Comparison of PNF Stretching and Static Stretching to Reduce Spasticity of Lower Extremity in Spastic Cerebral Palsy Children

Main Article Content

Marium Zafar
Anbreena Rasool
Nisar Fatima
Muhammad Waqar
Zain Ali


Background: Cerebral palsy (CP) presents a significant burden on childhood health, with the spastic type being the most prevalent manifestation. This neurological disorder, affecting 2-3 per 1000 births, stems from various prenatal, perinatal, or postnatal brain injuries. Commonly impacted outcome measures include muscle tone, pain, and range of motion, assessed by the Modified Ashworth Scale, Wong-Baker Face Pain Rating Scale, and popliteal angle measurement, respectively. While conservative static stretching is a widely used treatment option for spasticity, its efficacy remains inconclusive due to temporary effects. Conversely, proprioceptive neuromuscular facilitation (PNF) stretching, introduced by Harman Kabat and Margaret Knott in the 1940s, has shown promise in improving functional outcomes and reducing spasticity in neurological conditions like stroke and CP. However, limited evidence exists regarding its comparative efficacy with conventional static stretching in reducing spasticity among children with spastic cerebral palsy. Therefore, this study aims to compare the effectiveness of PNF stretching and static stretching in reducing lower extremity spasticity in children with spastic cerebral palsy, with pain and popliteal angle as secondary objectives.

Objective: The primary objective of this study is to assess the comparative effectiveness of PNF stretching and static stretching in reducing spasticity in the lower extremities of children with spastic cerebral palsy. Additionally, pain intensity and popliteal angle will be evaluated as secondary objectives.

Methods: A sample size of 60 children was determined using Epitool Google calculator and selected through non-probability purposive sampling. Participants were randomly assigned to either the experimental group, receiving PNF stretching, or the control group, receiving static stretching, with both groups undergoing identical baseline treatment. Pre- and post-intervention assessments were conducted for spasticity, pain intensity, and popliteal angle measurement using appropriate scales and instruments. Data were analyzed using SPSS 20.0, employing independent sample t-tests and paired sample t-tests for intergroup and intragroup comparisons, respectively.

Results: Inter-group analysis revealed significant improvements in both groups concerning pre- and post-treatment outcomes across all variables. However, intra-group analysis demonstrated statistically significant improvements in the PNF stretching group compared to the static stretching group across all measured variables.

Conclusion: The study concludes that proprioceptive neuromuscular facilitation stretching is more effective than static stretching in reducing spasticity in children with cerebral palsy. Nevertheless, both techniques exhibit efficacy in their respective capacities.

Article Details

How to Cite
Zafar, M., Rasool, A., Fatima, N., Waqar , M., & Ali, Z. (2024). Comparison of PNF Stretching and Static Stretching to Reduce Spasticity of Lower Extremity in Spastic Cerebral Palsy Children. Journal of Health and Rehabilitation Research, 4(1), 664–669.
Author Biographies

Marium Zafar, The University of Faisalabad

Assistant Professor/Academic & Post-Graduate Coordinator, Department of Rehabilitation sciences.

Anbreena Rasool, The University of Faisalabad

Assistant Professor, Department of Rehabilitation sciences

Nisar Fatima, The University of Faisalabad

Assistant Professor, Department of Rehabilitation sciences

Muhammad Waqar , The University of Faisalabad

Lecturer, Department of Rehabilitation Sciences

Zain Ali, The University of Faisalabad

Lecturer, Department of Rehabilitation Sciences


Paul S, Nahar A, Bhagawati M, Kunwar AJJOm, longevity c. A review on recent advances of cerebral palsy. 2022;2022.

Savasan ZA, Kim SK, Oh KJ, Graham SFJAicc. Advances in cerebral palsy biomarkers. 2021;100:139-69.

Patel DR, Neelakantan M, Pandher K, Merrick JJTp. Cerebral palsy in children: a clinical overview. 2020;9(Suppl 1):S125.

Cavarsan CF, Gorassini MA, Quinlan KAJJon. Animal models of developmental motor disorders: parallels to human motor dysfunction in cerebral palsy. 2019;122(3):1238-53.

Abd Elmagid DS, Magdy HJTEJoN, Psychiatry, Neurosurgery. Evaluation of risk factors for cerebral palsy. 2021;57:1-9.

Franki I, Bar-On L, Molenaers G, Van Campenhout A, Craenen K, Desloovere K, et al. Tone reduction and physical therapy: strengthening partners in treatment of children with spastic cerebral palsy. 2020;51(02):089-104.

Multani I, Manji J, Hastings-Ison T, Khot A, Graham KJPD. Botulinum toxin in the management of children with cerebral palsy. 2019;21(4):261-81.

