Osteopathic technique
Muscle energy
MET
What it is
The joint or muscle is taken to its restricted barrier. The patient gently pushes against the clinician’s equal counterforce, relaxes, and the clinician takes up the new barrier.
How it’s done
The patient gently pushes against the clinician’s equal counterforce, so nothing moves (an isometric contraction). Then the patient relaxes and the clinician takes the joint or muscle to its new barrier. This is repeated a few times, then retested. MET is direct and active, with no thrust.
A typical recipe: light effort (about 10–20%), hold 5–10 s, relax 3–5 s, 3–5 rounds. Most regional chapters use 3–5 s holds.
Two common forms: post-isometric relaxation (the patient pushes away from the barrier) and reciprocal inhibition (the patient pushes into the barrier, using the opposite muscle).
MET techniques by region
31 techniques from the StatPearls osteopathic MET chapters, summarised in our own words. Full set-ups and photos are in each chapter (linked under each table); they are not reproduced here.
Neck · 3
| Joint or muscle | What is done | Position |
|---|---|---|
| OA joint | Head taken into the barrier (opposite each plane of the diagnosis) while one hand monitors the OA joint. The patient tries to bring the head back to neutral for 3–5 s. Re-engage the barrier; 3–5 rounds. | Supine, clinician at the head |
| AA joint | Neck flexed to lock the levels below, head rotated toward the barrier. The patient turns back toward neutral for 3–5 s; 3–5 rounds. | Supine |
| C2–C7 | Articular pillar monitored. Head taken into flexion/extension, side-bend and rotation toward the barrier. The patient pushes back toward neutral for 3–5 s; 3–5 rounds. | Supine |
Thoracic spine · 3
| Joint or muscle | What is done | Position |
|---|---|---|
| Upper thoracic (T1–T4) | Head and neck used as the lever, transverse process monitored. The patient tries to return the head to upright against equal counterforce for 3–5 s, then relaxes 3–5 s. 3–5 rounds, then a final passive stretch. | Seated (clinician behind) or supine |
| Lower thoracic (T5–T12) | Trunk used as the lever: arms crossed, side-bend through the shoulder/axilla, rotation to the barrier. Same contract-relax cycle. | Seated |
| Group curve (type 1, neutral) | Treat the apex of the curve first. | Seated |
Ribs · 6
| Joint or muscle | What is done | Position |
|---|---|---|
| Ribs 1–2 (exhaled) | Rib angle held and drawn inferolaterally on inhalation. Wrist on the forehead, head turned about 40° away. The patient holds the breath and lifts the head (scalenes) for 3–5 s, then relaxes 5 s; repeat. | Supine |
| Ribs 3–5 (exhaled) | Same rib-angle hold. The patient pulls the arm toward the opposite hip (pectoralis minor) for 3–5 s. | Supine |
| Ribs 6–8 (exhaled) | Arm abducted 90°. The patient pushes the arm forward (serratus anterior) for 3–5 s. | Supine |
| Ribs 9–10 (exhaled) | Arm overhead. The patient brings the elbow down to the side (latissimus dorsi) for 3–5 s. | Supine |
| Ribs 11–12 (exhaled) | Arm overhead. The clinician holds the ASIS and the lower rib, helps the rib up on inhalation and stops it dropping on exhalation; at least 3 cycles. | Prone |
| Inhaled rib group | Key rib = the lowest of the group. Clinician at the head with fingers on top of the key rib. Flexion (ribs 2–5) or side-bend (ribs 6–10) to the barrier. The patient breathes out and holds the exhalation for 3–5 s while the clinician takes up the slack; 3–5 rounds. | Supine |
Jawed et al. · StatPearls 2024 · Flodine & Thomas · StatPearls 2023
Lumbar spine & psoas · 4
| Joint or muscle | What is done | Position |
|---|---|---|
| Lumbar, type 1 (neutral) group | The patient pushes into side-bend and rotation against resistance: about 30% effort, 3–5 s, 3–5 rounds. | Seated, straddling the table |
| Lumbar, type 2 flexed segment | Taken into extension to the barrier. The patient pushes into flexion/side-bend/rotation. | Seated, straddling the table |
| Psoas | The patient pushes the front of the hip into the table. The clinician then takes the hip further into extension; 3–5 s, 3–5 rounds. | Prone |
| Psoas | Leg off the end of the table, other knee to the chest. The patient lifts the knee; the clinician then takes the hip into extension. | Supine |
Lafans & Troncoso · StatPearls 2024 · Eldemire & Goto · StatPearls 2023
Pelvis & piriformis · 6
| Joint or muscle | What is done | Position |
|---|---|---|
| Piriformis | Foot crossed over the opposite knee. The clinician takes the knee medially and the patient pushes back; 3–5 s, 3 rounds. | Supine |
| Pubic symphysis | Knees bent to 90° or more, feet together. The patient squeezes the knees against the clinician’s forearm, then pushes them apart against resistance (about 3 counts each). Up to 3 rounds, then a short bridge and recheck. | Supine, knees bent |
| Innominate, anterior rotation | Hip and knee flexed to the barrier. The patient pushes the leg back down (hip extensors) for 3–5 s; 3–5 rounds. | Supine |
| Innominate, posterior rotation | Leg dropped off the side of the table, knee pressed down into hip extension. The patient lifts the knee (hip flexors) for 3–5 s; 3–5 rounds. | Supine |
| Innominate, inflare | Figure-4 position, knee pressed toward the table. The patient lifts the knee (adductors) for 3–5 s. | Supine |
| Innominate, outflare | Hip flexed 90°, knee pushed medially. The patient pushes outward (abductors) for 3–5 s. | Supine |
Malhotra & Bordoni · StatPearls 2023 · Xu & Vilella · StatPearls 2024
Sacrum · 3
| Joint or muscle | What is done | Position |
|---|---|---|
| Forward torsion | Axis side down. Trunk rotated to lock above L5, hips flexed to S2, legs lowered off the table. The patient lifts both feet toward the ceiling for about 5 s; 3–5 rounds. | Sims position (semi-prone, side-lying) |
| Backward torsion | Axis side down. Trunk rotated back, top leg dropped off the table. The patient lifts the leg for about 5 s; 3–5 rounds. | Side-lying |
