PNF (proprioceptive neuromuscular facilitation) stretching is an occupational therapy and physical therapy procedure designed in the 1940s and

1950s to rehabilitate patients with paralysis.[1] It is often a combination of passive stretching and isometrics contractions. 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.[1] 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 isometric is when it remains the same.[1]

[edit] Techniques
Hold-Relax Agonist: Most familiar. It can be used to lengthen out tight muscle and increase passive range of motion. In this technique, the tight muscle is the antagonist, hence the agonist contracts (provided that the agonist is strong enough). The therapist asks the patient to isometrically contract the agonist for around 6 seconds before it gets moved further into range. Through Reciprocal Inhibition, the tight muscle is relaxed, and allowed to lengthen. Verbal cues for the patient performing this exercise would include, "Hold. Hold. Don't let me move you." Hold-Relax Antagonist: Very similar to the Hold-Relax Agonist technique. This is utilised when the agonist is too weak to activate properly. The patient isometrically contracts the tight muscle (the antagonist muscle) against the therapist's resistance. After a 6 second hold has been achieved, the therapist removes his/her hand and the patient concentrically contracts the agonist muscle (the muscle opposite the tight muscle, the non-tight muscle) in order to gain increased range of motion. This technique utilizes the golgi tendon organ, which relaxes a muscle after a sustained contraction has been applied to it for longer than 6 seconds. Hold-Relax-Swing/Hold-Relax Bounce: These are similar techniques to the Hold-Relax and CRAC. They start with a passive stretching by the therapist followed by an isometric contraction. The difference is that at the end, instead of an antagonist muscle contraction or a

passi st t i ami st t i and ballisti st t ing is used. It is very risky, and is successfully used only by people t at have managed to achieve a high level of control over their muscle stretch reflex. Ballistic stretching should ONLY be used by athletes prior to engaging in a High Energy movement (e.g. A sprinter running a 100m dash).[2] Rhythmi I iti ti : Developed to help patients with Parkinsonism overcome their rigidity. Begins with the therapist moving the patient through the desired movement using passive range of motion, followed by active-assistive, active, and finally active-resisted range of motion. Rhythmi tabili ati : and lternating I metri are very similar in that they both encourage stability of the trunk, hip, and shoulder girdle. With this techni ue, the patient holds a weight-bearing position while the therapist applies manual resistance. No motion should occur from the patient. The patient should simply resist the therapist s movements. For example, the patient can be in a sitting, kneeling, half-kneeling, or standing position when the therapist applies manual resistance to the shoulders. Usually, the therapist applies simultaneous resistance to the anterior left shoulder and posterior right shoulder for 2 3 seconds before switching the resistance to the posterior left shoulder and the anterior right shoulder. The therapist s movements should be smooth, fluid, and continuous. In AI, resistance is applied on the same side of the joint. In R , resistance is applied on opposite sides of the joint.

edit] Gallery

Arm-front diagonal flexion.

Leg-front diagonal flexion.

PNF patterns (diagonal), lower extremities

Front cross

Out back

Back cross

Out front

PNF patterns (diagonal), upper extremities

Cross low

Back high

Cross high

Back low

Reciprocal inhibition describes muscles on one side of a joint relaxing to accommodate contraction on the other side of that joint. Reciprocal Inhibition, however, can backfire by both muscles attempting to contract at the same time. Thus a common tear can occur at muscle level. The body handles this pretty well during physical activities like running, where muscles that oppose each other are engaged and disengaged sequentially to produce coordinated movement. This facilitates ease of movement and is a safeguard against injury. Sometimes, for example, a football running back can

experience a "misfiring" of motor units and end up simultaneously contracting the quads and hamstrings during a hard sprint. If these muscles, which act opposite to each other are fred at i the same time, at a high intensity, a tear can result. The stronger muscle, usually the quadriceps in this case, overpowers the hamstrings. This sometimes results in a common injury known as a pulled hamstring.

The term reciprocal inhibition has also been used in the literature on parallel processing and laterali ation. It was used to describe the reduced activation in the less dominant hemisphere in response to laterali ed stimuli during processing. This term was used in Hirnstein, Hausmann, Gunturkun's (2008) article on Functional Cerebral Asymmetries.[citation The Golgi organ (also called Golgi tendon organ, tendon organ, neurotendinous organ or neurotendinous spindle), is a proprioceptive sensory receptor organ that is located at the insertion of skeletal muscle fibers into the tendons of skeletal muscle. It provides the sensory component of the Golgi tendon reflex. The Golgi organ should not be confused with the Golgi Apparatus, which is an organelle in the eukaryotic cell, or the Golgi stain, which is a histologic stain for neuron cell bodies.

