Proprioceptive neuromuscular facilitation training induced alterations in muscle fibre type and cross sectional area

Efficacy and safety of proprioceptive neuromuscular facilitation for chronic low back pain: A meta-analysis of randomized controlled trials

Objectives: This study aimed to evaluate the effectiveness and safety of proprioceptive neuromuscular facilitation for chronic low back pain.

Materials and methods: Eleven databases were searched from their inception through January 2021. The primary outcomes were pain intensity, individual activities, quality of life, and adverse events.

Results: Four randomized controlled trials (RCTs) with 184 patients (mean age: 37.8±3.1 years; range, 35 to 50 years) met the inclusion criteria. The pooled effect size showed proprioceptive neuromuscular facilitation, relieved pain (standard means difference [SMD]: -0.835, 95% CI: -1.139 to -0.531, p<0.001, n=4), and improved individual activity (Roland Morris Disability Questionnaire, SMD: -1.765, 95% CI: -2.642 to -0.888, p<0.001, n=2; Oswestry Disability Index, SMD: -0.893, 95% CI: -1.434 to -0.352, p=0.001, n=1) for chronic low back pain (CLBP).

Conclusion: This study verified that proprioceptive neuromuscular facilitation could relieve pain and improve individual activities without serious adverse events in patients with CLBP; however, it should be cautiously recommended due to the small number of included RCTs.

Comparison of different neuromuscular facilitation techniques and conventional physiotherapy in knee osteoarthritis

Background/aim

This study was conducted to compare the effects of conventional physiotherapy and two different ‘proprioceptive neuromuscular facilitation’ (PNF) techniques on knee muscle strength, knee muscular endurance, and proprioception in knee osteoarthritis (KOA).

Materials and methods

The study included 35 patients between the ages of 47 and 62 who were diagnosed with stage 1-2 KOA. The patients were divided into three groups with block randomization method as Repeated Stretching Group (N = 12) With Repeated Stretching Technique, Combined Isotonic Contraction Group (N = 11) With Combined Isotonic Contractions (CIC) Technique, And Conventional Physiotherapy Group (n = 12). PNF was applied to all patterns of the lower extremity in full pattern and patients in all groups were treated for 6 weeks, 3 days a week. Muscle strength, muscle endurance, and proprioception were evaluated with Biodex System Pro3 (Biodex Corp. Shirley NY, USA).

Results

Knee extensor muscle strength showed more improvement at CIC group than the other groups, and CIC group showed more improvement compared to the conventional physiotherapy in terms of knee joint position sensation evaluated at 60° (p < 0.05).

Conclusion

All methods were effective in patients with early-stage knee osteoarthritis; however, the most effective results were obtained by PNF using CIC technique.

Post-stroke BDNF concentration changes following proprioceptive neuromuscular facilitation (PNF) exercises

Background:

Brain-derived neurotrophic factor (BDNF) plays an important role in repairing normal as well as in the injured brain. Physical exercise may have a positive impact on the release of BDNF.

Objective:

PNF is a neurophysiological approach that facilitates the stimulation of central and peripheral nervous systems. In this study, our aim was to assess the levels of BDNF as well as functional recovery before and after the intervention of PNF in patients with acute stroke.

Methods:

A total of 208 patients with first time confirmed stroke were recruited and assessed for stroke severity, type, mini-mental state exam (MMSE), functional independence measure scale, and BDNF levels before and after PNF intervention. BDNF levels were also assessed in healthy individuals for control values.

Results:

A significant decline in levels of BDNF was observed after in stroke. BDNF levels in patients (with different risk factors) with diabetes, hypertension and DM+ HTN, alcohol, and smoking history were 8.8 ± 4.04 ng/mL, 8.86 ± 4.68 ng/mL, 8.65 ± 3.26 ng/mL, 8.51 ± 4.26 ng/mL, and 8.9 ± 3.4 ng/mL, respectively. A decline in BDNF levels was observed in accordance with the severity of stroke in both ischemic and hemorrhagic stroke with the least level being in severe stroke (NIHSS >15 and ICH >3). Despite the type of stroke and the presence of risk factors, a significant improvement in BDNF levels and FIM scale scores was seen in all subjects who received PNF exercises.

