Chronic Ankle Instability

By Annelise Modica, SPT

 

 

What is Chronic Ankle Instability?

Chronic ankle instability can be broken down into two categories: Mechanical instability and Functional instability. Mechanical instability is when there is a laxity in the ligaments of your ankle joint and you have a history of previous ankle sprains. Functional instability is when you feel that your ankle is unstable or that it is “giving way” without any other physical symptoms such as pain.

 

 

How does Chronic Ankle Instability happen?

This usually arises from repeated ankle sprains where the ligaments do not heal properly or completely. The most common mechanism of injury (~80%) involves a forceful inversion (foot turning in) and plantarflexion (extension of the ankle) motion of the foot and ankle. This results in damage to the structures of the lateral (outside) ankle including: the Anterior talofibular ligament (ATFL) and the Calcaneofibular ligament (CFL).

 

     

Did you know that up to 20% of lateral ankle sprains can lead to chronic ankle instability?

 

 

How can I treat chronic ankle instability?

You can treat ankle sprains and instability with a variety of conservative methods including:

  • Rest
  • Ice
  • Bracing
    • For protection and stability during weight bearing
  • Taping
  • Orthotics
  • Physical Therapy
    • To work on:
      • Muscle strength and endurance
      • Ankle range of motion
      • Balance (proprioception) training

 

 

 

If conservative methods fail, due to increased damage to the ligaments resulting in a high level of instability, surgery may be an alternative an option. Consult with your PT and MD to discuss the best option for you!

 

 

 

References:

  1. Hiller CE, Kilbreath SL, Refshauge KM. Chronic ankle instability: Evolution of the model. Journal of Athletic Training. 2011; 46(2):133-141.
  2. Waterman et al. The epidemiology of ankle sprains in the United States. J Bone Joint Surg Am. 2010; 92-A(13):2279-2284.
  3. Li et al. Treatment of chronic lateral ankle instability: A modified brostrom technique using three suture anchors. Journal of Orthopaedic Surgery and Research. 2009; 4 (41). DOI: 10.1186/1749-799X-4-41
  4. Wainright et al. The Effect of Modified Brostrom-Gould Repair for Lateral Ankle Instability on in Vivo Tibiotalar Kinematics. Am J Sports Med. 2012; 40(9): 2099-2104.
  5. Sherry, M. Rehabilitation guidelines for Lateral Ankle reconstruction. University of Wisconsin Sports Medicine. 2014. https://www.uwhealth.org/files/uwhealth/docs/sportsmed/SM-39916_Laterl_AnkleProtocol.pdf

The Resolution Solution

By Chris Nentarz, PT

 

 

The New Year provides an excellent opportunity for us to inventory our lives, reflect on our wins and losses, and set new goals.  When it comes to making lasting improvements in our lives, sometimes good intentions just aren’t good enough.  The truth is that only 8 percent of us will actually keep our new years resolutions.  There are many things that side track us along the way, but here are some tips to turn some of the most common new years resolutions into healthy habits that will last into this year and beyond. 

 

 

  1. Don’t “Lose Weight,” try to “Gain lean mass while increasing your fitness level!”

 

 

Losing weight is quite possibly the most common, and honestly one of the most difficult, resolutions.  The scale tells how much one weighs, but not how strong, fit or mobile one is.  The scale can also be misleading because it does not account for how much lean muscle you have gained!  Muscle gain is a desirable effect of a good fitness program and can certainly have a seemingly negative effect on the scale. 

 

 

Forget the scale and focus on fitness outcomes, such as strength measures and endurance tests to measure your results.  If weight loss is your primary goal, try measuring your weight every 2 weeks or measure body mass composition instead.

 

 

  1. Don’t just “Get organized,” create a lifetime habit by scheduling “Daily Morning Movement Sessions!”

 

 

Finding time for a daily movement program is vital to sustained health.  Unfortunately, working out is one of the first things to go out the window when schedules get busy.  If this sounds familiar, try scheduling your workout time in the morning.  Evidence shows most people who regularly exercise perform their training in the morning before they start their day. 

 

 

Life happens, and working out in the AM naturally removes some of the barriers to late day plans.  In addition, morning movement routines offer many other benefits that will help you have a successful day, including increasing concentration and improving mood!  Incorporating morning movement sessions will increase your fitness levels and have a positive effect on the rest of your day!

