Trigger points are taut fibers within the muscle fiber. The sarcomere, or contractile unit of the muscle fiber, becomes shortened due to trauma, injury, overload of a muscle or muscle groups, nutritional deficiencies, poor posture and sleeping positions among other perpetuating factors.

Chronic tension often starts with a muscle that doesn’t return to its resting length. Over time, that shortened state alters joint mechanics, movement patterns, and pain thresholds—especially when trigger points are involved. Traditional massage can loosen surface restrictions, but deeper dysfunction tends to persist without neuromuscular retraining.

Proprioceptive Neuromuscular Facilitation (PNF) offers a way to interrupt that cycle. By using active resistance and guided release, it engages both the muscular and nervous systems to reset the tissue’s baseline state. When integrated with trigger point therapy, it becomes a powerful method for restoring mobility, improving motor control, and reducing pain at the source.

We are excited to share insights from contributing author Julie Zuleger, PhD. She discusses how PNF massage techniques boost flexibility, ease joint stiffness, and improve muscle performance.

Trigger points are taut fibers within the muscle fiber. The sarcomere, or contractile unit of the muscle fiber, becomes shortened due to trauma, injury, overload of a muscle or muscle groups, nutritional deficiencies, poor posture, and sleeping positions, among other perpetuating factors.

Most massage therapists I have taught thought that trigger points cause only referred pain; but, more recently, trigger points have been shown to cause loss of range of motion. They also can cause pain or other types of sensations such as tingling, heaviness, or numbness and a decrease in strength or endurance.

How PNF Advanced Massage Techniques Help You

  1. Improve Flexibility PNF stretching techniques are excellent for increasing flexibility. For example, if you struggle to touch your toes because of tight hamstrings, PNF helps lengthen those muscles over time. Facilitated stretching is particularly effective in supporting muscle elongation and improving range of motion. Learn more about how assisted stretching techniques will improve your results and income in your practice in this guide.
  2. Enhance Muscular Function These techniques are a great way to help your muscles become stronger and work together better. Think about an athlete who is recovering from a leg injury. PNF will make a difference by helping those muscles get back to doing their job well.
  3. Reduce Joint Stiffness If you’ve ever felt like your joints are stiff or hard to move after sitting too long, PNF loosens them up. For example, using PNF to stretch your shoulders might help you regain your full range of motion and reduce discomfort.
  4. Boost Muscle Strength PNF doesn’t just stretch your muscles—it also strengthens them. For someone with chronic pain or muscle weakness, PNF techniques target trigger points and help rebuild strength over time, supporting daily activities like climbing stairs or lifting groceries.
  5. Support Recovery from Injuries Physical therapists and sports massage practitioners often use PNF to help clients recover from injuries. For instance, a runner with a strained calf muscle might benefit from these techniques to restore balance and mobility.
  6. Help the Human Body Regain Balance and Mobility Whether you’re dealing with chronic pain or recovering from an injury, PNF helps your body move more naturally. For example, PNF assists in aligning your posture by releasing tight muscles that pull your body out of balance.
  7. Relieve Chronic Pain PNF techniques are especially helpful for people dealing with long-term discomfort. If you have chronic back pain, PNF targets tight muscles and trigger points to provide relief and restore function.

Proprioceptive Neuromuscular Facilitation (PNF) techniques have been shown to improve pain intensity and functional disability in patients with low back pain, with large effect sizes favoring its use over other physical therapy interventions (Pourahmadi et al., 2020).

The Biochemical Feedback Loop

When muscle fibers become shortened, they can create myofascial dysfunction. This leads to postural changes that make it harder for someone to live and work comfortably. As these tight fibers keep the muscles short, they increase pain, creating a cycle that may result in myofascial pain syndrome. It’s important to address these issues to help improve comfort and well-being.

You might ask: “My client’s muscles are in the painful feedback loop. How do I stop it?”

When muscles are tight and hold trigger points, they create some discomfort. It’s important to recognize that this tension leads to a buildup of chemicals in the trigger point area. Let’s focus on ways to relieve this tension and promote relaxation for better health.

Painful Muscles:

  1. Lead to tight muscles: Imagine a domino effect—when your shoulder muscles feel sore, they tighten up naturally to protect that area. This tension can spread and may cause your neck and upper back to feel stiff as well.
  2. Make it hard to move: Have you ever experienced a cramp in your calf that made walking tough? Tight muscles limit your movement, making simple tasks like climbing stairs or bending down feel more difficult.
  3. Cause even more pain: It can feel like a never-ending loop—tight hamstrings pull on your lower back, leading to discomfort. This new pain keeps those muscles tight, making it hard to find relief. Together, we’ll focus on easing that tension and breaking this cycle.

