Clarifying the Muscle Energy Technique

I recently heard from a reader who’d been struggling with SI joint dysfunction for several years.  One of the things she she mentioned is that she’d previously seen a physical therapist who was certified in the muscle energy technique, yet hadn’t experienced any benefit from her sessions.

Her email brought a few things to mind, which I wanted to clarify for anyone else in a similar situation.

What is the Muscle Energy Technique?

It’s a form of manual therapy, or “hands-on” therapy.  To me, the name sounds a little bit more new-agey than it needs to.

The kind of Muscle Energy Technique that I use simply means you are using muscle contractions to move your joints into place.  (There is no special “energy” involved, other than muscles moving).

You should feel a benefit immediately.

This reader’s experience actually reminded me of part of my story.

I had to go through five physical therapists before I found my PT Paula, who really helped me.  She’s the one who taught me to use the MET to realign my own hips.

However, the third physical therapist I saw on my journey was also trained in MET.  Technically, anyway.

However, this PT’s adjustments didn’t help me at all.  Ironically, I had scheduled some of my visits directly after my chiropractic adjustments.  My original thinking had been that it would be good to have my joints in place, so that I’d be more likely to be able to do any exercises she wanted to give me.

But the whole thing was really a joke.  Somehow, even though I felt that I was mostly in a good place, she still found multiple “imbalances” in my alignment which she believed needed to be corrected.   I never perceived any improvement from the things she did.

A year or so later, when Paula finally showed me her version of the MET– and how to use it on myself– I realized that it was possible to feel benefits immediately.

Unfortunately, finding someone who really knows what they’re talking about might not be as easy as finding someone who has the right certification on paper.

As I’ve explored the PT field more, I’ve realized that there are many different schools and institutions which offer additional trainings for PT on a continuing ed basis.  (This would be how a PT receives additional certification in something like MET, which they aren’t required to be familiar with in order to become licensed).

The sad truth is that, although different trainings can have the same name, they are not all necessarily created equal.

So, don’t waste your time on having multiple visits with someone who performs MET (or similar manual therapy) if you don’t perceive an improvement quickly.

***

How I use MET

Again, the form of MET that Paula showed me was fairly straightforward.  I only ever used it to correct one specific pattern of dysfunction, and that turned out to be all I needed.

That pattern is the forward and backward rotation of the hip bones (known as the ilia) in relation to the base of the spine (known as the sacrum).  When you have sacroiliac joint dysfunction, the ligaments that are supposed to hold the ilia in place become stretched out, and don’t completely do their job, allowing things to move around too much.

250px-sacroiliac_joint-svg

However, if you learn to use the MET correctly, you can learn to identify which way your hip bones are rotated (it’s not always easy to tell) and use muscle contractions to move them back into place.

I have been looking for a helpful video and/or visual aide on the MET for you.

So far, I haven’t found anything perfect.

I have found a few videos from physical therapists, which actually do include the MET, however the explanations aren’t great, and for some reason it’s lumped in with other exercises.

MET is not something you do for exercise, although it certainly can strengthen the muscles you’re using as a side effect.

But really, what you are doing is contracting the hip flexors on the side that is rotated backward, in order to move the hip bone forward:

Anterior_Hip_Muscles_2

And you are contracting the hip extensors, on the side that is rotated forward, in order to move the hip bone backwards:

posterior_hip_muscles_3

I know this is not the easiest thing to understand– you definitely need a trained PT to show you how to do it.  The point of this post is mainly to show you what you’re looking for, so you don’t waste time on a PT like my second PT!

Below is one video that gives you sort of an idea of what you’re supposed to do.  You will be lying down on your back, and pushing against your legs in a way so that your leg doesn’t actually move– instead, you are providing resistance against it with your hands (or, if that’s too hard, you can also use something like a foam roller).

In this video, the first exercise– the “Knee to Chest” isometric– is actually what you would do to contract the hip flexors and rotate the hip bone forward:

However, the problem with this video is that to use the MET correctly, you would only be performing this on one side.

You’d be performing a motion that looks similar– but actually has a very different effect– in order to rotate the hip bone backwards on the opposite side.

***

I know this is a bit complicated, but I hope this post can at least get you pointed in the right direction.  I definitely value your feedback about what sorts of posts are helpful for not, as I try to clarify my explanations.

Here are a few links you might find helpful:

My main page on the Muscle Energy Technique with links to a few additional resources on MET.

What happens when an SI joint gets stuck?  This post describes the problem you’ll be using MET to correct.

SI Joint Concepts: Useful Terminology A brief primer on what some of the anatomy down there is.

As always, hope this was helpful!  Please feel free to drop me a line.

 

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