 

 

  1. “Enjoy life to the fullest” by finding a “FUNctional training routine.”

 

 

More than ever we are beginning to understand the connection of our mind and body.  A regular exercise program significantly reduces stress and depression while simultaneously boosting immunity and enhancing mood. However, all exercise is not created equal.

 

 

Some training techniques can be harmful to our bodies moving parts or too heavily focused on aesthetics.  Functional training includes integrated, multidimensional movement that requires stability and mobility through a range of motion.  Functional training isn’t a direct method but comes in many forms, including Tai Chi, TRX suspense training, and many other traditional exercises, including squats and lunges.  Your training should mimic the movement you perform in life.  Lastly, functional training should be FUN and enjoyable!  After all, why do something you don’t enjoy?

 

 

While in reality, each day represents a new beginning, the energy of new years resolutions can be used to change our health and wellness for the better.  This year, move away temporary resolutions and towards permanent solutions!  Gain lean mass, get moving early, and incorporate FUNctional training methods! 

 

 

 

References:

 

Norcross JC1, Mrykalo MSBlagys MD.  Auld lang syne: success predictors, change processes, and self-reported outcomes of New Year’s resolvers and nonresolvers. Clin Psychol. 2002 Apr;58(4):397-405.

 

The Benefits of Tai-Chi & Qigong

By Kacper Kazibut, SPT

 

 

Tai chi & Qigong have been part of eastern culture for thousands of years and has slowly made its way into the western world. If you are new to the idea of tai chi or qigong, they have their origins as martial arts and have been utilized as both a way of activity and mindfulness. Tai chi involves a series of large sweeping movements, shifting of one’s body weight and prolonged holds to promote both mobility and strengthening. It also incorporates mindfulness and a focus on the present.

 

 

Qigong focuses on the movement of energy within the body known as qi (chee) to promote health, wellness and longevity. It too involves the same low impact movements, weight shifting and mindfulness as tai chi. While they may sound like some sort of esoteric rituals, the recorded benefits of both qigong & tai chi have been well documented over the past decade. Here are a few things that they can help improve and manage:

 

 

Improved Balance: Due to the large sweeping, positional holds, and weight shifting one’s balance is not only challenged but can also provide someone the ability to recover from a loss of balance. It has been shown in a recent 2018 study, the incidence in falls in people 65 and older over a 6-month time had significantly reduced.

 

 

Heart & Lung Health: The slow and rhythmic movements in conjunction with deep, controlled breathing has shown improvements in blood pressure and heart rate. Another study had found it to improve feelings of breathlessness and fatigue.

 

 

Arthritis Management: The repetitive shifting of weight over joints have shown to improve the quality of the life of participants. In addition, there have been documented results of decreased pain and improvement in function (stair climbing, walking etc.)

 

 

Strengthening: The use of large muscle groups and maintenance of posture and form provide increases in strength and endurance. In a study conducted in 2016 found significant strength gains were made after a 12 weeks tai chi program in individuals with knee osteoarthritis.

 

 

Look into your community programs to see if they offer any group classes so that you can experience the benefits yourself! Discuss with your PT or health care team to see if it is right for you!

 

 

 

References:

Jahnke R, Larkey L, Rogers C, Etnier J, Lin F. A comprehensive review of health benefits of qigong and tai chi. Am J Health Promot. 2010;24(6): e1-e25.

Lan C, Lai J-S, Chen S-Y, Wong M-K. Tai Chi Chuan to improve muscular strength and endurance in elderly individuals: A pilot study. Archives of Physical Medicine and Rehabilitation. 2000;81(5):604-607. doi:10.1016/s0003-9993(00)90042-x.

Li F, Harmer P, Fitzgerald K, et al. Effectiveness of a Therapeutic Tai Ji Quan Intervention vs a Multimodal Exercise Intervention to Prevent Falls Among Older Adults at High Risk of Falling. JAMA Internal Medicine. 2018;178(10):1301. doi:10.1001/jamainternmed.2018.3915.

