Facilitated Stretching Techniques

PNF stretching is an extremely effective stretching technique for increasing range of motion (ROM).

There are several techniques and all of them rely on stretching a muscle to its limit, thereby triggering the inverse myotatic reflex. (A protective reflex that calms the muscle to prevent injury.)

During this technique(s) the brain basically sends a message to let the muscle telling it to relax a little more than it would normally in order for it not to be injured.

By working with your natural reflexes, PNF stretching is an easy and effective way to increase your overall flexibility and range of motion (ROM).

Autogenic Inhibition – A.K.A. Post Contraction Inhibition

  • The Golgi Tendon Organ (GTO) detects and regulates the tension within a muscle either when the muscle is passively stretched or its actively contracting.
  • After a muscle is contracted it reflecively relaxes for a short period due to the GTO inhibiting or regulating the tension within the muscle. This is known as Autogenic Inhibition

Reciprocal Inhibition

  • When a muscle is contracted its opposite (antagonist) muscle is reflexively inhibited or relaxed.

Proprioceptive Neuromuscular Facilitation (PNF)

  • Originally used as a rehabilitative technique for stroke victims
  • Uses diagonal patterns of movement such as; multi-directional, multi-plane, diagonal and rotatory movements
  • Multiple muscle groups are contracted simultaneously using the principles of autogenic and reciprocal inhibition

Active Inhibition Techniques

  • Adapted from PNF techniques
  • Uses anatomical planes or opposing lines of pull of a specific muscle or muscle group
  • In these techniques the patient uses autogenic inhibition and reciprocal inhibition
  • When a muscle is relaxed (inhibited) it is able to stretch easier without resistance
  • This technique should only be used when the muscle to be stretched is normally innervated and should NOT be used in muscles with severe weakness, spasticity or paralysis
  • It relaxes only the contractile structures within a muscle
  • Non-contractile tissue is not really affected unless the stretch is held for a long period of time to reach plasticity
  • Forms of active inhibition techniques are Hold-Relax, Contract-Relax, Post Isometric Relaxation, Agonist Contract and Hold-Relax with Agonist Contract
  • If someone has a muscle spasm, by contracting the muscle’s antagonist, the muscle should relax

Hold-Relax (HR)

  • Used when slight pain and restricted ranges are present
  1. Passively lengthen the tight muscle to a feeling of resistance known as the 1st barrier (usually myofacial in nature)
  2. Hold this position
  3. The person who is being stretched should isometrically (no joint movement) contract the tight muscle near maximal (to about 80%) against resistance.
  4. The contraction should be held for 7 – 10 seconds
  5. Following this amount of time the person being stretched should voluntarily relax
  6. When the muscle relaxes the muscle should be stretched to the (new) 2nd barrier which is usually a combination of myofascia and muscle stretch
  7. The person being stretched should again isometrically contract at about 80% strength against resistance. At this point the autogenic inhibition begins to take place
  8. Hold this contraction again for 7 – 10 seconds
  9. Following this amount of time the person being stretched should voluntarily relax again
  10. When the muscle relaxes the muscle should be stretched to the (new) 3rd barrier
  11. The person being stretched should again isometrically contract at about 80% strength against resistance.
  12. Hold this contraction again for 7 – 10 seconds
  13. Then hold the last barrier stretch for 30 seconds or longer.
  14. This technique uses autogenic inhibition
  15. The person being stretched should inhale during the contraction and exhale during relaxation phases of the contraction known as Respiratory Synkinesis
  16. NOTE: Inhalation facilitates muscular contraction whereas passive inhalation inhibits muscular activity and facilitates relaxation.

Contract-Relax

  • Used when no pain or restricted ranges of motion (ROM) are present
  • This technique also uses autogenic inhibition
  • This procedure is the same as Hold-Relax, except that the person being stretched uses an isotonic (moves through the ROM of the joint) and still uses near-maximal (80%) contraction
  • The same breathing pattern as the Hold-Relax technique is used

Post-isometric Relaxation

  • This type of stretching technique is used when there is pain and restricted ranges of motion present
  • This technique also uses Autogenic Inhibition
  • This technique is the same as Hold-Relax except the person who is being stretched uses an isometric and uses a sub-maximal contraction (20% of maximum strength) followed by relaxation and a gentle stretch
  • The person being stretched can use eye movements (Occulomotor Synkinesis) to increase the ROM during this technique. IE. When a person actively turns his/her head to the left he/she can simultaneously look to their left in order to help increase their ROM.
  • The same breathing pattern as the Hold-Relax technique is used

Agonist-Contract

  • This type of stretching technique should be used when pain and muscle spasms are present causing restricted ROM
  • Usual reference point is that the tight muscle (agonist) and the “opposing muscle” is the antagonist
  • The terminology is reverse during this technique since the reference point is the opposite muscle to the one that is “tight” (spasmed) therefore the opposing muscle is now known as the agonist for this technique
  1. The person being stretched should stretch the tight (antagonist) muscle to the point of 1st resistance
  2. The person being stretched should then contract the opposite muscle (agonist) near maximal (80%) and isometrically against resistance
  3. The contraction should be held for 7 – 10 seconds
  4. As the contraction is released the tight muscle (antagonist) is now relaxed (reciprocal inhibition) and able to be stretched
  5. Stretch the tight (antagonistic) muscle to the 2nd barrier
  6. The person being stretched should again contract the opposite muscle (agonist) near maximal (80%) and isometrically against resistance
  7. The contraction should again be held for 7 – 10 seconds
  8. Stretch the tight (antagonistic) muscle to the 3rd barrier
  9. The person being stretched should then contract the opposite muscle (agonist) near maximal (80%) and isometrically against resistance
  10. The contraction should again be held for 7 – 10 seconds
  11. The person being stretched should then stay at the 3rd barrier and stretch the tight (antagonist) muscle for 30 secs
  • The same breathing pattern as the Hold-Relax technique is used
  • This technique uses Reciprocal Inhibition.
  • An alternative for this technique is to use near-maximal (80%) and an isotonic contraction on the opposing muscle against resistance.

Hold-Relax with Agonist Contract

  • This technique is a combination of Hold-Relax and Agonist Contract
  • This technique also uses Autogenic Inhibition and Reciprocal Inhibition
  • The same breathing pattern as the Hold-Relax technique is used
  1. Follow the same procedure as done for Hold-Relax for the 1st barrier, contracting the muscle you are stretching for 7 – 10 secs
  2. Following the contraction of the agonist, the person being stretched should contract the opposing muscle for 7 – 10 secs
  3. A facilitator then passively brings the tight muscle into its new range (2nd barrier) and repeat
  4. A facilitator then passively brings the tight muscle into its new range (3rd barrier) and repeat
  5. At this 3rd barrier stretch the tight muscle for 30 secs
  6. If needed, repeat until desired length is achieved