PNF ; Proprioceptive Neuromuscular Facilitation

What is the PNF
- Proprioceptive Neuromuscular Facilitation (PNF) is a more advanced form of flexibility training, which involves both the stretching and contracting of the muscle group being targeted.
- Increase ROM

Neuromuscular Mechanisms related normal muscle movement
- The Role of the Stretch Reflex
  - The muscle spindle is a long thin nerve receptor found within the muscle. Information from this receptor transmits information to the spinal cord regarding muscle length and the speed of lengthening. When a muscle is stretched quickly this muscle spindle fires and causes a reflexive contraction within that muscle that is undergoing the stretch. The greater the speed of stretch, the stronger the reflex contraction in the muscle being stretched.
- Reciprocal Inhibition
  - inhibition of the antagonist muscle group is mediated by the muscle spindle. If the agonist muscle contracts, then the spindle fires, sending messages to the spinal cord causing the antagonist muscle to relax.
- Autogenic Inhibition
  - The golgi tendon organ is a nerve receptor found in tendons. This receptor fires when tension increases within the tendon. This tension can be due to stretch or contracting muscle. When the golgi tendon organ fires a signal is sent to the spinal cord causing the agonist muscle to relax.

Techniques of PNF
1. Reciprocal inhibition : creat relaxation of the target muscle using contraction of the opposit muscle(antagonist)
  1. Agonist contract
    1. This is used when the affected muscle is in spasm, or very tight and painful. Since that muscle can’t be contracted further, we take advantage of this relfex effect
    2. Procedure
      1. therapist lengthens the spastic muscle to its pain free barrier (ex, biceps)
      2. client then concentrically and submaximally contracts the opposit muscle to the spasm, against the therapist’s resistance for 5 to 10 seconds (ex, triceps)
      3. client then fully relax the muscle ( ex, triceps)
      4. therapist lengthens to the spastic muscle to its new pain free barrier
      5. Steps ‘b-d’ should be done 3 times
      6. Passively stretch the target muscle for 30 seconds(biceps) ; no boudcing movement
2. Active inhibition : Creat relaxation of a muscle by using the same muscle’s own contraction, relaxation and enlogation
  1. Hold Relax ( Most use)
    1. To reduce pain and restricted range of motion. use maximal muscle contraction
    2. Procedures
      1. therapist lengthens the muscle to its pain free barrier
      2. client then isometrically and maximally contracts the muscle against the therpist’s resistance for 5 to 10 seconds
      3. client then fully relaces the muscle
      4. therapist lenghtens to the muscle to its new pain free barrier
      5. Steps b-d should be done 3 times
      6. passively stretch the target muscle for 30 seconds
  2. Contract – Relax
    1. only be used when there is no pain present, use maximal contraction
    2. Procedures
      1. therapist lengthens the muscle to its pain free barrier
      2. client concentrically and maximally contracts the tight muscle against the therapist’s resistance for 5 to 10 seconds. client should have the intent to move, but therapist should only allow minimal movement
      3. client then fully relaces the muscle
      4. therapist lenghtens to the muscle to its new pain free barries
      5. Steps b-d should be done 3 times
      6. passively stretch the target muscle for 30 seconds
  3. Post Isometric Relaxation(PIR)
    1. Use minimal isometric contraction followed by relaxation and gentle stretch
    2. Procedures
      1. therapist lengthens the muscle to its pain free barrier
      2. client then isometrically and sub maximally(10~25%) contracts the muscle against the therpist’s resistance for 5 to 10 seconds. client ihnhales slowly and deeply
      3. client completely relaces the muscle while slowly exhaling through pursed lips
      4. herapist lenghtens to the muscle to its new pain free barries
      5. Steps b-d should be done 3 times
      6. passively stretch the target muscle for 30 seconds

Techniques	Elongate	Contract	Movement	Forece	Stretch
Agonist Contract	Target	Opposite	Concentric	Submaximally	Target
Hold – Relax	Target	Target	Isometric	Maximally	Target
Contract – Relax	Target	Target	Concentric	Maximally	Target
PIR	Target	Target	Isometric	10 ~ 25%	Target

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