Reid K, Price L, Harvey W, Driban J, Fielding R, Wang C. Changes in leg muscle strength and power after Tai Chi exercise in patients with symptomatic knee osteoarthritis. Osteoarthritis and Cartilage. 2016;24. doi: 10.1016/j.joca.2016.01.776

Tousignant M, Corriveau H, Roy P-M, Desrosiers J, Dubuc N, Hébert R. Efficacy of supervised Tai Chi exercises versus conventional physical therapy exercises in fall prevention for frail older adults: a randomized controlled trial. Disability and Rehabilitation. 2012;35(17):1429-1435. doi:10.3109/09638288.2012.737084.

 

 

5 Tips to Improve Your Turkey Trot Run!

By Kelly Sweeney, SPT

 

 

 

 

  1. Be light on your heels. This doesn’t mean you have to run on your toes, but you should have quick transitions from your heels to your toes.
  2. Keep your strike under your hips. You want to strike under your center of mass. Prevent over striding by keeping your ankle almost behind your knee as you strike the ground. This will reduce excessive impact and braking forces.
  3. Run with a slight forward lean of the body. Having a slight forward trunk lean (5-10 degrees) allows you to “fall” forward rather than having to pull yourself forward, which requires extra effort. But don’t lean forward too much. You don’t want to hunch over at the waist or shoulders.
  4. Strike softly with a slight toe out. Also, relax your hands and shoulders. Tension in the upper body wastes energy.
  5. Keep a quick tempo. In order to minimize contact time and help prevent injury, increase your tempo. A recommended cadence is 88-90 strides/minute or 180 steps per minute.

 

As with any exercise, remember to stay hydrated, pace yourself, and listen to your body. Consult with your healthcare team if you have any questions or concerns.

 

Gobble Gobble!

 

 

Reference

Walsh, M. The Running Athlete: Part B- Clinical Assessment and Rehabilitation. MedBridge Continuing Education Online Course. http://www.medbridgeeducation.com. Accessed January 2015.

 

 

Do It for the Girls! How Physical Therapists and Exercise Can Assist Breast Cancer Survivors

by Alaina Militello, SPT

 

One in eight women in the United States will be diagnosed with breast cancer in their lifetime. That is one diagnosis every 2 minutes. Although diagnoses are on the rise, medical treatment has advanced so much over the years that survivorship is at an all-time high. With more survivors living longer after initial cancer treatment, the healthcare world is having to shift gears in treatment to focus on increasing longevity and quality of life for these women. When it comes to increasing function and quality of life, who better to consult than your friendly neighborhood physical therapist!

 

There are many hardships that women face after treatment of breast cancer, both physically and psychologically. One of the most common physical complaints that breast cancer survivors have are an increased sensitivity to pain, largely in the upper extremity on the same side of the affected breast. Lymphedema, or swelling of the extremity, may cause discomfort but more severe pain and discomfort is often due to central sensitization.

 

Central sensitization is a phenomenon that occurs in the nervous system where activation of the pain centers in the brain are constantly firing and often do not turn completely “off”. This means that ordinary touch in these patients may be painful, and painful sensations become even more painful. Breast cancer survivors with this kind of response will often have features like:

 

  • Pain disproportional to the extent of the injury
  • Widespread pain
  • Hyperalgesia (persistent elevated pain)
  • Altered sensitivity to external stimuli (i.e. light, noise, odors)

 

Physical therapists are trained in how to differentiate pain responses, between normal and hypersensitive, and then know how to proceed appropriately within their treatment plan. They are also experts in exercise and human movement which allows them to create programs specialized for increasing a survivors’ function and therefore quality of life. Evidence has proven that through exercise, cancer patients can increase peak oxygen consumption, increase physical functioning and well-being, as well as decrease symptoms of fatigue that often follows cancer treatment.

 

Although physical therapists have a direct effect on the physical hardships of cancer survivorship, there is research out there that shows mind-body exercises, like yoga and dance, can improve self-esteem and body image. Many women following breast cancer treatment are concerned with their appearance and sexuality as a woman because they feel a loss of control between their mind and their body. Mind-body therapies can assist women in gaining a sense of control over their bodies and increase their confidence overall after winning their battle against cancer.

 

Physical therapy along with these complementary therapies can bring these resilient breast cancer survivors towards a better quality of life and a better outlook in their years of remission.