| Unilateral flexion or extension | Breathing-assisted: the clinician follows the sacrum with one breath phase and holds it during the other; 3–5 cycles. | Prone (extension: up on the elbows) |
Shoulder girdle · 3
| Joint or muscle | What is done | Position |
|---|---|---|
| AC joint, internally rotated | A “handshake” hold takes the shoulder into external rotation to the barrier. The patient rotates inward for 3–5 s; 3–5 rounds. | Seated |
| SC joint, adducted clavicle | Arm abducted 90°, thumb down, against the clinician’s thigh. The patient pushes into the thigh for 3–5 s. The clinician presses the SC joint down and abducts further; 3–5 rounds. | Supine |
| SC joint, horizontally extended clavicle | The patient’s arm goes around the clinician’s shoulder. The patient pulls the shoulder blade toward the table for 3–5 s. The clinician pushes the SC joint back and brings the shoulder forward; 3–5 rounds. | Supine |
Jaw (TMJ) · 1
| Joint or muscle | What is done | Position |
|---|---|---|
| TMJ | Mandible taken to the restriction barrier. The patient slowly opens the mouth against equal resistance for 3–5 s. Find the new barrier; 3–5 rounds. Stop if the patient feels dizzy or nauseous. | Supine, clinician at the head |
Knee (fibular head) · 2
| Joint or muscle | What is done | Position |
|---|---|---|
| Fibular head, anterior | Head pushed posteromedially, foot into plantarflexion/supination. The patient resists; 3–5 s, 3–5 rounds. | Supine or seated, knee at 90° |
| Fibular head, posterior | Head drawn anterolaterally, foot into dorsiflexion/pronation. The patient resists; 3–5 s, 3–5 rounds. | Supine or seated, knee at 90° |
Myth vs evidence
Kay et al. · Med Sci Sports Exerc 2015 · Mitchell et al. · J Sport Rehabil 2007 · Sharman et al. · Sports Med 2006 · Magnusson et al. · J Physiol 1996
Waxenbaum & Sina · StatPearls 2026 · Mitchell et al. · J Sport Rehabil 2009 · Sharman et al. · Sports Med 2006
How might it help?
- Leading model: the nervous system changes how it perceives stretch and pain, plus a short-lived drop in muscle-tendon stiffness.
- One small study (12 people without symptoms) found lower spinal reflex and corticospinal excitability after a lumbosacral MET.
- Honest caveat: in low back pain, a Cochrane review found low-quality evidence that MET adds nothing to other treatment, and not enough evidence to say whether it works.
- Other reviews are more positive: neck pain, lateral elbow pain and range of motion. For hamstring flexibility, MET had a small edge over stretching on one of two measures.
Sharman et al. · Sports Med 2006 · Kay et al. · Med Sci Sports Exerc 2015 · Fryer & Pearce · J Bodyw Mov Ther 2013 · Franke et al. · Cochrane 2015 · Thomas et al. · Chiropr Man Therap 2019 · Kang et al. · Healthcare 2023
Body map: where MET is graded
Tap a region to see how MET applied there is graded on our condition pages. Filled automatically from those grades.
How it’s done, by region
The neck is positioned against the restricted barrier. The patient gently pushes back toward neutral for 3–5 seconds against equal resistance, relaxes, and the neck is taken to the new barrier. Repeat 3–5 times, then re-check.
- Reference bookStenersen & Bordoni · StatPearls 2024
The muscle is taken to the edge of its available range. The patient makes a light contraction (about 10–20% effort) against an unyielding counterforce for 5–10 seconds, then fully relaxes for 3–5 seconds, and the new range is taken up. Repeat a few times, then re-check.
- Reference bookWaxenbaum & Sina · StatPearls 2026
Usually seated (or side-lying). The lumbar segment is taken to its restricted barrier in side-bending and rotation. The patient gently pushes toward the free direction for 3–5 seconds against equal resistance, relaxes, and the new barrier is taken up. Repeat 3–5 times, then re-check.
- Reference bookLafans & Troncoso · StatPearls 2024
The innominate (or pubis) is taken to its restricted barrier. The patient makes a short, gentle contraction against equal resistance (a few seconds), relaxes, and the new barrier is taken up. Repeat, then re-check pelvic landmarks. Check for pubic dysfunction first, with consent.
- Reference bookXu & Vilella · StatPearls 2024
The hip is taken into extension to the barrier (prone, or supine with the leg off the table). The patient pulls the hip toward flexion for 3–5 seconds against equal resistance, relaxes, and the hip is taken further into extension. Repeat 3–5 times, then re-check.
- Reference bookEldemire & Goto · StatPearls 2023
MET: supine, the affected foot rests beside the opposite knee and the knee is taken across to the barrier; the patient pushes back gently against resistance, relaxes, and the stretch is taken up. Counterstrain: prone, the leg is hung off the table with the hip flexed, abducted and externally rotated until the tender point eases, held 90 seconds.
- Reference bookMalhotra & Bordoni · StatPearls 2023
Seated or supine. The restricted segment is localised (using the head and neck as a lever for T1–T4, the trunk for T5–T12) and taken to its barrier while the transverse process is monitored. The patient gently pushes back toward neutral for a few seconds against equal resistance, relaxes, and the new barrier is taken up. Repeat, then re-check.
- Reference bookTalley & Goto · StatPearls 2023
Treat the matching thoracic segment first, or the rib correction often does not hold. With the patient supine, the practitioner holds the affected rib at its angle. The patient breathes in, holds the breath for 3–5 seconds and gently contracts a muscle attached to that rib (for example the scalenes for ribs 1–2) against equal resistance, then relaxes. Take up the new barrier and repeat.
- Reference bookJawed et al. · StatPearls 2024
Patient supine. Find the restriction by watching the jaw deviate on slow opening and gently gliding the mandible. With the jaw held at the barrier, the patient slowly opens against equal resistance for 3–5 seconds, relaxes, and the jaw is taken to the new barrier. Repeat 3–5 times, then re-check opening.
