PNF and Myofascial Pain Syndromes & Trigger Points

[sdkashif]

Have any one ever tried PNF techniques for treating the myofascial pain syndromes & trigger points? How effective the PNF techniques are in managing the myofascial pain syndromes? Please, share your clinical experiences, findings and any evidence based studies regarding that.

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[maposat]

good question. i think i will also benefit from the answers that will come.

[sdkashif]

There is no doubt about the efficacy of PNF in the cases of facial palsy. But I was looking for some views, clinical experiences and research specifically with regard to the myofascial pain syndromes and trigger points. if you have such experience, kindly share it with us.

[tiger99]

Good evening, sdkashif
I am the first time learned that PNF is efficacy for fascial palsy. Is it efficacy for central fascial palsy or peripheral fascial palsy(bell's palsy), or both?Would you mind tell me how to do it? In our country, we just use medication and ultrashort wave or laser to treat bell's palsy.

[sdkashif]

Exercises are initiated when there are signs of recovery and so of movement. PNF is efficacious in the both upper and lower motor neuron type facial paly. However, the underlying causes for upper motor neuron type facil palsy should be addressed. PNF was orininated in USA and many physiotherapists from all over the world visited USA to learn that. Now these technques are know world wide among physiotherapists. A description of techniques of PNF for facial palsy has been described below.

The normal facial movements are bilateral symmetrical in character: both sides of face move in indentical motions. The normal subject is capable of innumerable combination of facial movements which include unilateral and bilaterally symmetrical motions. Although the normal subject may isolate certain motions to a degree, in situation of emotional stress facial motions are usually bilaterally symmetrical in character. During vigorous physical activity, facial motions may take on bilaterally asymmetrical character when facial movements are brought into play as reinforcement. Inability to perform bilaterally symmetrical motions voluntarily is an indication of weakness resulting in asymmetry of facial expression.

Facial movements may be grouped as antagonistic motions involving three pivots of action: mouth, nose and the eyes. Extreme ranges of motion of any one pivot bring into play related movements of other pivots. Antagonistic motions may be considered as follows:

Elevation of Eye brows upwards and lateral ward
Depression of eye brows downward and medial ward

Opening of eyelids, lateral ward
Closing of eyelids medial ward

Elevation and opening of nostrils lateral ward
Depression and closing of nostrils, medial wards

Retraction of angle of mouth upward
Protraction of lips downward

Retraction of angle of mouth, downward
Protraction of lips upward

Closing of lips with protrusion
Opening of lips with inversion

The facial muscles are spiral and diagonal in character and are arranged for symmetrical motions. Strong contraction of cicular muscles about the mouth and eyes demand lenghthening and shortening reactions of other facial groups including those of scalp. Strong contraction of nasal groups in turn demands cooperation of muscles responsible for motion about the eyes and mouth. The various techniques of PNF that may be applied to facial motions include pressure, stretch, resistance, reinforcement, repeated contractions and reversal of antagonistics. Relaxation techniques may be used as indicated. The physical therapist uses the tips of the fingers as manual contacts. Stronger motions are resisted in order to stimulate and reinforce weaker motions.

For example, a patient may present with weakness of elevation of the left eye brow. The physial therapist places her finger tips on both sides of patients brows and applies pressure and stretch in a downward and medial direction. Having achieved the stretch, he instruct the patient, "Look up at me! Raise your eyebrows" At this point physical therapist resist strongly the motion on the right and allows range of motion to occur on the left. The patient is instructed to raise his eye brows, and the physical therapist applies the technique of repeated contractions. Reversing motion and relaxation techniques may be used to increase mobility of the elevation and depression of eye brows.

Motions of the eye brows may be used to reinforce opening and closing of eyes; motion of lips may be used to reinforce about the nose and the eyes. Study of normal subject will reveal the relationship of facial motions. Neck patterns are used as reinforcement. Any facial motion that requires elevation or upward motion is reinforced by neck extension. Facial motion that require depression or downward motion are reinforced by neck flexion. Neck rotation reinforces the motion of the side of face to which the head is turned. If it is desired to reinforce the motion on the left, the head is turned to the left.

Examples:

Elevation and depression of eyebrows, diagonal direction

A- Ready ( Str downward and medial ward)
B- Look up ! Raise your eye brows
C- Hold it! Now Look up some more! And higher! and Higher! Now look down and in."

Opening and closing of eyelids, diagonal direction

A-Open your eyes wide! Hold them open
B- Now close your eyes! Don't let me open them! (MR) and Relax.

Retraction of the angle of mouth upward, protruction of lips downward.

A- Smile wide! Hold it there!
B- Pull your lips together forward and downward, Hold it! (MR, SR-H). And Smile gaian and Hold!

Retraction of the angle of mouth downward, protruction of lips upward.

A-Frown! Hold it! (Str, MR)
B- Pucker up and hold it ! Now pucker up some more! And some more! (MR,RC)

Lips open with inversion, Lips close with protrusion as cheek compress.

A- Close your lips (Str, MR)
B- Hold it ! Now close tightly! And again and relax. (RC)

[physiocrazy]

hi,
I have used PNF techniques in the treatment of trigger points. It is helpful to use a hot pack before and after the treatment. However I am not very sure as i do have patients complain of incrteased pain post treatment.

consider using PNF as an additional technique ie in conjunction with some other mobilization technique like cyriax tchnique. I find it effective in my practice.

regards,