Introduction
Materials and methods
Inclusion and exclusion criteria
Study designs
Participants
Interventions
Comparators
Outcomes
Search strategy
Selection of studies
Quality assessment
Statistical analysis
Results
Author | Sample size (n) | Population | Purpose | Protocol Duration | Anatomical administration of MET | Outcome | Pre-VAS | Post-VAS | Pre- ROM | Post-ROM | Other |
---|---|---|---|---|---|---|---|---|---|---|---|
Ballantyne et al. [22] | 40 | Asymptomatic participants | Flexibility increase | 1 session | Hamstring | Increased ROM | n/a | n/a | 167.3° | 170.0° | n/a |
Bindra [10] | 30 | Patients with chronic LBP | Effect of technique | 6 sessions | Sacroiliac joint | Decreased Pain | 6.5 | 1.6 | n/a | n/a | Oswestry disability index |
Burns et al. [33] | 18 | Asymptomatic participants | Flexibility increase | 1 session | Cervical spine | Increased ROM | n/a | n/a | 71.5° | + 3.9° | n/a |
Cassidy et al. [14] | 100 | Mechanical neck pain patients | Effect of technique | 1 session | Upper trapezius | Pain decreased more than ROM improved | n/a | n/a | n/a | n/a | NRS-101 pain score (pre 37.7 vs post 20.4) |
Fryer et al. [15] | 52 | Asymptomatic participants | Flexibility increase | 1 session | Atlanto-axial joint | Increased ROM | n/a | n/a | 52.41° | 59.06° | n/a |
Fryer et al. [34] | 12 | Asymptomatic participants | Neurophysiological responses | 1 session | L5/S1 segment bilaterally | Decreased motor excitability (increased silent period and decreased H reflex) | n/a | n/a | n/a | n/a | n/a |
Hamilton et al. [16] | 90 | Asymptomatic participants | Effect of technique | 1 session | Sub-occipital region | No difference in pressure pain thresholds | n/a | n/a | n/a | n/a | n/a |
Kamali et al. [35] | 46 | Women with thoracic Kyphosis | Effect of technique | 15 sessions | Thoracic spine | Reduced Kyphosis and increased Strength | n/a | n/a | n/a | n/a | Sitting kyphosis angle pre 45.7° Sitting kyphosis angle post 40.6° |
Küçükşen et al. [17] | 82 | Patients with chronic lateral epicondylitis | Effect of technique | 8 sessions | Elbow | Improvement on strength, pain and function | 7.39 | 3.28 | n/a | n/a | DASH score pre 46.7 post 22.7 |
Laudner et al. [36] | 39 | Asymptomatic participants | Effect of technique | 12 sessions | Pectoralis minor | Increased muscle length, Decreased forward scapular position | n/a | n/a | n/a | n/a | Pectorali s length pre 8.0 post 8.8, Scapular position pre 13.6 post 12.1 |
Lenehan et al. [21] | 59 | Asymptomatic participants | Increase trunk ROM | 1 session | Thoracic spine | Increased ROM | n/a | n/a | 26.4° | 36.7° | n/a |
Moore et al. [37] | 61 | Asymptomatic Athletes | Flexibility increase | 1 session | Glenohumeral joint | Increased Joint mobility | n/a | n/a | −13.5 | −8.5 | n/a |
Nagrale et al. [38] | 60 | Patients with non-specific neck pain | Effect of technique | 12 sessions | Upper trapezius | Pain and Disability reduction | 8.2 | 6.1 | n/a | n/a | Neck disability index pre: 42.9 and post: 31.9 |
Oliveira-Campelo et al. [39] | 117 | Patients with unilateral latent trigger points | Effect of technique | 1 session | Upper trapezius | Improves cervical motion and pain pressure sensitivity | n/a | n/a | 57.4 | 58.7 | n/a |
Phadke et al. [13] | 60 | Neck pain population | Effect of technique | 6 days | Upper trapezius and levator scapulae | Decreased VAS | 5.5 | 1.64 | n/a | n/a | n/a |