Wissel J, Ri SJERoN. Assessment, goal setting, and botulinum neurotoxin a therapy in the management of post-stroke spastic movement disorder: updated perspectives on best practice. 2022;22(1):27-42.

SEYHAN K, GÜNEL MK, AKYÜZ EÜJTFvRD. Family-centred, goal-directed multidisciplinary approach for lower extremity botulinum toxin with physical therapy and rehabilitation in cerebral palsy. 2020;31(1):1-10.

Surya B. The Effect of Stretching and Propiroceptive Neuromuscular Facilitation in Spastic Diplegic Cerebral Palsy: A Comparative study: Madha College of Physiotherapy, Chennai; 2019.

Alashram AR, Alghwiri AA, Padua E, Annino GJPTR. Efficacy of proprioceptive neuromuscular facilitation on spasticity in patients with stroke: A systematic review. 2021;26(3):168-76.

Kruse A, Habersack A, Weide G, Jaspers RT, Svehlik M, Tilp MJCB. Eight weeks of proprioceptive neuromuscular facilitation stretching and static stretching do not affect muscle-tendon properties, muscle strength, and joint function in children with spastic cerebral palsy. 2023:106011.

Ganvir S, Nayak R, Harishchandre MJVJOPT. Influence of Stretching & Icing In Neurological Conditions to Relieve Spasticity-A Systematic Review. 2020;2(2):76-84.

Gülören G, Doğan Y, Özgül S, Gürşen C, Çinar GN, İpekten F, et al., editors. Acute Effects of Remedial Exercises with and without Compression on Breast-Cancer-Related Lymphedema. Healthcare; 2023: MDPI.

Chaturvedi P, Singh AK, Kulshreshtha D, Maurya P, Thacker AJMAP. Proprioceptive neuromuscular facilitation (PNF) vs. task specific training in acute stroke: the effects on neuroplasticity. 2018;5(1).

Amin GM, Abdalkhair SSJASNJ. Effect of Virtual Reality on Alleviating Children's Fear and Pain during Painful Procedures. 2023;11(39):341-8.

Padysakova HJBMJBLL. Circadian pain assessment in neonates from a nurse's perspective. 2019;120(7).

Pergolizzi Jr J, LeQuang JAK, Coluzzi F, Magnusson P, Lara-Solares A, Varrassi GJC. Considerations for Pain Assessments in Cancer Patients: A Narrative Review of the Latin American Perspective. 2023;15(6).

van Gorp M, Hilberink SR, Noten S, Benner JL, Stam HJ, van der Slot WM, et al. Epidemiology of cerebral palsy in adulthood: a systematic review and meta-analysis of the most frequently studied outcomes. 2020;101(6):1041-52.

Sadowska M, Sarecka-Hujar B, Kopyta IJNd, treatment. Cerebral palsy: current opinions on definition, epidemiology, risk factors, classification and treatment options. 2020:1505-18.

Nabi M, Chiragh S, Tariq A, Rehman A, Kompal R, Nadeem IJIJoNM, et al. An experimental study on comparison between proprioceptive neuromuscular facilitation technique and conventional physical therapy on lower extremity function of cerebral palsy. 2023;2(2):35-8.


Dabhi M, Rakholiya SJEE. A Study to Evaluate the Effect of Proprioceptive Neuromuscular Facilitation Stretching on Balance and Gait in Spastic Diplegic Cerebral Palsy: An Interventional Study. 2020;11(7):481.

Fosdahl MA. Hamstring muscle length in ambulant children with spastic bilateral cerebral palsy: Development and physiotherapy treatment. 2020.

Kim B, Kang T, Kim DJPTRS. Effect of proprioceptive neuromuscular facilitation stretching on pain, hip joint range of motion, and functional disability in patients with chronic low back pain. 2021;10(2):225-34.

Namsawang J, Srijunto W, Werasirirat P, Snieckus A, Bradauskiene K, Kamandulis S, et al. The effects of 6-week home-based static stretching, dynamic stretching, or eccentric exercise interventions on muscle-tendon properties and functional performance in older women. 2024;22(2):117-26.

Lempke L, Wilkinson R, Murray C, Stanek JJJosr. The effectiveness of PNF versus static stretching on increasing hip-flexion range of motion. 2018;27(3):289-94.

Elnaggar RK, Alhowimel A, Alotaibi M, Abdrabo MS, Elshafey MAJEJop, MEdicinE r. Accommodating variable-resistance exercise enhance weight-bearing/gait symmetry and balance capability in children with hemiparetic cerebral palsy: A parallel-group, single-blinded randomized clinical trial. 2022;58(3):378.

Most read articles by the same author(s)