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PNF stretching - Wikipedia, the free encyclopedia

PNF stretching
From Wikipedia, the free encyclopedia

PNF stretching, or proprioceptive neuromuscular facilitation stretching, is a set of stretching techniques

commonly used in clinical environments to enhance both active and passive range of motion with the ultimate goal
being to optimize motor performance and rehabilitation. The literature regarding PNF has made the technique the
optimal stretching method when the aim is to increase range of motion, especially in short-term changes. Generally
an active PNF stretch involves a shortening contraction of the opposing muscle to place the target muscle on
stretch. This is followed by an isometric contraction of the target muscle. PNF can be used to supplement daily
stretching and is employed to make quick gains in range of motion to help athletes improve performance.[1] Aside
from being safe and time efficient, the dramatic gains in range of motion seen in a short period of time may also
promote compliance with the exercise and rehabilitation program.[2]

Contents
1 History
2 Mechanisms
3 Techniques
4 Gallery
5 See also
6 References
7 External links

History
In the early to mid 1900s physiologist Charles Sherrington popularized a model for neuromuscular facilitation and
inhibition. This subsequently led Herman Kabat, a neurophysiologist, to develop the clinical PNF stretching
technique using natural movement patterns. He knew of the myotatic 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. Initial PNF techniques were used to aid the rehabilitation of clients with spasticity and
weakness by facilitating muscle elongation. This is theorized to be accomplished through enhanced inhibitory
mechanisms affecting the spastic muscle, and improving the muscle strength through improved excitation
mechanisms in the weakened muscle.[3]
Kabat 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.eccentric isotonic is when it lengthens even though resisting a force is being applied, and
isometric contraction is when the muscle remains the same length even while it is contracting.[4]
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Mechanisms
Proposed mechanisms underlying the PNF stretching response: Autogenic Inhibition and Reciprocal Inhibition have
traditionally been accepted as the neurophysiological explanations for the superior ROM gains that PNF stretching
achieves over static and ballistic alternatives.[2]

Techniques
The patterns of movement associated with PNF are composed of multijoint, multiplanar, diagonal, and
rotational movements of the extremities, trunk & neck.[5] There are 2 pairs of foundational movements for the
upper extremities; UE D1 flexion & extension, UE D2 flexion & extension. There are also 2 pairs of foundational
movements for the lower extremities; LE D1 flexion & extension, LE D2 flexion & extension.[6] Various PNF
stretching techniques based on Kabats concept are: Hold Relax, Contract Relax, and Contract Relax Antagonist
Contract (CRAC) etc.[7]
Contract Relax: Passive placement of the restricted muscle into a position of stretch followed by an isometric
contraction of the restricted muscle. Most isometric contractions in PNF stretching techniques should be held for a
minimum of 3 seconds[8] at a sub maximal effort (20-50% of maximal effort) to avoid muscle fatigue and injury.[9]
After the contraction period the patient is instructed to relax the restricted muscle that was just contracting and
activate the opposing muscle to move the limb into a greater position of stretch. Through Golgi tendon organ, the
tight muscle is relaxed, and allowed to lengthen.
Hold Relax: Very similar to the Contract Relax technique. This is utilized when the agonist is too weak to activate
properly. The patient's restricted muscle is put in a position of stretch followed by an isometric contraction of the
restricted muscle. After the allotted time the restricted muscle is passively moved to a position of greater stretch.
Contraction times and efforts will remain the same as the Contract Relax technique. This technique utilizes the
reciprocal inhibition, which relaxes a muscle after a sustained contraction has been applied to it for longer than 6
seconds.
Contract Relax Antagonist (Agonist) Contract (CRAC) is performed by-passive stretch of agonist muscle,
followed by maximum isometric contraction of agonist muscle and passive stretch of agonist muscle again. After
that, maximum isotonic contraction of antagonist muscle is performed. This technique used autogenic and reciprocal
inhibition.[10]
Rhythmic Initiation: Developed to help patients with Parkinsons overcome their rigidity. Begins with the therapist
moving the patient through the desired movement using passive range of motion, followed by active-assistive,
active-resisted range of motion, and finally active range of motion.
Rhythmic Stabilization: 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 23 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

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AI, resistance is applied on the same side of the joint. In RS, resistance is applied on opposite sides of the joint.
Note this is not a stretching technique, but instead a technique used to strengthen joint musculature and improve
proprioception.
Slow reversals: This technique is based on Sherrington's principle of successive induction, i.e. that immediately
after the flexor reflex is elicited the excitability of the extensor reflex is increased.This technique is used to strengthen
and buildup endurance of weaker muscles and develop co-ordination and establish the normal reversal of
antagonistic muscles in the performance of movement.

