Here’s How PNF Improves Myofascial Trigger Point Therapy Outcomes


Trigger points are tense fibers in the muscle fiber. The sarcomere, or contractile unit of muscle fiber, becomes shortened due to trauma, injury, overloading of a muscle or muscle groups, nutritional deficiencies, poor posture and positions of sleep, among other perpetuating factors.

Most massage therapists I have taught thought that trigger points only caused referred pain; however, trigger points have more recently been shown to cause loss of range of motion. They can also cause pain or other types of sensations like tingling, heaviness, or numbness; and decreased strength or endurance.

The biochemical feedback loop

The myofascial dysfunction that accompanies shortened muscle fibers causes postural distortions that further complicate a person’s ability to live and work without pain. As the tight fibers keep the muscle shortened and increase pain, it becomes a biochemical feedback loop that can cause the person to develop myofascial pain syndrome.

You might ask, “My client’s muscles are in the painful feedback loop. How can I stop it? »

As the painful muscles (bearing the trigger points) remain in the shortened position, a chemically mediated crisis is brewing in the trigger point complex. Painful muscles:

1. Build tight muscles;

2. Stop us from moving; and

3. Create more pain.

Myofascial trigger point therapy is now to the rescue! A properly trained massage therapist can incorporate the 7-step trigger point protocol, and proprioceptive neuromuscular facilitation (PNF) is one of the most valuable parts of this protocol. You’ve probably tried static stretches, yoga classes, and foam rollers. It’s not enough. PNF is the best way to stop the pain-tightness-pain feedback loop and restore contracted muscle segments to normal resting length.

What is PNF?

Let’s look at the concept of the length-tension relationship and the sarcomere. The premise of the length-tension relationship is that the amount of tension produced by a sarcomere or a group of sarcomeres is based on its length.

A shortened sarcomere (or tens of thousands of muscle cells with contracted sarcomeres) can be found within the active trigger point complex. This contracted muscle bundle will produce less force and will not work to its full potential, because an already shortened muscle cannot fully contract to create the necessary force or work. The same applies to an overstretched sarcomere. There is no room for a stretch for preload, so again less power or endurance is the result.

Let’s take a closer look at the length-tension relationship and how it affects overall muscle performance and force production.

Think back to anatomy and physiology classes and the theory of sliding filaments. Actin and myosin filaments intersect to produce muscle contraction. The “Z” lines are the outer border of a sarcomere. In a shortened sarcomere, the distance between the Z lines is shorter compared to a normal sarcomere.

A shortened sarcomere will not produce peak force. This is where myofascial trigger point therapy and PNF techniques can be used to restore normal rest duration in these shortened or contracted areas.

The physiology of PNF techniques

PNF is based on moving the part of the body towards a point of resistance within the range of motion in which it operates.

This movement integrates both passive and active muscular actions facilitating muscular inhibition of the antagonist (this is autogenic inhibition). Additionally, this technique, using active muscle contraction initiated by the client, allows the client to be aware of the force produced so that they in turn can be aware of the tension in their usual feedback loop.

PNF is a great addition to a massage or myofascial trigger point therapy treatment to help normalize and optimize tissue length and tension, restore resting length, eliminate pain, and break up joints. neuromuscular maintenance patterns.

The PNF stretch begins with a 10 second pre-stretch. The following steps vary depending on the PNF technique used. The last step is a stretch held for 30 seconds.

PNF stretches can be incorporated into the treatment session or taught to your clients to do at home as part of a self-care program. There are several different PNF techniques to incorporate into your treatment session. These include contract-relax, hold-relax, and hold-relax with agonist contraction.

The Hold-Relax technique: For this technique, I made a video that shows how to stretch the hamstrings using the Hold-Relax PNF technique. It’s a great way to engage your client in the session and re-train their muscles. This video demonstrates the hold-relax technique for the hamstrings.

Hold-Relax Technique and Reciprocal Inhibition Stretch: For this technique, I made a video that shows how to stretch the quadriceps using the Hold-Relax Technique and the Reciprocal Inhibition Technique. This video demonstrates these techniques.

What is proprioception?

Let’s talk about proprioception. Proprioception is simply where your body is in space. Proprioceptors are a type of receptor cell that is sensitive to stimuli regarding joint and muscle position. There are two types of mechanoreceptors worth discussing, muscle spindles and Golgi tendon organs.

Muscle spindles are located in the intrafusal fiber of the muscle and monitor the stretch of a muscle and its rate of change in length. Thus, when the muscle is lengthened, so are the intrafusal fibers. The central nervous system intervenes when a muscle is overstretched or elongated and sends a stimulus for the muscle to contract.

The Golgi tendon organs are located in the musculotendinous junction. Their role is to help the body respond to changes in muscle tension. GTOs monitor the pulling force on the tendon and if too much force or tension is detected, the muscle will relax due to inhibitory signals sent from the nervous system.

If you work with trigger points, consider adding PNF to your session to improve myofascial trigger point therapy results.

Julie Zuleger

About the Author:

Julie Zuleger, PhD, has over 20 years of experience as a licensed massage therapist, certified myofascial trigger point therapist, athletic trainer, and human movement specialist. She teaches continuing education courses for massage therapists, athletic trainers, fitness and wellness professionals. Zuleger is the owner of Impact Nutrition and Wellness Coaching LLC. For more information on his online courses, visit Chicago Trigger Point Seminars.


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