- Reference bookNahian & Mathew · StatPearls 2023
Take the arm to the barrier in horizontal adduction or internal rotation. The patient gently pushes back (horizontal abduction or external rotation) against equal resistance at 10–20% effort for 5–10 seconds, then relaxes for 3–5 seconds, and the arm is taken to the new barrier. Repeat 3–5 times, then re-check range.
- Journal articleMoore et al. · J Orthop Sports Phys Ther 2011
- Reference bookWaxenbaum & Sina · StatPearls 2026
- Reference bookDowning & Bordoni · StatPearls 2023
Patient seated or supine. Monitor the AC or SC joint with one hand and use the arm as a lever to take the joint to its barrier (for example, external rotation for an internally rotated AC joint, or more abduction for an adducted clavicle). The patient pushes gently against isometric resistance for 3–5 seconds, relaxes, and the joint is taken to the new barrier. Repeat 3–5 times, then re-check.
- Reference bookDowning & Bordoni · StatPearls 2023
The muscle (for example the hamstrings, adductors or rectus femoris) is taken to its barrier. The patient pushes gently, at about 10–20% effort, against resistance for 5–10 seconds, relaxes for 3–5 seconds, and the new barrier is taken up.
- Reference bookWaxenbaum & Sina · StatPearls 2026
Patient supine or seated with the knee bent to 90°. Draw the fibular head toward its restricted direction while taking the foot to its barrier (plantarflexion and supination, or dorsiflexion and pronation). The patient pushes the ankle gently against resistance for 3–5 seconds, relaxes, and the new barrier is taken up. Repeat 3–5 times, then re-check fibular head motion.
- Reference bookDecker et al. · StatPearls 2024
The calf is taken to its barrier by dorsiflexing the ankle. The patient pushes the foot gently down, at about 10–20% effort, against resistance for 5–10 seconds, relaxes for 3–5 seconds, and the new barrier is taken up.
- Reference bookWaxenbaum & Sina · StatPearls 2026
The wrist or forearm is taken to the barrier of the tight muscle group (wrist extensors or flexors, pronators or supinators). The patient pushes gently back, at about 10–20% effort, against resistance for 5–10 seconds, relaxes for 3–5 seconds, and the new barrier is taken up.
- Reference bookWaxenbaum & Sina · StatPearls 2026
The muscle is taken to its barrier. The patient pushes gently, at about 10–20% effort, against resistance for 5–10 seconds, relaxes for 3–5 seconds, and the new barrier is taken up.
- Reference bookWaxenbaum & Sina · StatPearls 2026
Evidence by condition
Filled automatically from the grades on each condition page. It grows as each body region is finished.
| Condition | Technique | Grade | In short |
|---|---|---|---|
| Cervical Facet SyndromeNeck | Muscle energy, cervical (C2–C7) | Grade C Limited evidence: indirect or low-quality support only | One trial in chronic neck pain: MET beat usual physio and matched facet mobilisation. |
| Cervical SpondylosisNeck | Muscle energy, cervical (C2–C7) | Grade C Limited evidence: indirect or low-quality support only | One small trial in cervical spondylosis. Adding MET improved neck position sense, but not pain or disability. |
| Cervicogenic HeadacheHeadache | Muscle energy, cervical (C2–C7) | Grade C Limited evidence: indirect or low-quality support only | MET plus exercise ranked among the effective options for short-term headache intensity. This comes from a network meta-analysis, not head-to-head trials. |
| Frozen ShoulderShoulder | Muscle energy, glenohumeral (posterior shoulder) | Grade C Limited evidence: indirect or low-quality support only | MET tended to beat usual conservative care in frozen shoulder, with low to very low certainty. Adding MET boosted the Spencer technique's effect. |
| Lumbar Facet SyndromeLower Back | Muscle energy, lumbar | Grade C Limited evidence: indirect or low-quality support only | Indirect: from chronic low back pain trials. Small pain benefit in one review, none in a Cochrane review. |
| Non-Specific Low Back PainLower Back | Muscle energy, lumbar | Grade C Limited evidence: indirect or low-quality support only | Small pain benefit in one review; a Cochrane review found no added benefit. Trials are small. |
| Non-Specific Neck PainNeck | Muscle energy, cervical (C2–C7) | Grade C Limited evidence: indirect or low-quality support only | 26 trials, low certainty. Helped pain only when added to other treatment, not on its own. |
| Piriformis SyndromeHip | Muscle energy and counterstrain, piriformis | Grade C Limited evidence: indirect or low-quality support only | Two small trials: an MET-based protocol beat positional release, and post-facilitation stretching beat ELDOA. Neither had a sham group. |
| Rotator Cuff TendinopathyShoulder | Muscle energy, thoracic | Grade C Limited evidence: indirect or low-quality support only | Thoracic MET beat placebo for pain and disability in shoulder impingement, up to 1 year. This is one trial of 75 patients. |
| Sacroiliac Joint DysfunctionLower Back | Muscle energy, pelvis (innominate and pubis) | Grade C Limited evidence: indirect or low-quality support only | MET reduced pain and disability, about as much as other therapies. Small trials. |
| Shoulder Impingement SyndromeShoulder | Muscle energy, thoracic | Grade C Limited evidence: indirect or low-quality support only | Thoracic MET beat placebo for pain and disability in shoulder impingement, up to 1 year. This is one trial of 75 patients. |
| Subacromial BursitisShoulder | Muscle energy, thoracic | Grade C Limited evidence: indirect or low-quality support only | Thoracic MET beat placebo for pain and disability in shoulder impingement, up to 1 year. This is one trial of 75 patients. |
| Supraspinatus TendonitisShoulder | Muscle energy, thoracic | Grade C Limited evidence: indirect or low-quality support only | Thoracic MET beat placebo for pain and disability in shoulder impingement, up to 1 year. This is one trial of 75 patients. |
