Hello and welcome back to Body Mechanics. Today we will be covering a topic completely different from anything we have covered in the past. In the previous weeks we covered postural assessments quite extensively, and I sincerely hope you grew a better awareness behind the importance of muscular balance. Functional training helps to re-create balance within the body. However, if it is to be effective we must thoroughly understand how the body functions and take methods to correct any deviation.
In my last article a question arose regarding a particular muscle, the piriformis. I’m glad the question arose because it allowed a natural progression in to the next topic. There are various static stretches that may lengthen the piriformis. However, in terms of strengthening the piriformis, the best method I see of accomplishing this is through the spiral-diagonal patterns of proprioceptive neuromuscular facilitation (PNF). Before we get into this article I want to inform you that this application is more intimately associated with the professions associated with sports therapy and or rehabilitative physiotherapy.
A man named Herman Kabat MD along with two physical therapists Margaret Knott and Dorothy Voss developed the PNF techniques. This revolutionary technique was influenced by the principles of neurophysiological development and Sherrington’s law’s of irradiation, successive induction and reciprocal inhibition. The reason for its development and implementation was to increase the range of motion in polio patients. He found that stimulating distal proprioceptors within the limb also served to increase proprioception in the proximal limb. In other words the body was becoming better understood as one integrated unit. Before Kabat rehabilitation was performed through isolation movements that focused on one muscle or motion at a time. His concept derived from the spiral design of the skeletal system and how muscles spiral around the bone from origin to insertion.
PNF stretches are performed passively or active assisted, there are two main types of PNF stretching techniques, hold-relax and contract-relax. Hold-relax is used typically when ROM is limited or if active movement is not an option. It works by having the individual hold the desired limb at the lengthened ROM while isometrically contracting or resisting the therapist’s force.
Contract-relax on the other hand works best with clients who have a restricted ROM. This method works in a similar fashion, the difference being that the physical therapist moves the limb passively into limited range of motion. When the limit has been met, the individual is instructed to attempt to move the limb into a shortened ROM while the therapist resists. Once this has been completed the therapists moves past the old limited ROM into a deeper ROM. The process is repeated and once the prescribed repetitions have been completed the individual is instructed to move through the new ROM passively.
As always, I have managed to save the best for last, the spiral-diagonal patterns of PNF. These movements are further broken down into diagonal 1 (D1) and diagonal 2 (D2). Both the upper and lower extremity includes a D1 and a D2 pattern of which I will explain.
D1 pattern of the upper extremity incorporates two movements, however it is the starting position that determines whether it is D1 flexion or D1 extension. D1 flexion has the arm finish in flexion, adduction and external rotation. While D1 extension has the arm finish in extension, abduction, and internal rotation. I will try to describe this as best as possible in the manner that I was taught. D1 flexion consists of grabbing of the seatbelt, while D1 extension consist of buckling the seatbelt.
The D2 patterns of the upper extremity are cross-body movements in the opposite direction of D1. D2 flexion has the arm finish in flexion, abduction, and external rotation. While D2 extension has the arm finish in extension, adduction and internal rotation. D2 flexion can be described best as drawing a sword while D2 extension can be visualized as sheathing the sword. It is important to note that for this cross-body movement D2 flexion has the arm finish in an extended position while D2 extension is the opposite and the arm finishes in a flexed position. Confusing I know but take a look at the pictures and practice them to better understand them.
Lets move onto the lower extremities, I apologize for the delay in the delivery. The truth is that in order to get here I had to explain the rest, otherwise it would not make sense. The lower extremities, just like the upper extremities consist of two patterns D1 and D2 each with two movements that consist of flexion and extension.
The D1 flexion of the lower extremities has the leg finish in flexion, adduction, and external rotation. While D1 extension of the lower extremities has the leg finish in extension, abduction, and internal rotation. The simplest way to remember these two is D1 flexion as a soccer kick on the ipsilateral side of the body. D1 extension as the toe off on the ipsilateral side of the body which has the leg behind, and just outside your base of support with the toe facing the ground a few inches from the ground.
The D2 patterns of the lower extremity are also cross-body movements flexion and extension. D2 flexion has the leg finish in flexion, abduction, and internal rotation. D2 flexion is best described as the snow plow which has the leg in front just outside of your base of support on the ipsilateral side of the body. The toe points upward and in the same direction of the midline of the body but not precisely. D2 extension has the leg finish in extension, adduction and external rotation. D2 extension has the toe placed directly on the floor behind and just outside of the body on the contralateral side of the body.
These 4 patterns 2 for the upper extremities and 2 for the lower extremities are the basis of how are body functions naturally. As you can see each movement offers two directions through the exact same plane of movement. I encourage you to practice the basic movements while having an object like a dowel to assist with balance as you complete the movement. Do not add any resistance and acclimate yourself to the movement before we take it to the next level.
The spiral-diagonal patterns of proprioceptive neuromuscular facilitation are ideal in strengthening the neurological pathways in which our brain serves to function when our muscles contract. It improves coordination and strength while promoting functionality because it works in the manner the body is designed to function in. It is best to start with the PNF stretches we discussed earlier and then progress to the spiral-diagonal patterns. As always I must caution you in your efforts to implement such a technique without proper guidance. Ask a trainer or someone you’re confident can help aid in the process. Join me next time when we continue to discuss the importance of how our body works and how to maximize efficiency at the neurological level.
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