Monday, 30 July 2012

PNF Techniques

PNF Techniques( Proprioceptive Neuromuscular Facilitation) help develop muscular strength and endurance, joint stability, mobility, neuromuscular control and coordination-all which are aimed at increasing the overall functional ability of patients. Coded in the 1940s, PNF Techniques would be the result of work by Kabat, Knott and Voss.They combined their analysis of functional movement with theories from motor development, motor control, motor learning and neurophysiology.

PNF History:
In early to mid 1900s physiologist Charles Sherrington popularized one for how the neuromuscular system operates. Irradiation happens when maximal contraction of the muscle recruits the aid of additional muscle flexibility. According to that, Herman Kabat, a neurophysiologist, began in 1946 to consider natural patterns of motion for rehabilitating the muscles of polio patients. He knew from the myostatic stretch reflex which in turn causes a muscle to contract when lengthened too rapidly, and of the inverse stretch reflex, which in turn causes a muscle to unwind when its tendon is pulled with an excessive amount of force. He believed mixtures of movement would be much better than the traditional moving of 1 joint at a time. To locate specific techniques, he soon started an institute in Washington, DC by 1951 had two offices in California too. His assistants Margaret Knott and Dorothy Voss in California applied PNF to any or all types of therapeutic exercise and began presenting the strategy in workshops in 1952. Throughout the 1960s, the physical rehabilitation departments of several universities began offering courses in PNF by the late 1970s PNF stretching techniques started to be used by athletes along with other healthy people for additional flexibility and flexibility. Terms about muscle contraction are generally used when discussing PNF.

Basic PNF Techniques:
Revarsal of Antagonists: Several techniques that allow for agonist contraction then antagonist contraction without pause or relaxation.

Dynamic Reversals (Slow Reversals): Utilizes isotonic contractions of first agonists, then antagonists performed against resisitance . Contraction of stronger pattern is selected first with progression to weaker pattern. The limb is moved through full-range of motion.
Indications Impaired strength and coordination between agonist and antagonist, limitations in flexibility, fatigue.
Stabilizing Reversals: Utilizes alternating isotonic contractions of first agonists, then antagonists against resistance, allowing only limited range of motion.
Indications Impaired strength, stability and balance, coordination.
Rhythmic Stabilization (RS): Utilizes alternating isometric contractions of first agonists, then antagonists against resistance; no motion is allowed .
Indications Impaired strength and coordination, limitations in ROM; impaired stabilization control and balance.
Repeated Contractions, RC (Repeated stretch): Repeated isotonic contractions in the lengthened range, induced by quick stretches that has been enhanced by resistance; performed with the range or a part of range at a reason for weakness. Technique is repeated (i.e.,3 or 4 stretches) during one pattern or until contraction weakens.
Indications Impaired strength, initiation of motion, fatigue and limitation in active ROM.

Mixture of Isotonics (Agonist Reversals, AR): Resisted concentric, contraction of agonist muscles moving with the range is then a stabilizing contraction (holding within the position) and then eccentric, lengthening contraction, moving slowing to the start position; there isn't any relaxation between the kinds of contractions. Typically used in antigravity activities/assumption of postures (i.e., bridging, sit to face transitions).
Indications Weak postural muscles, wherewithal to eccentrically control body weight during movement transitions, poor dynamic posture control.

Rhythmic Initiation (RI): Voluntary relaxation then passive movements progressing to active assisted and active resisted movements to finally active movements. Verbal commands are utilized to set the speed and rhythem from the movements. Light tracking can be used during the resistive phase to facilitate movement.
Indications Wherewithal to relax, hypertonicity (spasticity, rigidity); difficulty initiating movement; motor planning deficits (apraxia or dyspraxia); motor learning deficits; communication deficits (aphasia).

Contract Relax (CR): It's one of PNF Techniques usually performed in a point of limited ROM within the agonist pattern. Strong, small range isotonic contraction from the restricting muscles (antagonists) with focus on the rotators is then an isometric hold. The contraction is held for 5-8 seconds and it is then followed by voluntary relaxation and movement in to the new range of the agonist pattern. Movement could be passive but active contraction is preffered.
Contract-relax-active-contraction (CRAC): Active contraction in to the newly gained range serves to keep the inhibitory effects through reciprocal inhibition.
Indications Limitation in ROM.

Hold Relax (HR): It's one of PNF Techniques usually performed in a position of comfort and below an amount that causes pain. Strong isometric contraction from the restricting muscles (antagonists) is resisted, then voluntary relaxation, and passive movement in to the newly gained selection of the agonist pattern.

Hold-relax-active-contraction (HRAC): Much like HR except movement in to the newly gained selection of the agonist pattern is active, not passive. Active contraction serves to keep the inhibitory effects through reciprocal inhibitions.
Indications Limitation in PROM with pain.
pnf techniques

Replication (Hold Relax Active Motion, HRA): The individual is positioned in the shortened range/ end position of the movement and is inspired to hold. The isometric contraction is resisted then voluntary relaxation and passive movement in to the lengthened range. The individual is then instructed to move into the end position; stretch and resistance are put on facilitate the isotonic contraction. For every repitition, increasing ROM is desired.
Indications Marked weakness, wherewithal to sustain a contraction within the sustained range.

Resisted Progression (RP): Stretch, approximation and tracking resistance is used manually to facilitate pelvic motion and progression during locomotion; the amount of resistance is light in order to not disrupt the patient's momentum, coordination and velocity. RP may also be applied using rubber band resistance.
Indications Impaired timing and charge of lower trunk/pelvic segments during locomotion, impaired endurance.

Rhythmic Rotation (RRo): Relaxation is achieved with slow, repeated rotation of the limb at a point where limitation is noticed. As muscles relax the limb is slowly and gently moved in to the range. As a new tension is felt, RRo is repeated. The individual can use active movements (voluntary efforts) for RRo or even the therapist can perform RRo passively. Voluntary relaxation whenever possible is important.
Indications Relaxation of excess tension within the muscles (hypertonia) combined with PROM from the range-limiting muscles.

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