Effectiveness of Hold-Relax Proprioceptive Neuromuscular Facilitation in Enhancing Knee Flexion after Total Knee Replacement: A Randomized Controlled Trial
DOI:
https://doi.org/10.70749/ijbr.v3i11.2660Keywords:
Total knee replacement, proprioceptive neuromuscular facilitation, hold-relax, rehabilitation, knee flexion, randomized controlled trialAbstract
Background: For end-stage osteoarthritis, total knee replacement (TKR) is a standard surgical procedure; nevertheless, postoperative knee flexion is frequently restricted, which delays functional rehabilitation. Although physiotherapy is essential to recovery, there is disagreement over the best stretching technique for restoring range of motion (ROM). Although its use in post-TKR therapy is not well established, proprioceptive neuromuscular facilitation (PNF), in particular the hold-relax approach, has demonstrated promise in enhancing flexibility across musculoskeletal disorders. Objective: The purpose of this study was to compare the PNF hold-relax technique to normal therapy after TKR in order to assess how well its improved knee flexion range of motion. Methods: Thirty-five patients (aged 45–65) who had unilateral or bilateral TKR at a tertiary care institution participated in a single-blind randomized controlled experiment. Participants were randomly assigned to one of two groups: the experimental group received the same program with PNF hold-relax stretching, while the control group received routine postoperative therapy. A goniometer was used to quantify knee flexion range of motion both before and after the four to five-month intervention. Paired-sample t-tests were used to examine the data, and p < 0.05 was considered significant. Results: The participants' average age was 57.1 years, and 74.3% of them were female. The range of baseline ROM was 45° to 70°. In contrast to the control group, which saw less increases, 91.4% of patients in the PNF group attained flexion ≥120° after the intervention. Statistically significant improvements were seen (p < 0.05). Conclusion: PNF hold-relax, a safe and affordable supplement to traditional physiotherapy, dramatically improves postoperative knee flexion in TKR patients when incorporated with regular rehabilitation.
Downloads
References
1. Boca, L.-C., & Dan, M. (2014). The effectiveness of proprioceptive neuromuscular facilitation techniques in knee rehabilitation. Journal of Physical Therapy Science, 26(12), 1887–1891.
2. Caplan, N., Rogers, R., Parr, M. K., & Hayes, P. R. (2009). The effect of proprioceptive neuromuscular facilitation and static stretch training on running mechanics. Journal of Strength and Conditioning Research, 23(4), 1175–1180.
https://doi.org/10.1519/JSC.0b013e318199d6f6
3. Higgs, F., & Winter, S. L. (2009). The effects of chronic PNF stretching on knee flexion ROM and isokinetic torque. Journal of Sports Science and Medicine, 8(3), 401–406.
4. O’Hora, J., Cartwright, A., Wade, C. D., Hough, A. D., & Shum, G. L. (2011). Efficacy of static stretching and proprioceptive neuromuscular facilitation stretch on hamstring length after a single session. Journal of Strength and Conditioning Research, 25(6), 1586–1591.
https://doi.org/10.1519/JSC.0b013e3181df7f98
5. Sharman, M. J., Cresswell, A. G., & Riek, S. (2006). Proprioceptive neuromuscular facilitation stretching: Mechanisms and clinical implications. Sports Medicine, 36(11), 929–939.
https://doi.org/10.2165/00007256-200636110-00002
6. Prentice, W. E. (1983). A comparison of static stretching and PNF stretching for improving hip joint flexibility. Journal of Athletic Training, 18(1), 56–59.
7. Knott, M., & Voss, D. E. (1968). Proprioceptive neuromuscular facilitation: Patterns and techniques (2nd ed.). Harper & Row.
https://doi.org/10.1097/00000441-195710000-00021
8. Tanigawa, M. C. (1972). Comparison of the hold-relax procedure and passive mobilization on increasing muscle length. Physical Therapy, 52(7), 725–735.
https://doi.org/10.1093/ptj/52.7.725
9. Brosseau, L., Milne, S., Wells, G. A., Tugwell, P., Robinson, V., Judd, M., ... & Shea, B. (2003). Efficacy of continuous passive motion following total knee arthroplasty: A meta-analysis. Physical Therapy Reviews, 8(2), 99–107.
https://doi.org/10.1179/108331903225002563
10. Harmer, A. R., Naylor, J. M., Crosbie, J., & Russell, T. G. (2009). Land-based versus water-based rehabilitation following total knee replacement: A randomized controlled trial. Arthritis Care & Research, 61(2), 184–191.
https://doi.org/10.1002/art.24105
11. Minns Lowe, C. J., Barker, K. L., Dewey, M., & Sackley, C. M. (2007). Effectiveness of physiotherapy exercise following total knee replacement: Systematic review and meta-analysis. BMC Musculoskeletal Disorders, 8(1), 36.
https://doi.org/10.1186/1471-2474-8-36
12. Bade, M. J., Stevens-Lapsley, J. E. (2011). Early high-intensity rehabilitation following total knee arthroplasty improves outcomes. Journal of Orthopaedic & Sports Physical Therapy, 41(12), 932–941.
https://doi.org/10.2519/jospt.2011.3734
13. Moffet, H., Collet, J. P., Shapiro, S. H., Paradis, G., Marquis, F., & Roy, L. (2004). Effectiveness of intensive rehabilitation on functional ability and quality of life after first total knee arthroplasty: A randomized controlled trial. BMJ, 329(7474), 36.
https://doi.org/10.1136/bmj.38165.421438.EB
14. Lenssen, A. F., De Bie, R. A., Bulstra, S. K., Van Steyn, M. J., & Roox, G. M. (2003). Continuous passive motion after total knee arthroplasty: A prospective randomized study with follow-up to 1 year. Clinical Orthopaedics and Related Research, 408, 289–296.
https://doi.org/10.1097/00003086-200303000-00042
15. Naylor, J. M., Harmer, A. R., Fransen, M., Crosbie, J., & Innes, L. (2006). Status of physiotherapy rehabilitation after total knee replacement in Australia. Physiotherapy Research International, 11(1), 35–47.
https://doi.org/10.1002/pri.40
16. Milne, S., Brosseau, L., Robinson, V., Wells, G., Tugwell, P., Shea, B., ... & Pelland, L. (2003). Continuous passive motion (CPM) following total knee arthroplasty. Cochrane Database of Systematic Reviews, 2, CD004260.
https://doi.org/10.1002/14651858.CD004260
17. Stevens-Lapsley, J. E., Balter, J. E., Kohrt, W. M., Eckhoff, D. G. (2010). Quadriceps and hamstring muscle dysfunction after total knee arthroplasty. Clinical Orthopaedics and Related Research, 468(9), 2460–2468.
https://doi.org/10.1007/s11999-009-1219-6
18. Bade, M. J., Kohrt, W. M., & Stevens-Lapsley, J. E. (2010). Outcomes before and after total knee arthroplasty compared to healthy adults. Journal of Orthopaedic & Sports Physical Therapy, 40(9), 559–567.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Indus Journal of Bioscience Research

This work is licensed under a Creative Commons Attribution 4.0 International License.