Vol.13(No.1 2013)

【The Original】 page 1-7

Effect of static contraction facilitation technique without stretching in the middle range of　motion of the PNF pattern on the active range of motion of the knee joint in orthopedic patients

Masumoto Kazue, Arai Mitsuo, Shiratani Tomoko, Akagi Satoko, Shimizu Ayumi, Tsuboi Akio, Yanagisawa Ken, Michele Eisemann Shimizu

Abstract：The purpose of this study was to investigate the immediate effects of a static contraction facilitation (SCF) technique utilizing a contraction of the target muscle without stretching in the middle range of motion using a Proprioceptive Neuromuscular Facilitation (PNF) pattern for the extremities on the active range of motion (AROM) of the knee joints in orthopedic patients. Twenty-one subjects with orthopedic knee joint disabilities (mean age=79.4 years, SD=8.1) were randomly assigned to a sustained stretch (SS) group, hold relax (HR) (a maximal static contraction of the antagonist muscles (hip extensorabductor-internal rotator muscles)) on stretch using a diagonal position (hip flexion-adduction-external rotation) group, or SCF (contraction of the target muscle (hamstrings) without stretching in the middle range of motion using a PNF pattern for the extremities (extension-abduction-internal rotation)) group. The AROM of knee extension with the hip stabilized at 90 degrees was measured in the supine position before and after each exercise. The percentage change in AROM before and after each exercise was calculated. Result: The result of a one-way ANOVA calculated between groups using the percentage change in AROM showed a significant difference between the groups (p<0.05). A post hoc Scheff  test revealed that the HR and SCF groups showed significant improvement as compared to the SS group (p<0.05). Conclusion: These results suggest that the SCF technique have immediate effects for

increasing the AROM of knee joint in orthopedic patients.

Key words： PNF, hold relax (HR), static contraction facilitation technique (SCF), active range of motion, stretch

【The Original】 page 8-17

Effects of a resistive static contraction of the pelvic depressors technique on the passive range of motion of the knee joints in patients with lower-extremity orthopedic conditions.

Shiratani Tomoko, Arai Mitsuo, Masumoto Kazue, Akagi Satoko, Shimizu Ayumi, Tsuboi Akio, Nitta Osamu, Yanagisawa Ken, Michele Eisemann Shimizu

Abstract：The purpose of this study was to determine the remote after-effects (RAE) of a resistive static contraction of the pelvic depressors (SCPD) technique using a Proprioceptive Neuromuscular

Facilitation (PNF) pattern in the mid-range of pelvic motion as an indirect approach in comparison with direct approaches, such as a sustained stretch (SS) and hold relax (HR) techniques, for the improvement of the passive range of motion (PROM) of knee extension by lengthening the hamstrings in patients with lower-extremity orthopedic problems. The effects of the duration of intervention were also considered. If a stretching approach is difficult because of pain, we previously found that the RAE of the SCPD could improve the PROM [Arai 2002] and active range of motion of the shoulder [Tanaka 2009] and knee joints [Shiratani 2009] without stretching.

The source patients consisted of 30 outpatients (22 women, 8 men) with lower-extremity orthopedic conditions. Subjects were randomly assigned to one of six groups (20s-SCPD, 40s-SCPD, 20s-HR, 40s-HR, 20s-SS, or 40s-SS groups) in which the technique and duration of intervention were combined. The percentage change in the PROM of the knee joint after each technique was calculated in comparison with the PROM before the technique was performed.

A two-way non-repeated ANOVA for percentage change in the PROM showed that only the group factor produced a main effect (p<0.05). Bonferroni post hoc testing revealed a significant difference only between the SCPD and SS group (p<0.05), reflecting a greater percentage change in PROM in the SCPD

group. The results of this study on orthopedic patients suggest that the indirect SCPD technique without stretch may be an effective approach to improve the PROM as a RAE in patients with orthopedic

conditions.

Key words：PNF, SCPD, stretch, hold relax, range of motion, remote after-effect

【The Original】 page 18-29

Effects of muscle contraction in ipsilateral lower extremity on muscle activities in contralateral lower extremit

Hiroshi Tomita, Ken Yanagisawa

Abstract：The purpose of this study was to verify that the amount of muscle activity in contralateral lower extremity becomes correspondingly varied on the activities of joints in ipsilateral lower extremity (hip joint/knee joint/ankle joint) and its activities of the motion (e.g. extension, flexion) as well as loading intensity in activities.

