Running head: DOES QUANTITY OF PNF STRETCH SETS AFFECT LOWER BODY 1

FLEXIBILITY

Does Quantity of PNF Stretch Sets Affect Lower Body Flexibility

Christine Mejia

Brittany Cruz

Jose Flores

KINE 3160.03

University of Texas Rio Grande Valley

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Abstract

Flexibility is a component of health related fitness, however, commonly forgotten topic

when it comes to physical activity. The evidence-based recommendation for flexibility according

to ACSM is ≥2-3 days per week, with daily being most effective. (​M​agyari, P., Lite, R.,

Kilpatrick, M., & Schoffstall, J. 2018) Our research is to find if the quantity of sets during

proprioceptive neuromuscular facilitation (PNF) stretching affects our lower-body flexibility.

With the help of local UTRGV students, we are able to study if lower amount of sets is just as

effective as a greater amount. Increasing an individual’s range of motion (ROM), can improve

both flexibility and posture/balance. Flexibility training can also benefit individuals with ROM

imbalances by reducing their risk of injury during activity. However, because all athletes are

different, and need different flexibility programs in order to maintain an adequate ROM

according to their desired sport, a proper program must be developed. (​M​agyari, P., Lite, R.,

Kilpatrick, M., & Schoffstall, J. 2018)

Keywords: ​Flexibility, PNF, Range of Motion

DOES QUANTITY OF PNF STRETCH SETS AFFECT LOWER BODY FLEXIBILITY ​ 3

Does Quantity of PNF Stretch Sets Affect the Lower Body Flexibility

Introduction

Flexibility is defined as range of motion of a joint or group of joints, as per the skeletal

muscles and not any external forces. (​M​agyari, P., Lite, R., Kilpatrick, M., & Schoffstall, J.

2018) Although flexibility training has shown little to no improvement on muscle soreness, or

athletic performance, excluding gymnastics, ballet, etc.prior to exercise, it is important to

maintain an adequate range of motion necessary for daily activities. The recommendation for

flexibility is ≥2-3 days a week, with daily being most effective. Factors affecting flexibility

include muscle properties, physical activity/exercise, anatomical structure, age and gender.

Following the appropriate guidelines for flexibility can improve a greater range of motion,

improve balance/posture, and increase flexibility. (​M​agyari, P., Lite, R., Kilpatrick, M., &

Schoffstall, J. 2018) There are several types of flexibility training modes, for this research we are

focusing on proprioceptive neuromuscular facilitation (PNF).

PNF is a stretching technique used to improve muscle elasticity. ​Haff, G., & Triplett, N.

T. (2016)​ The purpose of proprioceptive neuromuscular facilitation is to activate the use of

autogenic and reciprocal inhibition responses of the Golgi tendon organs (GTOs). GTOs are

located in the musculotendinous junction and respond to the changes in muscle tension. PNF

stretching stimulates the GTOs to elicit in autogenic inhibition, this promotes further lengthening

of the muscle. ​Haff, G., & Triplett, N. T. (2016)​ There are a total of three PNF techniques

hold-relax, hold-relax with antagonist contraction, and agonist contraction. Each technique

consists of three phases a passive prestretch, passive stretch, and contractions. Because PNF

techniques require passive stretches with isometric and concentric muscle actions there are
DOES QUANTITY OF PNF STRETCH SETS AFFECT LOWER BODY FLEXIBILITY ​ 4

limitations such as the need for trained partner. Flexibility is evaluated by terms in degrees, a

goniometer is most helpful when quantifying range of motion in most parts of the body. A

sit-and-reach test is also helpful in determining flexibility in the lower back and hip joint.

