Living With Chronic Pain

PNF Stretching

Flexibility is key in allowing us to be more active and suffer less pain throughout the day. The more flexible we are, the easier it is to accomplish simple, routine activities while preventing injury. One of the best ways to increase flexibility is by stretching. For many of us suffering from chronic pain, improving range of motion and lengthening our muscles so they move better is imperative. There’s an effective technique that accomplishes both. Research suggests that Proprioceptive neuromuscular facilitation (PNF) stretching, which relies on reflexes to produce deeper stretches that increase flexibility, works best.

PNF Stretching 

This technique can be passive- when the muscle is moved for us and no voluntary muscle contraction is seen, a therapist moves your arm or leg. Or active- when you move a muscle group and cause your own muscles to  contract. PNF is effective because it stretches muscles to their limits. This then triggers a protective reflex that sends a message to the brain preventing it from going too far and simultaneously causes the muscle to relax more than it would normally.

Techniques

Hold-Relax

A physical therapist or trainer extends one leg to the point a mild stretch is felt and holds it there for 10 seconds. The patient then isometrically contracts (when a muscle contracts without moving) the hamstring muscles by pushing the extended leg against the providers hand while the provider pushes back with just enough force to keep the leg steady. This hold should last for 6 seconds. This triggers an autogenic inhibition reflex. That reflex allows for a beyond normal stretch when the patient relaxes while the provider extends the leg in a second passive stretch, holding this position for 30 seconds. This time the patient’s leg should have been able to stretch deeper than the first time.

Contract-release 

This technique is almost identical to the hold-relax version, except that instead of contracting the muscle without moving, the muscle is contracted while moving, or isotonic stretching. For a hamstring stretch, the provider moves the patient’s extended leg in a passive stretch where mild discomfort is felt for 10 seconds. In the contract phase, a patient then pushes their extended leg against the providers hand while the provider exerts enough pressure to push the leg to the floor. The patient then relaxes while the provider extends the leg again and holds that position for 30 seconds. The final stretch should be further than the first time again due to activation of the autogenic inhibition reflex.

Hold- release- contract

This is similar to hold-relax, but instead of letting the patient relax as the provider passively stretches the leg at the end of the exercise, the patient actively pushes into the stretch (for example, pulls the leg in the same direction as it’s being pushed). This activates a reciprocal inhibition reflex in the hamstrings that increases the stretch even further.

There should be a noticeable increase in stretch from 10 to 45 degrees with each session. Remember to breathe through the stretches and exhale fully during the final stretch.

Guidelines

Always clear with your healthcare provider. Focus on one muscle group per session with 3-5 repetitions. Wait 48 hours between sessions to allow full recovery of the muscles. Always warm up first and if done in conjunction with your exercise routine, perform after that exercise program. Research shows PNF can actually decrease performance by diminishing the power of muscular contractions if performed first. It’s a great way to cool down after exercising.  

On your own

  • Make sure the muscle you want to stretch is fully, but passively stretched and under a slight tension against an exercise band or the floor or wall to keep it steady.
  • Isometrically contract the muscle by contracting (pushing) the extremity against the tension in a way where no movement is allowed.
  • Hold 6 seconds.
  • Relax the contraction for 3 seconds then move into another full but passive stretch for 20 seconds. This stretch should be noticeably deeper than the first one.
  • Completely relax all stretching for 30 seconds. Then repeat 3-5 times. Studies show even 1 repetition is sufficient to improve range of motion.

Ask your provider if this might be a great addition to your regimen to improve strength, flexibility and range of motion.


-https://humankinetics.me/2018/04/25/what-is-pnf-stretching/

-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3588663/#__sec1title

-https://www.fittrail.com/20station.html

-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3588663/

-https://www.healthline.com/health/fitness-exercise/pnf-stretching#TOC_TITLE_HDR_1

-https://www.ipnfa.org/?id=113

-https://pubmed.ncbi.nlm.nih.gov/17052131/

-https://m.activebeat.com/fitness/12-full-body-exercises-for-working-out-in-tight-spaces/11/

-https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1319233/pdf/jathtrain00013-0036.pdf

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