Sadria et al. [12] | 64 | Patients with latent trigger points | Effect of technique | 1 session | Upper trapezius | Decreased VAS and increased ROM | 7.61 | 6.65 | 5.68 cm | 6.56 cm | n/a |
Sakshi et al. [40] | 30 | Patients with chronic neck pain | Effect of technique | 8 sessions | Suboccipitalis, upper trapezius, and pectoralis major | Reduced Pain | 6.4 | 1.6 | n/a | n/a | Disability index pre 34.9 post 11.9 |
Schenk et al. [41] | 18 | Asymptomatic participants | Effect of technique | 7 sessions | Cervical region | Increased ROM | n/a | n/a | Flexion: 51.8° Extention: 69.1° L Rotation: 35.6° R Rotation: 35.2° | Flexion: 54.4° Extention: 71.9° L Rotation: 40.8° R rotation: 43.4° | n/a |
Schenk et al. [18] | 26 | Asymptomatic patients | Flexibility increase | 8 sessions | Lumbar region | Increased ROM | n/a | n/a | 13.8° | 36.7° | n/a |
Selkow et al. [7] | 20 | Patients with non-specific LBP | Effect of technique | 1 session | Lumbar region | Decreased pain | 2.9 | 2.5 | n/a | n/a | n/a |
Shadmehr et al. [20] | 30 | Female with Knee Rom impairment | Effect of technique | 10 sessions | Hamstrings | Increased ROM | n/a | n/a | 145.1° | 167.2° | n/a |
Smith et al. [19] | 40 | Asymptomatic participants | Flexibility increase | 2 sessions | Hamstrings | Increased ROM | n/a | n/a | 145.5° | 154.0° | n/a |
Tanwar et al. [42] | 30 | Patients with plantar fasciitis | Effect of technique | 18 sessions | Gastrocnemius | Increased ROM and reduced pain | 6.46 | 2.2 | 6.73 | 14.53 | n/a |
Ulger et al. [9] | 113 | Patients with chronic low back pain | Effect of manual therapy | 18 sessions | Low back | Pain reduction and increase of functional parameters | 6.9 | 2.08 | n/a | n/a | n/a |
Wilson et al. [8] | 8 | Patients with acute low back pain | Effect of technique | 8 sessions | Low back | Change in ODI score (functional improvement) | n/a | n/a | n/a | n/a | Oswestry Disability Index pre 45 post 7 |
Yeganeh Lari et al. [11] | 60 | Female with latent trigger points | Effect of technique | 4 sessions | Upper trapezius | Decreased VAS and increased ROM | 6.8 | 4.6 | 23.8° | 31.1° | n/a |
Authors | Sample size (n) | Sessions (n) | Anatomical administration of MET | Procedure | Outcome | Additional information | Comparison with other technique | |
---|---|---|---|---|---|---|---|---|
Ballantyne et al. [22] | 40 | 1 | Hamstring | 5 s contraction at 75% of max – 3 s relaxation -at a point of discomfort – 4 contractions | Increased Rom | n/a | n/a | |
Burns et al. [33] | 18 | 1 | Cervical spine | 3 to 5 s contraction at 0.5 kg of pressure - 3 to 5 s relaxation – to a new barrier of motion – 2 to 4 contractions | Increased Rom with MET – Decreased with Sham | n/a | With Sham treatment (stretching for 3 to 5 s – return to neutral position - for 3 stretches) | |
Fryer et al. [15] | 52 | 1 | Atlanto-axial joint | 5 s: 5 s contraction at the first resistance point – 5 s relaxation – 3 times 20s: 20 s contraction at the first resistance point – 5 s relaxation – 3 contractions | Increased Rom in the MET groups. With the 5 s group showing the gretest increase. | The increase was greater in the direction of restriction compared to the direction of no restriction | Comparison of a 5 duration contraction with a 20 duration contraction + Sham therapy and control group. | |
Fryer et al. [34] | 12 | 1 | L5/S1 segment bilaterally | 5 s contraction at a first tissue tension point - relaxation – new barrier contractions – 3 contractions | Decreased H-reflex and silent period. | MET produces decreased motor excitability in the motor cortex and spinal cord. | Control Group | |
