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PNF Stretching. Uses an isometric contraction prior to the stretch to achieve greater gains than are typically achieved from static stretching alone. PNF stretching. Robert E. McAtee. This article offers a brief look at facilitated stretching, an active- assisted form of stretching based on proprioceptive neuromuscular facilitation. Facilitated Stretching, 4 th ed. CORRESPONDENCE EDUCATION PROGRAM # CCA. Check your receipt for course expiration date. After that date no credit.
Facilitated stretching is designed to be done by the stretcher. This places responsibility for success squarely where it belongs.
Don't allow the stretcher to overpower you. The stretcher actively lengthens the muscle to be stretched the target muscle to its maximal pain-free end range. This readiness to lengthen may be the result of the inverse stretch reflex. As the partner. Detailed Version As mentioned earlier. The muscle spindle cells and the Golgi tendon organs are stimulated.
This stretches the hamstrings to their end range. We use this inhibition loop to actively lengthen the target muscle. During this time. In passive work. The more detailed steps involved in a partner-assisted facilitated stretch are as follows: Self-stretching is emphasized so that the stretcher can do it alone. Breathing Muscles need oxygen to work. If pain persists. In fact. On the exhale. Support the strethcer's leg using proper biomechanics. PNF stretches should always be pain free.
This also refers back to our discussion of empowering the stretcher to take an active. If the stretcher experiences pain. This communicates more clearly what you wish to have happen. Now the partner moves into the new position to once again offer resistance. How do we reconcile these two conflicting file: If you ask the stretcher to ''resist. But many times.
Use of Language: Repeat the process 2 to 3 times. The legs are set wide apart. I think it's more important to breathe.
Safety Issues Stretching safely is of utmost concern for both the stretcher and the partner. Another reason for normal breathing is that holding the breath during the isometric phase is often accompanied by compensatory recruitment of other muscles. The partner applying the resistance may be expending unnecessary energy because of poor ergonomics.
Not only can you become acutely injured by using these techniques carelessly. It's easy to monitor the stretcher's breathing and your own throughout the process. Plan carefully and communicate freely with each other. And third. Body mechanics are extremely important during all phases of stretching. Safety for the Partner The athletic stance. We've found that three cycles of normal breathing in and out takes about 6 to 10 seconds.
Another component of having the stretcher more involved in stabilizing his motion is the discovery of where he is unaware. The learning that results is extremely useful for the stretcher as he incorporates it into his "real" life.
When you are acting as the partner in facilitated stretching. This discovery enables us to work together to figure out how to simply contract this quadratus lumborum without bringing in other muscles inappropriately. I've come to realize that the stretcher needs to take an active role in preventing compensation.
Tighten your abdominal muscles to help keep your back from arching too far. Some areas of the athletic stance to pay attention to include the following: As you work. This file: If he can learn to use his gluteus maximus and hamstrings without compensation on the table.
Safety for the Stretcher Because the stretcher does most of the work in facilitated stretching. When I first started doing facilitated stretching. They begin recruiting like mad to try to do the simple motion required for the stretch. This lengthening helps prevent undue stress on the spine.
Use a wide stance to help you remain balanced and stable. I was taught to stabilize the stretcher when necessary to prevent compensatory shifts in position. Remember that you control the strength of the stretcher's isometric contraction. It is the "strongest" position. Use the large muscles of the trunk and extremities to resist the isometric contraction instead of smaller. Keep your low back area flattened to reduce pressure on your lumbar spine. Over the years. This will help prevent low back pain.
Be sure that the stretcher begins slowly during the isometric phase. Stop immediately if either person has pain. Provide resistance only up to the level that is comfortable for you. Avoid unnecessary twisting or bending. Be aware of keeping your spine lengthened as you work. By paying attention to your posture and body mechanics.
The active learning translates into his daily life. To avoid losing your balance when you're acting as the partner. Importance of Positioning To achieve the most benefit from stretching. When you are acting as the partner during facilitated stretching. One of the benefits of facilitated stretching is that the stretcher does most of the work. For you. The stretcher moves the limb into position. Reducing Fatigue Because facilitated stretching is an active form of work.
This unconscious shift engages the gluteus maximus more and is usually because of a weak hamstring. Relax whenever possible during the session and expend only the effort necessary. Reducing fatigue can reduce the chance of injury. Breathe correctly. When performing facilitated stretching. Compensation Patterns We all develop compensatory patterns of muscular contraction to make up for muscle weakness or imbalance.
