinal health and manipulation. Sports medicine’s use of a method known as proprioceptive neuromuscular facilitation (PNF) is said to be a direct descendant of osteopathic MET.
Muscle Energy Technique Described
MET is a method of somatic correction (joint and muscle corrective therapy) in which the patient and the doctor work together to activate the injured, shortened or stiff muscle. From precise and controlled positions, the patient is asked to use force to press his limb (held in a specific position based on diagnosis and muscles treated) against opposing force from the doctor’s hands. This, in effect, re-sets the muscle tone and bone structure toward normalcy to restore normal range of motion and decrease pain.
How it works is that muscle energy is used, or energy is applied through muscle flexing, against a fixed restrictive barrier, usually the doctor’s hand. The doctor places his hand on the side of the knee, for example, of a patient lying on his back with knees bent and feet flat; and he applies an amount of force that the patient must match. The force from the muscle meets the force of the barrier, and it seems as if neither the physician’s hand nor the patient’s knee move. Yet internally there is much happening through the isometric contraction of the patient’s muscles.
How It Works
This simple action causes the agonistic muscle to fatigue and relax, thereby allowing the antagonistic muscle to move farther along its range of motion with less restriction and pain. There are eight basic steps to the application of MET as applied to a specific treatment site:
- A correct somatic assessment and diagnosis is made.
- The restrictive barrier is engaged in as many planes as possible.
- Counterforce is matched between physician and patient, with the physician setting and managing the force.
- The patient applies isometric force in the opposite direction of the restriction (if it hurts to pull the leg in, push it out) and holds against the physician’s barrier for five to 21 seconds, depending on what the doctor thinks is necessary.
- After the count, the patient is asked to release all force but not move the limb from its location, thus allowing the muscles to relax completely.
- The physician moves the patient’s limb to the next barrier of pain, a new position further along the range of motion that was not possible before the session.
- Steps 3 through 6 are repeated not more than five times in one session, as this allows the greatest change in range of motion without causing inflammation or rebound pain.
- Somatic assessment is again made to judge how much correction has taken hold and whether further sessions are required.
When MET Is Appropriate
Be advised that not every type of pain and range restriction is suitable to treat with MET. For best results, MET is most suited for decreased range of motion caused by muscle spasm and tightness, hypertonic and hypotonic muscles (too tight or too lax), altered joint position, and decreased elasticity in ligaments and muscles. Barring serious physical traumatic injury, people suffering stiffness, pain and limited range of motion in the legs, hips, low back, pelvis, mid back, shoulders and neck have been treated. This technique has even been successful in alleviating edema and respiratory dysfunctions.
The important thing is to consult your physician and ask if he is skilled in MET. If he is not and if your pain and range of motion are taking a toll, tell him that you are interested in learning more about it and ask for a referral to a practitioner. It is gentler and more specific than PNF and other, similar, physical therapy and sports medicine modalities. I studied several such methods and prefer to use MET with my clients. Being assessed properly is essential to determine which joint structures or muscle groups are out of balance or alignment. This can be tricky to determine if one is untrained in the somatic diagnosis method, and so finding an educated practitioner is advised.