SOFT TISSUE MASSAGE THERAPY

Golgi organ capsule

Muscle fibres

Collagen fibrils running

lengthwise

BOX 1: CLINICAL APPLICATION OF MET AND PNF BASED ON CHAITOW 2001, GOODRIDGE AND KUCHERA 1997, LEWIT AND SIMONS 1984 (8,9,17)

MET 1. Target muscle is stretched to a position until resistance barrier is met

Held for 15 seconds

Tendon bundle

Sensory nerve and branches interweaving with collagen fibrils

Figure 2: Golgi tendon organ

The biomechanical theory involves a viscoelastic response of the muscle tendon unit (3,23).

Clinical considerations of MET and PNF Box 1 describes the main steps in conducting MET and PEF. Note that the patient must breathe normally throughout this procedure.

In "acute" conditions, the isometric contraction should start at the resistance barrier, but in chronic conditions it starts short of the barrier. In acute conditions MET is applied to the new resistance barrier but in chronic conditions it is applied to the previous resistance barrier with a sustained stretch. In this setting, "acute" means a strain or injury that occurred in the last 3 weeks. If there are symptoms of pain or active inflammation, activation of the antagonist would be more appropriate. There are a number of common errors met during application of MET and PNF and these are summarised in Box 2. These errors usually result from inadequate instruction or proprioceptive feedback from the clinician.

CONCLUSION

The lack of consensus on the classification and application of MET and PNF results in equivocal research for both techniques. On the whole, it seems MET is slower to apply than PNF, using just 25% contraction of muscle to decrease the risk of tissue provocation. True PNF is used for work on movement patterns and recruitment of muscle fibres. As with any manual therapy techniques, the effectiveness of each of them depends on accurate diagnosis, using an appropriate level of force and sufficient localisation of the targeted muscle. Box 3 contains a number of valuable tips for your work with MET and PNF.

References 1. Davis SD, Ashby PE, McCale KL, McQuain JA, Wine JM. The effectiveness of three stretching techniques on hamstring flexibility using consistent stretching parameters. Journal of

www.sportEX.net

BOX 2: COMMON ERRORS IN APPLICATION OF PNF AND MET BASED ON GREENMAN 1989 AND CHAITOW 2001 (7,9)

Patient-related errors

n Contraction is incorrect, in the wrong direction or not sustained for long enough n The patient does not relax completely after the contraction n The patient starts or finishes the contraction too quickly (rather than a slow build up)

Clinician-related errors

n Inaccurate positioning of joint or muscle in relation to resistance barrier n Inadequate application of counter-force n Movement of muscle to new position too quick (prevents latency in the muscle tone) n Patient given inadequate instructions n Muscle not maintained in stretch position for long enough

15

2. Patient SLOWLY resists 20–25% of maximum strength of either target muscle (PIR) or opposing muscle (IR) which is matched by the clinician to produce isometric contraction with no movement

Held for 7–10 seconds

3. Patient relaxes completely while clinician finds new resistance barrier

Relaxed for about 5 seconds

4. New barrier is found Held for 15 seconds

5. Whole procedure repeated three times

DEFINITION OF MET.

THERE IS A LACK OF CONSENSUS ON A

PNF 1. Target muscle is stretched to a position until resistance barrier is met

Held for 15 seconds

2. Patient IMMEDIATELY resists 75% or more of maximal strength of either target muscle (CR) or opposing muscle (HR) Held for 7–15 seconds

3. Patient relaxes completely Relaxed for 2–3 seconds

4. Patient IMMEDIATELY places limb into passive stretch further than initial barrier Held for 10–15 seconds

5. Patient relaxes completely Relaxed for 20 seconds

6. Procedure repeated three times