This can be especially important for stretchers who don't participate in a regular exercise program because they may experience delayed onset muscle soreness the day after a stretching session if they work too hard. Injuries are more likely if you're fatigued. By being aware of compensation and working with the stretcher to eliminate it during facilitated stretching.
Although it's impossible to completely isolate and activate only one muscle. Use self-stabilization to prevent compensation. Self-Stretching Principles In keeping with the theme of stretcher learning and self-help. Assert appropriate effort during isometric phase. Where appropriate. The principles for self-stretching are just like the ones for partner work: Use proper positioning to isolate the target muscle.
If you're using good body mechanics. Remain pain free throughout the sequence. This leverage allows you to accomplish your work with minimal physical effort.
We need only a good contraction of the target muscle during the isometric phase. For the stretcher. Stretch the target muscle by contracting the antagonist. Manual of Orthopedic Massage. The blood within the arteries moves in a spiral pattern. And myosin contains globular heads that spiral around the myosin filament. The levator scapula.
On the macroscopic level. The spiral is also an essential pattern in the body.
Each actin filament is a double helix. Like the Earth. We live in a spiral universe. Hendrickson Our local galaxy. And DNA. The spiral is a fundamental shape in the movement of air currents over the surface of the Earth. I'm indebted to Thomas Hendrickson. The gross structure of the tendon and ligament is also a spiral.
Muscles are also organized in spirals. Figure 3. When the biceps contract. Even though we don't use the full patterns in facilitated stretching. Many muscles are actually capable of motion in three planes. This spiral is especially noticeable in the movements of your arms.
The muscles spiral around the bones from origin to insertion. The spiral-diagonal character of normal movements arises from the design of the skeletal system and the placement of the muscles on it. Voss et al. These give a sense of the natural rhythm of the patterns and let you feel the movements through a full range of motion. The same is true for D2 extension and D2 flexion. Each pattern is divided into two parts: The movement sequence for the D1 extension pattern is the exact opposite of the sequence for D1 flexion.
It's also the starting position for D1 flexion. This is the beginning position for D1 extension. The right forearm is supinated. From this position. Go as far in each plane of motion as you can to fully lengthen all the involved muscles.
D1 Practice: Arm 1. So take a moment now and practice D1 before going on. This makes more sense when you perform the pattern instead of just reading about it. D1 and D2. D1 flexion of the arm ends in flexion.
This motion blends internal rotation. Stand and bring your right arm up and across your body. The patterns are named for their ending positions. This is the ending position for D1 extension. From this starting position. It's also the ending position for D1 flexion. D1 extension ends in extension. The forearm pronates. So take some time to practice D2 now.
It's also the ending position for D2 flexion because the patterns are named for their ending positions. D2 Practice: D1 extension reverse push- ups: This is flexion. This is the beginning position for D2 extension. It may help you remember the ends of each pattern by giving them nicknames.
Repeat these patterns several times with each arm. Once again. D2 extension ends in extension. D2 flexion ends in flexion. Stand and bring your right arm up. D2 Patterns for the Arm The second arm pattern. What activities use motion like this? Throwing a Frisbee.
D1 flexion self-feed: In reality. We'll call D2 extension "sheathing a sword" and D2 flexion "drawing a sword. As with the arm.
Stand and bring your right leg forward and across your body. The patterns are similar but not identical. The ending position for D2 extension is also the starting position for D2 flexion. D1 flexion ends in flexion. D2 flexion drawing a sword: D2 extension sheathing a sword: Active practice will make this easier to understand.
Throwing a ball. Leg You'll find it easier to do this practice if you use a wall or a chair for balance and support. Check your position against the model in figure 3. Leg 1. Swing your leg through this pattern several times to feel the rhythm of it. Compare your position with that of the model in figure 3.
This is extension. Slowly swing your leg. Many athletic activities require aspects of the D1 pattern. D1 flexion is called the "soccer kick.
D1 extension toe- off: D1 flexion soccer kick: Active practice makes it clearer. D2 extension begins in flexion. Stand and bring your right leg forward and out away from your body. The foot is dorsiflexed and everted.
Check your position with the model in figure 3. Working at the End of Range For stretching. Slowly swing your leg back and across your body. When a physical therapist uses these PNF patterns with a patient. We stretch groups of related muscles simultaneously when we use these three-dimensional patterns. This is the beginning position for D2 extension and the ending position for D2 flexion. The foot is plantarflexed and inverted. D2 flexion snowplow: Compare your position to the model in figure 3.