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

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D2 extension, "Down &

In"[11]

D2 flexion, "Up &

Out"[12]

D1 flexion, "Up & In"[13]

D1 extension, "Down &

Out"[14]

See also
Pitt-Brooke, J. et al. (1998) Rehabilitation of movement: theoretical basis of clinical practice (pp 38294)
London: Elsevier (ISBN 0702021571)
Adler, S. Beckers, D. Buck, M. (2007) PNF in Practice: An Illustrated Guide (ISBN 3540739017)

References
The Truth About PNF Techniques: Proprioceptive neuromuscular rehabilitation is more than just stretching
and functional movement. (http://physical-therapy.advanceweb.com/Article/The-Truth-About-PNFTechniques-1.aspx) 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
(http://www.bradapp.net/docs/rec/stretching/) 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
Kisner, Carolyn & Colby, Lynn A. (2012): "Therapeutic Exercise: foundations & techniques", F.A Davis 6th
ed.
^ Marek, S., Cramer, J., Fincher, A., Massey, L., Dangelmaier, S., Purkayastha, S., Fitz, K. and
Culbertson, J. Y. (2005). Acute effects of static and proprioceptive neuromuscular facilitation stretching on
muscle strength and power output. Journal of Athletic Training, 40, 94-103.
^ a b Sharman, M., Cresswell, A. and Riek, S. (2006). Proprioceptive Neuromuscular Facilitation
Stretching. Journal of Sports Medicine, 36, 929-939.
^ Sharman, M., Cresswell, A. and Riek, S. (2006). Proprioceptive Neuromuscular Facilitation Stretching.
Sports Medicine, 36, 929-939.
^ McAtee RE, Charland J. Facilitated stretching: assisted and unassisted PNF stretching made easy. 2nd ed.
Champaign (IL): Human Kinetics, 1999
^ Kisner & Colby, p208,(2012)
^ Kisner & Colby 2012, p208
^ Nagarwal, A.K., Zutshi K., Ram C.S., Zafar R.(2010). Improvement of hamstring flexibility: A
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comparison between two PNFstretching techniques. International Journal of Sports Science and
Engineering.4 (2010) 1, pp 025-033
^ Surburg PR, Schrader JW. Proprioceptive neuromuscular facili- tation techniques in sports medicine: a
reassessment. J Athl Train 1997; 32 (1): 34-9
^ Feland JB, Marin HN. Effect of submaximal contraction intensity in contract-relax proprioceptive
neuromuscular facilitation stretching. Br J Sports Med 2004; 38: e18
^ Pantamat, S.,Raksaman, D., & Keawutan, AJP. (2010). effect of different PNF stretchingtechniques on
hamstrings flexibility in Thai women aged 18-25 years. A abstractretrieved from allied.tu.ac.th/detail
abstract.php
^ Kisner & Colby "Therapeutic Exercise" p208, F.A. Davis Co, 6th ed, 2012
^ Kisner & Colby "Therapeutic Exercise" p208, F.A. Davis Co, 6th ed, 2012
^ Kisner & Colby "Therapeutic Exercise" p208, F.A. Davis Co, 6th ed, 2012
^ Kisner & Colby "Therapeutic Exercise" p208, F.A. Davis Co, 6th ed, 2012

External links
PNF stretching (http://www.marykaa.com/fitness/PNF/pnf1.htm)
Animated stage by stage tutorial
(http://www.flashmavi.com/stretching_pnf_stretching_proprioceptive_neuromuscular_facilitation.shtml)
Retrieved from "http://en.wikipedia.org/w/index.php?title=PNF_stretching&oldid=598103212"
Categories: Physical exercise
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