M​agyari, P., Lite, R., Kilpatrick, M., & Schoffstall, J. (2018)

Flexibility

Muscle properties play a major role in a joint’s ROM. When stretched, skeletal muscles

exhibit viscous and elastic properties also known as viscoelastic properties. This allows them to

extend through the process of creep and stress relaxation. ​M​agyari, P., Lite, R., Kilpatrick, M., &

Schoffstall, J. (2018) Anatomical structures also affect flexibility because joint flexibility is not

affected equally by connective tissue around the joint. Soft tissue, such as subcutaneous fat and

muscle tissue, may affect joint flexibility because of movement restrictions. The relationship

between age and gender to any given joint are related. As aging occurs, there is a reduction in

collagen, which increases tendon rigidity and decreases joint range of motion (ROM). Women

have a greater ROM in comparison to men. Reasons for this are smaller muscles, wider hips, and

difference in hormonal levels. “A study by Park et al. has demonstrated that changes in estradiol

and progesterone levels during ovulation led to a greater degree of knee joint laxity.” (​M​agyari,

P., Lite, R., Kilpatrick, M., & Schoffstall, J. 2018) Individuals with ROM imbalances can benefit

in flexibility training, in reduction of possible risk for injury during activity.

Flexibility training can be attained by completing two-three sessions per week for at least

3-4 weeks. Most effective, however, is practicing flexibility on a daily basis. FITT-VP is used in

many health-related fitness categories, it can also be used to guide individuals about the

flexibility training recommendations. Intensity of a stretch should feel to a point of tightness with
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a slight discomfort. Time usually varies with age, specifically with PNF, 3-6s light-to-moderate

contraction followed by a 10-30s assisted stretch. In order to create long-lasting effects in the

bodies, a dedicated flexibility program is required. Just like other health-related fitness

components, flexibility utilizes progressive overload, specificity of training, individual

difference, and reversibility. Overload in flexibility can applied by increasing sessions per

day/week, increasing the angle of stretch, or increasing the time per session. Reversibility in

flexibility training is also similar to other health-related components, “...use it or lose it”. Gains

in flexibility are lost within 4 to 8 weeks of decreased/no training. ​Kluwer, W. (2018)

Flexibility and Performance

In order to reduce possible risks when performing flexibility training, it is best to

warm-up the muscles before stretching. Not only does this prevent injury, but increase the joint’s

range of motion. “Inadequate warm-up exercises have been shown to be associated with strains

to muscles and tendons.'' Shellock​, F. G., & Prentice, W. E. (1985)​ According to Beaulieu, when

muscles are warmed, they become more extensible, meaning stretching after a warm-up can lead

to a greater range of motion. ​Beaulieu IE. (1981)​ In comparison to not warming-up before a

stretch, research shows a greater increase in ROM in many areas of the body, when participants

warm-up before flexibility training. The determination of which stretching techniques/muscles to

use, is based on the similar motions an athlete undergoes during the sport. However, athletes

should only stretch following practice/competition or as a separate session. Because flexibility

training has shown to decrease, in some cases, performance, athletes should perform post

practice stretches within 5-10 minutes after practice. ​Haff, G., & Triplett, N. T. (2016). ​ On the

other hand, flexibility training is crucial in improving athletic performances that require higher
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ranges of motion; such as ballet, gymnastics, etc. ​Kluwer, W. (2018) Overall, stretching benefits

athletes in different ways. XXXX

Proprioceptive Neuromuscular Facilitation (PNF)

There are different methods of stretching that exist but for the purpose of this study we

will be focusing on proprioceptive neuromuscular facilitation (PNF) because it has the best

improvements in muscle elasticity and is used to increase strength and help restore functional

ROM.​Haff, G., & Triplett, N. T. (2016)​. PNF includes stretching techniques that combines

passive stretching with isometric and concentric muscle actions performed with the goal of

utilizing autogenic and reciprocal inhibition response of the Golgi tendon organs (GTOs). ​Haff,

G., & Triplett, N. T. (2016).​ Improved flexibility or ROM is theorized to be caused by the

responses from the GTO with the muscles and tendons are able to elongate causing these

improvements. It is still uncertain where these changes come from completely. PNF stretching is

broken down into three techniques which are hold-relax, hold-relax with agonist-contraction, and

agonist contraction. Each of them has three phases during the stretch, a passive prestretch,

passive stretch, and contractions. First phase incorporates a passive pre-stretch of 10 seconds in

all 3 techniques, however, they differ second and third phase depending on the technique being

used. Decoster, L., Cleland, J., Altieri, C., Russel, P. (2005). Usually, the later phases determine

the name of the technique. For example, second phase in contract-relax is “concentric action” in

hip extensors PNF stretch.