As you practice this D2 pattern a few times. To help you remember it. If you're a skier. You've achieved the end of D2 extension and the beginning of D2 flexion. D2 extension turnout: The stretch occurs when the stretcher actively moves farther into the lengthened range of the pattern. Rotational Component In the first edition of Facilitated Stretching.
Use this line as a guide for the movement of the leg to be sure you have a balanced blend of flexion and adduction. This change also makes it less complicated to perform the stretch. It may be helpful to visualize a diagonal line through opposite corners of the table or plinth on which the stretcher is lying figure 3.
This was based on our understanding of statements made by Voss et al. Subsequent reading. Although this blend of motion is usually what we're looking for. When you place your hands on the medial side of the limb. Asking for a lateral push while holding on the medial side may be very confusing to the stretcher because your verbal commands don't match the proprioceptive cues your hands are communicating. Facilitated stretching is based on these principles but focuses on increased flexibility and coordination.
We also looked at the various types of stretching and the importance of using good biomechanics when stretching. We use single muscle. We use the spiral-diagonal patterns as a way to increase the flexibility and coordination of groups of muscles that act together. In part II. When should you use patterns. We can also use the patterns as an evaluative tool to determine which muscles in a synergistic group are limiting motion.
Once these deficiencies are identified. Using these three-dimensional patterns. Chapter 7 looks at how PNF techniques can be incorporated into a rehabilitation program to restore pain-free motion.
Chapter 4 covers the hips and legs. An isometric contraction is one in which no movement occurs. Stretch pain free. The partner should never push or pull to deepen the stretch. The symbols you see throughout the exercises in part II are explained here.
Please adhere to these special notes and cautions when doing any stretch. Organization of Stretches We've divided each chapter into single muscle stretches and spiral-diagonal patterns. It all depends on how strong you are in relation to the stretcher. Those are indicated with a special symbol. Stop movement. In some cases. Once the stretcher has achieved the proper level of isometric contraction.
Each muscle group is presented as follows: The format for the stretches provides you with the information you need to do them effectively and safely. Don't push or pull. Special notes and cautions. Facilitated stretches should always be pain free. The stretcher begins slowly and builds the contraction as you provide matching resistance. This translates to taking more steps over a given distance than a runner with more flexibility. In addition. More steps means more work and more impact.
The stretches in this chapter will help you develop flexibility in the major muscles of the hips and legs. When a muscle is chronically shortened. They can also restrict stride length in walking or running. Runners often have short. Origin Insertion Action Long head: Both heads: Straight Leg Hamstrings Stretch This is an effective. Hip flexion to 90 degrees with the leg straight is optimal. After the isometric push. You may need to work with the stretcher on body awareness. Direct the stretcher to begin slowly to attempt to push his heel toward the table.
If range is less than 90 degrees. Position yourself to offer resistance to the isometric contraction of the hamstrings figure 4. He lifts his right leg. Now move into the new position to once again offer resistance. As the stretcher lifts his leg higher. He must keep both hips flat on the table.
This deepens the hamstrings stretch.
The stretcher must keep his hips flat on the table during the entire sequence. Check range of motion figure 4. The stretcher is supine. The stretcher may bend his left knee and rest his foot flat on the table. This lengthens the right hamstrings to their pain-free end of range. Repeat 2 to 3 times.
Figure 4. Stabilize the thigh in this position while the stretcher straightens the lower leg as far as possible. The stretcher lies supine and lifts his thigh to flex his hip to 90 degrees. This lengthens the hamstrings to their pain-free end of range figure 4.
Once they've achieved more flexibility. Bent Knee Hamstrings Stretch This is a better stretch for people with very short hamstrings. You may need to work with the stretcher on body awareness until he is able to stabilize his hips properly before performing this stretch.
As the stretcher straightens his leg. Hamstrings Self-Stretch For self-stretching. Lie in a doorway and use the doorjamb to provide resistance to the hamstrings contraction.
Position yourself to offer resistance to the isometric contraction of the hamstrings. The towel simply replaces the partner. Use a towel wrapped around your heel to provide resistance to the hamstrings contraction.
Never pull on the towel to deepen the stretch figure 4. The quads are usually involved in any type of knee pain or instability. Chronically short quads can contribute to low back pain. One of the quads. Check range of motion. The stretcher is seated. If range is limited. As the stretcher straightens the lower leg. The quadriceps extend straighten the knee.
While on her stomach. The stretcher lies prone. Facilitated stretching works quite well here if the limitation is due to tight quads. The stretcher must keep his hips flat on the table or on the pillow during the entire sequence. Position yourself to offer resistance to the isometric contraction of the quads by placing your hands or shoulder against the stretcher's shin figure 4.
