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.