PNF and other techniques

Chapter 15

Neurophysiological basis:

Principles of facilitation and inhibition attributed to

Sherrington
PNF based on stretch reflex

Muscle spindles detect length changes

GTOs detect tension changes

Autogenic inhibition: GTOs override the muscle

spindles and cause relaxation
Reciprocal inhibition: contraction or stretch of
agonist relaxes antagonist

Quick stretch of antagonist facilitates contraction of

agonist

Rational for use:

Goal is to provide maximal response for

strength, flexibility, and coordination
Emphasis on selective reeducation through
neuromuscular control
Contraction strength is directly proportional
to activated motor units

Irratiation: overflow effect where stronger

muscle groups help weaker ones

Basic principles:

Teach the patterns and

sequences start to
finish
Patient should look at
the limb
Use verbal cues
Appropriate pressure
is essential

Mechanics and body

positioning are
essential
Rotational movement
is critical component
Distal movements
occur first
Quick stretch before
contraction is facilitory

PNF techniques:

Strength:

Slow reversal:

Agonist isotonic
Agonist isometric
Antagonist isotonic
Antagonist isometric

Rhythmic stabilization:

Stretching:

Agonist isotonic
Antagonist isotonic

Slow reversal hold:

Agonist isometric
Antagonist isometric
Manual pertubation

Contract relax:

Hold relax:

PROM into agonist

Antagonist isotonic
PROM into agonist
Antagonist isometric

Slow reversal hold

relax:

Agonist isotonic
Antagonist isometric

PNF patterns:

All patterns have three components:

Flexion-extension
Abduction-adduction
Internal rotation-external rotation

Upper and lower extremity have 2 diagonal patterns

Trunk patterns are called chopping and lifting
Neck patterns involve flexion/rotation to one side
and extension/rotation to the other
Figure 15-4 and figure 15-5 page 310-311

Other techniques:

Strain-counterstrain:

Used to decrease
muscle tension
ATC locates tender
points, then moves the
patient into a position of
comfort
Hold the position for 90
sec, then return to
neutral
Works by reducing
spindle input to allow
relaxation

Active release
technique (ART):

Used to correct fibrotic

adhesions
Locate the adhesion
and apply pressure with
thumb or fingers in
direction of fiber
Patient actively moves
part while ATC applies
pressure
Treatments are
uncomfortable

Sports massage:

Mechanical stimulation of tissue

Hoffa massage: traditional strokes

No conclusive evidence of effectiveness

Effleurage, petrissage, percussion/tapotement, vibration

Friction massage: increase inflammatory response

Acupressure: massage of trigger points
Connective tissue massage: circulatory pathologies
Myofascial release: relieve tight fascia
Rolfing: manual soft tissue manipulation to balance
the bodys gravitational field
Trager: used to establish neuromuscular control