| Temporomandibular DisorderHeadache | Muscle energy, TMJ (facial MET) | Grade C Limited evidence: indirect or low-quality support only | MET to the chewing muscles improved mouth opening, pain and jaw deviation in a review of 7 studies. The studies had risk of bias. |
| Temporomandibular DisorderHeadache | Muscle energy, cervical (C2–C7) | Grade C Limited evidence: indirect or low-quality support only | Neck manual therapy reduced jaw pain more than placebo, with moderate evidence. MET was not tested on its own. |
| Tennis ElbowElbow | Muscle energy, elbow and forearm | Grade C Limited evidence: indirect or low-quality support only | In two small trials, MET did better than a steroid injection at 6 and 12 months, and matched mobilisation with movement when added to home exercise. |
Show 121 more pairings graded D or “no trials found”
| Cervical Disc HerniationNeck | Muscle energy, cervical (C2–C7) | Grade D Low evidence: expert consensus or could not be verified against literature | No trial comparing MET with usual care or sham in radiculopathy was found. |
| Cervical RadiculopathyNeurological | Muscle energy, cervical (C2–C7) | Grade D Low evidence: expert consensus or could not be verified against literature | No trial comparing MET with usual care or sham in radiculopathy was found. |
| CostochondritisMid Back | Muscle energy, thoracic | Grade D Low evidence: expert consensus or could not be verified against literature | No trials. A small case series treating the upper back and ribs with manual therapy and exercise reported improvement. |
| Ehlers-Danlos SyndromeOther | Muscle energy, general (affected muscle) | Grade D Low evidence: expert consensus or could not be verified against literature | No trials of this technique on its own in hypermobility. A 2024 scoping review found only weak evidence for manual therapy; exercise and motor training had the best evidence. |
| Golfer's ElbowElbow | Muscle energy, elbow and forearm | Grade D Low evidence: expert consensus or could not be verified against literature | No trials in golfer’s elbow. In tennis elbow, MET did better than a steroid injection at 6 and 12 months in one trial. |
| Hypermobility Spectrum DisorderOther | Muscle energy, thoracic | Grade D Low evidence: expert consensus or could not be verified against literature | No trials of this technique on its own in hypermobility. A 2024 scoping review found only weak evidence for manual therapy; exercise and motor training had the best evidence. |
| Iliopsoas BursitisHip | Muscle energy, psoas | Grade D Low evidence: expert consensus or could not be verified against literature | No trials in iliopsoas bursitis. A reference chapter describes MET and counterstrain procedures for the psoas. |
| Lumbar Disc HerniationLower Back | Muscle energy, lumbar | Grade D Low evidence: expert consensus or could not be verified against literature | No trials in disc-related leg pain. Indirect evidence from non-specific low back pain only. |
| Lumbar RadiculopathyNeurological | Muscle energy, lumbar | Grade D Low evidence: expert consensus or could not be verified against literature | No trials in disc-related leg pain. Indirect evidence from non-specific low back pain only. |
| Medial Tibial Stress SyndromeFoot & Ankle | Muscle energy, calf (gastrocnemius and soleus) | Grade D Low evidence: expert consensus or could not be verified against literature | No trials of calf muscle energy technique in MTSS. Reviews found stretching and strengthening exercise unproven. |
| MigraineHeadache | Muscle energy, cervical (C2–C7) | Grade D Low evidence: expert consensus or could not be verified against literature | No trials of MET on its own in migraine. Only indirect evidence from whole osteopathic treatment. |
| Mortons NeuromaFoot & Ankle | Muscle energy, calf (gastrocnemius and soleus) | Grade D Low evidence: expert consensus or could not be verified against literature | No trials in Morton neuroma. StatPearls recommends calf and Achilles stretching to cut forefoot pressure from a tight calf (equinus). |
| Myofascial Pain SyndromeOther | Muscle energy, general (affected muscle) | Grade D Low evidence: expert consensus or could not be verified against literature | No controlled trials. In one large uncontrolled series, post-isometric relaxation gave immediate relief in most treated muscles. |
| Osgood-Schlatter DiseasePaediatric | Muscle energy, hip and thigh muscles | Grade D Low evidence: expert consensus or could not be verified against literature | No trials of MET. Hamstring stretching is a recommended add-on, and stretching looks helpful in a review of low-quality studies. |
| OsteoporosisOther | Muscle energy, lumbar | Grade D Low evidence: expert consensus or could not be verified against literature | No trials of this technique on its own in osteoporosis. One small trial found an osteopathic treatment package beat sham for quality of life, but not for pain. |
| Peroneal TendinopathyFoot & Ankle | Muscle energy, fibular head (proximal tibiofibular joint) | Grade D Low evidence: expert consensus or could not be verified against literature | No trials in peroneal tendinopathy. StatPearls notes fibular head dysfunction can contribute to ankle pain. |
| Perthes DiseasePaediatric | Muscle energy, psoas | Grade D Low evidence: expert consensus or could not be verified against literature | No trials of MET. Hip flexor and adductor stretching is part of non-operative care. |
| Plantar FasciitisFoot & Ankle | Muscle energy, calf (gastrocnemius and soleus) | Grade D Low evidence: expert consensus or could not be verified against literature | No trials of calf muscle energy technique in plantar fasciitis. Calf and plantar fascia stretching is part of first-line care. |
| Post-Concussion HeadacheHeadache | Muscle energy, thoracic | Grade D Low evidence: expert consensus or could not be verified against literature | No trials after concussion. Indirect: neck and vestibular rehab is recommended for lingering neck symptoms. |
| Postural SyndromeOther | Muscle energy, lumbar | Grade D Low evidence: expert consensus or could not be verified against literature | No trials of lumbar MET in postural syndrome. In upper crossed syndrome, MET was part of effective exercise programmes. |