 

 

 

 

 

 

References:

  1. De, A. G., Meeus, M., De, T. V., Vos, L., Van, M. K., Geraerts, I., & Devoogdt, N. (2018). Unraveling Self-Reported Signs of Central Sensitization in Breast Cancer Survivors with Upper Limb Pain: Prevalence Rate and Contributing Factors. Pain physician21(3), E247-E256.
  2. Husebø, A. M. L., & Husebø, T. L. (2017). Quality of Life and Breast Cancer: How Can Mind–Body Exercise Therapies Help? An Overview Study. Sports5(4), 79.
  3. McNeely, M. L., Campbell, K. L., Rowe, B. H., Klassen, T. P., Mackey, J. R., & Courneya, K. S. (2006). Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. Cmaj175(1), 34-41.
  4. Nijs, J., Leysen, L., Adriaenssens, N., Aguilar Ferrandiz, M. E., Devoogdt, N., Tassenoy, A., … & Kuppens, K. (2016). Pain following cancer treatment: guidelines for the clinical classification of predominant neuropathic, nociceptive and central sensitization pain. Acta oncologica55(6), 659-663.
  5. Sandel, S. L., Judge, J. O., Landry, N., Faria, L., Ouellette, R., & Majczak, M. (2005). Dance and movement program improves quality-of-life measures in breast cancer survivors. Cancer nursing28(4), 301-309.
  6. http://www.nationalbreastcancer.org/breast-cancer-facts
  7. https://www.health.ny.gov
  8. https://www.cancer.org

ACL Injuries and Prevention

By Sports PT Clinical Blog Team

 

(Photo credit: https://www.skysports.com/nfl/news/12040/11507127/jimmy-garoppolo-suffers-potential-season-ending-injury-in-san-francisco-49ers-defeat) 

 

 

The San Francisco 49’ers quarterback Jimmy Garrapolo’s worst fears were confirmed Monday when an MRI revealed that he suffered a torn ACL in his left knee late in Sunday’s game against the Kansas City Chiefs.  

 

 

49’ers coach Kyle Shanahan said after the game the team feared Garoppolo had suffered such a devastating injury but further testing was needed to be sure. That certainty came Monday afternoon, as the team announced the official diagnosis.

 

 

Garrapolo’s next steps will be an initial course of daily Physical Therapy for swelling reduction and range of motion exercises to maximize outcome in surgery. He will have 6-9 months of intensive rehabilitation in hopes to return to the NFL.

 

 

 

In the US each year 200,000 ACL injuries are reported, making ACL injuries one of the most common injuries among athletes. Athletes from the high school level to the pros are impacted by devastating ACL injuries.

 

 

 

About ACL’s:

 

 

  • Two-thirds of ACL tears are NON-CONTACT injuries.

Most ACL injuries occur when an athlete pivots or lands from a jump, not direct collisions.

 

 

  • High school females are at the highest risk for ACL injury.  WHY?

Females are bio-mechanically structured with muscle imbalances including wider, weaker hips and hormonal fluctuations that make ligaments looser.

 

 

  • 8-50% of athletes do NOT return to their sport after ACL reconstruction.

The rehabilitation process is lengthy and requires skilled physical therapy along with mental preparedness for return to sport.

 

 

 

Proper training and ACL risk reduction programs are key.

It is crucial that proper form with squat mechanics, jump training, plyometrics, and strengthening are the focus of a training program.

 

 

 

We have SportsmetricsTM certified clinicians that train athletes in specific ACL reduction programs. Additionally, our clinicians are trained in Functional Movement Screens (FMS) to screen for objective risk of injury.

 

 

 

For more information on ACL risk reduction, contact us at info@sptny.com.

 

 

Falls Risk Prevention

By Dr. Alanna Pokorski, PT, DPT

 

 

 

How Can a Physical Therapist Help?

 

A physical therapist can conduct a brief check (“screening”) of your fall risk. If the screening shows that you are at risk, the therapist will perform a thorough evaluation, including:

 

  • Review of your medical history
  • Review of your medications
  • Simple vision test
  • Home safety assessment
  • Simple test of your thinking abilities
  • Check of your heart rate and blood pressure measurements at rest and while you change positions (from sitting/lying to standing)
  • Foot and footwear assessment
  • Balance, strength, and walking ability assessment

 

Based on the evaluation results, your physical therapist will design a plan that is tailored to your needs. Your treatment plan may include:

 

 

Balance training. Balance training has been shown to be an important and effective part of falls prevention. Your physical therapist will design exercises that challenge your ability to keep your balance as well as recover from a loss of balance, including exercises such as single-leg standing, or holding your balance while performing an action like reciting the alphabet.