However, PNF does have its drawbacks. When PNF stretching is done prior to exercise

it is shown a decrease in muscle performance. PNF stretching done after exercise or without

exercise improves muscle performance and flexibility. ​Haff, G., & Triplett, N. T. (2016).​ Four
DOES QUANTITY OF PNF STRETCH SETS AFFECT LOWER BODY FLEXIBILITY ​ 7

theoretical mechanisms have been identified to increase flexibility. ​Haff, G., & Triplett, N. T.

(2016).​ ​Heiser T.M, Weber I, Sullivan G, Clare P. Jacobs. (1984)​Autogenic inhibition occurs

when a contracted muscle when a decrease in the excitability as a result of the inhibitory signals

sent from the GTOs of the same muscle. Tension in the muscles causes the Ib afferent fibers

within the GTO to activate, which send signals to the spinal cord resulting in an inhibitory

response on the alpha motor neuron. This stimulus decreases the muscles’ efferent motor drive

and decreasing nerve excitability, which is theorized to be one of the ways flexibility improves

by attempting to evenly distribute workload eveningly over motor units in the muscle and

asynchronous recruitment of motor units to prevent fatiguing causing the muscle to relax.

Beaulieu IE. (1981). Haff, G., & Triplett, N. T. (2016).​ Autogenic inhibition relies on the body’s

natural mechanisms and structures so as the GTO to protect itself from injury. This is crucial in

understanding how the body reacts to stretching so we know where these improvements come

from. ​Haff, G., & Triplett, N. T. (2016).​ ​Sharman, M. J., Cresswell, A. G., & Riek, S. (2006).

Reciprocal inhibition occurs when the opposing muscle is contracted to voluntarily by the

participant by sending less neurological stimulation to the target muscle. In order to maximize

the contraction force of the muscle the opposing muscle is contracted. In simpler terms, what

happens is one relaxes while the other one contracts causing them to be inhibited to prevent the

muscles from contracting each others actions. ​Beaulieu IE. (1981). ​Decoster, L., Cleland, J.,

Altieri, C., Russel, P. (2005). ​Haff, G., & Triplett, N. T. (2016). ​Sharman, M. J., Cresswell, A.

G., & Riek, S. (2006).

Stress relaxation occurs when the musculotendinous unit(MTU) is under constant stress.

This relies on the principle that muscles and tendons are made of viscoelastic materials, meaning
DOES QUANTITY OF PNF STRETCH SETS AFFECT LOWER BODY FLEXIBILITY ​ 8

that the material has the ability to resist both shear flow and strain on a linear plane. When the

musculotendinous unit is under constant stress then “stress relaxation” takes place. The “stress

relax” phenomenon causes a decrease in the force generated by the viscous material, muscles and

tendons, when resisting elongation stimulus. As the muscles and tendons slowly lose their ability

to resist the stretching then the MTU increases in its own length or “creeping”. The properties of

the musculotendinous unit are applicable to in the multiple theories because the viscoelastic

materials of muscle tissue and tendons permits the elongation and stretch slowly “creeping” so

that the muscle gets longer with more progression in the stretching. Despite this the

improvements to flexibility do not last very long for about 80 seconds to an hour the PNF

stretching which raises the question of how exactly long term improvements are achieved, if they

can be achieved, with stress relaxation. ​Haff, G., & Triplett, N. T. (2016).

The gate-control theory occurs when there are two kinds of stimuli that in turn are

activated at the same time. In contract-relax and contraction-relax-agonist-contract (CRAC),

when a muscle is stretched to its maximum point the stretch is then resisted on so the target

muscle is able to be stretched even further. When the participant stretches this way then a large

amount of force is generated in the elongated muscle. This theory is believed to benefit range of

motion (ROM) by forcibly and forcefully stretching the target muscle past its natural range of

motion in order to activate the Golgi tendon organs (GTOs) which will react to the excess

stretching and attempt to reduce any further injury from occurring. ​Haff, G., & Triplett, N. T.