Healthy male subjects were assigned to perform the eight types of static contraction, which were extension, flexion, abduction and adduction in right hip joint, extension and flexion in right knee joint, and dorsi flexion and planter flexion in right ankle joint, in 20%, 40%, 60% and 80% of maximal voluntary contraction (MVC) in order to comprehensively analyze the myoelectric activities caused in the muscles of left lower extremity.

Higher muscle activities tended to occur by the static contraction around muscles in the right hip joint (proximal joint) compared to the one, which occurred in the right ankle joint (distal joint), and the muscle activities which occurred around muscles in the left hip joint (proximal joint) tended to be higher than the one in the left ankle joint (distal joint). And it indicates that as the loading intensity in the muscles of right lower extremity grew, the muscle activities of left lower extremity increased. Also, although it was limited to gluteus medius muscle and some other muscles, when static contraction (80%MVC) was performed in ipsilateral lower extremity, it generated muscle contraction which could

be enough to expect to maintain or/and enhance muscle strength in contralateral lower extremity.

Key Word：muscle contraction, ipsilateral lower extremity, contralateral lower extremity, irradiation, electromyography

【The Original】 page 30-37

Remote after-effects of static contraction of the upper extremity muscle on the active range of motion of the knee joints

Yasuhiro Harada, Mituo Arai, Osamu Nitta, Ken Yanagisawa, Michele Eisemann Shimizu

Abstract：Aim: The purpose of this study was to investigate the immediate remote after-effect (RAE) of a resistive static contraction of the upper extremity muscles using a Proprioceptive Neuromuscular Facilitation (PNF) pattern for the improvement of the active range of motion (AROM) of the knee joints.

Design: Randomized design. Methods: Forty five healthy volunteers (mean age: 22.1 years, SD: 4.2) were randomly assigned to the sustained stretch (SS) group, extension (extension-internal rotation) group, or PNF (extension-abduction-internal rotation) group. The AROM of knee extension with the hip stabilized at 90 degrees was measured in the supine position before and after each exercise to determine the hamstrings flexibility. Results: A one-way ANOVA test showed a significant difference between the groups (p<0.05). The Scheffe post hoc test revealed that the PNF group showed significant improvements as compared to the SS group, and the PNF group showed significant improvements as compared to the extension group (p<0.05). Conclusion: Compared to both the SS and extension groups, the PNF group showed an immediate RAF for increasing the extensibility of the hamstrings, It is

suggested that RAE may be used to facilite knee extension muscles.

Key words：PNF, Hamstrings, Static facilitation contraction , Active range of motion, Remote aftereffect

【The Original】 page 38-43

The remote after-effects of a resistive static contraction facilitation technique on the improvement of range of motion of internal rotation of shoulder joint

Satoshi Saya, Mitsuo Arai, Takuya Hukushima, Hiroaki Mizuno, Mitsuaki Kanei, Terumasa Hayash, Michele Eisemann Shimiz, Ken Yanagisawa

Abstract：The purpose of this study was to determine the remote after-effects of resistive a static contraction facilitation technique (SCFT) applied with manual resistance using a proprioceptive

neuromuscular facilitation pattern in the mid-range pelvic posterior depression technique (SCPDT) or anterior elevation technique (SCAET) on the improvement of the active range of motion (AROM) of shoulder joint internal rotation. The exercises included a sustained stretching of shoulder internal rotation (SS), SCAET, and SCPDT. Thirty normal subjects without any neurologic deficits (26 men; 4 women), with a mean average age (SD) of 26.7 (7.0) years, were randomly assigned to one of three exercise groups. The result of a one-way ANOVA test showed a significant difference between the groups. Tukey's HSD post-hoc test revealed that the SCAET showed a significant improvement as compared with the SS group, and SCPDT showed significant improvements as compared with the SS and SCAET groups. Conclusion: Remote after-effects of both SCPDT and SCAET on the AROM of shoulder internal rotation were found in normal subjects without neurological deficits. These results suggested that SCFT may influence the flexibility of shoulder muscles in normal subjects.

