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Landon Lempke, Rebecca Wilkinson, Caitlin Murray and Justin Stanek

extensibility. 1 Two common methods of stretching in clinical practice are static stretching and proprioceptive neuromuscular facilitation (PNF) stretching. It is generally believed that PNF stretching will result in increased ROM compared with static stretching due to increased inhibition of the targeted

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Reed Ferber, Denise C. Gravelle and Louis R. Osternig

The effects of proprioceptive neuromuscular facilitation (PNF) on joint range of motion (ROM) for older adults are unknown, and few studies have investigated changes in joint ROM associated with age. This study examined PNF stretch techniques' effects on knee-joint ROM in trained (T) and untrained (UT) older adults. Knee-joint ROM was tested in T and UT adults age 45–55 and 65–75 years using 3 PNF stretch techniques: static stretch (SS), contract-relax (CR). and agonist contract-relax (ACR). The 45–55 UT group achieved significantly more ROM than did the 65–75 UT group, suggesting an age-related decline in ROM. The 65–75 T group achieved significantly greater knee-extension ROM than did their UT counterparts, indicating a training-related response to PNF stretch techniques and that lifetime training might counteract age-related declines in joint ROM. The ACR-PNF stretch condition produced 4–6° more ROM than did CR and SS for all groups except the 65–75 UT group, possibly as a result of lack of neuromuscular control or muscle strength.

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Kristian J. Hill, Kendall P. Robinson, Jennifer W. Cuchna and Matthew C. Hoch

Clinical Scenario:

Increasing hamstring flexibility through clinical stretching interventions may be an effective means to prevent hamstring injuries. However the most effective method to increase hamstring flexibility has yet to be determined.

Clinical Question:

For a healthy individual, are proprioceptive neuromuscular facilitation (PNF) stretching programs more effective in immediately improving hamstring flexibility when compared with static stretching programs?

Summary of Key Findings:

A thorough literature search returned 195 possible studies; 5 studies met the inclusion criteria and were included. Current evidence supports the use of PNF stretching or static stretching programs for increasing hamstring flexibility. However, neither program demonstrated superior effectiveness when examining immediate increases in hamstring flexibility.

Clinical Bottom Line:

There were consistent findings from multiple low-quality studies that indicate there is no difference in the immediate improvements in hamstring flexibility when comparing PNF stretching programs to static stretching programs in physically active adults.

Strength of Recommendation:

Grade B evidence exists that PNF and static stretching programs equally increase hamstring flexibility immediately following the stretching program.

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Darin A. Padua, Kevin M. Guskiewicz, William E. Prentice, Robert E. Schneider and Edgar W. Shields

Objective:

To determine whether select shoulder exercises influence shoulder-rotation strength, active angle reproduction (AAR), single-arm dynamic stability, and functional throwing performance in healthy individuals.

Design:

Pretest–posttest.

Setting:

Laboratory.

Participants:

54, randomly placed in 4 training groups.

Intervention:

Four 5-week training protocols.

Main Outcome Measures:

Average shoulder-rotation torque, AAR, single-arm dynamic stability, and functional throwing performance.

Results:

Repeated-measures ANOVAs revealed a significant group-by-test interaction for average torque (P > .05). Post hoc analyses revealed significantly increased average torque in the open kinetic chain and proprioceptive neuromuscular facilitation (PNF) groups after training. AAR and sway velocity were not affected in any of the groups (P > .05), but functional performance revealed a significant group-by-test interaction (P < .05). Post hoc analysis demonstrated that the PNF group significantly improved after training (P < .05).

Conclusions:

Shoulder strength can be improved in healthy individuals, but improvements depend on the exercise performed. Shoulder proprioception and neuromuscular control were unchanged in all groups, but functional performance improved in the PNF group

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Diane Austrin Klein, William J. Stone, Wayne T. Phillips, Jaime Gangi and Sarah Hartman

The impact of proprioceptive neuromuscular facilitation (PNF) on physical function in assisted-living older adults (73-94 years old) was studied. A 5-week pretraining period consisting of weekly visits by trainers to participants preceded a 10-week training period of warm-up, PNF exercises, and cool-down. Training progressed from 1 set of 3 repetitions to 3 sets of 3 repetitions. Assessments were conducted at baseline (T1), postpretraining (T2), and posttraining (T3). Eleven of 14 volunteer participants completed the study. Physical function was assessed by range of motion (ROM), isometric strength, and balance and mobility measures. Repeated-measures ANOVA identified 6 measures (sit-to-stand, shoulder- and ankle-flexion ROM, and hip-extension, ankle-flexion, and ankle-extension strength) with statistically significant differences. With the exception of hip-extension strength, these measures were statistically significant from T2 to T3 in post hoc univariate tests. Results indicate that PNF flexibility training can improve ROM, isometric strength, and selected physical-function tasks in assisted-living older adults.

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Ulrike H. Mitchell, J. William Myrer, J. Ty Hopkins, Iain Hunter, J. Brent Feland and Sterling C. Hilton

Background and Purpose:

Proprioceptive neuromuscular facilitation (PNF) stretches are widely used in athletics and rehabilitation. Although it has been shown that they produce better range-of-motion (ROM) increases than the slow or static stretch, the mechanisms responsible remain an enigma. This study was conducted to determine whether the previously proposed neurophysiological mechanisms of reciprocal inhibition and autogenic inhibition are responsible for the success of PNF stretches. In addition, the authors assessed the existence of the phenomenon of successive induction because it is used to strengthen reciprocal inhibition.

Methods:

Eighteen subjects 17–44 y performed the PNF stretches contract-relax (CR) and contract-relax, agonist contract (CRAC). EMG data were collected from the medial hamstring muscles via surface and indwelling wire electrodes and analyzed for reciprocal inhibition and successive induction, as well as autogenic inhibition (surface electrodes only).

