PNF stretching
Encyclopedia
PNF stretching, or proprioceptive
neuromuscular facilitation
stretching, is an occupational therapy
and physical therapy
procedure designed in the 1940s and 1950s to rehabilitate patients with paralysis
. It is often a combination of passive stretching
and isometrics contractions. In the 1980s, components of PNF began to be used by sport therapists on healthy athletes. The most common PNF leg or arm positions encourage flexibility and coordination throughout the limb's entire range of motion. PNF is used to supplement daily stretching and is employed to make quick gains in range of motion to help athletes improve performance. Good range of motion makes better biomechanics, reduces fatigue and helps prevent overuse injuries. PNF is practiced by chiropractors, physical therapists, occupational therapists, massage therapists, athletic trainers and others.
is when maximal contraction of a muscle recruits the help of additional muscle flexibility. Based on that, Herman Kabat, a neurophysiologist, began in 1946 to look for natural patterns of movement for rehabilitating the muscles of polio patients. He knew of the myostatic stretch reflex which causes a muscle to contract when lengthened too quickly, and of the inverse stretch reflex, which causes a muscle to relax when its tendon is pulled with too much force. He believed combinations of movement would be better than the traditional moving of one joint at a time. To find specific techniques, he started an institute in Washington, DC and by 1951 had two offices in California as well. His assistants Margaret Knott and Dorothy Voss in California applied PNF to all types of therapeutic exercise and began presenting the techniques in workshops in 1952. During the 1960s, the physical therapy departments of several universities began offering courses in PNF and by the late 1970s PNF stretching began to be used by athletes and other healthy people for more flexibility and range of motion. Terms about muscle contraction are commonly used when discussing PNF. Concentric isotonic contraction is when the muscle shortens, eccentric isotonic is when it lengthens even though resisting a force, and isometric is when it remains the same length.
, the tight muscle is relaxed, and allowed to lengthen. Verbal cues for the patient performing this exercise would include, "Hold. Hold. Don't let me move you."
Hold-Relax Antagonist: Very similar to the Hold-Relax Agonist technique. This is utilised when the agonist is too weak to activate properly. The patient isometrically contracts the tight muscle (the antagonist muscle) against the therapist's resistance. After a 6 second hold has been achieved, the therapist removes his/her hand and the patient concentrically contracts the agonist muscle (the muscle opposite the tight muscle, the non-tight muscle) in order to gain increased range of motion. This technique utilizes the golgi tendon organ, which relaxes a muscle after a sustained contraction has been applied to it for longer than 6 seconds.
Hold-Relax-Swing/Hold-Relax Bounce: These are similar techniques to the Hold-Relax and CRAC. They start with a passive stretching by the therapist followed by an isometric contraction. The difference is that at the end, instead of an antagonist muscle contraction or a passive stretching, dynamic stretching and ballistic stretching is used. It is very risky, and is successfully used only by people that have managed to achieve a high level of control over their muscle stretch reflex. Ballistic stretching should ONLY be used by athletes prior to engaging in a High Energy movement (e.g. A sprinter running a 100m dash).
Rhythmic Initiation: Developed to help patients with Parkinsonism overcome their rigidity. Begins with the therapist moving the patient through the desired movement using passive range of motion, followed by active-assistive, active, and finally active-resisted range of motion.
Rhythmic Stabilisation: and Alternating Isometrics are very similar in that they both encourage stability of the trunk, hip, and shoulder girdle. With this technique, the patient holds a weight-bearing position while the therapist applies manual resistance. No motion should occur from the patient. The patient should simply resist the therapist's movements. For example, the patient can be in a sitting, kneeling, half-kneeling, or standing position when the therapist applies manual resistance to the shoulders. Usually, the therapist applies simultaneous resistance to the anterior left shoulder and posterior right shoulder for 2–3 seconds before switching the resistance to the posterior left shoulder and the anterior right shoulder. The therapist's movements should be smooth, fluid, and continuous. In AI, resistance is applied on the same side of the joint. In RS, resistance is applied on opposite sides of the joint.
Proprioception
Proprioception , from Latin proprius, meaning "one's own" and perception, is the sense of the relative position of neighbouring parts of the body and strength of effort being employed in movement...
neuromuscular facilitation
Neural facilitation
Neural facilitation, also known as paired pulse facilitation, is a concept in neuroscience where an increase in the postsynaptic potential is evoked by a second impulse....
stretching, is an occupational therapy
Occupational therapy
Occupational therapy is a discipline that aims to promote health by enabling people to perform meaningful and purposeful activities. Occupational therapists work with individuals who suffer from a mentally, physically, developmentally, and/or emotionally disabling condition by utilizing treatments...
and physical therapy
Physical therapy
Physical therapy , often abbreviated PT, is a health care profession. Physical therapy is concerned with identifying and maximizing quality of life and movement potential within the spheres of promotion, prevention, diagnosis, treatment/intervention,and rehabilitation...
procedure designed in the 1940s and 1950s to rehabilitate patients with paralysis
Paralysis
Paralysis is loss of muscle function for one or more muscles. Paralysis can be accompanied by a loss of feeling in the affected area if there is sensory damage as well as motor. A study conducted by the Christopher & Dana Reeve Foundation, suggests that about 1 in 50 people have been diagnosed...