Myofascial trigger points (MTrPs) are small, sensitive knots in tight muscle bands that are often linked to chronic pain. Research shows they can cause muscle stiffness, reduced blood flow, and changes in the surrounding tissue.

Myofascial trigger point therapy is now to the rescue! A properly trained massage therapist can incorporate the 7-Step Trigger Point Protocol, and Proprioceptive Neuromuscular Facilitation (PNF) is one of the most valuable parts of this protocol. You’ve probably tried static stretching, yoga class, and foam rolling. That’s not enough. PNF stretching, with its focus on passive range and gentle resistance, is the best way to stop the feedback loop of pain-tightness-pain and restore contracted muscle segments to normal resting length.

What is PNF?

Let’s look at the concept of the length-tension relationship and the sarcomere. The premise of the length-tension relationship is the amount of tension produced by a sarcomere or group of sarcomeres is based on its length.

A shortened sarcomere (or tens of thousands of muscle cells with contracted sarcomeres) is found within the active trigger point complex. This contracted muscle bundle will produce less force and not perform to its full potential because an already-shortened muscle cannot fully contract to create the force or work that is needed. The same thing applies to an overstretched sarcomere. There is no room for a stretch for pre-load; less power or endurance is the result.

Understanding PNF and How It Helps Your Muscles

  1. Helping Paralysis Patients: PNF techniques were first developed to assist people with paralysis caused by polio. These techniques helped improve their muscle function and movement, setting the foundation for what we use today in massage and physical therapy.
  2. The Length-Tension Relationship: Think of your muscles like elastic bands. When they’re stretched too far or too tight, they can’t work properly. The length-tension relationship explains that muscles need to be at the right length to produce the most force. For example, if your hamstring is too tight, it won’t generate the strength needed for something as simple as walking up stairs.
  3. The Sliding Filament Theory: Remember anatomy class? Muscles contract when two proteins—actin and myosin—slide past each other. In a shortened sarcomere (the muscle’s smallest functional unit), these proteins don’t have enough room to slide. This means your muscles can’t fully contract, which leads to weakness and reduced function. For instance, tight calves might make running feel much harder. Discover how fascia, movement, and stretching contribute to effective therapy in this insightful article.
  4. Why Shortened Muscles Need Help: When muscles stay shortened, they lose their ability to generate force. That’s where PNF techniques come in. They restore the muscle to its normal length so it works at its best again. For example, using PNF on your shoulders will help you lift objects overhead without strain.
  5. Key Techniques: Isometric Stretching and Reciprocal Inhibition:
    • Isometric Stretching: This involves contracting a muscle without moving it. For example, pressing your foot against a wall during a calf stretch activates and lengthens the muscle.
    • Reciprocal Inhibition: This is when one muscle relaxes while its opposing muscle contracts. For instance, tightening your quadriceps helps your hamstring relax and stretch more effectively.
  6. Targeting Trigger Points PNF isn’t just about stretching; it’s about targeting those painful spots (trigger points) in your muscles. By combining techniques like isometric stretching and reciprocal inhibition, PNF helps release tight spots and restore normal muscle function, giving you a better range of motion and reduced pain.

How PNF Techniques Work: A Friendly Guide

PNF (Proprioceptive Neuromuscular Facilitation) is all about using specific movements to help muscles relax, stretch, and strengthen. By gently moving the body into a point of resistance—just where the muscle feels tight—PNF works to improve flexibility and overall muscle performance.

Key Steps of PNF Stretching:

  1. Start with a Stretch The first step is a manual stretch that lasts about 10 seconds. For example, the therapist may gently stretch your hamstring to its current limit.
  2. Activate the Muscle Next, you’ll engage the muscle by pressing against gentle resistance for a few seconds. This contraction helps the muscle prepare for a deeper stretch. Don’t worry—it only requires about 10% of your strength, so it’s safe and controlled.
  3. Stretch Again After the muscle contraction, the therapist stretches the muscle again, but this time, you’ll notice a greater range of motion. This step helps lengthen the muscle further and optimize its function.

Why PNF is So Effective

  1. Relaxes Tight Muscles PNF techniques encourage tight muscles to relax, a process called autogenic inhibition. For instance, contracting your hamstring during a stretch can signal the muscle to release tension, making the stretch more effective. Relaxing tight muscles through techniques like active isolated stretching is important for recovery and flexibility. Learn self-care techniques for the shoulder with our guide.
  2. Builds Awareness By actively engaging in the process, clients become more aware of how their muscles feel and how much tension they carry. This awareness can lead to better self-care and body mechanics.
  3. Improves Joint Stability Regular PNF stretching helps strengthen muscles and stabilize joints, making everyday movements—like walking or lifting—easier and safer.
  4. Prepares Mechanoreceptor Cells These tiny cells in your muscles adapt to the new length achieved through PNF. Daily stretching with PNF reinforces this, helping your muscles stay flexible and strong.

