Proprioceptive Neuromuscular Facilitation PNF

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Proprioceptive Neuromuscular Facilitation (PNF
) PHYT 633 April, 2009
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PNF developed in 1940s and 50s - Kabat, Knott,
and Voss

• Definition Promote or hasten the response of the
  neuromuscular system through activation of
  proprioceptors via application of specific
  facilitation techniques

• Movements are in multiple planes, involve
  multiple muscle groups and include rotational
  components.
• Used to develop strength and endurance,
  facilitate stability, mobility, neuromuscular
  control and coordinated movements

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Basic concepts

• Diagonal patterns

• Sensory cues to augment motor response

• Strong muscle groups facilitate the weaker
  muscle groups in the pattern

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• Neurophysiologic basis for many techniques is now
  thought to be incorrect (e.g.- contract-relax)

• No conclusive evidence that facilitating movement
  or stability using basic neurophysiology
  (i.e.-stretch reflex, approximation) is carried
  over to volitional control

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PNF Patterns
Two pairs of diagonal patterns
D1 and D2 can be performed in flexion or
extension
Identified by the position of proximal joint when
the movement ends
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Upper Extremity Patterns

• D1 Upper Extremity Pattern
• Shoulder ABD, IR, EXT ? ADD, ER, FLEX
• Elbow/Forearm EXT PRO ? FLEX SUP
• Wrist EXT, ULNAR DEV ? FLEX, RADIAL DEV
• Hand OPEN ? CLOSED

pull off your earring and throw it away
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Upper Extremity Patterns

• D2 Upper Extremity Pattern
• Shoulder ADD, IR, Ext ? ABD, ER, FLEX
• Elbow/Forearm SEMI-FLEX PRO ? SEMI-EXT SUP
• Wrist FLEX, ULNAR DEV ? EXT, RADIAL DEV
• Hand CLOSED ? OPEN

draw your sword from its sheath
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Lower Extremity Patterns

• D1 Lower Extremity Pattern
• Hip ADD, ER, FLEX ? ABD, IR, SEMI-EXT
• Knee FLEX ? EXT
• Ankle DF, INV ? PF, EV

hacky sack
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Lower Extremity Patterns

• D2 Lower Extremity Pattern
• Hip ABD, IR, SEMI-FLEX ? ADD, ER, SEMI-EXT
• Knee FLEX ?EXT
• Ankle DF, EV ? PF, INV

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General Principles of PNF
Tactile stimulation Using tactile input to guide
the patients movement

• Normal timingtiming of activation of movement
  components, e.g. distal to proximal.
• Distal components should be completed roughly
  halfway through the pattern

Types of contractions (specific nuance in PNF)
Differ according to patient intent.
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General Principles of PNF

• Manual contact Using your hands in the
  appropriate locations on the patients body to
  facilitate their movement. Should be over muscle
  groups or tendon insertions.
• One manual contact distal and one proximal

• Appropriate resistance Resistance provided that
  is appropriate to the goal of the pattern (e.g.
  strength improvement vs. control) and the
  patients strength capacity.
• If trying to strengthen resistance should be
  maximum amount that still allows patient to move
  smoothly through all components of diagonal.

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General Principles of PNF

• Verbal Commands Use of appropriate verbal
  commands to reinforce and guide patients effort.
  Also appropriate instructions to patient before
  beginning practice of pattern.

• Voice inflection important
• Sharp/strong commands increase muscle
  contraction
• Soft/calm commands promote relaxation
• Moderate tones for directions/instructions

• Terminology guidelines
• Flexion pattern pull
• Extension pattern push
• Isometrics hold/relax

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General Principles of PNF

• Patient-Therapist Position Patient should be
  positioned as comfortably and securely as
  possible. Therapist should be in the diagonal and
  maintain his/her own body mechanics.

• Irradiation and reinforcement Idea that
  patients voluntary effort in a stronger movement
  component can facilitate the activation of weaker
  components, reinforcing the movement of the
  weaker component.

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General Principles of PNF

• Approximation compression of adjacent joint
  surfaces (thought to enhance co-contraction).

• Traction slight separation of adjacent joint
  surfaces (thought to decrease pain and facilitate
  movement).

• Quick stretch place patient in position that
  lengthens the muscles that you want to contract.

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PNF Techniques

• Rhythmic Initiation always start with this
• Passive, move through available range
• Demonstrates pattern correct rate of movement

• 2. Repeated contractions
• Emphasize a weak component of a pattern or a
  weak pattern
• Combine resistance with stretch of muscle(s)

Ex. D2 elbow flex strengthening at weak point
in range give quick stretch to biceps and give
command pull while you provide resistance that
allows patient to continue to move
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PNF Techniques
3. Reversal of Antagonists 3.1 Slow Reversal
use the agonist pattern to stimulate weak
antagonist pattern Ex. Patient is weak in D1
flexion, provide resistance throughout D1
extension and then reverse to D1 flexion
3.2 Slow Reversal Hold same as slow reversal
but with isometric hold at the end of each pattern
3.3 Rhythmic Stabilization Isometric resistive
motion (agonist) ? Isometric resistive motion
(antagonist) Patient does not move and is NOT
trying to move
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PNF Techniques
4. Relaxation techniques
4.1. Hold-Relax Resisted isometric contraction
(antagonist)? Relaxation ? passive movement into
new range Ex. tight hamstrings supine flex hip
with knee extended until feel resistance,
instruct patient to try to extend hip against
your resistance, relax, stretch into more hip
flexion
4.2 Hold-Relax with Agonist Contraction Same as
hold-relax except with contraction of muscles
opposite tight muscle Ex. tight elbow flexors-
hold your elbow bent and dont let me move it
(apply isometric resistance), let go, push
your elbow into extension
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PNF Patterns to Facilitate other movements

• Chop to facilitate rolling-D2 using other arm to
  assist, emphasize rotation of head also

• Bilateral D2 flexion to facilitate trunk
  extension and upright posture, emphasize
  extension of neck also

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PNF Patterns
Scapular Anterior Elevation-Posterior Depression
Scapular Posterior Elevation-Anterior Depression
Pelvic Anterior Elevation-Posterior Depression
Pelvic Posterior Elevation-Anterior Depression
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