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Whilst this abnormal function is of low magnitude, it is its repetitive nature that causes the problem over a sustained period of time. The average person takes 5000 steps per day, or 2500 per foot, thus subtle imbalances are repeated thousands of times per day. It is easy to translate the picture drawn by Prior, and to move the dysfunctional stresses upwards towards the upper back, neck and shoulders. The lesson that we can learn from this excellent example of ‘chain reactions of dysfunction’ is that all efforts to normalise postural stresses should commence with attention to the foundations of the body, the feet.

In such cases the periarticular and osteophytic changes, all too apparent in degenerative conditions, are the major limiting factor in joint restrictions. In both situations, however, MET may be useful, although more useful where muscle shortening is the primary factor. The restriction which takes place as a result of tight, shortened muscles is usually accompanied by some degree of lengthening and weakening of the antagonists. A wide variety of possible permutations exists in any given condition involving muscular shortening which may be initiating, or be secondary to, joint dysfunction combined with weakness of antagonists.

Correct understanding of the role of the supporting musculature would frequently lead to normalisation of these tissues, without the need for heroic manipulative efforts. MET and other soft tissue approaches focus attention on these structures and offer the opportunity to correct both the weakened musculature and the shortened, often fibrotic, antagonists. More recently, Norris (1999) has pointed out that: The mixture of tightness and weakness seen in the muscle imbalance process alters body segment alignment and changes the equilibrium point of a joint.