| Postural SyndromeOther | Muscle energy, psoas | Grade D Low evidence: expert consensus or could not be verified against literature | No trials of psoas MET in postural syndrome. In a 2022 meta-analysis, manual therapy did not change anterior pelvic tilt. |
| Rotator Cuff TearShoulder | Muscle energy, thoracic | Grade D Low evidence: expert consensus or could not be verified against literature | No trials in rotator cuff tears. Thoracic MET beat placebo in shoulder impingement in one trial. |
| SciaticaLower Back | Muscle energy, lumbar | Grade D Low evidence: expert consensus or could not be verified against literature | No trials in disc-related leg pain. Indirect evidence from non-specific low back pain only. |
| ScoliosisMid Back | Muscle energy, thoracic | Grade D Low evidence: expert consensus or could not be verified against literature | No trials of MET in scoliosis. Manual therapy helped only as an add-on to exercise or other care. |
| Sever's DiseasePaediatric | Muscle energy, calf (gastrocnemius and soleus) | Grade D Low evidence: expert consensus or could not be verified against literature | No trials of calf MET. Calf stretching is a recommended part of care. |
| SLAP LesionShoulder | Muscle energy, glenohumeral (posterior shoulder) | Grade D Low evidence: expert consensus or could not be verified against literature | No trials in SLAP tears. In baseball players, posterior shoulder MET improved range straight away. |
| Tarsal Tunnel SyndromeNeurological | Muscle energy, calf (gastrocnemius and soleus) | Grade D Low evidence: expert consensus or could not be verified against literature | No trials found. A reference chapter lists calf stretching as possibly helpful. |
| Tennis ElbowElbow | Muscle energy, cervical (C2–C7) | Grade D Low evidence: expert consensus or could not be verified against literature | No trials of cervical MET in tennis elbow. Neck manipulation and cervical SNAGs helped as add-ons in trials. |
| Tension HeadacheHeadache | Muscle energy, cervical (C2–C7) | Grade D Low evidence: expert consensus or could not be verified against literature | No trials of MET on its own in tension-type headache. Manual therapy in general improved pain, frequency and neck movement. |
| Thoracic Facet SyndromeMid Back | Muscle energy, thoracic | Grade D Low evidence: expert consensus or could not be verified against literature | No trials in the mid back. Indirect: a review found MET effective for chronic neck pain. |
| Thoracic Mechanical PainMid Back | Muscle energy, thoracic | Grade D Low evidence: expert consensus or could not be verified against literature | No trials in the mid back. Indirect: a review found MET effective for chronic neck pain. |
| Thoracic Outlet SyndromeNeck | Muscle energy, scalenes and upper trapezius | Grade D Low evidence: expert consensus or could not be verified against literature | No trial of this technique alone. One small trial tested a mixed osteopathic package. |
| Achilles TendinopathyFoot & Ankle | Muscle energy, calf (gastrocnemius and soleus) | No trials found | No trials of calf muscle energy technique in Achilles tendinopathy. |
| ACL InjuryKnee | Muscle energy, hip and thigh muscles | No trials found | No trials of hip muscle energy technique in ACL injury. |
| Acromioclavicular Joint SprainShoulder | Muscle energy, AC joint, clavicle and SC joint | No trials found | No trials of AC joint or clavicle MET in AC joint sprains. |
| Acute TorticollisNeck | Muscle energy, cervical (C2–C7) | No trials found | No trials of MET in acute torticollis. |
| Adductor StrainHip | Muscle energy, hip and thigh muscles | No trials found | No trials of adductor MET in adductor strain. |
| Adductor StrainHip | Muscle energy, psoas | No trials found | No trials of hip flexor MET in adductor strain. |
| Adductor StrainHip | Muscle energy, pelvis (innominate and pubis) | No trials found | No trials of pelvic MET in adductor strain. |
| Athletic Groin PainHip | Muscle energy, hip and thigh muscles | No trials found | No trials of adductor MET in athletic groin pain. |
| Athletic Groin PainHip | Muscle energy, pelvis (innominate and pubis) | No trials found | No trials of pubic or pelvic MET in athletic groin pain. |
| Baker's CystKnee | Muscle energy, calf (gastrocnemius and soleus) | No trials found | No trials of calf muscle energy technique in Baker cysts. |
| Calcific TendinitisShoulder | Muscle energy, thoracic | No trials found | No trials of thoracic MET in calcific tendinitis. |
| Carpal Tunnel Syndrome (Neurological)Neurological | Muscle energy, elbow and forearm | No trials found | No trials of forearm muscle energy technique in carpal tunnel syndrome. |
| Chondromalacia PatellaKnee | Muscle energy, hip and thigh muscles | No trials found | No trials of quadriceps muscle energy technique in chondromalacia patellae. |
| Claw ToeFoot & Ankle | Muscle energy, calf (gastrocnemius and soleus) | No trials found | No trials of calf muscle energy technique in claw toe. |
| CoccydyniaLower Back | Muscle energy and counterstrain, piriformis | No trials found | No trials of piriformis MET or counterstrain in coccydynia. |
| Complex Regional Pain SyndromeOther | Muscle energy, thoracic | No trials found | No trials of thoracic or lumbar muscle energy technique in CRPS. |
| Costovertebral Joint SprainMid Back | Muscle energy, ribs | No trials found | No trials of rib muscle energy technique in costovertebral joint sprain. |
| Cubital Tunnel SyndromeElbow | Muscle energy, cervical (C2–C7) | No trials found | No trials of cervical muscle energy technique in cubital tunnel syndrome. |
| De Quervain's TenosynovitisWrist & Hand | Muscle energy, elbow and forearm | No trials found | No trials of forearm muscle energy technique in De Quervain tenosynovitis. |
| Double Crush SyndromeElbow | Muscle energy, cervical (C2–C7) | No trials found | No trials of cervical muscle energy technique in double crush syndrome. |
