Muscle energy technique
Muscle Energy Techniques (METs) describes a broad class of manual therapy techniques directed at improving musculoskeletal function or joint function, and improving pain. METs are commonly used by manual therapists, physical therapists, occupational therapist, chiropractors, athletic trainers, osteopathic physicians, and massage therapists. Muscle energy requires the patient to actively use his or her muscles on request to aid in treatment. Muscle energy techniques are used to treat somatic dysfunction, especially decreased range of motion, muscular hypertonicity, and 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. It was first described in 1948 by Fred Mitchell, Sr, D.O. Pathophysiology. Injury can occur as a result of trauma, accidents, overuse, strain/sprain, etc., not all of which should be treated with muscle energy. These techniques are most appropriate for the following injury patterns: Mechanism of action for muscle energy techniques. Muscle energy is a direct and active technique; meaning it engages a restrictive barrier and requires the patient's participation for maximal effect. A restrictive barrier describes  the limit in range of motion that prevents the patient from being able to reach the baseline limit in his range of motion. As the patient performs an isometric contraction, the following physiologic changes occur: Despite the many claims made regarding the efficacy of these techniques, there are only two peer-reviewed studies that have shown that muscle energy techniques can significantly decrease disability and improve functionality in patients with disorders such as low back pain. Indications and contraindications. Muscle energy techniques can be employed to reposition a dysfunctional joint and treat the affected musculature. Indications include, but are not  limited to: muscular shortening, low back pain, pelvic imbalance, edema, limited range of motion, somatic dysfunction, respiratory dysfunction, cervicogenic headaches, and many others. These techniques are inappropriate when a patient has injuries such as fractures, avulsion injuries, severe osteoporosis, open wounds, or has metastatic disease. Additionally, because these techniques require active patient participation, they are inappropriate for any patient that is unable to cooperate. Techniques. Muscle energy techniques can be applied to most areas of the body. According to one textbook, each technique requires 8 essential steps: Types. There are several different types of muscle energy techniques: Effectiveness. A 2015  Cochrane review concluded that Muscle Energy Technique is not effective for patients with low back pain, and that the quality of the research testing the effectiveness of MET is poor.