Key words：remote after-effect, static contraction facilitation technique, flexibility, proprioceptive neuromuscular facilitation

【Case Report】 page 44-49

The effects of changing the manual contact for a pelvic resistive exercise on gait speed in stroke hemiplegia

Yuki Shigeta, Tomoko Shiratani, Mitsuo Arai, Masumi, Yanagisawa, Michele Eisemann Shimizu, Ken Yanagisawa

Abstract：Background: The immediate effects of a resistive static contraction in the pelvic depressors technique (SCPD) using a proprioceptive neuromuscular facilitation pattern in the mid-range of pelvic motion of posterior depression has been reported in the literature. In a previous study, the manual contact of the therapist's hands for resistance was the ischial tuberosity. Aim: The purpose of this study was to investigate the immediate effects of a different manual contact while using SCPD for gait speed in stroke hemiplegia. Design: Randomized design. Methods: Fifteen stroke patients (mean age=59.3 years, SD=4.6) were randomly assigned to the SCPD-I group (manual contact on the ischial tuberosity),

the SCPD-G group (manual contact on the upper gluteal surface of the ilium), or the repeated gait exercise group (control subjects). A 10m gait-time was recorded before and after each exercise. The

percentage change of gait-time (PCG) after each exercise was calculated and compared with the gaittime before each exercise. SPSS for Windows, version 10.07, was used for statistical analyses. Results: The mean PCG (SD) was -6.6 (3.5) % for the SCPD-I group, -8.2 (3.8) % for the SCPD-G group, and 0.5 (5.6) % for the repeated gait exercise group. The results of a one way ANOVA calculated between groups

using PCG variances showed a significant difference between the groups (p<0.05). The Sheff  post hoc test revealed that the SCPD-G group showed significant improvements as compared to the repeated gait exercise group (p<0.05). Conclusion: These results suggest that SCPD-G may have immediate effects for increasing the gait speed in stroke hemiplegia. More research is needed to identify the neurophysiological effects of SCPD-G.

Key words：proprioceptive neuromuscular facilitation (PNF), static contraction facilitation technique, SCPD, gait speed, after-effect

【Case Report】 page 50-55

The effect of differences in hip rotation position on knee extension strength

Takashi Ito, Shingo Tomoshige, Manabu Nakamura, Ken Yanagisawa

Abstract：Proprioceptive neuromuscular facilitation is a therapy that utilizes specific patterns of movement involving rotation on complex surfaces. In this study, we tested isometric contraction by

using a handheld dynamometer to investigate whether varying hip rotation position between the neutral position , 30° i nternal rotation, and 30°e xternal rotation during knee extension in the seatedposition influenced the strength of the knee extensor. The subjects were 17 healthy adult men (mean age (SD), 26.1 (4.0) years). The mean (SD) maximum strength of the knee extensor for all the subjects was 143.5 (25.1) Nm in the neutral hip position, 166.9 (29.7) Nm in the internally rotated position, and 154.9 (24.5) Nm in the externally rotated position, with a significant difference between the neutral and internally rotated positions. In other words, this suggested that the maximum isometric knee extension strength in the seated position was greater when the hip was rotated internally than in the neutral position. It is probable that the strength of the knee extensor was significantly greater when the hip was rotated internally because the addition of the contractile force exerted by the hip external rotator muscles to the force exerted by the extensor generated a diagonally oriented resultant force.

Key words：hip rotation position, the strength of the knee extensor, handheld dynamometer, PNF

【Case Report】 page 56-62

The cumulative effect of pelvic sustained contraction of the posterior depression technique on the forward reach test in the sitting position when using the unaffected upper extremity in hemiplegic patients

Miho Takezawa, Tomoko Shiratani, Mitsuo Arai, Yoshimi Tanaka, Michele Eisemann Shimizu, Ken Yanagisawa

Abstract：The purpose of this study was to compare the cumulative effects of a resistive sustained contraction using the Proprioceptive Neuromuscular Facilitation pattern for pelvic posterior depression

(SCPD) with the repetition of the forward reaching task in sitting (FRT) for increasing the reaching distance toward the affected side while using the unaffected upper extremity of hemiplegic patients. The reaching distance toward the affected FRT with the unaffected upper extremity in the sitting position was used to determine the effect of each exercise. Twelve subjects with hemiplegia were randomly assigned to the SCPD or the FRT repetition group. Reaching distances (RD) were measured three times before each exercise for one minute and ten repetitions after each exercise for three minutes. The results of a repeated measure ANOVA indicated that the RD showed more significant increases in the SCPD group than in the FRT repetition group. Significant differences were found between the RD measured in the 1st and 10th trials. These results indicated that, as remote after-effects, the cumulative effect of SCPD for increasing FRT ability might increase postural stability and ability to control postural sway.

Key words：hemiplegia, SCPD, Proprioceptive Neuromuscular Facilitation (PNF), sitting forward reach test, remote after-effect