Efficiency of Proprioceptive Neuromuscular Facilitation Technique in Musculoskeletal Injury of Knee - Research Proposal Example

THE EFFECTIVENESS OF PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION TECHNIQUE IN THE CASE OF MUSCULO SKELETAL IMPAIRMENT OF KNEE. Introduction The musculoskeletal system is composed of muscles, tendons, ligaments, and bones, the physical backbone providing the unique structure of the human physique. Impairment in this system affects the individual aesthetically and portably, causing loss to ability to function normally or provide a living. This is most notably the case with those who engage in sports, resulting in a loss in the normal application of joint sense. This makes the physical rehabilitate of the knee of the highest priority. One of the most predominant techniques used to alleviate knee pain and improve knee strength in sports rehabilitation is the proprioceptive neuromuscular facilitation (P.N.F) technique. Proprioceptive neuromuscular facilitation is a form of muscle stretching used to improve the static-passive flexibility. Unlike other forms of stretching, such as active, ballistic, dynamic, etc, PNF uses passive stretching on a muscle, which is then isometrically contracted in opposition to resistance, and then passively stretched. The result is an enhancement in the range of motion. Anatomy The knee is a hinge joint, dynamically unstable whilst its intricate parts give it the ability to move flexibly. It is composed of the distal end of the femur (medial and lateral condyles) as it is connected to the proximal tibia (medial and lateral condyles). In front this area of communication is covered by the patella. The knee is surrounded by several ligaments which include the medial and lateral collateral ligaments (medial and lateral to joint capsule, resist abduction and adduction of the knee), and the anterior and posterior cruciate ligaments (the ACL attaches to the tibia anteriorly, the PCL posteriorly, the prevent anterior and posterior displacement). Within the knee joint the medial and lateral menisci (fibrocartilaginous, medial C-shaped and attached to medial collateral ligament, lateral O-shaped and not rigidly attached to tibia) are found between the tibial and femoral condyles. Due to the medial meniscus shape and attachment, it is predisposed to injury with resultant injury also to the medial collateral ligament and anterior cruciate ligament. Between the knee joint and the ligaments medial and lateral there are bursae which provide a supportive cushion, with another popliteal bursa posterior in the knee. The patella is supported superiorly by the tendon from the quadriceps muscle and inferiorly by the patellar ligament. Operational Definition 1. Impairment Is the loss of the normal level of anatomical, physiological, or psychological functioning of a body system or organ. 2. Isometric contraction (Muscle setting) When the most distal ends of a contracting muscle are firmly fixed, with the resultant effect of a contraction causing an increase in tension at a constant length throughout the muscle. It is done by first allowing the muscle to endure a passive stretch, then for 7-15 seconds the muscle is tensed by having resist an immovable object, and lastly the muscle is allowed to relax for 20 seconds. 3. Repeated contraction The application of successive contractions of a specific muscle groups within a set period of time. The result of this causes an increase of lactic acid, hormones and proteins in muscle. 4. Hold relaxed Technique used in PNF in which after a passive stretch the muscle undergoes an isometric contraction for 7-15 seconds. Following a relaxation period of 2-3 seconds, the passive stretch is attempted again for 10-15 seconds. Afterwards a relaxation period of 20 seconds is allowed. 5. Rehabilitation The ability to restore functioning to normal subsequent to injury or disease. 