 

 

Walking and moving. A prescribed exercise program should include a walking program. However, starting a walking program with poor balance can actually increase your risk for falling. Talk to your doctor or a physical therapist before you initiate a walking program to make sure that it is the right choice for you.

 

While working with a physical therapist, you may be asked to perform activities, such as:

  • Dance steps
  • Walking in circles
  • “Figure 8” exercises to strengthen the core abdominal muscles that help stabilize your body
  • Working through an obstacle course

 

 

Doing more than one thing at the same time—safely. Older adults who have difficulty walking and talking at the same time are at a higher risk of falling. To help increase your safety during daily activities, your physical therapist can design a “dual-task” training program. This kind of training will challenge you to maintain walking speed, while you perform another task, such as counting backward, engaging in a conversation, or carrying a bag of groceries.

 

 

Strength training. Strengthening is a key element of fall prevention and is very effective in preventing falls, especially when combined with balance exercises. Your physical therapist will design an individualized strengthening program that focuses on specific muscle groups to help improve your standing balance, your balance while walking, and your ability to recover from a loss of balance.

 

 

Endurance training. Aerobic exercise is physical exercise of relatively low intensity and long duration; it can help improve almost every aspect of your health, especially your endurance. Your physical therapist can work with you to plan a safe aerobic program, such as a walking or an aquatic program, to address your specific needs. The program may start with as little as 10-minute sessions and progress to 30-minute sessions, as your endurance improves.

 

 

Pain management. Pain management plays a crucial role in older adults’ risk for falling and quality of life. Certain exercises, such as strengthening and aerobic exercises, are appropriate interventions to relieve pain in addition to decreasing fall risk. Treatments need to be modified appropriately, depending on each individual’s source of pain. Physical therapy has been shown to help individuals reduce or eliminate their need for pain medication, including opioids.

 

 

Education. Your physical therapist will take the time to explain how you can best manage your own risks for falling. Your therapist also may talk to you about the best activities to help maintain your quality of life, and offer educational resources, such as:

 

 

Fear management. It is important for you to talk with your physical therapist about the fear you have of falling. The therapist will work with you to build your confidence and help you get back to the activities that you may be avoiding because you are afraid of falling. Your individual assessment can also identify the activities that you actually should avoid to stay safe.

 

 

Community programs. Several community-based fall-prevention programs are promoted by the Injury Prevention and Control Center of the Centers for Disease Control and Prevention in collaboration with the Administration on Aging. These programs help people:

  • Reduce their fear of falling
  • Set goals for increasing their physical activity
  • Make their homes more safe
  • Exercise more to increase their strength and balance

These programs often are led by volunteer coaches. Your physical therapist may be involved in setting up one of these programs or can help you find programs in your area that are best for you.

 

 

Personal recommendations. Your physical therapist can provide personal recommendations based on your condition and goals to help you:

  • Increase the safety of your home environment by making changes, such as removing throw rugs or clutter
  • Adjust how you complete your daily tasks to reduce your fall risk
  • Choose appropriate footwear
  • Learn about proper nutrition, improving your sleep schedule, and other general information that can help reduce your fall risk
  • Meet with other health care providers when appropriate

 

 

What Kind of Physical Therapist Do I Need?       

 

All physical therapists are prepared through education and experience to treat people who have a fear of falling, and balance problems. You may want to consider:

  • A physical therapist who is experienced in treating people with neurological problems or treating the geriatric population. Some physical therapists have a practice with a neurological or a vestibular (balance) rehabilitation focus or run an interdisciplinary fall-prevention clinic.
  • A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in neurologic physical therapy or geriatrics. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

 

Contact us at www.sptny.com

3 Tips for Backpack Safety

By: Dr. Alanna Pokorski, PT, DPT

 

 

 

Now that kids are back in school and homework is in full swing, children and parents should follow these 3 key tips to prevent injury from those heavy backpacks: 

 

 

  • Wear both straps. Using just one strap causes one side of the body to bear the load of the backpack and creates a muscular imbalance, making the body vulnerable to injury. Wearing both straps creates a healthy symmetry and weight is better distributed amongst the shoulders and spine.