Conclusion:

Thus, PNF is efficient in improving functional level in acute stroke irrespective of the type of stroke and risk factors.

Investigation of alpha band of the electroencephalogram before and after a task of proprioceptive neuromuscular facilitation

The proprioceptive neuromuscular facilitation (PNF) sets up a feature of treatment developed with the objective to facilitate and improve the motor performance. The aim of this study was to investigate in healthy female individuals the effects of electrophysiological of a diagonal of the PNF upper limb. The sample consisted of 30 female participants aged between 18 to 28 years, randomly divided into 3 groups (G1, G2, and G3). The three groups had 2 moments of electroencephalographic signal detection, before and after the task. The statistical neurophysiological design allowed the analysis of the relative power of alpha band in three leads (Fz, F7, and F8). Thus, a three-way mixed factorial analysis of variance (ANOVA) was performed to investigate the factor inter subjects (groups) and intrasubjects (areas and moments), a two-way ANOVA to investigate the interactions between the three factors, and a one-way ANOVA to analyze separately the factors time and area. A P≤0.05 was considered as significance level. The results showed significant increase of alpha band in the three groups analyzed, being more evident to the G2 group. Therefore, the PNF can be considered favorable also in relation to the cortical behavior, reinforcing its use in rehabilitation processes, especially in the clinical practice of physiotherapy.

Comparison of anterior gluteus medius fiber activation during general exercises and PNF exercises

[Purpose] This study compared the activation of anterior gluteus medius fibers during general exercises and proprioceptive neuromuscular facilitation exercises. [Subjects and Methods] The study enrolled 15 healthy adults. The participants performed general hip abductor strengthening exercises and proprioceptive neuromuscular facilitation exercises; during both types of exercise, electromyography activity was recorded. [Results] Greater anterior gluteus medius fiber activation was observed during the proprioceptive neuromuscular facilitation exercises compared with the general hip abductor strengthening exercises. The anterior gluteus medius fibers exhibited greater activity during pattern 2 exercises compared with any other type of exercise. [Conclusion] The results suggest that pattern 2 exercises can selectively activate anterior gluteus medius fibers.

Changes of Achilles tendon properties via 12-week PNF based robotic rehabilitation of ankle joints with spasticity and/or contracture

Ankle joint with spasticity and/or contracture can severely affect mobility and independence of stroke survivors. Due to that, the Achilles tendon(AT) is affected. In this paper, we aim to study changes of AT properties via proprioceptive neuromuscular facilitation (PNF) treatment. A robotic ankle-foot rehabilitation system has been proposed, which consists of a robotic ankle-foot platform and a graphic user interface. In this pilot study, two post-stroke patients participated and carried out a 12-week PNF treatment with the robotic system. The treatment is evaluated quantitatively in AT properties. The evaluation shows that after the PNF treatment, the average decrease of AT length is 4.1 mm (6.5%) and the recovery ratio is 30.4%, while the thickness has no change. The results indicate that the PNF based robotic rehabilitation for ankle joints with spasticity and/or contracture is effective to improve the ankle spasticity/contracture.

Changes in muscle strength in elderly women after proprioceptive neuromuscular facilitation based training

Introduction Proprioceptive neuromuscular facilitation (PNF) can be used to improve the quality of life of both healthy and diseased subjects, including the elderly, who suffer muscular weakness due to aging, leading to an impairment in functional capacity. Objective Verify the effectiveness of PNF as a tool for functional conditioning. Materials and methods We evaluated a total of ten elderly women aged 60–70 years, clinically healthy and physically active. They had the force of motion of hip flexion with knee extension analyzed by an analog dynamometer. They were then randomly and equally divided into experimental (EG) and control group (CG). The GC was instructed to continue with their normal activities while the GE held 15 training sessions in the lower limb (LL) based on the diagonal D1 and D2. Finally, a new collection wrench the two groups was performed and the data compared. Results There was a significant increase in the average strength of GE, on the order of 31% (p < 0.01). The GC also had increased strength, but not significant (p > 0.05). Discussion : The results confirm that the FNP through initial work of readjustment and proprioceptive neuromuscular activation, and after that, conditioning of the muscle fibers (mainly resistive) is capable of amplifying the force developed by the muscle. Conclusion The PNF was effective as training to gain muscle strength, should be better analyzed as a tool fitness, not to cause health risks, have low cost and easy application.