Direct the stretcher to begin slowly to try to straighten his leg. Push only until the stretcher feels the quads beginning to stretch. Stretching the hamstrings prior to the file: This position can also eliminate low back discomfort. If this position causes any low back discomfort. Because of the bulk of the hamstrings and calf muscles. Quadriceps Stretch This stretch is used to improve knee flexion.
This is the pain-free end of range. Quadriceps Self-Stretch Assume the same beginning position as in step 1 of the quadriceps stretch.
Use your opposite hand to hold the leg and provide resistance right hand to left leg. You may also use a towel wrapped around your leg if this is easier figure 4. As a further precaution. This prevents excessive stress on the medial collateral ligament figure 4.
For a more detailed discussion of this seeming contradiction. Origin Insertion Action Psoas: Psoas-Piriformis Balance" Because of its attachment along the lumbar spine. If the psoas is too tight. Normal range of flexion degrees allows the stretcher to bring her flexed knee to her chest figure 4.
Check hip range of motion. If the stretcher's left thigh lifts off the table figure 4. This indicates tight quadriceps especially rectus femoris and tensor fascia latae TFL on the left leg figure 4. If the iliopsoas is too tight. Check to see whether the stretcher's left lower leg straightens. Normal range in extension is approximately 30 degrees figure 4.
Repeat for the other leg. The left lower leg extends. If the quads are too tight. It's common for both the quads and the iliopsoas to be hypertonic on the same leg. He is not trying to straighten his lower leg. This lengthens the iliopsoas to its end of range. The stretcher must keep his hips flat on the table or on the pillow throughout this stretch. There will be a strong tendency for him to lift his hip as he lifts his leg.
Support the leg just above the knee to provide resistance to the isometric contraction of the iliopsoas. If the stretcher has any low back discomfort in this position. The stretcher uses his hip extensors gluteals and hamstrings to lift his leg off the table as high as possible.
If you use your leg to provide resistance. Be sure the stretcher keeps his hips flat on the table. Direct the stretcher to begin slowly to try to pull his thigh toward the table. Nelson et al. Vertical jump and throwing distance increased more than double in those in the PNF stretching group than those in the weight training group.
The PNF group completed stretches twice a week for eight weeks. Each session consisted of three sets of six against maximal force on both lower and upper extremities. This study infers that PNF may enhance force production as well as functional movements in untrained individuals. PNF stretching has been proven to decrease strength and power when done prior to high intensity and maximal effort exercises, such as jumping, plyometrics, sprinting, cutting, and other similar movements.
These effects can last longer than ninety minutes. PNF is effective if completed after exercise and done at least twice a week to ensure lasting ROM and sustained beneficial effects. When done prior to exercise, PNF has been shown to decrease muscle strength, power, EMG activity, vertical jump height, and ground reaction time Bradley et al.
This may be due to the muscles being stretched too far outside of their capacity, causing inhibition following the stretching. However, PNF has been shown to be beneficial for submaximal exercises such as jogging. Increased stride length, frequency, and ROM were recorded by Caplan et al. Therefore, PNF stretching should be completed after exercise at least two times a week to increase ROM and induce increases in muscle strength, power, and athletic performance.
PNF exercises done before exercise will diminish performance for the short term 90 minutes , however the long term effects may be similar Funk et al. Effects on ROM Funk et al. Each stretching method was performed for five minutes after 60 minutes of exercise or no exercise. The results showed that those who exercised and received PNF stretching experienced more of an increase in flexibility when compared to the baseline group and the group without exercise and PNF.
However, there were no differences observed in the static stretching groups baseline, with exercise, and without exercise. Lucas and Koslow recruited 63 college women for their seven week study in which they examined the effects of three methods of stretching on the hamstring and gastrocnemius muscles. Each subject was assigned to one of the three treatment groups and received three treatments a week. Three measuring ROM tests were performed on all subjects; before the treatments began, after 11 rounds of treatment, and after all 21 rounds of treatment had been completed.
Each of the treatments was found to produce significant improvements when comparing the beginning test to the end test. It turned out that the longer the treatment time, the less significant the results differed among the three treatments. Wallin et al. These four groups represented each group of TMs being stretched; the gastrocnemius, the ankle dorsiflexors, the hip adductors, or the hamstrings.
