Effectiveness of Hold Relax Proprioceptive Neuromuscular Facilitation Technique in Total Knee Arthroplasty

Proprioceptive Neuromuscular Facilitation (PNF) is a popular flexibility training, which involves stretching and contraction of the target muscle group. PNF stretching is effective among athletes for improving passive range of motion, flexibility, and performance. Patients who undergo total knee replacement surgeries exhibit pain, swelling, decreased range of motion, muscle weakness, and stiffness. This study aimed to investigate the effect of the hold relax PNF technique to improve the balance and muscle strength in subjects with a bilateral knee replacement. Sixty four patients were selected based on inclusion/exclusion criteria. The patients were allocated into two groups by random allocation. The experimental group A (n=32) received the Hold Relax PNF technique with conventional treatment whereas, the control group B (n=32) received only conventional treatment as a part of the Home Exercise Program (HEP). Outcome measures used for evaluation included the Visual Analogue Scale (VAS), Manual Muscle Testing (MMT), and Berg Balance Scale (BBS) Score for measuring pain, muscle strength, and balance respectively. Students t-test showed significant differences between variables mean scores from two groups after three weeks of intervention. There was a statistical significant (t(32) = 2.38, p = 0.02) change in the mean scores of VAS in the experimental group (mean difference pre-post=3.19) as compared to control group ( mean difference pre -post=3.19) with Cohen’s d = 2.744588. Similarly for MMT(t(32) = 0.415, p = 0.005) and BBS scores (t(32) = 2.628, p = 0.035). The result of the study suggests that the Hold Relax PNF technique is more effective than conventional treatment alone in decreasing pain as well as increasing balance and muscle strength in bilateral knee replacement patients.