 

 

  • Strap adjustment and backpack placement. The backpack should rest on the middle of the back and straps should be adjusted so that the child can easily stand with good posture AND take the backpack off easily. Straps that are too loose or too tight can create neck strain and a backpack should never rest on the low back.

 

 

  • Lighten the load. The weight of the backpack should be 10-15% of the childs bodyweight, so using a scale can be helpful to create a good balance. Arrange the items so that the heaviest items are closest to their back as to create a more stable backpack.

 

 

 

If you have made sure that your child is using their backpack properly, and they continue to have neck or back pain, contact us for a Physical Therapy evaluation at www.sptny.com.

 

The Elbow Epidemic: Baseball’s Recent Rise in “Tommy John” Surgery and What Can Be Done About It

By Daniel Fox, SPT

 

 

 

What Is Tommy John Surgery?

 

Tommy John surgery, more formally known as Ulnar Collateral Reconstruction (UCLR), is a surgical procedure first performed by Frank Jobe in 1974 on MLB pitcher Tommy John. The surgery consists of repairing/replacing a torn UCL, which is a small ligament on the inside of the elbow that serves to stabilize the elbow. It is frequently performed in overhead throwing athletes and has notably shown a significant rise in the past 10 years amongst baseball players of all ages.

 

 

The Increase in UCLR Prevalence

 

Between the years 2007 and 2011, 790 athletes documented in a private player database underwent Tommy John surgery. This number is likely smaller than the actual representation, due to not every player in the country being included in these kinds of databases. Over half of these athletes (58.6%) were between 15-19 and 22.2% were between 20-24 years old. Major League Baseball has seen a rise in this category as well as over 400 Tommy John surgeries have been performed from 1974 to date.

 

 

Higher Risks

 

In recent 2018 study, 115 out of 134 Division I baseball players who had undergone the surgery were identified as pitchers. Which equates to a surgery rate 5.9 times higher than non-pitchers. The majority of these surgeries were performed on freshman and sophomore pitchers, during the season, and who played in warm-weather states. Recent studies have also shown a relationship between elbow injuries and lack of external rotation, total rotation and lack of flexion of the throwing arm. Studies on youth pitchers have shown a correlation between elbow injuries and higher number of games played, pitches thrown and innings pitched.

 

 

What Can You Do?

 

  1. Sport Diversification: Warm weather states show higher prevalence for Tommy John surgeries due to the fact that baseball is accessible virtually all year round and young athletes are choosing to specialize in one sport. Decrease the amount of stress and strain on your arm/your child’s arms by giving rest time to participate in other sports/activities.
  2. Play Different Positions: To decrease the amount of stress to the throwing arm by taking a break from the mound to play other areas in the field that involve less repetitive throwing.
  3. Limit Pitch Counts: Limit the number of pitches thrown per game, week, month and year to keep the arm healthy. http://m.mlb.com/pitchsmart

 

 

What Can Physical Therapy Do?

 

  1. Address Individual Differences: Physical therapists can identify and address limitations in elbow, shoulder, core and hip range of motion, strength and stability to help limit the risk of injury.
  2. Mid-Season Prehab Programs: Physical therapists can design and implement mid-season programs that include stretching, strengthening, stability and recovery work in order to ensure that your arm stays healthy throughout the season.
  3. Rehab: For those who unfortunately have to have elbow surgery, Physical Therapy can get you back on the field through individualized rehab programs.

 

 

 

 

 

References:

  1. Erickson BJ, Nwachukwu BU, Rosas S, et al. Trends in medial ulnar collateral ligament reconstruction in the united states: A retrospective review of a large private-payer database from 2007 to 2011. Am J Sports Med. 2015;43(7):1770-1774. Accessed Aug 13, 2018. doi: 10.1177/0363546515580304.
  2. Rothermich MA, Conte SA, Aune KT, Fleisig GS, Cain EL, Dugas JR. Incidence of elbow ulnar collateral ligament surgery in collegiate baseball players. Orthopaedic Journal of Sports Medicine. 2018;6(4):232596711876465. http://journals.sagepub.com/doi/full/10.1177/2325967118764657. doi: 10.1177/2325967118764657.
  3. Erickson BJ, Chalmers PN, Bush-Joseph CA, Romeo AA. Predicting and preventing injury in major league baseball. Am J Orthop. 2016;45(3):152-156. Accessed Aug 13, 2018.
  4. Erickson BJ, Harris JD, Tetreault M, Bush-Joseph C, Cohen M, Romeo AA. Is tommy john surgery performed more frequently in major league baseball pitchers from warm weather areas? Orthopaedic journal of sports medicine. 2014;2(10):2325967114553916. https://www.ncbi.nlm.nih.gov/pubmed/26535277.