PNF Techniques to Try

  1. Contract-Relax (CR) Also called the hold-relax method, this involves contracting the muscle against resistance, then relaxing and stretching it further. For example, pressing your leg against a therapist’s hand before a hamstring stretch.
  2. Hold-Relax with Agonist Contraction This adds another step—after relaxing, you activate the opposing muscle group to deepen the stretch. For instance, tightening your quad while stretching your hamstring.
  3. Hold-Relax-Swing A more dynamic option, this combines static stretches with gentle, controlled movements to improve range of motion.

How PNF Fits Into Your Routine

PNF techniques can be included in a massage or myofascial trigger point therapy session to reduce pain, break tight patterns in your muscles, and restore balance. They’re also great for self-care—your therapist can teach you how to do PNF stretches at home for long-term benefits.

Whether you’re recovering from an injury, dealing with chronic pain, or simply looking to improve flexibility, PNF techniques are a powerful tool to help your body feel and move better.

Incorporating PNF techniques into your practice will boost your sessions and provide long-term benefits for clients. Check out this comprehensive guide to assisted stretching techniques to explore more approaches.

Hold-Relax Technique and Reciprocal Inhibition Stretching

The Hold-Relax Technique: For this technique, I made a video that shows how to stretch the hamstrings using the hold-relax PNF technique. This is a great way to get your client engaged in the session and to re-train their muscles. This video demonstrates the hold-relax technique for the hamstrings.

Hold-Relax Technique and Reciprocal Inhibition Stretching: For this technique, I made a video that shows how to stretch the quadriceps using the hold-relax technique and reciprocal inhibition technique. This video demonstrates these techniques.

What is Proprioception?

Let’s have a friendly chat about proprioception! Proprioception helps you understand where your body is in space. Proprioceptors are special cells that respond to signals about the position of your joints and muscles. Using PNF methods improves the connection between your brain and spinal cord, leading to better coordination.

There are two types of mechanoreceptors that are worthy of discussion: muscle spindles and Golgi tendon organs:

  • Muscle Spindles: Located in the intrafusal fiber of the muscle, the stretch of a muscle and its rate of change in length are monitored. So when the muscle is lengthened are the intrafusal fibers. The central nervous system gets involved when a muscle is stretched or lengthened too far and sends a stimulus for the muscle to contract.
  • Golgi Tendon Organs: Located in the musculotendinous junction. Their role is to help the body respond to changes in the tension of a muscle. GTOs monitor the pulling force on the tendon, and if too much force or tension is detected, the muscle will relax due to inhibitory signals sent from the nervous system. 

If you work with trigger points, consider adding PNF to your session to improve the outcome of myofascial trigger point therapy.

Final Thoughts

If you use trigger points in your practice, try adding PNF techniques like passive stretching and isometric contraction. These techniques boost the effectiveness of myofascial trigger point therapy. Plus, they help your clients gain a better range of motion, increased flexibility, and less pain.

As contributing author Julie Zuleger, PhD, highlights, PNF transforms the way your muscles perform and how you feel day-to-day. Whether added to a therapeutic massage session or practiced as part of your self-care routine, these techniques offer a path to greater mobility, less pain, and a healthier, more vibrant life.

Protect Your Career with Massage Liability Insurance

As a massage therapist, your work has a profound impact on your clients’ well-being—but who’s protecting your career? Unexpected situations happen such as client injuries and having the right insurance assures your practice stays secure.

With Massage Magazine Insurance Plus, you get comprehensive professional liability insurance designed specifically for massage therapists. Our policies protect you against the unexpected, so you can focus on what you do best: helping your clients.

Don’t leave your career to chance. Contact us today to learn more about how we can support your journey as a massage therapist. It’s time to protect your passion and secure your future!

Julie Zuleger

About the Author:

Julie Zuleger, PhD, has over 20 years of experience as a licensed massage therapist, board certified myofascial trigger point therapist, athletic trainer and human movement specialist. She teaches continuing education courses for massage therapists, athletic trainers, fitness, and wellness professionals. Zuleger is the owner of Impact Nutrition and Wellness Coaching LLC. For more information about her online courses visit Chicago Trigger Point Seminars.

Related Posts