Anatomy
The body of the organ is made up of strands of collagen that are connected at one end to the muscle fibers and at the other merge into the tendon proper. Each tendon organ is innervated by a single afferent type Ib sensory fiber that branches and terminates as spiral endings around the collagen strands. The Ib afferent axon is a large diameter, myelinated axon. Each neurotendinous spindle is enclosed in a fibrous capsule which contains a number of enlarged tendon fasciculi (intrafusal fasciculi). One or more nerve fibres perforate the side of the capsule and lose their medullary sheaths; the axis-cylinders subdivide and end between the tendon fibers in irregular disks or varicosities (see figure).

edit] Function

Mammalian tendon organ showing typical position in a muscle (left), neuronal connections in spinal cord (middle) and expanded schematic (right). The tendon organ is a stretch receptor that signals the

force deve oped by the musc e The se sory e dings of the Ib afferent are entwined amongst the musculotendinous strands of 10 to 20 motor units Animated version: [1]

When the muscle generates force, the sensory terminals are compressed. This stretching deforms the terminals of the Ib afferent axon, opening stretch-sensitive cation channels. As a result, the Ib axon is depolarized and fires nerve impulses that are propagated to the spinal cord. The action potential frequency signals the force being developed by the 10 to 20 motor units within the muscle. This is representative of whole muscle force [1] The Ib sensory feedback generates spinal reflexes and supraspinal responses which control muscle contraction. Ib afferents synapses with interneurons within the spinal cord that also project to the brain cerebellum and cerebral cortex. One of the main spinal reflexes associated with Ib afferent activity is the autogenic inhibition reflex, which helps regulate the force of muscle contractions. Tendon organs signal muscle force through the entire physiological range, not only at high strain.[1][2] During locomotion, Ib input excites rather than inhibits motoneurons of the receptor-bearing muscles and it also affects the timing of the transitions between the stance and swing phases of locomotion.[3] The switch to autogenetic excitation is a form of positive feedback.[4] The ascending or afferent pathways to the cerebellum are the dorsal and ventral spinocerebellar tracts. They are involved in the cerebellar regulation of movement.
In order to understand how the PNF (Proprioceptive Neuromuscular Facilitation) stretching technique works physiologically, we must first understand what the muscle spindle and Golgi Tendon Organ (GTO) are, and <iframe src="http://us.adserver.yahoo.com/a?f=2143440278&pn=acont&p=achlth&l=LREC&kw=&c= sh&bg=wh ite&rand=1038951229" width=300 height=250 marginwidth=0 marginheight=0 hspace=0 vspace=0 frameborder=0 scrolling=no></iframe> understand the terms autogenic inhibition and reciprocal inhibition. The muscle spindle is a receptor found within a muscle, which is made up of unique muscle fibers, sensory endings, and motor endings. The purpose of the muscle spindle is to prevent over stretching of the muscle in which they are contained. When a muscle is put on stretch, the sensory endings in the spindle are activated and in turn send a message to the muscle telling it to contract. This contraction prevents the muscle from stretching into a plastic stage and attempts to prevent tearing of the muscle. The GTO, on the other hand, works to relax a muscle so that the stretch being applied does not cause tearing or overactivity of the nerve fibers. These structures are found attached to the fibers of the tendons of a muscle. The GTO structure is made up of sensory nerve afferent fibers, which are very sensitive to the changes in tension of the tendon. When a muscle is put on stretch for a prolonged amount of time or contracts isometerically, the GTO is activated and inhibits the tension, allowing the muscle to relax and elongate. This elongation during a stretch or extreme tension helps prevent the possible tearing of a tendon or muscle. This process is known as autogenic inhibition. Reciprocal inhibition is the physiological process that occurs when the agonist muscle concentrically contracts, causing the antagonist muscle to in turn relax. This relaxation of the antagonist muscle allows the <iframe src="http://us.adserver.yahoo.com/a?f=2143440278&pn=acont&p=achlth&l=LREC&kw=&c=sh&bg=wh ite&rand=1771766410" width=300 height=250 marginwidth=0 marginheight=0 hspace=0vspace=0 frameborder=0 scrolling=no></iframe>

P stret hing ainl focuses on the rinci l e of reci rocal inhi i tion. As the antagonist uscle of the li eing stretched contracts, the agonist uscle relaxes and increases its flexi i lit . his rocess is used specificall in the contract relax techni ue of P stretching. he contract relax pattern causes neural responses that inhi it the contraction of the uscle eing stretched. he principle of autogenic inhi i tion is found specificall in the slow -reversal-hold-relax techni ue of P stretching. Here, the sustained isotonic contraction the antagonist uscle increases tension in the uscle and tend ns, o which sti ulate the . nce a uscle that was performing an isometric stretch relaxes, it gains the abilit to stretch beyond its initial length. P stretching attempts to increase the muscle's range of motion by immediately passively stretching the just contracted muscle. his stretching of the previously isometrically contracted muscle helps to train the muscle's stretch receptors in the muscle spindle to immediately accommodate a greater muscle length. Also, the prolonged, intense contraction fatgues the fast-twitch i muscles. his makes it harder for the fibers to contract in resistance to the stretch.
                         