(2016). ​Weijer, V., Gorniak, C., Shamus, E. (2003). ​Sharman, M. J., Cresswell, A. G., & Riek, S.

(2006).​ Weijer, V., Gorniak, C., Shamus, E. (2003).

DOES QUANTITY OF PNF STRETCH SETS AFFECT LOWER BODY FLEXIBILITY ​ 9

These four theories are not fully understood yet but their effects are clear and apparent.

Stretching is such an overlooked aspect of physical fitness that there are people completely

unaware of the benefits that it provides to your overall health and fitness. Smith, C.

(1994).Smith, C. (1994). Being in sports only makes the possibility of injury even more likely to

occur and these chances are increased when the athlete participating in the sport has poor

flexibility. Rigid, tight muscles and tendons will eventually snap from just the right amount of

pressure. This could occur from simply placing your foot on the ground wrong, stepping on a

pebble and needing to catch yourself to avoid falling, or getting tackled in a football game.

Muscles and tendons are naturally made of viscoelastic materials meaning that they are able to

stretch and lengthen, however, if an athlete never takes the time to ensure the muscles are loose

and elastic then it could lead to possible injuries occurring. Thus the importance of stretch

programs becomes more apparent. Stretching also helps in promoting muscle performance.

Smith, C. (1994). As previously stated, PNF stretching has the potential to negatively impact

muscle performance if done prior to exercise, however, if done at the proper time of the workout

which would be after exercise or without exercise, then there is a significant increase in muscle

performance. ​Haff, G., & Triplett, N. T. (2016).

Contract-relax is first taking the muscle to its lengthened position and actively

contracting it against resistance, then relaxing it through self-inhibition. The lengthened position

is held for approximately 10 seconds, this should feel like a mild discomfort. Once relaxed, a

passive stretch is applied for 30 seconds. With continuous sets of contract-relax, the individual

will see an improvement in after the stretching however, for more notable, permanent changes

the individual would need to stretch regularly so a stretch program is recommended. Decoster,
DOES QUANTITY OF PNF STRETCH SETS AFFECT LOWER BODY FLEXIBILITY
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L., Cleland, J., Altieri, C., Russel, P. (2005). ​Heiser T.M, Weber I, Sullivan G, Clare P. Jacobs.

(1984).

Results

All athletes are different, meaning they all have play different roles, according to the

sport that is being played. Flexibility programs need to be suitable for the athlete from

pre-workout to post-work out. Speechly, J. (1990) An example is a football player vs a gymnast;

the gymnast relies heavily on greater ranges of motion, therefore, their program will include

intense stretching compared to the football player. The developed program should include

warm-up sessions of 5-15mins, this helps the muscles become more extensible by “warming

them up”. For maximal benefit, muscles should be stretched 3-5 times for 15-20 seconds. Smith,

C. (1994)

Discussion/Conclusion

Proprioceptive neuromuscular facilitation improves range of motion and flexibility by

increasing muscle length, thanks to the aid of GTOs, and neuromuscular efficiency. ​Haff, G., &

Triplett, N. T. (2016)​. These improvements in flexibility and range of motion can manifest in

both trained and untrained individuals performing PNF, which would last, about 90 minutes or

more but substantial stretching must be done for the improvements to last longer. ​Beaulieu IE.

(1981)​. ​Haff, G., & Triplett, N. T. (2016)​. Decoster, L., Cleland, J., Altieri, C., Russel, P. (2005).

Performing proper PNF stretching has been proven to provide results it is just up to the

participant to want to take the time to do it. PNF stretching does require the aid for someone who

must be knowledgeable of how to perform it if not then the results will be lacking in any

significant improvement. PNF provides the best results when it comes to improving flexibility
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and range of motion but it is not one of the easiest to do making it an unattractive option when

choosing which method of stretching to use but in general stretching should be more prioritized

in our modern era.

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