Osteopathic Manipulative Treatment: Muscle Energy Procedure With Post-Isometric Relaxation - Thoracic Vertebrae

Muscle energy technique, commonly known as MET, is a form of manual therapy and stretching used in osteopathy. The patient actively contracts muscles in a precise direction while the therapist provides counterforce resistance. Isometric contractions relax and lengthen muscles. The technique is often regarded as direct, as the patient is placed toward the barrier.  In 1948, Fred Mitchell, Sr, DO, developed the technique after deducing the kinematic motions in the pelvis. From these concepts, he started to treat these somatic dysfunctions using muscle action as an activating force. Osteopathic physicians typically use MET to correct somatic dysfunction that causes pain and discomfort, especially when performing therapy on the thoracic spine. There are 9 physiologic principles to muscle energy: joint mobilization using muscle force, respiratory assistance, oculocephalic reflex, reciprocal inhibition, crossed extensor reflex, isokinetic strengthening, isolytic lengthening, muscle force in one region of the body to achieve movement in another and post-isometric relaxation. Out of these 9, post-isometric relaxation is the most commonly performed MET.  Dr Mitchell, Sr initially hypothesized that after an isometric contraction, the muscle is in a refractory state where it may be passively stretched without a reflexive contraction. MET with post-isometric relaxation involves putting increased tension on the muscle fibers by asking the patient to contract against a barrier; this activates the Golgi tendon fibers. Once activated, there is a reflexive inhibition and relaxation of the muscle through the Ia fibers, and the clinician may further passively stretch the muscle due to the refractory state.