PNF
he method of Proprioceptive euromuscular acilitation P was developed at the Kabat-Kaiser Institute over a period of years, -1951, by Herman Kabat, MD, a clinical neurophysiologist, and the Physical herapist, Margaret Maggie" Knott. Mr. Kaiser, whose son had Multiple Sclerosis, provided the financial backing for the Institute, at first in ashington, D. ., and later in Vallejo, alifornia. riginally the method was developed for patients with neurological deficits, especially Poliomyelitis. ater it developed into a method to be used for musculoskeletal as well as neurological deficits.

ame of concept tells us which part of human body we should use during treatment for improvement of function.
y

Means proprioceptor receptor which perceives changes in human body), through which the i treatment are muscular contracting is stimulated contract on). Main receptors used by P in muscle muscular spindle and free nervous end), in tendom olgi's tendom organ), and in joints corpuscles of Vater Pacini, uffini's corpuscles and free nervous ends). But beside proprioceptors we use also exeteroceptors receptors which perceive changes in skin, eye, and ear). Proprioceptors and exteroceptors could be differently activated through basic P 's principles, by contraction or relaxations of muscle/muscles.
y

Means neuromuscular connection and symbolizes motor unit. During the treatment we try to include optimal number of motor units neuromuscular connections), because only in this way we could make movement light, coordinated, exact, strong.
y

agoni t


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ove t e li

t ough the total allowed ange of

otion without interfering tension.

Facilitation means that the inflow on motor c ell in spinal cord is from every direction and so strong, that optimal muscular activity become possible.

A VANTAGES

Are you suffering from sore joints and muscles? Is limited range of joint motion affecting the quality of your life? Do you want greater flexilbility to aid your athletic performance. PNF stretching offers an efficient and effective method for obtaining greater muscle and joint flexibility. PNF stands for proprioceptive muscular facilitation and it is generally considered as one the most effective forms of stretching available. This does not mean that normal static stretching does not have any value. The benefits that arise from PNF stretches occur as a result that the stretches promote inhibition of the muscles which assists in increasing the amount that the specific muscles can be stretched. PNF stretching initially developed as a form of rehabilitative therapy so as to lessen and hopefully reverse the impact of a paralysis or stroke. The effectiveness of the technique led physiotherapists and other health/sports professionals to investigate it further and apply it to other areas. PNF stretching refers to a group of techniques in which a specific muscle is passively stretched, then contracted isometrically against resistance while the muscle is held in the stretch (ie the amount of stretch in the muscle is maintained) and then passively stretched again with an increased range of motion, delivering results that would not be found with traditional passive stretches. PNF stretching is used to target a specific muscle or muscle group. This means specific will be performed on specific muscles for a specific period of time. Please take care when you are attempting these stretches. You will need to warm up the muscles with very light and gentle stretching prior to moving on to the more involved PNF stretches. This will reduce the potential for injury and make the entire venture well worth it in the end.
exercises

So how is a PNF stretch actually performed? The process is not difficult, particularly if you have a partner to help you. Here is a brief overview of the most common way a PNF stretch is done: You will need to select the specific muscle group that you want to work on and position them in such a manner that they can be effectively stretched while under constant tension. To hold the muscle in a stretch then either use a partner or suitable equipment. Common benches, towels, walls, chairs can suffice. Whilst the muscle is held in a passively stretched state by your partner or the equipment then contract the target muscle for around 6-8 seconds. Don't overdo this - for an effective pnf stretch then the amount of contraction does not need to be particularly strong. After about ten seconds, allow the muscle to relax. Then, perform a regular stretch for about 10-15 seconds. For the maximum effect then repeat this step a number of times. One interesting aspect of PNF stretching is that for the most rapid improvement in flexibility and joint range of motion then daily stretching of a given muscle group is not recommended. Two or three sessions a week on a muscle group is more than sufficient and allows the muscle

to recover from any microtrauma before restretching. When undertaking a PNF stretch, then only stretch as much as feels comfortable, pain is an indication that you are overstretching. If you experience any pain during the exercise then you may be overstretching. If pain persists then consult your health care professional. Those are some of the basics and benefits of incorporating PNF stretching into your exercise regime. Working with a partner makes it easier and more effective to understand and explore your body's response to PNF stretching. When performed properly and regularly then your flexibility will improve dramatically in a relatively short period of time. Article Source: http://www.abcarticledirectory.com