Results:

Reciprocal inhibition was not evident. The results indicated an elevated rather than an inhibited EMG during the antagonist contraction, possibly representing cocontraction. The authors did confirm the presence of successive induction. Autogenic inhibition was also not evident, and the expected inhibition and therefore lower EMG values after muscle contraction were not observed; instead, they were higher than baseline.

Conclusion:

Previous neurophysiological explanations for mechanisms of PNF stretching appear to be inadequate. This study corroborates previous findings that a muscle’s tone increases during its antagonist’s contraction. Other explanations should be considered regarding the mechanism for the effectiveness of the CRAC and CR PNF techniques in a nonneurologically impaired population.

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Ulrike H. Mitchell, J. William Myrer, J. Ty Hopkins, Iain Hunter, J. Brent Feland and Sterling C. Hilton

Context:

Some researchers have suggested that an alteration of stretch perception could be responsible for the success of the contract-relax (CR) stretch, a stretch technique derived from proprioceptive neuromuscular facilitation (PNF).

Objective:

This study was conducted to determine if the alteration of the stretch perception is a possible explanation for the range of motion (ROM) gains of the CR stretch.

Participants:

Eighteen subjects performed two stretches in randomized order: the slow stretch and the CR stretch.

Main Outcome Measure:

The stretch intensity was controlled. The stretch force was measured and compared between the slow stretch and CR stretch.

Results:

There was a significant difference between the stretch force that could be applied in the PNF stretch (126.0 N) and the slow stretch (108.4 N); P = 0.00086. The average stretch tolerance progressively increased with successive trials from 120.6 N in the first trial to 132.4 N in the fourth trial.

Conclusion:

The alteration of stretch perception plays a role in the success of the CR form of PNF stretching. At least four repetitions of the CR stretch are recommended to get the greatest ROM gain.

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Jwa-jun Kim, So-youn Ann and Se-yeon Park

Objectives:

The aim of this study was to investigate the effects of visual trace on shoulder muscle activation during diagonal pattern of exercises. Sixteen healthy male participants volunteered to participate.

Design:

Repeated-measure design.

Setting:

Laboratory setting.

Participants:

Sixteen physically active male participants volunteered to participate.

Intervention:

Five muscles of the shoulder were investigated during standing performance of diagonal shoulder exercises with and without visual trace. Two patterns of the diagonal exercises were used: diagonal 1 flexion (D1F) and diagonal 2 fexion (D2F). Two-way repeated measures analysis of variance was used, with factors being the presence of visual trace and exercise variations.

Main Outcome Measure:

Electromyography (EMG).

Results:

The average muscle activity values of the lower trapezius and anterior deltoid were higher with the D2F compared with the D1F (P < .05). The visual trace effect was observed within the serratus anterior, with values significantly greater in exercise with visual trace (P < .05). There was a significant increase of the lower trapezius during the exercise with the visual trace condition compared with the exercise without visual trace, which was only observed during D2F (P < .05).

Conclusions:

Present results suggest that the D2F exercise pattern is effective for activating lower trapezius and anterior deltoid muscles. The visual trace condition has the additional advantage of activating the scapulothoracic muscle activities depending on the specific pattern of diagonal shoulder exercise.

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Hiroshi Takasaki, Yu Okubo and Shun Okuyama

performance can be associated with the magnitude of the JPS. 4 Therefore, interventions to enhance the JPS would be concerns in the area of athletic training and sports science. Proprioceptive neuromuscular facilitation (PNF) can be a promising intervention, and several studies have investigated this subject

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W. Steven Tucker and Stephen W. Slone

Context:

Clinicians use various stretching techniques to prevent the onset of and treat glenohumeral internal-rotation deficit (GIRD). It is unknown which stretching technique is the most effective.

Objective:

To investigate the acute effects of hold–relax proprioceptive neuromuscular facilitation (PNF) with and without vibration therapy on internal rotation in individuals with GIRD.

Design:

2-within (stretch × time) comparison with repeated measures.

Setting:

Controlled laboratory.

Participants:

11 male current and former overhead athletes (19.8 ± 1.4 y, 184.5 ± 4.5 cm, 91.8 ± 11.6 kg) who presented with GIRD.

Interventions:

At 3 separate sessions, participants performed 1 of 3 randomly assigned stretches: hold–relax PNF (PNF), hold–relax PNF in combination with a whole-body-vibration unit set at 30 Hz (PNF-V), and static stretch (SS). Pretest and posttest maximum passive glenohumeral internal-rotation measurements were taken with a digital protractor.

Main Outcome Measures:

The dependent variables were the mean glenohumeral internal-rotation measurements taken at the pretest and posttest. The influence of stretch (PNF, PNF-V, and SS) and time (pretest and posttest) on mean glenohumeral internal rotation was compared using a 3 × 2 factorial ANOVA with repeated measures on both variables (P ≤ .05).

Results:

There was a stretch-by-time interaction (F 2,20 = 34.697, P < .001). Post hoc testing revealed that the PNF posttest (73.0° ± 10.4°) was greater than the PNF pretest (60.0° ± 11.8°), the PNF-V posttest (74.7° ± 10.0°) was greater than the PNF-V pretest (57.4° ± 10.4°), and the SS posttest (67.0° ± 10.7°) was greater than the SS pretest (60.1° ± 9.4°). When comparing the posttest values, the PNF-V posttest was greater than the SS posttest.

Conclusions:

All 3 stretches (PNF, PNF-V, and SS) resulted in acute increases in glenohumeral internal rotation in individuals presenting with GIRD. The PNF-V stretch resulted in the greatest increase and would be the most clinically beneficial for patients with GIRD.