| Dupuytren's ContractureWrist & Hand | Muscle energy, elbow and forearm | No trials found | No trials of forearm muscle energy technique in Dupuytren disease. |
| Elbow MCL SprainElbow | Muscle energy, elbow and forearm | No trials found | No trials of forearm muscle energy technique in elbow UCL sprain. |
| Elbow MCL SprainElbow | Muscle energy, glenohumeral (posterior shoulder) | No trials found | No trials of shoulder muscle energy technique in elbow UCL sprain. |
| Fat Pad Syndrome (Hoffa's)Knee | Muscle energy, hip and thigh muscles | No trials found | No trials of quadriceps muscle energy technique in fat pad syndrome. |
| Femoroacetabular ImpingementHip | Muscle energy and counterstrain, piriformis | No trials found | No trials of deep hip rotator MET in FAI. |
| Freiberg's DiseaseFoot & Ankle | Muscle energy, calf (gastrocnemius and soleus) | No trials found | No trials of calf muscle energy technique in Freiberg disease. |
| Glenohumeral InstabilityShoulder | Muscle energy, glenohumeral (posterior shoulder) | No trials found | No trials of glenohumeral MET in shoulder instability. |
| Gluteal BursitisHip | Muscle energy, psoas | No trials found | No trials of hip flexor MET in gluteal bursitis. |
| Gluteal TendinopathyHip | Muscle energy, pelvis (innominate and pubis) | No trials found | No trials of pelvic MET in gluteal tendinopathy. |
| Golfer's ElbowElbow | Muscle energy, glenohumeral (posterior shoulder) | No trials found | No trials of shoulder muscle energy technique in medial epicondylitis. |
| Greater Trochanteric Pain SyndromeHip | Muscle energy, psoas | No trials found | No trials of hip flexor MET in GTPS. |
| Guyon's Canal SyndromeWrist & Hand | Muscle energy, elbow and forearm | No trials found | No trials of forearm muscle energy technique in Guyon canal syndrome. |
| Hallux RigidusFoot & Ankle | Muscle energy, calf (gastrocnemius and soleus) | No trials found | No trials of calf muscle energy technique in hallux rigidus. |
| Hallux ValgusFoot & Ankle | Muscle energy, calf (gastrocnemius and soleus) | No trials found | No trials of calf muscle energy technique in hallux valgus. |
| Hammer ToeFoot & Ankle | Muscle energy, calf (gastrocnemius and soleus) | No trials found | No trials of calf muscle energy technique in hammertoe. |
| Hamstring StrainHip | Muscle energy, hip and thigh muscles | No trials found | No trials of hamstring MET in hamstring strain. |
| Heel Fat Pad SyndromeFoot & Ankle | Muscle energy, calf (gastrocnemius and soleus) | No trials found | No trials of calf muscle energy technique in heel fat pad syndrome. |
| Hip Flexor StrainHip | Muscle energy, psoas | No trials found | No trials of psoas MET in hip flexor strain. |
| Hip Labral TearHip | Muscle energy, hip and thigh muscles | No trials found | No trials of hip MET in hip labral tears. |
| Hip OsteoarthritisHip | Muscle energy and counterstrain, piriformis | No trials found | No trials of piriformis MET in hip osteoarthritis. |
| Iliopsoas TendinopathyHip | Muscle energy, psoas | No trials found | No trials of psoas MET in iliopsoas tendinopathy. |
| Infrapatellar BursitisKnee | Muscle energy, hip and thigh muscles | No trials found | No trials of hip muscle energy technique in infrapatellar bursitis. |
| Ischial BursitisHip | Muscle energy, hip and thigh muscles | No trials found | No trials of hip MET in ischial bursitis. |
| ITB Friction Syndrome – HipHip | Muscle energy, lumbar | No trials found | No trials of lumbar or sacroiliac MET in ITB pain at the hip. |
| ITB SyndromeKnee | Muscle energy, hip and thigh muscles | No trials found | No trials of TFL muscle energy technique in ITB syndrome. |
| Knee OsteoarthritisKnee | Muscle energy, hip and thigh muscles | No trials found | No trials of hip muscle energy technique in knee osteoarthritis. |
| LCL SprainKnee | Muscle energy, fibular head (proximal tibiofibular joint) | No trials found | No trials of fibular head MET in LCL sprains. |
| LCL SprainKnee | Muscle energy, hip and thigh muscles | No trials found | No trials of hip muscle energy technique in LCL sprains. |
| Lumbar Facet SyndromeLower Back | Muscle energy, psoas | No trials found | No trials of psoas MET in facet syndrome. |
| Lumbar Spinal StenosisLower Back | Muscle energy, lumbar | No trials found | No trials of lumbar MET in spinal stenosis. |
| Mallet FingerWrist & Hand | Muscle energy, elbow and forearm | No trials found | No trials of forearm muscle energy technique in mallet finger. |
| MCL SprainKnee | Muscle energy, hip and thigh muscles | No trials found | No trials of hamstring or adductor muscle energy technique in MCL sprains. |
| Meniscal InjuryKnee | Muscle energy, calf (gastrocnemius and soleus) | No trials found | No trials of calf muscle energy technique in meniscal tears. |
| Meralgia ParaestheticaNeurological | Muscle energy, psoas | No trials found | No trials of psoas MET in meralgia paraesthetica. |
| MetatarsalgiaFoot & Ankle | Muscle energy, calf (gastrocnemius and soleus) | No trials found | No trials of calf muscle energy technique in metatarsalgia. |
| MyalgiaOther | Muscle energy, general (affected muscle) | No trials found | No trials of muscle energy technique in myalgia. |
| Myositis Ossificans – KneeKnee | Muscle energy, hip and thigh muscles | No trials found | No trials of hip muscle energy technique in myositis ossificans. |
| Myositis Ossificans – ThighHip | Muscle energy, hip and thigh muscles | No trials found | No trials of hip muscle energy technique in myositis ossificans. |
| Occipital NeuralgiaHeadache | Muscle energy, cervical (C2–C7) | No trials found | No trials of cervical MET in occipital neuralgia. |
| Olecranon BursitisElbow | Muscle energy, elbow and forearm | No trials found | No trials of forearm muscle energy technique in olecranon bursitis. |
| Osteitis PubisHip | Muscle energy, hip and thigh muscles | No trials found | No trials of adductor MET in osteitis pubis. |
| Osteitis PubisHip | Muscle energy, pelvis (innominate and pubis) | No trials found | No trials of pubic MET in osteitis pubis. |
