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PNF: PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION stretching procedures -…
PNF: PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION stretching procedures
definition
Sometimes referred to as active stretching or facilitative stretching
Integrate active ms contractions into stretching maneuvers purportedly to inhibit or facilitate ms activation & to increase the likelihood that the ms to be lengthened remains as relaxed as possible as it is stretched
Proprioceptive:
Having to do with any of the sensory receptors that give information concerning movement & position of the body.
Neuromuscular:
Involving the nerves & ms
Facilitation:
Making easier
Later his work was continued more effectively by 2 physical therapists, Margaret Knott & Dorothy Voss
They stressed the importance of the central excitation & the muscular strength which is directly proportional with the number of activated motor units
The importance of proprioceptors in particular, the ms spindle was recognized as key factor in facilitating contraction of ms
It is based on the principle of influencing the alpha & gamma motor neural activity by modifying the effects of higher centers through stimulation of proprioceptors
Beevo’s axiom states that “the brain knows not of ms but of movements”
Hence this concept of PNF becomes imp in movement therapy as it concerns with mass movement pattern that are closely related to the activities of daily living.
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TYPES OF PNF STRETCHING
Hold relax (HR) or contract-relax
Agonist contraction
Hold-relax with agonist contraction
1.conventional PNF/classical PNF
Hands on clinical approach
modified PNF
This adapts certain PNF techniques & principles for application by hand or apparatus in physical conditioning.
Eg: springs, weights, therabands etc
FUNDAMENTALS OF PNF
5 imp factors to be kept in mind while giving PNF
Principles
Procedures
patterns
positions
postures
NEUROPHYSIOLOGICAL PRINCIPLES
All human beings have potential that is not fully developed.
The capacity of motor activity performed by an individual depends upon his learned neuromuscular response.
This capacity even under normal circumstances is much less than the actual potential of the individual.
Such untapped potential can be developed under environmental situations, stressful situations, or by increased voluntary efforts.
PNF is based on this principle where the remaining potential in the patient is used to reach the maximum performance level in him or her
Motor development takes place in cervico-caudal sequence or proximal to distal direction.
During normal growth & development, motor activity first develops in the head & lastly in the extremities (cephalocaudal) & proximal to distal.
Thus, the treatment using PNF also should progress in the same developmental sequence.
Early motor behavior is dominated by reflex activity whereas mature motor behavior is supported or reinforced by postural reflex.
With maturity, the primitive reflexes get integrated & become useful for various activities like crawling, rolling, etc.
Even in normal individuals, some of these reflexes have been shown to influence tonic changes in the ms ( Helebrant & associates).
Thus, reflexes may be used to facilitate movement at some body parts by using various developmental posture or by using the head & trunk with extremity patterns.
Early motor behavior is characterized by movements that oscillate between extremes of flexion & extension.
These movements are rhythemic & oscillatory.
This principle means that any goal directed movement that we perform has 2 directions, one to accomplish the task & the other for unwinding the task.
Hence, when we treat a patient we should give the movement patterns in both the direction.
The development of motor behavior takes place in an orderly sequence consisting of movement patterns & posture.
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PRINCIPLES OF TECHNICAL APPLICATION
Appropriate positioning
The patient should be positioned appropriately so that movements are free to occur without any hindrance.
The therapist position should be comfortable and such that he is able to maintain the manual contact without any discontinuity.
Manual contact
Manual contact of the therapist is necessary to facilitate and guide movement.
The specific manual contact recommended is lumbrical grip.
The grip should offer exteroception, stretch, resistance and traction / approximation.
Multiple grips may cause a conflict in the sensory
information sent to the brain and hence should be prevented.
Stretch
Stretch is used to facilitate movement or to increase the power of the weak muscle.
According to Sherrington’s principle, when a muscle is stretched, the Ia and Il fibres in the muscle
spindle send excitatory messages to the alpha motor neurons which innervate the stretched muscle.
Inhibitory messages are sent to the antagonistic muscle simultaneously.
In PNF, while giving stretch, the muscle is kept in the lengthened position which is the starting position of the
pattern.
Stretch produces reflex activation of the muscle which is then synchronized with the volitional effort using the visual, verbal and auditory cueing.
The applied stretch should be
appropriate as stretching too enthusiastically can only be harmful.
4.Patterns
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PNF patterns
for the extremities
flexion Abduction
(D1 Flexion)
2.Extension Adduction
(D1 Extension)
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combination for
upper limb
Shoulder flexion with shoulder girdle elevation & lateral rotation
Shoulder extension with shoulder girdle depression & internal rotation
Abduction with wrist extension
Adduction with wrist flexion
combination for
lower limb??
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