|Is that Ace and Gary?|
reminder - abbreviations post here.
I remember one of my first University of St. Augustine Courses fondly. What a LOOONG time ago that was!
I was a new grad, literally, took my first course the Monday after I graduated, all psyched to start my DPT and take MTC courses and start clinical residency. I was going to learn manipulation! Less yacking, more cracking!
Do you know what the instructor said? She said two things I scoffed at
- One of the main things that separates PTs from other movement based professions is our knowledge of exercise
- You have to incorporate PNF with your joint manipulations
PNF? What? Like diagonals?
Apparently that was all I got out of PNF, is that it's for "neuro" patients and it's a bunch of diagonals. What does eating food or drawing your sword have to do with manual therapy?
It was not until years later, taking some IPA courses, and then moving onto our modern views of manual therapy and neurophysiologic effects did I realize that PNF absolutely should be used in any setting, like exercise and manual therapy... there is no peds, neuro, and ortho... just the neuromusculoskeletal system. There may be different presentations seen depending on what setting you work in, but the treatments to change and affect neurology are the same.
Here are 5 reasons you should be using PNF
1) It facilitates
- someone can't do a baby get up?
- try giving them a little resistance on the way up by pushing their lead arm posteriorly
- the light resistance cues the proper movement
- a patient this afternoon was having difficulty going down from the propped elbow position to her shoulder due to a lack of eccentric control or knowledge of the pattern in that direction
- the same posterior resistance to her arm helped her lower from the end position of the BGU
2) It inhibits
- what we often thing of "tissue release" or "ischemic release" or "ART" is not breaking up anything, it's merely changing tone
- the generic but helpful thing about PNF and manual therapy in general is that once the reset occurs, the body often starts moving correctly
- where there is too much tone, PNF inhibits it (if performed correctly)
- example - hypertonic psoas, light abdominal pressure with belly breathing decreases tone and improves hip ROM and ipsilateral lumbar movement
- the opposite is true for the first point - facilitation, where there is inhibition, manual therapy/PNF facilitates
3) It helps PDM
- one of the difficulties of implementing repeated motions as a treatment without adjunct OMPT techniques is when a patient has PDM
- a patient will not perform their HEP if the pain during the movement is too threatening
- step 1 should always be remove the threat, and after the educational piece, next you have to remove the movement part
- I have found agonist reversals at the painful point of range, or simple hold relax at the painful barrier either greatly reduces or eliminates the pain
- threat eliminated = compliant patient = rapid resolution
4) It gets you to end range
- see above for MDT reason
- years ago, I learned from a student who literally gave the shoddiest inservice ever
- on a torn out piece of notebook paper, complete with spiral holes on the left side and written in pencil
- I was still in full on OMPT mode two years after completing my MTC and MDT was just something I did for the credentials
- we were having trouble maintaining pain free end range on a shoulder patient's IR after 10-15 minutes of anterior, posterior glides, distractions. etc...
- this student told me one day, look at Mr X's shoulder IR! - it was full, pain free AROM and PROM
- flabbergasted, I asked, what did you do?
- his answer, hold relax stretches!!!!
- another great use of PNF, through simple hold relax is setting up prior to a thrust manipulation
- often the patient may be guarding and clinicians use mob or manip their way through it, that is almost never comfortable
- use some hold relax to get to get past the painful barrier, have the patient relax and reduce tone, then mob or thrust
5) It doesn't hurt
- this certainly is not the last but least, but most likely the most important
- lighting touching someone to inhibit tone or facilitate tone/movement is much less threatening than scraping with a tool, end range oscillations or neural tensioners
- this can be used as an effective gateway technique for touch adverse patients to other inputs that may be needed to get the patient feeling and moving better
Keeping it Eclectic...