Hamilton. et al. [16] | 90 | 1 | Subocciptal region | 3 to 5 s contraction – 5 s relaxation – 3 contractions | Pressure pain thresholds increased in the MET compared to the sham but not HVLA procedure | n/a | Comparison with HVLA and Sham treatment | |
Laudner et at. [36] | 39 | 12 | Pectoralis Minor | 3 s stretch – 5 s contraction at 25% of max force – 4 contractions – no rest | Increased pectoralis length and decreased forward scapular position. | No increase of scapular upward rotation. | n/a | |
Lenehan et al. [21] | 59 | 1 | Thoracic spine | 5 s contraction at the first rotational barrier – no rest – new rotational barrier - four repetitions | Increased Trunk ROM | Restricted direction of treatment increased rotation more than non-restricted rotation | Comparison with control group. | |
Moore et al. [37] | 61 | 1 | Glenohumeral Joint | 5 s contraction at 25% max force - the participant then internally rotated the arm for 30-s and an active assisted stretch was applied - 3 contractions | Increased horizontal adduction and internal rotation ROM | n/a | Control group | |
Schenk et al. [41] | 18 | 7 | Cervical region | 5 s contraction – 3 s relaxation – increase of direction of limitation – 4 contractions | Increased Rom in all six ranges of motion of the cervical region. | n/a | Control group | |
Schenk et al. [18] | 26 | 8 | Lumbar region | Greenman Protocol. | Increased extension of the Lumbar Spine | No increase of ROM in control group | Control group | |
Shadmehr et al. [20] | 30 | 10 | Knee Rom | Hamstrings | 10s contraction at 50% max force – 10s relaxation – greater resistance point – 3 contractions | Improvement of knee extension. | MET had an early effect on improving muscle’s flexibility compared with the passive stretch. | Passive stretch |
Smith et al. [19] | 40 | 2 | Hamstrings | Chaitow MET: 7–10s contraction at 40% max force – 2-3 s relaxation – 30 s stretch to the palpated and/or tolerance to stretch – 3 contractions. Greenman MET: 7–10s contraction at 40% max force – 2-3 s relaxation – leg placed at a new barrier – 4 contractions. | Both Greenman and Chaitow approaches produced increases of active knee extension immediately after intervention. | No statistical differences between the two techniques. | Chaitow vs. Greenman protocol | |
Total 485
|
Mean: 3.8
|
Authors | Sample size (n) | Sessions (n) | Patients symptom | Anatomical administration of MET | Procedure | Outcome | Additional information | Comparison with other technique |
---|---|---|---|---|---|---|---|---|
Bindra [10] | 30 | 6 | Chronic LBP | Sacroiliac Joint | Contraction for 8–10s at 25% max force – 2-3 s relaxation – 4-6 contractions – at the barrier of restriction | VAS and ROM improved at the end of treatment | MET and conventional therapy are both effective in managing lumbar back pain | Conventional therapy (ultrasound 5 mins, intensity of 1 W/cm2 and TENS for 10 mins 50–100 Hz) |
Cassidy et al. [14] | 100 | 1 | Mechanical neck pain | Upper trapezius | 5 s contraction – 4 contractions – at the restricted joint movement | Pain decreased and ROM increased | HVLA technique has larger benefits than MET after a single application | Comparison with HVLA |
Kamali et al. [35] | 46 | 15 | Thoracic Kyphosis | Thoracic spine | 5–7 s contraction at 25% of max force – 5 contractions – at the barrier of movement | Reduced Kyphosis increased ROM | Manual therapy is as effective as exercise therapy in reducing thoracic kyphosis | Exercise Therapy |
