Muscle energy techniques for post-stroke spasticity: mechanisms and clinical applications

Spasticity is a common and disabling complication after stroke, often leading to progressive joint stiffness, restricted movement, and reduced functional independence. Current management strategies for post-stroke spasticity (PSS) are limited by inconsistent efficacy and a lack of standardized protocols. Muscle energy techniques (MET) have emerged as a promising non-invasive approach, though their mechanisms and clinical value in PSS remain poorly understood. This review summarizes available evidence on MET for PSS based on systematic searches of PubMed, Web of Science, CNKI, and WanFang up to November 2025. MET may alleviate PSS through two main routes, namely inhibiting spinal and cortical motor neuron excitability and modulating pain pathways, though the evidence for these mechanisms remains limited and comes mainly from experimental studies. Key clinical studies indicate that MET can reduce muscle tone, improve range of motion, and enhance functional outcomes, with particularly notable effects on upper limb spasticity. However, heterogeneity in treatment protocols and a shortage of high-quality trials limit the strength of current conclusions. We further discussed critical limitations, including the reliance on active patient participation, which may preclude its use in persons with stroke with significant cognitive or motor deficits. Future directions include standardizing treatment protocols and integrating MET with emerging technologies such as biofeedback and brain-computer interfaces. This review offers a mechanistic and clinical framework to support the evidence-based integration of MET into PSS rehabilitation.