Cerebral palsy (CP) is a disorder affecting movement, resulting from permanent damage to
posture and motor development during fetal or infant brain development, caused by
non-progressive disturbances. CP affecting about 1 in 500 children with an estimated
prevalence of 17 million people worldwide. In CP, spasticity is often regarded to be the
most common motor impairment. Spastic cerebral palsy stands out as the predominant
subtype, constituting 77% of all cases, with bilateral spastic cerebral palsy dominating
the spastic group (70%). Spasticity is only one of several components of the upper motor
neuron (UMN) syndrome. Spasticity is a form of hypertonia due to hyperexcitable tonic
stretch reflexes. Adult CP reported that 77% of CP children were having problems with
spasticity. Hypertonicity resulting in abnormal movement patterns in both gross motor
function and manual abilities in the children with CP.
Traditionally the treatment of tightness in children with spasticity has consisted
primarily of techniques which involve static stretching, strengthening of the
antagonistic muscles, use of orthosis and postural education etc. Some authorities also
recommend Myofascial release to cause elongation of the spastic muscle with a component
of tightness. Myofascial therapy can be defined as "the facilitation of mechanical,
neural and psycho physiological adaptive potential as interfaced by the myofascial
system". Akta Bhalara et al (2014) concluded in a study that myofascial release is
effective in reducing spasticity in children suffering from spastic diplegic cerebral
palsy. A study conducted in 2018 proved that myofascial release is effective in reducing
spasticity of hamstring muscle and improves range of motion in spastic diplegic cerebral
palsy. Ujwal Bhattacharya et al (2017) in a study concluded that MFR and passive
stretching is effective in reducing spasticity and improving range of motion in spastic
diplegic Cerebral Palsy.
Fred Mitchell first described MET in 1948 as a type of osteopathic manipulative diagnosis
and treatment, primarily utilized to address somatic dysfunction, particularly issues
such as reduced range of motion, muscular hypertonicity, and pain. MET involves the use
of two physiological phenomena: Post Isometric Relaxation and Reciprocal Inhibition. Post
Isometric Relaxation is a technique that was later developed by Karel Lewitt . Post
Isometric Relaxation (PIR) is the effect of the decrease in muscle tone in a single or
group of muscles, after a brief period of submaximal isometric contraction of the same
muscle.
Preeti Gazbare et al ( 2018) conducted a Comparative Study On The Effect of Myofascial
Release Over Post Isometric Relaxation On Calf Muscle Tone in Spastic Diplegic Cerebral
Palsy and concluded that both MFR and PIR are equally effected in reducing calf muscle
tone in spastic Cerebral Palsy. PIR improves better flexibility and decrease tightness of
hamstring muscle as compared to static stretching. MET improves the independent mobility
of stroke patients with hemiplegia enhances balance and stability. Janstephan T (2015)
conducted a study to evaluate the effectiveness of neurodevelopment therapy with post
isometric relaxation for lower extremity to improve functional ability in children with
spastic diplegic cerebral palsy. The result suggested that neurodevelopmental therapy
along with muscle energy technique improved the functional ability in children with
spastic diplegic cerebral palsy.
Post Facilitation Stretch (PFS) is a technique developed by Janda.This technique is more
aggressive than PIR but is also based on the concept of autogenic inhibition. Post
facilitation stretching is a MET technique which uses postisometric relaxation. The term
refers to the effect of the subsequent relaxation experienced by a muscle after an
isometric contraction has been performed. The effect of a sustained contraction on the
Golgi tendon organs seems pivotal, since their response to such a contraction seems to be
set the tendon and the muscle to a new length by inhibiting it. A study concluded that
Post Facilitation Stretching is effective in increasing Flexibility of tight hamstring
muscles. A study concluded that post facilitation stretch is effective in reducing pain
and improving muscle length. A study in published in 2024 compared the effect of the
muscle energy technique (MET) and stretching technique on ankle dorsiflexion passive
range of motion, balance, and gait ability of stroke patients with limited ankle
dorsiflexion. And concluded that MET and Stretching both are effective in improving range
of motion , balance and gait ability of stroke patients with limited ankle dorsiflexion.
The rationale for this study is that Post-facilitation stretch relaxation (PFSR) is
proposed as an effective intervention for reducing lower limb spasticity in spastic
cerebral palsy. By combining passive stretching with relaxation techniques post-
facilitation, PFSR aims to decrease muscle tone and improve range of motion. This
approach is individualized, often integrated with other therapies, and emphasizes patient
education for long term management.