PNF stretching
This article needs additional citations for verification. (May 2008) |
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.[1] 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.[1]
History
In the early to mid 1900s physiologist Charles Sherrington popularized a model for how the neuromuscular system operates. Radiation 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.[1]
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 Inhibition, 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).[2]
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.
Gallery
-
Arm-front diagonal flexion.
-
Leg-front diagonal flexion.
- PNF patterns (diagonal), lower extremities
-
Front cross
-
Out back
-
Back cross
-
Out front
- PNF patterns (diagonal), upper extremities
-
Cross low
-
Back high
-
Cross high
-
Back low
References
- The Truth About PNF Techniques: Proprioceptive neuromuscular rehabilitation is more than just stretching and functional movement. By James R. Scifers, DScPT, SCS, LAT, ATC. Advance for Physical Therapists and PT Assistants, December 6, 2004.
- Stretching and flexibility: Everything you never wanted to know by Brad Appleton.
- Westwater-Wood S, Adams N, Kerry R (2010): The use of proprioceptive neuromuscular facilitation in physiotherapy practice Physical Therapy Reviews Vol.15 No.1,p23-27
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)
External links