EMS 361 Sports Medicine Laboratory:

Proprioceptive Neuromuscular Facilitation

 

 Objectives:

 To understand how proprioceptive information is used in PNF stretching and strengthening techniques.

 To get hands-on experience in PNF techniques used in assessment and rehabilitation.

 

Definition of PNF:

 Hastening the response of the neuromuscular mechanism through stimulation of the proprioceptors; could result in either facilitation or inhibition.

 

 Mechanisms of PNF:

 Autogenic inhibition: inhibitory signals (from GTOs) override excitatory impulses (from muscles spindles) causing gradual relaxation.

 

Reciprocal inhibition: contraction of agonist muscle elicits relaxation of antagonist.

 

Stretch Reflex: sudden stretch of muscle spindle causes agonist to contract and antagonist to relax (ie., patellar tap reflex)

 

Basic Principles:

 

Patterns of movement - should be taught to patient

 Visual stimulus - look at moving limb

 Verbal cues - to coordinate reflex and voluntary movements

 Manual contact - to resist and direct

 Proper mechanics - body positioning of therapist

 Resistance - should be maximal

 Rotational movement - for maximal ROM

 Normal timing - proper sequence of muscle contraction

 Timing for emphasis - to affect specific points on a range

 Traction or approximation - for extra proprioceptive response

 Quick stretch - facilitates greater muscular contraction

 

 Techniques:

 Strengthening:

 

Rhythmic initiation: a progression of 1) initial passive, 2) active-assistive, and 3)active movement through the agonist pattern.

 

Rhythmic stabilization: an isometric contraction of the agonist followed by an isometric contraction of the antagonist.

 

Repeated contraction: an isotonic contraction against maximal resistance both concentrically and eccentrically throughout the range of motion.

 

Slow Reversal: isotonic contraction of the agonist followed immediately by an isotonic contraction of the antagonist.

 

Slow reversal-hold: an isotonic contraction of the agonist followed immediately by an isometric contraction.

 * all can employ quick stretch to facilitate muscular activity

 

a. Rhythmic Initiation: P-ROM, active-assissted, MRE

 b. Rhythmic Stabi1ization: "HOLD"

 c. Repeated Contraction: "PUSH/PULL" (INSERT QUICK-STRETCH)

 d. Slow reversal: "PUSH-PULL"

 e. Slow reversal-ho1d: "PUSH-HOLD, PULL-HOLD"

 

 Stretching:

 

Contract relax: isotonic contraction of the antagonist followed by passive stretch

Hold-relax: isometric contraction of the agonist followed by passive stretch

Agonist contract-relax: body part is moved actively in the agonist pattern via isotonic contraction of the agonist (active stretch).

Slow reversal-hold-relax: isotonic contraction of the antagonist followed by an isometric contraction of the agonist followed by a relaxation phase.

 

Stretching (hamstring stretching example)

 

a. Contract-Relax: PUSH through ROM, then RELAX

 b. Agonist Contract-Relax: HOLD, PULL

 c. Slow Roversal-Hold-Re1ax: PUSH, HOLD, PULL

 

 

 Vll. MOVEMENT PATTERNS

 A combination of rotational and diagonal movements.

 

 UPPER EXTREMITY

 

 Dl into FLEXION from: HITCH HIKE to: SWAT fly

 Dl into EXTENSION from: SWAT FLY to: HITCH HIKE

 

 D2 into FLEXION from: HAND IN OPPOSITE POCKET to: CARRY TRAY

 D2 into EXTENSION from: CARRY TRAY to: HAND IN OPPOSITE POCKET

 

 

 LOWER EXTREMITY

 

 D1 into flexion from: FOOT OUT AND AWAY to: CROSS LEGS

Dl into EXTENSION from: CROSSED LEGS to: FOOT OUT AND AWAY

 

 D2 into FLEXION from: DISTAL LEGS CROSSED to: SOCCER WIND UP

 D2 into EXTENSION from: SOCCER WIND UP to: DISTAL LEGS CROSSED

 Note: Trainer may use limited ROM pattorn

 

 Discussion Questions:

 1. What are the possible advantages of PNF over other stretching/strengthening techniques?

 

2. Why are there so many techniques? In what specific conditions would each of the techniques be used?

 

3. Under what conditions should PNF techniques not be used?