Effect of joint mobilization using KEOMT and PNF on a patient with CLBP and a lumbar transitional vertebra: a case study

[Purpose] The purpose of this case study was to identify the effects of joint mobilization using Kaltenborn-Evjenth orthopedic manual therapy (KEOMT) and proprioceptive neuromuscular facilitation (PNF) techniques on a patient with chronic low back pain (CLBP) and a lumbar transitional vertebra. [Methods] The intervention methods were joint mobilization using KEOMT and PNF techniques. The program consisted of 40-min sessions 3 days a week for 4 weeks. The spinal motion (thoracic and lumbar vertebrae), pain, and thickness of the multifidus were measured. [Results] The angle of spinal curvature increased, and the range of motions (ROMs) flexion and extension increased in the thoracic and lumbar vertebrae. The pain score as measured on a visual analogue scale (VAS) and the Oswestry disability index (ODI) score decreased. The thickness of the multifidus (L4) increased on the left and right sides. [Conclusion] These results suggest that joint mobilization using KEOMT and PNF techniques had a positive effect on the spinal motion, pain, and thickness of the multifidus of a patient with chronic low back pain and a lumbar transitional vertebra.

Effect of upper extremity proprioceptive neuromuscular facilitation combined with elastic resistance bands on respiratory muscle strength: a randomized controlled trial

BACKGROUND

Elastic resistance bands (ERB) combined with proprioceptive neuromuscular facilitation (PNF) are often used in resistance muscle training programs, which have potential effects on peripheral muscle strength. However, the effects of the combination of ERB and PNF on respiratory muscle strength warrant further investigation.

OBJECTIVES

The assessment of the effects of PNF combined with ERB on respiratory muscle strength.

METHOD

Twenty healthy, right-handed females were included. Subjects were randomized to either the resistance training program group (TG, n=10) or the control group (CG, n=10). Maximal expiratory pressure (MEP) and inspiratory pressure (MIP) were measured before and after four weeks of an upper extremity resistance training program. The training protocol consisted of upper extremity PNF combined with ERB, with resistance selected from 1 repetition maximum protocol.

RESULTS

PNF combined with ERB showed significant increases in MIP and MEP (p<0.05). In addition, there were significant differences between the TG and CG regarding ∆MIP (p=0.01) and ∆MEP (p=0.04).

CONCLUSIONS

PNF combined with ERB can have a positive impact on respiratory muscle strength. These results may be useful with respect to cardiopulmonary chronic diseases that are associated with reduced respiratory muscle strength.

Effect of isokinetic training on muscle strength, size and gait after healed pediatric burn: a randomized controlled study

OBJECTIVE

The aim of this study was to investigate the effects of isokinetic training program on muscle strength, muscle size and gait parameters after healed pediatric burn.

DESIGN

Randomized controlled trial.

SUBJECTS

Thirty three pediatric burned patients with circumferential lower extremity burn with total body surface area (TBSA) ranging from 36 to 45%, and ages from 10 to 15 years participated in the study and were randomized into isokinetic group and a control group. Non-burned healthy pediatric subjects were assessed similarly to burned subjects and served as matched healthy controls.

METHODS

Patients in the isokinetic group (n=16) participated in the isokinetic training program for 12 weeks for quadriceps dominant limb, 3 times per week, at angular velocity 150°/s, concentric mode of contraction, time rest between each set for 3 min, 3 sets/day and control group (n=17) participated in home based physical therapy exercise program without isokinetic.

