A Q & A with Dr. Theresa Schmidt on MET, PNF, and the Art of Getting People Moving
Throughout her three-hour session on "Fast Track Flexibility for Rapid Functional Gains: Muscle Energy (MET) & Proprioceptive Neuromuscular Facilitation (PNF) Essentials," presenter Theresa Schmidt peppered the audience with delving questions and followed every one with the kind of candid, experience-driven insight that only comes from decades at the bedside.
For those who missed the live event, here is what Theresa Schmidt had to say in her own words.
Question 1
How much time do you typically get for assessing a patient?
Find out what their personal needs and goals are. It's very important. Most people say, yeah, I just want the pain to go away. Well, what would change in your life if the pain went away? Oh, I'd be able to pick up my grandchild. Or oh, I'd be able to walk a longer distance. I could go out on those rail trails like I used to do for hours."
"It's not just about the mobility of having more range of motion and less pain. What's it really about? It's about the juice people get out of life, isn't it? Find out. If you didn't have this problem, what would you be doing? Everyone has a reason. Find out what that is.
Question 3
Are MET and PNF really different things — or are they the same approach under different names?
One of the professors was very concerned. She said, these are two totally different things. They're not the same. I said, well, depending on the studies you read and the information from some of the leaders in the field, like Dr. Leon Chaitow, for example — very different perspectives, whether you're talking from the point of view of an osteopath, an OT, a PT, an athletic trainer. Little different perspective."
"Lots of different names, the same stuff. Chiropractors' active release technique — oh, let's add some soft tissue compression while we're doing this muscle energy PNF stuff. Active isolated stretching, more related in the massage field. How do we work on individual joints or linkages? Let's call it a different name so we can all sell different seminars."
"I'd love to just call this reflex release therapy, or reflex facilitation or reflex inhibition — because that's ultimately what we want. That's ultimately what we're doing. We're looking to impact someone's physical performance using neuromuscular reflexes.
Question 4
How long do you hold a stretch?
This is one of my favorite questions. I see people with stretches from like a couple of seconds to several minutes. The least amount of hold time for you guys is about 5 seconds. Others are typically up to about 30 or even 60 seconds. Interesting.
People need to be fully supported to relax. I see so many therapists hanging somebody's head off the end of the treatment table, just hanging in midair, and the patient's holding their head stiff because they think you're going to drop them — Humpty Dumpty gonna drop and crack that egg. Give good support. People need to be fully supported to relax.
"Active assistive stretch is nice because the patients feel more of a sense of control. They're doing some of the motion. You're helping along. They're in control. It's very nice if someone has pain. People like to be in control in many cases.
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Question 5
How do you use breathing as part of a stretching or flexibility intervention?
The breathing is so critically important. Having people breathe into their diaphragm, breathe into their bellies — you know, we're so socialized that we have to hold our bellies in. People restrict their breathing.
You ever watch a baby breathe? They proudly protrude that abdomen. They're not worried about that. So it's important. Breathe into the belly, slow, relaxed. Many times we use the word deep breathing and people go — and they get all tight and huffed up, using a lot of their accessory respiratory muscles. That's not relaxing. So tell them: I want you to breathe deeply in the belly, but take it gently and slowly, breathing into the belly.
Question 6
How do you wake up the tricep to facilitate elbow extension in a patient with a flexion contracture?
Your partner next to you is sleeping. How do you wake him up? Tap. Hello, wakey wakey, right? Tap the muscle. Tap the tricep to wake it up. Okay, that gives a quick stretch. Or a quick stretch — push, push, push, keep pushing. You might feel a little bounce, a little quick stretch at the end of the motion.
"We're going to activate the antagonist — the triceps in this case — to go beyond the barrier. Press on the tendons. If you press the tendon of the biceps brachialis, you will elicit the Golgi tendon organ reflex and help the muscle to stretch. So if you're looking to stretch a muscle, press on its tendon.
"How about if you get the other arm working? Push with that left arm — the uninvolved arm — at the same time you push with the right arm. Oh yeah, we get that elbow extending. So radiation of facilitation into the contralateral side.
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Question 7
What contraction intensity should you use when applying muscle energy technique?
We typically use low contraction intensity so that we avoid hurting anybody. We avoid having pain, and we don't have to work that hard due to dissipation. You still get inhibition to enable you to relax the muscles and allow more mobility.
"Give me 20% of effort — bend your elbow, give me only 20% of maximum contraction, not 100%. People are pretty good at figuring out what percent of effort. Think about perceived exertion. They're pretty good at giving you about 20%. Hold it two or three seconds, relax. After they fully relax and I feel it soften, then we follow with a stretch. Oh look, you can go a little farther. So we're using that latency period — which on EMGs has been shown to be about 15 to 30 seconds. Quick and easy opportunity: jump in and stretch.
Question 8
What is your advice on treating tight hip flexors — one of the most common mobility impairments clinicians encounter?
Hip flexors are an outrageous tension mobility impairment. It's making people slower to get up out of a chair. How many of my patients tell me, yeah, it takes me a while to get up, you know, I'm so tight in my hips.
People with back problems, hip problems, people who work very hard with their sports, people who sit too long — the couch potatoes. It's not just a sports problem. It's an everybody problem. And it doesn't just affect the hip. Think about how the position of the hip flexor affects the lumbar spine, the pelvis, the entire kinetic chain above it.
"If you didn't have this problem, what would you be doing? Oh, I'd be fishing. I'd be hunting. I'd be jumping hurdles. I'd be swimming. Everyone has a reason. The hip flexor is often standing between them and that reason. Find out what their reason is — and use it. ◼
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Opinions and viewpoints expressed in this article are the author's, and do not necessarily reflect those of CE Learning Systems.