PNF - Techniques

Classification of Techniques

Techniques directed to agonists

Techniques using antagonists to facilitate contraction of agonists

Techniques using antagonists for relaxation of antagonists

The techniques described are: ∗       Rhythmic Initiation ∗       Combination of Isotonics. ∗       Reversal of Antagonists ∗       Dynamic Reversal of Antagonists

(incorporates Slow Reversal) ∗       Stabilizing Reversal ∗       Rhythmic Stabilization ∗        Repeated Stretch (Repeated

Contraction) ∗       Repeated Stretch from beginning

of range ∗       Repeated Stretch through range ∗       Contract-Relax

Hold-Relax

     

Rhythmic Initiation (def)

Rhythmic motion of the limb or body through the desired range, starting with passive motion and progressing to active resisted movement

Rhythmic Initiation

Goals

Aid in initiation of motion Improve coordination and sense of motionNormalize the rate of motion, either

increasing or decreasing itTeach the motionHelp the patient to relax

Indications∗ Difficulties in initiating motion∗ Movement too slow or too fast∗ Uncoordinated or dysrhythmic motion∗ General tension

Combination of Isotonic

Combined concentric, eccentric, and stabilizing contractions of one group of muscles (agonists) without relaxation.

For treatment, start where the patient has the most strength or best coordination

Goals

Active control of motion Coordination Increase the active range of motion Strengthen Functional training in eccentric control of movement

Indication

Decreased eccentric control Lack of coordination or ability to move in a

desired directionLack of active motion within the range of

motionDecreased active range of motion

Reversal of Antagonists

Dynamic Reversals

Stabilizing Reversal

  Dynamic Reversals

(Incorporates Slow Reversal) Active motion changing from one direction (agonist) to the opposite (antagonist) without pause or relaxation. In normal life we often see this kind of muscle activity; throwing a ball, bicycling, walking etc

Goals* Increase active range of motion * Increase strength * Develop coordination (smooth reversal of

motion) * Prevent or reduce fatigue* Increase endurance

Indications * Decreased active range of motion * Weakness of the agonistic muscles* Decreased ability to change direction of motion* Exercised muscles begin to fatigue

Stabilizing Reversal –

Alternating isotonic contractions opposed by enough resistance to prevent motion. The command is a dynamic command ("push against my hands", or "don't let me push you") and the therapist allows only a very small movement.

Goals* Increase stability and balance * Increase muscle strength* Increase coordination between agonist and

antagonist

Indications * Decreased stability* Weakness* Patient is unable to contract muscle isometrically

Rhythmic Stabilization

- Alternating isometric contractions against resistance, no motion intended

Goals Increase active and passive range of motionIncrease strengthIncrease stability and balanceDecrease pain

Indications Imitated range of motion Pain, particularly when motion is attempted Joint instability Weakness in the antagonistic muscle group Decreased balance

Contraindications * Cerebellar involvement* The patient is unable to follow instructions due to age,

language difficulty, and cerebral dysfunction

Repeated Stretch from Beginning of Range -stretch reflex elicited from muscles under the

tension of elongation

Goals* Facilitate initiation of motion* Increase active range of motion* Increase strength* Prevent or reduce fatigue* Guide motion in the desired direction

Indications* Weakness* Inability to initiate motion due to weakness or

rigidity* Fatigue* Decreased awareness of motion

Contraindications* Joint instability* Pain* Unstable bones due to fracture or osteoporosis* Damaged muscle or tendon

-

Repeated Stretch from Beginning of Range stretch reflex elicited from muscles under the tension of elongation

Goals  ∗       Facilitate initiation of motion ∗       Increase active range of motion ∗       Increase strength ∗       Prevent or reduce fatigue * Guide motion in the desired

direction

Repeated Stretch (Repeated Contractions)

Indications∗       Weakness∗          Inability to initiate motion due to

weakness or rigidity∗       Fatigue∗       Decreased awareness of motion Contraindications ∗       Joint instability ∗       Pain ∗        Unstable bones due to fracture or

osteoporosis ∗       Damaged muscle or tendon  

Repeated Stretch-The stretch reflex elicited from muscles under the tension of contraction.

Goals* Increase active range of motion* Increase strength* Prevent or reduce fatigue* Guide motion in the desired direction

Indications* Weakness* Fatigue* Decreased awareness of desired motionContraindications * Joint instability* Pain* Unstable bones due to fracture or

osteoporosis* Damaged muscle or tendon

Contract-Relax

-Resisted isotonic contraction of the restricting muscles (antagonists) followed by relaxation and movement into the increased range.

Goal* Increased passive range of motion

Indication* Decreased passive range of motion

Hold-Relax: Direct Treatment-Resisted isometric contraction of the antagonistic muscles (shortened muscles) followed by relaxation

Goals* Increase passive range of motion* Decrease pain

Indications* Decreased passive range of motion* Pain* The patient's isotonic contractions are too strong

for the therapist to controlContraindication* The patient is unable to do an isometric

contraction

PNF STRETCHING

PNF stretching uses the neuromuscular patterns of each muscle group to help

improve flexibility. A series of intense contractions and

relaxations using a partner or equipment to help him stretch.

The PNF technique allows for greater muscle relaxation following each

contraction and increases the ability to stretch through a greater range of motion.

the hold-relax

This technique is also called the contract-relax. After assuming an initial passive stretch, the muscle being stretched is isometrically contracted for 7-15 seconds, after which the muscle is briefly relaxed for 2-3 seconds, and then immediately subjected to a passive stretch which stretches the muscle even further than the initial passive stretch. This final passive stretch is held for 10-15 seconds. The muscle is then relaxed for 20 seconds before performing another PNF technique

the hold-relax-contract This technique is also called the contract-relax-contract, and the contract-relax-antagonist-contract (or CRAC). It involves performing two isometric contractions: first of the agonists, then, of the antagonists. The first part is similar to the hold-relax where, after assuming an initial passive stretch, the stretched muscle is isometrically contracted for 7-15 seconds. Then the muscle is relaxed while its antagonist immediately performs an isometric contraction that is held for 7-15 seconds. The muscles are then relaxed for 20 seconds before performing another PNF technique

Passive stretch Isometric contraction

Passive stretch

Hold- relax

Concentric contraction

Contract-relax

Concentric contractionFull range

Passive stretch