Küçükşen et al. [17] | 82 | 8 | Chronic lateral epicondylitis | Elbow | 5 s contraction at 75% max force – 5 s relaxation – 5 contractions – at the resistance point | Decreased VAS, Decreased DASH score (Disabilities of the Arm, Shoulder and Hand), increased PFGS (pain-free grip strength) | MET and CSI improved the strength, pain, and functional status of patients. CSI is a better option as a short term option. MET is superior as a long term option. | Corticosteroid Injections (CSI) |
Nagrale et al. [38] | 60 | 12 | Non specific neck pain | Upper trapezius | 7–10s contraction at 20% max force – Relaxation phase – 30s stretch after contraction to a new resistance point – 3-5 contractions. | VAS, Neck disability index (NDI) and ROM. | Significantly greater improvements in pain and neck disability and lateral cervical flexion ROM were detected in favor of the INIT group | Integrated neuromuscular inhibition technique (INIT) |
Oliveira-Campelo et al. [39] | 117 | 1 | Unilateral latent trigger points | Upper trapezius | 5 s contraction at 25% max force – 5 s relaxation – new end point – 3-5 contractions | ROM, and pain thresholds improved after a single session. | Ischemic compression resulted with a more stable improvement | Passive stretch, ischemic compression, placebo, control. |
Phadke et al. [13] | 60 | 6 | Neck pain | Upper trapezius and levator scapulae | 7–10s contraction at 20% max force − 20 s stretch beyond the resistance barrier − 5 contractions | Reduced pain (VAS) and reduced NDI | MET and stretching are both effective in relieving pain and reducing disability. | Static stretching |
Sadria et al. [12] | 64 | 1 | Latent trigger points | Upper trapezius | 7–10s contraction at 20% max force – relaxation phase – 30s stretch at the restriction barrier - | VAS reduction | Both techniques are equivalent for treating latent trigger points | Active release |
Sakshi et al. [40] | 30 | 8 | Chronic neck pain | Suboccipitalis, Upper Trapezius and Pectoralis Major. | 7–10s contraction with mild effort – new barrier – 3 contractions. | Reduction of neck disability index, Reduced forward head posture and pain | MET was superior to exercise intervention. | Exercise intervention |
Selkow et al. [7] | 20 | 1 | Acute LBP | Lumbar region | 5 s contraction – 5 s relaxation – 4 contractions | VAS decreased | n/a | Control group |
Tanwar et al. [42] | 30 | 18 | Plantar fasciitis | Gastrocnemius | 7–10s contraction at 20% max force – new restriction barrier – 30s stretch – 3 contractions | Increased ROM, improved foot functional index (FFI) and reduced pain | n/a | Static Stretch |
Ulger et al. [9] | 113 | 18 | Chronic LBP | Low back | 8 s contraction at 30% of max force – new stretch position - repeated until necessary | Pain severity reduction, Decreased Oswestry disability index (ODI), Improved quality of live levels | MET and spinal mobilization are equally effective on pain, function and quality of life. MET is more effective for pain during activity and functional parameters. | Spinal mobilization |
Wilson et al. [8] | 8 | 8 | Acute LBP | Low back | 5 s contraction – new barrier of motion – 4 contractions | Reduction in ODI score | MET elicited superior changes compared to control group. | Control |
