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PNF(ProprioceptiveNeuromuscularFacilitation):

PNF Stretching is anoccupational therapyandphysical therapyprocedure designed in the 1940s and 1950s to rehabilitate patients with paralysis. It is often a combination ofpassive stretchingandisometricscontractions. In the 1980s, components of PNF began to be used by sport therapists on healthy athletes. The most common PNF leg or arm positions encourage flexibility and coordination throughout the limb's entire range of motion. PNF is used to supplement daily stretching and is employed to make quick gains in range of motion to help athletes improve performance. Good range of motion makes better biomechanics, reduces fatigue and helps prevent overuse injuries. PNF is practiced by chiropractors, physical therapists, occupational therapists, massage therapists, athletic trainers and others.PNF stretching is one of the most effective forms of flexibility training for increasing range of motion.PNF techniques can be both passive (no associated muscular contraction) or active (voluntary muscle contraction). While there are several variations of PNF stretching, they all have one thing in common - they facilitatemuscular inhibition. It is believed that this is why PNF is superior to other forms of flexibility training. Both isometric and concentric muscle actions completed immediatelybeforethe passive stretch help to achieve autogenic inhibition- a reflex relaxation that occurs in the same muscle where the golgi tendon organ is stimulated. Often the isometric contraction is referred to as 'hold' and the concentric muscle contraction is referred to as 'contract'. A similar technique involves concentrically contracting the opposing muscle group to that being stretched in order to achievereciprocal inhibition- a reflex muscular relaxation that occurs in the muscle that is opposite the muscle where the golgi tendon organ is stimulated.History:

In the early to mid 1900s physiologist Charles Sherrington popularized a model for how the neuromuscular system operates.Radiation is when maximal contraction of a muscle recruits the help of additional muscle flexibility. Based on that, Herman Kabat, a neurophysiologist, began in 1946 to look for natural patterns of movement for rehabilitating the muscles of polio patients. He knew of the myostatic stretch reflex which causes a muscle to contract when lengthened too quickly, and of the inverse stretch reflex, which causes a muscle to relax when its tendon is pulled with too much force. He believed combinations of movement would be better than the traditional moving of one joint at a time. To find specific techniques, he started an institute in Washington, DC and by 1951 had two offices in California as well. His assistants Margaret Knott and Dorothy Voss in California applied PNF to all types of therapeutic exercise and began presenting the techniques in workshops in 1952.

During the 1960s, the physical therapy departments of several universities began offering courses in PNF and by the late 1970s PNF stretching began to be used by athletes and other healthy people for more flexibility and range of motion. Terms about muscle contraction are commonly used when discussing PNF. Concentric isotonic contraction is when the muscle shortens, eccentric isotonic is when it lengthens even though resisting a force, and isometricis when it remains the same length.

Indications of PNF : -1. Loss of range of motion.2. Acute and chronic pain.3. Muscle tightness.4. Muscle cramp.5. Loss of flexibility.

Contra-indications : -1. Post-operative : PNF Stretching is not done after recent post operation because the repairs that were made during surgery can be counteracted like muscle or tendons pulling away from reattachment due to tension stretching implements. Tissue healing must be determined from intense stretching can be performed.2.Instabilityof joints : If a person has an unstable joint in the area where stretching is applied, he/she may not be able to control the movement of the stretch andhyper mobilitymay cause injury.3. Under age 18 years : PNF stretching is not recommended for anyone below the age of 18 years as intense stretching may disrupt the growth plates and may cause disease like Osgood Schlatters disease.4. Already stretched muscles : PNF is not performed more than once a day due to stress it produces on muscles and tendons.

