PNF for Active Straight Leg Raise

I love it when patients tell me they have "tight" hamstrings. The percentage of people with a real slow responding straight leg raise is low. Most of them are rapid responders.

Catch up with the terminology post here.

At the recent The Eclectic Approach to UQ and LQ 2 day course in the Philippines, I chose the oldest participant in the class, someone who had not touched his toes in years.

First test: MSF - result DN
ASLR - DN, but dramatically better passively than actively, at least 30 degrees bilaterally

The difference between where he stopped actively and where I was able to easily move past passively was similar to any "sticking point" which is normally a motor control issue.

For any sticking point, one of the easiest, least threatening, and effective hands on treatments is agonist reversals. After a few minutes of this to his more involved LE, the other one moved better and needed less Tx. We then retested his ASLR, which was close to FN, and after some instruction in diaphragmatic breathing and exhale during MSF, he was able to touch his toes, all in a little over 5 minutes.

Technique Highlight: Agonist Reversal to Improve ASLR

Patient:

supine
involved LE in hooklying
uninvolved LE in hip neutral and knee extension (flat on table)

Clinician:

standing beside patient on a table or kneeling if patient is on a mat
one hand on his anterior thigh and another behind (but not touching to start) posterior thigh

Technique:

cue ASLR by placing light pressure on the anterior thigh of the bent leg
verbally ask them to meet your resistance as they raise their hip and knee into flexion (bent knee)
you will feel them have difficulty at the sticking point
at the sticking point, give slightly increased resistance anteriorly to bring them past it, then contact posteriorly with light pressure as you lightly remove contact on the anterior thigh
posteriorly, lightly increase the pressure and cue them to meet your resistance as they move the hip into extension past the sticking point (keep the knee bent)
repeat this for 1-2 minutes lightly moving through the sticking point into hip flexion and extension
re-test ASLR and repeat for the other LE if it was equally limited
often, the other LE will have "learned" the movement pattern and ASLR will have improved
if it's not improved to FN, repeat on the other LE
re-test ASLR and MSF
both patterns will often be much better and hopefully FN
teach someone to repeat this on the patient or just give them pattern assisted ASLR for HEP or pattern assisted MSF repeatedly thoughout the day
they can even do self agonist reversals in sitting at the sticking point at work