Proprioceptive Neuromuscular Facilitation (PNF): Upper Extremity

Proprioceptive Neuromuscular Facilitation, which is a specialized stretching technique used in physical therapy and rehabilitation to improve flexibility and range of motion. It enhances both active and passive range of motion.

Indications of Proprioceptive Neuromuscular Facilitation

• Increased flexibility
• Improved rom
• Muscle strength
• Injury prevention
• Decrease muscle soreness
• Promote blood circulation
• Alleviate muscle spasm

Contra-indication of Proprioceptive Neuromuscular Facilitation

• Recent surgery
• Osteoporosis
• Joint instability
• Inflammation or swelling
• Nerve injury
• Fracture

Principle

The primary idea behind PNF is to draw in the neuromuscular reflexes that work with muscle unwinding, considering a more noteworthy stretch without setting off the stretch reflex, which could make the muscle contract in response of the stretch.

Hold-Relax (Contract-Relax):

In this technique, the patient actively stretches a muscle group until a comfortable limit is reached. The patient then contracts the target muscle isometrically (without moving) against resistance for about 5 to 10 seconds. After the contraction, the patient relaxes, and the therapist stretches the muscle further. This process helps to trigger the autogenic inhibition reflex, which allows for an increased stretch.

 

Contract-Relax-Antagonist-Contract (CRAC):

This technique builds upon the Hold-Relax method. After the isometric contraction and relaxation of the target muscle, the patient then contracts the opposing muscle (antagonist) while the therapist provides resistance. This reciprocal inhibition helps to further enhance the stretch and range of motion.

Slow Reversal-Hold-Relax (Slow Reversal PNF):

In this technique, the patient performs alternating concentric (muscle shortening) and eccentric (muscle lengthening) contractions of the target muscle against resistance. After several repetitions, a hold-relax contraction is performed to gain additional stretch.

 

PNF Pattern for Upper Extremity 

Flexion

• Shoulder flexed, adducted, and externally rotated
• Forearm supinated
• Fingers flexed
• Wrist radially deviated

Extension

• Shoulder extended, abducted, and internally rotated
• Forearm pronated
• Wrist ulnar deviated
• Fingers extended

 

How do you perform a PNF technique?

1. identify the target muscle
2. choose the starting position 
3. create tension in the target muscle by isometric contraction
4. relax the muscle
5. muscle is then further stretched passively by therapist
6. Repeat it few times i.e. 3-5 sets
7. Thera-band can also be used to provide resistance

General Guidelines for PNF Stretching

1. Always precede PNF stretching with 10-15 minutes of warm-up
2. Perform only one stretch per muscle group per PNF session
3. Perform at least two sets of each stretch for the muscle selected
4. Hold each stretch for 30 seconds after the initial contraction
5. Do not fatigue the muscle
6. Maintain breathing
7. Do not overstretch the muscle