Ruddy revisited (again): the value of Pulsed MET

It’s been some time since I expounded on one of the loves of my clinical world – the invaluable methods devised by Thomas Jefferson Ruddy DO, over 60 years ago.

Earlier today I received a message from a young Indian PT who is studying for a Masters Degree at Punjabi University, Patiala, India – which triggered this post.  She wrote as follows:

” I read have your Muscle Energy Technique book, and one article on MET variations, and also your blog Ruddy Revisited. You have mentioned that Ruddy is safe and effective, and also provided some study material to read. I have practised this on patients with patient consent and now am able to use Ruddy’s Pulsed MET in my research study.”

http://astore.amazon.co.uk/leonchaitow-21/detail/0702046531

http://astore.amazon.com/leonchaitowco-20/detail/0702046531

She goes on to ask about standardizing the application of the method?

I  sent  her one of Ruddy’s original papers and advised her to follow the advice of the developer of the method as outlined in that 1961 paper……

(Ruddy T 1961 Osteopathic rhythmic resistive duction therapy. Yearbook of Academy of Applied Osteopathy 1961, Indianapolis) ,    

….and to devise a protocol that works clinically for her patients.

Ruddy methodology is essentially extremely simple to apply:

1. Take any restricted joint to its EASY end of range, before any discomfort is sensed, and just short of any perceived restriction barrier
2. Offer very firm resistance to any attempt at movement in the directions you wish the patient to attempt to move
3. Ask the patient to move in that direction, against your firm resistance, using an extremely small amount of effort (say 10% of available strength) – for no more than a second.
4. The instruction should go something like this: “Push and stop, push and stop,  push and stop…etc etc”…with each “push”, and each “stop”, lasting approximately 1 second
5. The patient is coached as to direction, amplitude (very small amount of movement, firmly resisted), degree of effort (as above, very small), and rhythmicity.
6. The ideal is a  rhythmic repetition of around 20 pulsations before testing for increased range, and then trying a different direction/force vector for the pulsing contractions
7. A variety of directions of resisted movement should be tested
8. Absolute requirements include NO PAIN, during the pulsing, or when testing for increases in range of motion.
9. IMPORTANT KEY ADVICE:  Ruddy insisted that during the process of rhythmic isometric pulsations there should be “NO WOBBLE, NO BOUNCE”…..as shown in the video, the movements are very small, very controlled,…..

My personal experience is that this is a remarkable and efficient method for normalising dysfunction….of ANY joint that is controlled my muscles that can be engaged by the patient and resisted by the practitioner –  including spinal joints where the process seems to involve intrinsic muscles (rotatores for example).

The method seems to both increase mobility and retrain motor control – since the process of rhythmic minimal engagement and disengagement clearly involves proprioceptive reeducation.

See the embedded video for an example of Pulsed (and regular) MET for a shoulder restriction:

For more on Ruddy see older posts: