The effects of proprioceptive neuromuscular facilitation (PNF) exercises with a biopsychosocial approach on pain, joint stiffness, kinesthesia, and kinesiophobia in athletes post-ACL reconstruction

Background: Following anterior cruciate ligament (ACL) reconstruction, joint stiffness and kinesiophobia pose significant challenges to rehabilitation in some patients.
Objective: This study investigated the effects of proprioceptive neuromuscular facilitation (PNF) exercises with a biopsychosocial approach on pain, joint stiffness, kinesthesia, and kinesiophobia in athletes post-ACL reconstruction.
Methods: The study included 24 athletes (12 men and 12 women) selected from 192 patients, 4 weeks post-arthroscopic ACL reconstruction, who still experienced pain, stiffness, and kinesiophobia despite standard care. Participants were purposively selected and randomly matched by gender and range of motion (ROM) into control (routine physiotherapy) and experimental (PNF with a biopsychosocial approach) groups. Outcome measures, including pain (KOOS questionnaire), knee ROM, kinesthesia, and kinesiophobia (Tampa Scale), were assessed before and after an 8-week intervention (3 weekly 45-minute sessions). Data were analyzed using repeated-measures ANOVA.
Results: Statistical analysis revealed significant improvements in the experimental group across all outcome measures (pain, stiffness, kinesthesia, and kinesiophobia) compared to the control group (F(1,22)>22.3, P<0.001, η²>0.50).
Conclusion: PNF exercises with a biopsychosocial approach effectively reduced pain, stiffness, and kinesiophobia, making them a recommended method for post-ACL reconstruction rehabilitation.
Keywords: PNF exercises, biopsychosocial approach, knee stiffness, pain, kinesiophobia