MAIN MEASURES

Assessment of quadriceps strength by isokinetic dynamometer, quadriceps size and gait parameters were performed at baseline and at the end of the training period for both groups.

RESULTS

Patients in isokinetic group showed a significant improvement in quadriceps strength, quadriceps size and gait parameters as compared with those in the control group. Quadriceps strength and percentage of improvement was 79.25 ± 0.93 Nm (68.40%) for isokinetic group and 51.88 ± 1.31 Nm (9.84%) for the control group. Quadriceps size and percentage of improvement was 31.50 ± 0.89 cm (7.47%) for isokinetic group and 29.26 ± 1.02 cm (1.02%) for the control group. Stride length, step length, velocity and cadence and percentage of improvement for isokinetic group was 135.50 ± 2.82 (53.97%), 63.25 ± 2.97 (63.77%), 135.94 ± 1.65 (81.42%), 137.63 ± 1.36 (66.96%) and for the control group was 94.00 ± 2.69 (6.68%), 43.76 ± 1.34 (15.15%), 81.11 ± 1.91 (8.6%), 90.35 ± 1.32 (9.01%) respectively.

CONCLUSIONS

Participation in the isokinetic training program resulted in a greater improvement in quadriceps muscle strength, size and gait parameters in pediatric burn.

Evaluation of strength and irradiated movement pattern resulting from trunk motions of the proprioceptive neuromuscular facilitation

Introduction. The proprioceptive neuromuscular facilitation (PNF) is a physiotherapeutic concept based on muscle and joint proprioceptive stimulation. Among its principles, the irradiation is the reaction of the distinct regional muscle contractions to the position of the application of the motions. Objective. To investigate the presence of irradiated dorsiflexion and plantar flexion and the existing strength generated by them during application of PNF trunk motions. Methods. The study was conducted with 30 sedentary and female volunteers, the PNF motions of trunk flexion, and extension with the foot (right and left) positioned in a developed equipment coupled to the load cell, which measured the strength irradiated in Newton. Results. Most of the volunteers irradiated dorsal flexion in the performance of the flexion and plantar flexion during the extension motion, both presenting an average force of 8.942 N and 10.193 N, respectively. Conclusion. The distal irradiation in lower limbs became evident, reinforcing the therapeutic actions to the PNF indirect muscular activation.

Sequentially allocated clinical trial of rhythmic stabilization exercises and TENS in women with chronic low back pain

Objective: To examine the effectiveness of rhythmic stabilization exercises and transcutaneous electrical nerve stimulation (TENS) and their combination in treating women with chronic low back pain.

Design: Sequentially allocated, single-blinded and controlled study, with a two-month follow-up.

Setting: The data were collected in a patient rehabilitation setting.

Subjects: A total of 92 women (34—46 years old) with chronic low back pain were studied.

Interventions: Sequential allocation was undertaken into four groups: `rhythmic stabilization' (n=23), `rhythmic stabilization — TENS' (n=23), TENS (n=23), and a placebo group (n = 23). Each programme lasted for four weeks. All outcome measures were assessed prior to, immediately after, four weeks and eight weeks post intervention.

Main measures: Data were obtained on functional disability, pain intensity, trunk extension range of motion, dynamic endurance of trunk flexion and static endurance of trunk extension.

Results: A total of 88 patients provided two-month follow-up data. The `rhythmic stabilization' and the `rhythmic stabilization — TENS' groups displayed statistically significant (P<0.05) improvements in functional disability and pain intensity (ranging from 21.2 to 42.8%), trunk extension range of motion (ranging from 6.5 to 25.5%), dynamic endurance of trunk flexion and static endurance of trunk extension (ranging from 13.5 to 74.3%) compared with the remaining groups.

Conclusions: The rhythmic stabilization programmes resulted in more gains in women with chronic low back pain regarding the present outcome variables compared with the other groups; therefore, its application in female chronic low back pain patients aged 34—46 years is recommended.