| Patella DislocationKnee | Muscle energy, hip and thigh muscles | No trials found | No trials of hip muscle energy technique in patellar dislocation. |
| Patellar TendinopathyKnee | Muscle energy, hip and thigh muscles | No trials found | No trials of quadriceps muscle energy technique in patellar tendinopathy. |
| Patellar TendinopathyKnee | Muscle energy, calf (gastrocnemius and soleus) | No trials found | No trials of calf muscle energy technique in patellar tendinopathy. |
| Patellofemoral Pain SyndromeKnee | Muscle energy, hip and thigh muscles | No trials found | No trials of quadriceps muscle energy technique in patellofemoral pain. |
| PCL InjuryKnee | Muscle energy, hip and thigh muscles | No trials found | No trials of hip muscle energy technique in PCL injury. |
| Pes Anserine BursitisKnee | Muscle energy, hip and thigh muscles | No trials found | No trials of hamstring or adductor muscle energy technique in pes anserine bursitis. |
| Posterior Calcaneal BursitisFoot & Ankle | Muscle energy, calf (gastrocnemius and soleus) | No trials found | No trials of calf muscle energy technique in posterior calcaneal bursitis. |
| Prepatellar BursitisKnee | Muscle energy, hip and thigh muscles | No trials found | No trials of quadriceps muscle energy technique in prepatellar bursitis. |
| Psoas StrainHip | Muscle energy, psoas | No trials found | No trials of psoas MET in psoas strain. |
| Quadriceps StrainKnee | Muscle energy, hip and thigh muscles | No trials found | No trials of rectus femoris muscle energy technique in quadriceps strain. |
| Radial Tunnel SyndromeElbow | Muscle energy, elbow and forearm | No trials found | No trials of forearm muscle energy technique in radial tunnel syndrome. |
| Retrocalcaneal BursitisFoot & Ankle | Muscle energy, calf (gastrocnemius and soleus) | No trials found | No trials of calf muscle energy technique in retrocalcaneal bursitis. |
| Sartorius StrainHip | Muscle energy, hip and thigh muscles | No trials found | No trials of hip flexor MET in sartorius strain. |
| Scheuermann's DiseaseMid Back | Muscle energy, thoracic | No trials found | No trials of thoracic MET in Scheuermann's disease. |
| SciaticaLower Back | Muscle energy and counterstrain, piriformis | No trials found | No trials of piriformis MET or counterstrain in sciatica. |
| SesamoiditisFoot & Ankle | Muscle energy, calf (gastrocnemius and soleus) | No trials found | No trials of calf muscle energy technique in sesamoiditis. |
| Skier's ThumbWrist & Hand | Muscle energy, elbow and forearm | No trials found | No trials of forearm muscle energy technique in thumb UCL injury. |
| SLAP LesionShoulder | Muscle energy, thoracic | No trials found | No trials of thoracic MET in SLAP tears. |
| SpondylolisthesisLower Back | Muscle energy, psoas | No trials found | No trials of psoas MET in spondylolisthesis. |
| Sternoclavicular Joint InjuryShoulder | Muscle energy, AC joint, clavicle and SC joint | No trials found | No trials of SC joint or clavicle MET in SC joint injuries. |
| TFCC InjuryWrist & Hand | Muscle energy, elbow and forearm | No trials found | No trials of forearm muscle energy technique in TFCC injury. |
| Thoracic Disc HerniationMid Back | Muscle energy, thoracic | No trials found | No trials of thoracic MET in thoracic disc herniation. |
| Thoracic RadiculopathyNeurological | Muscle energy, thoracic | No trials found | No trials of thoracic MET in thoracic radiculopathy. |
| Tibialis Posterior TendinopathyFoot & Ankle | Muscle energy, calf (gastrocnemius and soleus) | No trials found | No trials of calf muscle energy technique in tibialis posterior tendinopathy. |
| Turf ToeFoot & Ankle | Muscle energy, calf (gastrocnemius and soleus) | No trials found | No trials of calf muscle energy technique in turf toe. |
| Whiplash Associated DisorderNeck | Muscle energy, cervical (C2–C7) | No trials found | No trials of MET in whiplash. |
| Wrist SprainWrist & Hand | Muscle energy, elbow and forearm | No trials found | No trials of forearm muscle energy technique in wrist sprain. |
Cautions
When not to use MET
- Don’t use: acute fracture or dislocation in the area; joint infection; bone malignancy; cervical instability (for neck work).
Waxenbaum & Sina · StatPearls 2026 · Talley & Goto · StatPearls 2023
- Image the neck first in rheumatoid arthritis or Down syndrome with neck pain (possible upper cervical instability).
- Take care, use lighter force: severe osteoporosis (rib fracture risk), recent surgery that limits contraction, low vitality or very unwell patients, recent tears of muscle, tendon or ligament, known ligament laxity.
Waxenbaum & Sina · StatPearls 2026 · Talley & Goto · StatPearls 2023 · Jawed et al. · StatPearls 2024
- The patient must be able to follow instructions.
Waxenbaum & Sina · StatPearls 2026 · Talley & Goto · StatPearls 2023
- Too much force can avulse a tendon (older patients) or fracture a rib (osteoporosis). Use the least force that engages the segment. Next-day soreness is common.
Waxenbaum & Sina · StatPearls 2026 · Talley & Goto · StatPearls 2023
- TMJ: stop if dizziness or nausea appears.
Cautions by region (15)
Muscle energy, cervical (C2–C7)
Do not use with fracture, dislocation, infection or muscle tear. Take care with cervical instability (check for it in rheumatoid arthritis and Down syndrome), other rheumatological disease, and recent heart attack or surgery. Use the least force needed, especially in older patients.
- Reference bookStenersen & Bordoni · StatPearls 2024
- Reference bookWaxenbaum & Sina · StatPearls 2026
Muscle energy, lumbar
Do not use after recent lumbar surgery, or with spinal fracture, acute cord compression, cauda equina syndrome, cancer in the spine, spinal infection (osteomyelitis) or severe osteoporosis. Use gentler options in frail patients and in anyone who cannot follow instructions.
- Reference bookLafans & Troncoso · StatPearls 2024
Muscle energy, pelvis (innominate and pubis)
Do not use if the contraction causes severe pain, with a fracture or unstable joint in the area, or after recent surgery.