The gastrocnemius, hamstring, and adductor groups received 14 treatment bouts of the CR method of PNF, while the ankle dorsiflexor group received a BS method. The ankle dorsiflexor group was switched to the CR method afterwards. Flexibility was increased more with the CR method than with the BS method for this group. Etnyre and Lee assessed 74 subjects, 49 men and 25 women, in order to compare changes in hip flexion and shoulder extension between men and women through SS, CR, and CRAC stretching techniques, over 12 weeks.
ROM measurements were obtained from all subjects before any treatment began and were taken once every three weeks until the end of the study. Significant increases in ROM were seen throughout the treatment groups, but it was found that the PNF techniques were more effective than the SS method for both hip flexion and shoulder extension.
Women generally started off with greater ROM in both of the movements being studied, though the results proved that the increases that the men and women made were not significantly different when compared to one another. Women differed from the men in that they did not have very significant ROM increase differences between either PNF method at either joint.
Feland et al. The subjects were assigned to one of three groups: control, the CR method, or the SS method. No significant differences between the SS and CR treatment groups were found, though the differences determined were more pronounced in the men compared to the women.
These differences between genders were even more pronounced amongst the younger subjects. As it turns out, age affects the flexibility gains in the CR method. As age increases, the soft tissues that are usually affected by PNF methods and receive the neural inhibition produced by PNF to reduce reflex activity and promote relaxation, which leads to greater ROM, are changed.
The soft-tissue matrices tend to lose elasticity and strength, and myofibrils are replaced by connective tissue. These changes cause the older muscles to be more susceptible to contraction-induced injury Feland et al. Each subject in the first three groups performed three six second CR method stretches, all at their respective intensities, with 10 second breaks in between each contraction for five days. Rowlands et al. Each subject was assigned to one of three groups.
These groups included five second isometric contractions, ten second isometric contractions, and the control. The two treatment groups performed the CRAC method of PNF two times per week, for six total weeks, with at least 24 hours between the two weekly treatments.
For both methods, the subjects held the isometric contraction of the hamstrings for their respective time. Even more improvement was found after six weeks and twelve treatments. It was determined that the longer stretching time did produce greater flexion ROM increases for the subjects.
Increases were more significant when PNF methods were performed after exercising, and the longer the contraction was held by reducing contractile activity Bonnar et al. However, this increase in flexibility and ROM is not permanent. Its effects were found to last for only six minutes after the stretching protocol ended Spernoga et al.
In order to maintain it, performing PNF over a longer period of time is required, although the results become less significant the longer the treatment time is, and the more it is performed over a longer period of time. There is a very significant increase after the first bout of treatment, therefore PNF is a good way to gain immediate improvements in ROM of a joint.
PNF methods increase the flexibility and ROM of all subjects who received PNF stretching, but there are some differences between gender and age groups. This difference between genders holds true even with different age groups. As the subjects got older though, it was discovered that there were fewer differences in flexibility and ROM gains found before and after the PNF methods.
Because there is a higher probability that older people will get injured from the intense contraction during PNF, this decrease in differences could possibly mean that PNF methods should not be utilized on the elderly Feland et al. However, proper protocol and consistency must be followed to attain and maintain the benefits of PNF techniques.
Four theoretical mechanisms were proposed as being responsible for these benefits, although there is little empirical evidence to support these mechanisms. The relationship between isometric contraction durations during hold-relax stretching and improvement of hamstring flexibility. J Sport Med Phys Fit. The effect of static, ballistic, and proprioceptive neuromuscular facilitation stretching on vertical jump performance.
The effect of proprioceptive neuromuscular facilitation and static stretch training on running mechanics. Do Golgi tendon organs really inhibit muscle activity at high force levels to save muscles from injury, and adapt with strength training? Sports Biomech. H-reflex during static stretching and two variations of proprioceptive neuromuscular facilitation techniques. Although this can result in greater flexibility gains, it also increases the likelihood of injury.
Even more risky are dynamic and ballistic PNF stretching techniques like the hold-relax-swing, and the hold-relax-bounce. If you are not a professional athlete or dancer, you probably have no business attempting either of these techniques the likelihood of injury is just too great.
Even professionals should not attempt these techniques without the guidance of a professional coach or training advisor. These two techniques have the greatest potential for rapid flexibility gains, but only when performed by people who have a sufficiently high level of control of the stretch reflex in the muscles that are being stretched.
Like isometric stretching see section Isometric Stretching , PNF stretching is also not recommended for children and people whose bones are still growing for the same reasons. Also like isometric stretching, PNF stretching helps strengthen the muscles that are contracted and therefore is good for increasing active flexibility as well as passive flexibility.