The Fundamentals of PNF : - PNF may be categorised in terms of five P-factors: Principles, Procedures, Patterns, Positions and Postures, with joint Pivots and Pacing (Timing) as important sub-categories. The methods comprising these factors were formulated from findings on neuromuscular development, such as the functional evolution of all movement from motor immaturity to motor maturity in the growing child or novice athlete in definite sequences progressing logically from:* total to individuated* proximal to distal, distal to proximal* mobile to stabile* gross to selective* reflexive to deliberate* overlapping to integrative* incoordinate to coordinateThe Principles of PNF : -The basic principles of PNF may be summarised as follows:1. Use of spiral and diagonal movement patterns2. Motion crossing the sagittal midline of the body3. Recruitment of all movement components (e.g. flexion-extension)4. Exercising of related muscle groups5. Judicious eliciting of reflexes6. Movement free of pain, but not free of effort7. Comfortable full-range movement8. Application of maximal resistance throughout the range of non-ballistic movement9. Use of maximal resistance to promote overflow (irradiation) of muscle activity10. Use of multiple joint and muscle action11. Commencement of motion in the strongest range12. Use of static and dynamic conditions13. Appropriate positioning of joints to optimise conditioning14. Exercising of agonists and antagonists15. Repeated contractions to facilitate motor learning, conditioning and adaptation16. Selection of appropriate sensory cues to facilitate action17. Emphasis on visuo-motor and audio-motor coordination18. Use of distal to proximal sequences in neuromuscularly mature subjects19. Use of stronger muscles to augment the weaker20. Progression from primitive to complex actions21. Planning of each phase to lay foundations for the next phase22. All activities are integrated and goal directed23. Use of adjunct techniques (e.g. massage, vibration).

Procedure for PNF : -Pattern of Motion :Normal motor activity occurs in synergistic and functional patterns of movement. PNF patterns are spiral and diagonal in character and combine motion in all three planes flexion/extension, abduction/adduction and transverse rotation.Neck Patterns : -1. Neck flexion with rotation to the right.2. Neck extension with rotation to the leftUpper Extremity : -Diagonal 1 : Shoulder Flexion, Adduction, External Rotation (D1 Flexion) and Extension, Abduction, Internal Rotation (D1 Extension); Elbow flexed/extended; Wrist & Fingers Extension to flexion.Diagonal 2 : Shoulder Flexion, Abduction, Lateral Rotation (D2 Flexion) and Extension, Adduction and Medial Rotation (D2 Extension); Elbow Extended; Wrist & Fingers Flexion to Extension.Trunk : -Upper trunk in sitting position : Flexion with rotation to the left (Chopping), Extension with rotation to the right (Lifting).Lower Trunk in supine position : Flexion with rotation to the left, Extension with rotation with the right.

Lower Extremity : -Diagonal 1 : Hip Flexion, Adduction, External Rotation; Knee extended; Foot Dorsi Flexion (D1 Flexion) and Hip Extension, Abduction, Internal Rotation; Knee Extension; Foot Planter Flexion (D2 Extension).Diagonal 2 : Hip Flexion, Abduction, External Rotation; Knee Extension; Foot Planter Flexion (D2 Flexion) and Hip Extension, Adduction, Interna Rotation; Knee Extension; Foot Dorsi Flexion (D2 Extension).

Timing:In PNF patterns normal timing is from distal to proximal. Distal segments(hand/wrist or foot/ankle) move first followed closely by more proximal components. Rotation occurs throughout the pattern, from beginning to end.Timing for Emphasis :Maximum resistance is used to elicit a strong contraction and allow overflow to occur from strong to weak components within a synergistic pattern; the strong muscles are resisted isometrically while motion is allowed in the weaker muscles.Resistance :Resistance facilitates muscle contraction and motor control. Resistance is applied manually and functionally through the use of gravity to all types of contractions.Overflow or Irradiation :Refers to spread of muscle response from stronger muscles in a synergistic pattern to weaker muscles; maximal resistance is the main mechanism for securing overflow or irradiation. Enhance synergistic actions of muscles, increase strength.Manual Contacts :Precise manual contacts (grip) are used to provide pressure to tactile and pressure receptors overlying the muscles to facilitate contraction and guide direction of movements; pressure is applied opposite to the direction of the desired motion.Positioning :Muscle positioning at optimal range of function allows for optimal responses of muscles. The greatest muscle tension is generated in mid-ranges with weak contractile force occuring in the shortened ranges.Therapist Position and Body Mechanics :Therapist is positioned directly in line with the desired motion in order to optimize the direction of resistance that is applied.Verbal Commands :Verbal commands allow for the use of well-timed words and appropriate vocal volume to direct the patients movement.Vision :Vision is used to guide the patients movements, enhance muscle contraction, and synergistic patterns of movement.Stretch :The elongated position/lengthened range and the stretch reflex are used to facilitate muscle contraction. All muscles in the pattern are elongated to optimize the effects of stretch. Commands for voluntary m

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