. It is often a combination of passive stretching
Passive stretching
Passive stretching is a form of static stretching in which an external force exerts upon the limb to move it into the new position. This is in contrast to active stretching. Passive stretching resistance is normally achieved through the force of gravity on the limb or on the body weighing down on it...
and isometrics contractions. In the 1980s, components of PNF began to be used by sport therapists on healthy athletes. The most common PNF leg or arm positions encourage flexibility and coordination throughout the limb's entire range of motion. PNF is used to supplement daily stretching and is employed to make quick gains in range of motion to help athletes improve performance. Good range of motion makes better biomechanics, reduces fatigue and helps prevent overuse injuries. PNF is practiced by chiropractors, physical therapists, occupational therapists, massage therapists, athletic trainers and others.
History
In the early to mid 1900s physiologist Charles Sherrington popularized a model for how the neuromuscular system operates. RadiationRadiation
In physics, radiation is a process in which energetic particles or energetic waves travel through a medium or space. There are two distinct types of radiation; ionizing and non-ionizing...
is when maximal contraction of a muscle recruits the help of additional muscle flexibility. Based on that, Herman Kabat, a neurophysiologist, began in 1946 to look for natural patterns of movement for rehabilitating the muscles of polio patients. He knew of the myostatic stretch reflex which causes a muscle to contract when lengthened too quickly, and of the inverse stretch reflex, which causes a muscle to relax when its tendon is pulled with too much force. He believed combinations of movement would be better than the traditional moving of one joint at a time. To find specific techniques, he started an institute in Washington, DC and by 1951 had two offices in California as well. His assistants Margaret Knott and Dorothy Voss in California applied PNF to all types of therapeutic exercise and began presenting the techniques in workshops in 1952. During the 1960s, the physical therapy departments of several universities began offering courses in PNF and by the late 1970s PNF stretching began to be used by athletes and other healthy people for more flexibility and range of motion. Terms about muscle contraction are commonly used when discussing PNF. Concentric isotonic contraction is when the muscle shortens, eccentric isotonic is when it lengthens even though resisting a force, and isometric is when it remains the same length.
Techniques
Hold-Relax Agonist: Most familiar. It can be used to lengthen out tight muscle and increase passive range of motion. In this technique, the tight muscle is the antagonist, hence the agonist contracts (provided that the agonist is strong enough). The therapist asks the patient to isometrically contract the agonist for around 6 seconds before it gets moved further into range. Through Reciprocal InhibitionReciprocal inhibition
“ When the central nervous system sends a message to the agonist to contract, the tension in the antagonist is inhibited by impulses from motor neurons, and thus must simultaneously relax. This neural phenomenon is called reciprocal inhibition. This information can be used to ease the pain of an...
, the tight muscle is relaxed, and allowed to lengthen. Verbal cues for the patient performing this exercise would include, "Hold. Hold. Don't let me move you."
Hold-Relax Antagonist: Very similar to the Hold-Relax Agonist technique. This is utilised when the agonist is too weak to activate properly. The patient isometrically contracts the tight muscle (the antagonist muscle) against the therapist's resistance. After a 6 second hold has been achieved, the therapist removes his/her hand and the patient concentrically contracts the agonist muscle (the muscle opposite the tight muscle, the non-tight muscle) in order to gain increased range of motion. This technique utilizes the golgi tendon organ, which relaxes a muscle after a sustained contraction has been applied to it for longer than 6 seconds.
Hold-Relax-Swing/Hold-Relax Bounce: These are similar techniques to the Hold-Relax and CRAC. They start with a passive stretching by the therapist followed by an isometric contraction. The difference is that at the end, instead of an antagonist muscle contraction or a passive stretching, dynamic stretching and ballistic stretching is used. It is very risky, and is successfully used only by people that have managed to achieve a high level of control over their muscle stretch reflex. Ballistic stretching should ONLY be used by athletes prior to engaging in a High Energy movement (e.g. A sprinter running a 100m dash).
Rhythmic Initiation: Developed to help patients with Parkinsonism overcome their rigidity. Begins with the therapist moving the patient through the desired movement using passive range of motion, followed by active-assistive, active, and finally active-resisted range of motion.
Rhythmic Stabilisation: and Alternating Isometrics are very similar in that they both encourage stability of the trunk, hip, and shoulder girdle. With this technique, the patient holds a weight-bearing position while the therapist applies manual resistance. No motion should occur from the patient. The patient should simply resist the therapist's movements. For example, the patient can be in a sitting, kneeling, half-kneeling, or standing position when the therapist applies manual resistance to the shoulders. Usually, the therapist applies simultaneous resistance to the anterior left shoulder and posterior right shoulder for 2–3 seconds before switching the resistance to the posterior left shoulder and the anterior right shoulder. The therapist's movements should be smooth, fluid, and continuous. In AI, resistance is applied on the same side of the joint. In RS, resistance is applied on opposite sides of the joint.
See also
- Pitt-Brooke, J. et al. (1998) Rehabilitation of movement: theoretical basis of clinical practice (pp 382–94) London: Elsevier (ISBN 0702021571)
- Adler, S. Beckers, D. Buck, M. (2007) PNF in Practice: An Illustrated Guide (ISBN 3540739017)