6. Sports Rehabilitation The discipline dealing with the restoring to normal functioning injury or disease resulting from sport activity participation. Review of literature 1. The effects of stretching protocols on maximal anaerobic Wingate test with a Monark 824-E (non-stretching, static stretching of three sets of thirty, dynamic stretching of three sets of five repetitions slow and ten repetitions fast, PNF of three sets with resistance for eight seconds) on the hamstrings, quadriceps and calves showed that, using fifteen active male volunteers was a significant difference for dynamic stretching on mean power and peak power. However, when comparing non-stretching no difference was found, providing evidence that stretching has no effect on the Wingate test. The tests were randomized, video recorded and the mean power, peak power and anaerobic fatigue index were noted and analysed with ANOVA. -Signorelli 2008 2. The acute effects of a short duration static stretching and PNF on the quadriceps and hamstring strength and knee range of motion shows that the static stretching has a disadvantageous effect compared to the PNF. The study was done with eight subjects separated into three alternating groups of control, static stretching and PNF. In the control group the isokinetic torque at its peak at 30 and 180 degrees, as well as the maximal voluntary isometric strength at 60 degrees were noted. In static stretching and PNF the knee range of movement was noted with a goniometer before and after the stretching, with the after stretching having measured with a dynamometer also torque and isometric strength. In all of the groups the vastus lateralis and biceps femoris muscles EMG tests were performed. -Davis 2007 3. Adhesive capsulitis of the shoulder results in decreased range of motion of the joint, with the cause still unknown. Physical therapy, in the form of PNF, joint and soft tissue mobilization, is helpful in Stage 3 adhesive capsulitis. These patients often have pain at rest and at night, with the shoulder noticeable stiff with limited use, affecting activities of daily living. Non-operative treatment is used to improve flexibility and range of motion, especially the ability to elevate the arm due to the inability to perform glenohumeral abduction. -Hannafin 2000 4. This study reviewed the ability of static stretching to decrease muscle activation, isometric force and jump power and improve and note duration of range of motion. Twelve individuals were used, grading the quadriceps and plantar flexors compared to the control. The maximal voluntary force, integrated EMG, peak twitch, tetanus, and interpolated twitch technique were measured. Also noted were vertical jump height and contact time, and hip flexion/extension and plantar flexion/dorsiflexion. The result was after the stretching a loss in force in the quadriceps for maximal voluntary force and interplolated twitch technique, remaining so for 120 minutes, but with no change in jump or plantar flexion. -Power 2004 5. Examined the effects of passive stretching on the plantar flexors. Used 13 volunteers in the groups of non-stretching, two minute stretching, four minute stretching, and eight minute stretching, with testing done before, and after immediately, 10 minutes, 20 minutes and 30 minutes. The result was that isometric PT was not decreased compared to the control, and contrarily cause slight improvement in the range of movement. -Ryan 2008 6. Delved into the evidence on MEDLINE and Sport Discus to determine if stretching can improve performance. Using 23 articles, 22 concluded that in regards to the acute effects of stretching there was no benefit for jumping height, isometric force and isokinetic torque. For running speed the results were inconclusive, with only one article stating it was beneficial for running economy, with beneficial or no effect for regular stretching. -Shrier 2004 7. This study researched if PNF would be able to decrease maximal voluntary contraction greater than static stretching. This was done due to the conclusion from other studies that acute static stretching decreased maximal voluntary contraction via mechanical and neurological factors. Using fourteen male students in three interchangeable groups of control, static stretch and PNF stretch (hold-relax), they found that flexibility was greatly improved by both static stretch and PNF, with PNF being significantly greater. However, the MVC and iEMG did not improve with either PNF or static stretching, with the latter decreasing. The students were tested by each stretch repeated five times with the biceps femoris measured by iEMG and the hamstrings by the Leighton flexometer before and after stretching. -Miyahara 2005 8. This study noted the effect of low (two sets) and high (five sets) volume static and PNF stretching on bench pressing in trained athletes. The triceps and chest muscle groups were targeted. The result was no significance between the various types of stretching. -Conley 2008 9. Contrary to