Neuromuscular Inhibition Techniques By: Mehak Abid Roll no. 70106100 Procedure for Neuromuscular Inhibition: • For Hold relax (HR) & Contract relax (CR): o With the HR and CR procedures, the range limiting target muscle is first lengthened to the point of tissue resistance or to the extent that is comfortable for the patient. o The patient then actively performs a pre-stretch, end-range, isometric contraction of the range limiting target muscle against manual resistance applied by the clinician. o This contraction is held for about 5 seconds and followed by voluntary relaxation of the target muscle. o The limb is then passively moved by the clinician into the new range as the range-limiting muscle is elongated. • NOTE: Although the term CR and HR often are used interchangeably, in classic PNF the technique descriptions are not identical. Both techniques are performed in diagonal patterns, but in the CR technique, the axial rotators of the limb are allowed to contract concentrically in the pre-stretch phase, while all other muscle groups of the diagonal pattern contract isometrically. In contrast, the pre-stretch isometric contraction occur in all muscles of the diagonal pattern during the HR technique. • For Agonist contraction: o With the AC procedure, the patient concentrically contracts the muscle opposite the range limiting muscle and then hold the end range position for at least several seconds. o The movement of the limb is controlled independently by the patient and is deliberate and slow, not ballistic. • For Hold-Relax: o In a HR stretch technique, relaxation of the muscles are facilitated to gain range of motion with the usage of isometric contraction rather than an isotonic. o The procedure for this type of stretching regime is to put the clients limb in a pain free range and an isometric contraction is then sustained afterwards the limb is then moved in a new range. Rationale behind each type of neuromuscular inhibition: • These techniques are used to inhibit or facilitate muscle activation and to increase the likelihood that the muscle to be lengthened remains as relaxed as possible as it is stretched. • Numerous studies have demonstrated that the various PNF stretching technique can increase flexibility and ROM. Preference of one technique over other: • Comparison of HR & CR with manual passive stretching: Clinicians with experience using PNF report that the HR and CR techniques appear to make passive elongation of muscles more comfortable for a patient than manual passive stretching. • Comparison of Agonist contraction with static stretching: Two studies have compared the effect of AC procedure , referred to as DROM, to static stretching of the hamstrings of healthy subjects over a six week period. • One study demonstrated that DROM is as effective as static stretching but the other study showed that one daily session of a 30 seconds static stretch was almost three times as effective in increasing hamstring flexibility as was six repetition s of a 5 seconds end range DROM hold performed daily. • Comparison of HR-AC technique with HR alone: Studies comparing two PNF stretching procedures have produced different results. • In one study the HR-AC technique produced a greater increase in ankle dorsiflexion range than the HR technique alone, while both HR-AC technique and HR alone produced a greater increase than manual passive stretching. REFERENCE: • Therapeutic Exercise Foundations and Techniques, 8th edition.