 

 

 

What is Proprioceptive Neuromuscular Facilitation?

By Courtney Roth, SPT

 

Proprioceptive neuromuscular facilitation (PNF) is a specific manual technique used by physical therapists to help improve a patient’s functional status. Traditionally, PNF was used to treat patients with neurological conditions such as stroke, multiple sclerosis, and Parkinson’s disease. However, research also supports its use for patients with orthopedic conditions such as back, neck and shoulder pain or muscle imbalances.1-7 PNF is a unique treatment approach because it uses diagonal patterns that incorporate multiple planes of movements, making the task more functional and effective in achieving patient goals.

 

 

 

The philosophy of PNF is based on five concepts8

 

  1. The human body moves as a unit, so PNF involves treating the whole person, not just the area of injury. Physical therapists can help identify whether someone has muscle imbalances or compensations in other areas of the body that may be contributing to their symptoms.
  2. PNF aims to tap into a patient’s underlying potential, by requiring active patient participation in order to mobilize strength, coordination, and range of motion reserves.
  3. A positive therapeutic environment is a critical component of PNF. Tasks that the patient is successful in performing without provoking symptoms are performed first, and then progress is built on those successes. Treatment avoids any movements that are painful for the patient.
  4. PNF aims to help patients achieve their highest level of function.
  5. In order to ensure progress made in the clinic carries over to a patient’s daily life, PNF implements principles of motor learning by using repetition and variability in multiple contexts to achieve retention of motor skill.

 

 

Adding PNF techniques to the treatment plan of many orthopedic conditions can help better integrate the nervous and musculoskeletal systems in order to move easier, more efficiently, and without pain.

 

 

 

References:

  1. Olkzac A, Wlodzislaw K, Domaniecki J. The PNF method in the treatment of intervertebral disc disease. The PNF method in the treatment of intervertebral disc disease. 2008;8(3):241-252.
  2. Rezasoltani A, Khaleghifar M, Tavakoli A, Ahmadi A, Minoonejad H. The Effect of a Proprioceptive Neuromuscular Facilitation Program to Increase Neck Muscle Strength in Patients with Chronic Non-specific Neck Pain. World Journal of Sport Sciences. 2010;3(1):59-63
  3. Maicki T, Bilski J, Szczygieł E, Trąbka R. PNF and manual therapy treatment results of patients with cervical spine osteoarthritis. Journal of Back and Musculoskeletal Rehabilitation. 2017;30(5):1095-1101. doi:10.3233/bmr-169718.
  4. Lee J-H, Park S-J, Na S-S. The Effect of Proprioceptive Neuromuscular Facilitation Therapy on Pain and Function. Journal of Physical Therapy Science. 2013;25(6):713-716. doi:10.1589/jpts.25.713
  5. Park K, Seo K. The Effects on the Pain Index and Lumbar Flexibility of Obese Patients with Low Back Pain after PNF Scapular and PNF Pelvic Patterns. Journal of Physical Therapy Science. 2014;26(10):1571-1574. doi:10.1589/jpts.26.1571.
  6. Jain AS, Anandh S, Pawar A. Effectiveness of Proprioceptive Neuromuscular Facilitation as an Adjunct to Eccentric Exercises in Subacromial Impingement. Indian Journal of Physiotherapy and Occupational Therapy – An International Journal. 2017;11(2):141. doi:10.5958/0973-5674.2017.00051.x.
  7. Voight M, Hoogenboom B, Cook G. The chop and lift reconsidered: integrating neuromuscular principles into orthopedic and sports rehabilitation. North American Journal Of Sports Physical Therapy: NAJSPT [serial online]. August 2008;3(3):151-159.
  8. Adler SS, Beckers D, Buck M. PNF in Practice: an Illustrated Guide. Berlin: Springer; 2014.