popular belief that stretching before a race is beneficial, this study researched into the possibility that it may actually reduce joint proprioception. It did this by evaluating PNF of the hamstrings and quadriceps of ten individuals, as a machine moved the knee at various intervals as the subjects were blocked of external cues by being blindfolded and wearing headphones. Statistical analysis was done via a t-test. The result was in no significant variation between the PNF or the group whose legs were only moved to test range of motion. -Mock 2008 10. This study evaluated the use of PNF and knee exercises post-knee surgery due to the dilemma of strengthening of the vastus medialis muscle due to the imbalance formed between it and the vastus lateralis. The EMG response of four muscles were noted: vastus medialis, vastus medialis longus, vastus lateralis, and rectus femoris. Also tests were the straight leg raise, internal rotation, adduction, and ankle dorsiflexion/inversion. It was discovered that PNF was better than the other stretching techniques at engaging all four muscle groups. -Hasegawa 2001 Research Method Research Sampling Inclusive Criteria The Sports Injured Person The Subject Whose Age Is 20-35 Exclusive criteria Age more than 50 years Rheumatoid Arthritis Osteoarthritis Sampling Hospital Name and address in London of 20 patients who have been treated Randomised, choosing those who can understand what shall be required from them with this assignment. Those with debilitating ailments will not be used to give as standardized of a result as possible. Apparatus Used Isometric Exercise Machine Measuring Procedure The Oxford Scale (The Oxford Handicap Scale) Table 1 : www.cebp.nl/vault_public/filesystem/?ID=1446 HANDICAP LIFESTYLE GRADE None No Change 0 Symptomatic (Minor) No Interference 1 Minor Some Restrictions But Able To Look After Self 2 Moderate Significant Restriction; Unable To Lead A Totally Independent Existence (Requires Some Assistance) 3 Moderate To Severe Unable To Live Independently But Does Not Require Constant Attention 4 Severe Totally Dependent; Requires Constant Attention Day And Night 5 Procedure 1. Explain Hold And Relax Technique 2. Repeated Contraction 3. Slow Reversal Research Design Hypothesis Alternative hypothesis This procedure will increase the strength of the muscle. Statistical Analysis Before and after the technique is done shall be tested. Therefore a line graph shall be displayed of the statistical analysis via a t-test amongst the twenty patients of before and after. The standard deviation shall be noted to determine the statistical significance of the scores’ relevance. Bibliography Conley, D., et al. Effects Of Low And High Volume Stretching On Bench Press Performance In Collegiate Football Players. Med. Sci. Sports Exerc., Vol. 40 (5), pp. 259, 2008. Davis, J., et. Al. Acute Effects of Static and Proprioceptive Neuromuscular Facilitation Stretching on Muscle Strength and Range of Motion. Med. Sci. Sports Exerc., Vol. 39 (5), pp. 487, 2007. Hannafin, J.A.., et al. Adhesive Capsulitis: A Treatment Approach. Cli. Ortho. Rel. Research, Vol. 372, pp. 95-109, 2000. Hasegawa, K., et al. EFFECTS OF STRETCHING EXERCISES ON VASTUS MEDIALIS AND VASTUS LATERALIS. Med. Sci. Sports Exerc., Vol. 33 (5), pp. 10, 2001. Miyahara, Y., et al. Effect Of Proprioceptive Neuromuscular Facilitation Stretching And Static Stretching On Maximal Voluntary Contraction. Med. Sci. Sports Exerc., Vol. 37 (5), pp. 441, 2005. Mock, M., et al. Effects of Quadriceps and Hamstrings PNF Stretching on Knee Proprioception. Med. Sci. Sports Exerc., Vol. 40 (5), pp. 167, 2008. POWER, K., D. BEHM, F. CAHILL, M. CARROLL, and W. YOUNG. An Acute Bout of Static Stretching: Effects on Force and Jumping Performance. Med. Sci. Sports Exerc., Vol. 36, No. 8, pp. 1389–1396, 2004. RYAN, E.D., et al. Do Practical Durations of Stretching Alter Muscle Strength? A Dose-Response Study. Med. Sci. Sports Exerc., Vol. 40 (8), pp. 1529-1537, 2008. Shrier, I D. Does Stretching Improve Performance?: A Systematic and Critical Review of the Literature. Cli. Journal Sports Med., Vol. 14 (5), pp. 267-273, 2004. Signorelli, G., et al. Acute Effect of Three Different Stretching protocols on Wingate Test. Med. Sci. Sports Exerc., Vol. 40 (5), pp. 423, 2008. “The Oxford Scale.” URL: www.cebp.nl/vault_public/filesystem/?ID=1446 (03/03/09). URL: http://www.aclsolutions.com/images/Seif_knee%20anatomy02.jpg (03/03/09). Read More