- Reference bookXu & Vilella · StatPearls 2024
Muscle energy, psoas
Do not use with a fracture in the area, an unstable pelvis or hip, recent surgery, or a patient who cannot contract on request or follow directions.
- Reference bookEldemire & Goto · StatPearls 2023
Muscle energy and counterstrain, piriformis
Do not use with a fracture, torn ligament or tendon, joint instability, recent surgery, active infection or open wounds. Not for neuropathic pain or pain caused by infection.
- Reference bookMalhotra & Bordoni · StatPearls 2023
Muscle energy, thoracic
Do not use with an acute fracture or dislocation. Recent ligament, tendon or muscle injury may make it unsuitable, and spasm driven by the central nervous system responds poorly. The patient must be able to follow instructions.
- Reference bookTalley & Goto · StatPearls 2023
Muscle energy, ribs
Do not use with a rib fracture, recent spinal injury, known ligament laxity, skin or muscle infection over the area, or cancer that has spread to the ribs. The patient must be able and willing to take part.
- Reference bookJawed et al. · StatPearls 2024
Muscle energy, TMJ (facial MET)
Stop if dizziness or nausea appears. Reconsider with a jaw fracture, an unstable joint, recent surgery or low vitality.
- Reference bookNahian & Mathew · StatPearls 2023
Muscle energy, glenohumeral (posterior shoulder)
Very safe, but not used with a fracture, a ruptured ligament, tendon or muscle, or a joint infection.
- Reference bookDowning & Bordoni · StatPearls 2023
Muscle energy, AC joint, clavicle and SC joint
Very safe, but not used with a fracture, a ruptured ligament, tendon or muscle, a joint infection, or when no dysfunction is found.
- Reference bookDowning & Bordoni · StatPearls 2023
Muscle energy, hip and thigh muscles
Not used with an acute fracture, a joint infection or a bone malignancy; take care with severe osteoporosis or after surgery that limits muscle contraction. Use the least force needed: too much can tear a muscle or pull off a tendon, especially in older patients.
- Reference bookWaxenbaum & Sina · StatPearls 2026
Muscle energy, fibular head (proximal tibiofibular joint)
Not used with an acute ankle sprain or a lax ankle, an acute fibular fracture or a deep vein thrombosis, or when positioning could aggravate an acute injury.
- Reference bookDecker et al. · StatPearls 2024
Muscle energy, calf (gastrocnemius and soleus)
Not used with an acute fracture, a joint infection or a bone malignancy; take care with severe osteoporosis or after surgery that limits muscle contraction. Use the least force needed: too much can tear a muscle or pull off a tendon, especially in older patients.
- Reference bookWaxenbaum & Sina · StatPearls 2026
Muscle energy, elbow and forearm
Not used with an acute fracture, a joint infection or a bone malignancy; take care with severe osteoporosis or after surgery that limits muscle contraction. Use the least force needed: too much can tear a muscle or pull off a tendon, especially in older patients.
- Reference bookWaxenbaum & Sina · StatPearls 2026
Muscle energy, general (affected muscle)
Not used with an acute fracture, a joint infection or a bone malignancy; take care with severe osteoporosis or after surgery that limits muscle contraction. Use the least force needed: too much can tear a muscle or pull off a tendon, especially in older patients.
- Reference bookWaxenbaum & Sina · StatPearls 2026
Always check the condition page’s red flags first. Refer-first conditions have no technique cards.
Sources
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- Magnusson SP, Simonsen EB, Aagaard P, Sørensen H, Kjaer M. A mechanism for altered flexibility in human skeletal muscle. J Physiol. 1996;497 ( Pt 1)(Pt 1):291-8. Link
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- Talley JT, Goto KK. Osteopathic Manipulative Treatment: Muscle Energy Procedure With Post-Isometric Relaxation - Thoracic Vertebrae. StatPearls [Internet]. StatPearls Publishing; updated 11 Sep 2023. Link
- Jawed M, Woo MJ, Bordoni B. Osteopathic Manipulative Treatment: Muscle Energy Procedure - Exhaled Ribs. StatPearls [Internet]. StatPearls Publishing; updated 29 Jan 2024. Link
- Flodine TE, Thomas M. Osteopathic Manipulative Treatment: Inhaled Rib Dysfunction. StatPearls [Internet]. StatPearls Publishing; updated 8 Aug 2023. Link
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- Eldemire F, Goto KK. Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain Procedures - Psoas. StatPearls [Internet]. StatPearls Publishing; updated 8 Aug 2023. Link
- Malhotra R, Bordoni B. Osteopathic Manipulative Treatment: Muscle Energy and Counterstrain - Piriformis. StatPearls [Internet]. StatPearls Publishing; updated 28 Aug 2023. Link
- Xu E, Vilella RC. Osteopathic Manipulative Treatment: Muscle Energy Procedure - Pelvic Dysfunctions. StatPearls [Internet]. StatPearls Publishing; updated 30 Jan 2024. Link
- McParland, Sina, DeLuca. Osteopathic Manipulative Treatment: Muscle Energy Procedure - Sacral Dysfunctions. StatPearls [Internet]. StatPearls Publishing; updated 1 Mar 2024. Link
- Downing M, Bordoni B. Osteopathic Manipulative Treatment: Muscle Energy Procedure - AC Joint, Clavicle, SC Joint. StatPearls [Internet]. StatPearls Publishing; updated 24 Jul 2023. Link
- Nahian A, Mathew J Jr. Osteopathic Manipulative Treatment: Facial Muscle Energy, Direct MFR, and BLT Procedure – for TMJ Dysfunction. StatPearls [Internet]. StatPearls Publishing; updated 12 Feb 2023. Link
- Decker N, Sina RE, Pozun A. Osteopathic Manipulative Treatment: Muscle Energy and HVLA Procedures - Fibular Head Dysfunction. StatPearls [Internet]. StatPearls Publishing; updated 26 Feb 2024. Link
Papers: abstracts read and citations built from PubMed records on 14 Nov 2026. StatPearls chapters read on 14 Nov 2026 and described in our own words.