Yeganeh Lari et al. [11] | 60 | 4 | Latent trigger points | Upper Trapezius | 7–10s contraction at 20% max force – relaxation phase – new barrier of motion – 30s stretch – 3-5 contractions | Reduced VAS, Increased neck ROM and increased pressure pain thresholds | MET+Dry needling was more effective in increasing rom and reducing pain than the 2 techniques alone. | Dry needling and MET+dry needling |
Total: 954
|
Mean: 7.6
|
Quality assessment of included RCT’s
Authors | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | Tot. |
---|---|---|---|---|---|---|---|---|---|---|---|---|
Bindra [10] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 5 | |||||
Cassidy et al. [14] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ||||
Kamali et al. [35] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 7 | |||
Küçükşen et al. [17] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 8 | ||
Nagrale et al. [38] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 8 | ||
Oliveira-Campelo et al. [39] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 7 | |||
Phadke et al. [13] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 7 | |||
Sadria et al. [12] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 8 | ||
Sakshi et al. [40] | ✓ | ✓ | ✓ | ✓ | ✓ | 4 | ||||||
Selkow et al. [7] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 8 | ||
Tanwar et al. [42] | ✓ | ✓ | ✓ | 2 | ||||||||
Ulger et al. [9] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 9 | |
Wilson et al. [8] | ✓ | ✓ | ✓ | ✓ | ✓ | 4 | ||||||
Yeganeh Lari et al. [11] | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | 6 | ||||
Mean | 10 | 10 | 5.7 | 9.3 | 3.6 | 1.4 | 2.9 | 6.4 | 7.9 | 8.6 | 7.9 | 6.4 |
Asymptomatic population
Author | Repetitions (n) | Contraction time (s) | Contraction force | Relaxation phase (s) | Stretch (s) |
---|---|---|---|---|---|
Ballantyne et al. [22] | 4 | 5 | 75% | 3 | none |
Burns et al. [33] | 4 | 3 | 0.5 kg | 3 to 5 | none |
Fryer et al. [15] | 3 | 5 | n/a | 5 | none |
Fryer et al. [15] | 3 | 20 | n/a | 5 | none |
Fryer et al. [34] | 3 | 5 | n/a | 5 | none |
Hamilton et al. [16] | 3 | 3 to 5 | n/a | 5 | none |
Laudner et at. [36] | 4 | 5 | 25% | 0 | none |
Lenehan et al. [21] | 4 | 5 | n/a | 0 | none |
Moore et al. [37] | 3 | 5 | 25% | n/a | 30 |
Schenk et al. [41] | 4 | 5 | n/a | 3 | none |
Schenk et al. [18] | 4 | 7 to 10 | 40% | 3 | none |
Shadmehr et al. [20] | 3 | 10 | 50% | 10 | none |
Smith et al. [19] | 3 | 7 to 10 | 40% | 3 | 30 |
Smith et al. [19] | 4 | 7 to 10 | 40% | 3 | none |
Median | 3.5 | 5 | 40% | 3 | 30 |
Symptomatic population
MET and chronic pain
MET and acute pain
MET and myofascial trigger points
MET and other dysfunctions
Author | Repetitions (n) | Contraction time (s) | Contraction force | Relaxation phase (s) | Stretch (s) |
---|---|---|---|---|---|
Bindra [10] | 4 to 6 | 8 to 10 | 25% | 2–3 | none |
Cassidy et al. [14] | 4 | 5 | n/a | n/a | n/a |
Kamali et al. [35] | 5 | 5 to 7 | 25% | 0 | none |
Küçükşen et al. [17] | 5 | 5 | 75% | 5 | none |
Nagrale et al. [38] | 3 to 5 | 7 to 10 | 20% | 2–3 | 30 |
Oliveira-Campelo et al. [39] | 3 to 5 | 5 | 25% | 5 | none |
Phadke et al. [13] | 5 | 7 to 10 | 20% | n/a | 20 |
Sadria et al. [12] | 4 | 7 to 10 | 20% | 3 | 30 |
Sakshi et al. [40] | 3 | 7 to 10 | Mild effort | n/a | none |
Selkow et al. [7] | 4 | 5 | n/a | 5 | none |
Tanwar et al. [42] | 3 | 7 to 10 | 20% | 3 | 30 |
Ulger et al. [9] | Until necessary | 8 | 30% | n/a | none |
Wilson et al. [8] | 4 | 5 | n/a | n/a | none |
Yeganeh Lari et al. [11] | 3 to 5 | 7 to 10 | 20% | 2–3 | 30 |
Median | 4 | 8 | 20% | 3 | 30 |