Proprioceptive neuromuscular facilitation, PNF, PRINCIPLES, PATTERNS

1. Proprioceptive
Neuromuscular
facilitation(PNF)
AKASH JAINTH
MPT

2. DEFINATION
• PROPRIOCEPTIVE: having to do any of the sensory
receptors that give information concerning movement
and position of the body.
• NEUROMUSCULAR: involving the nerve and muscles.
• FACILITATION: making easier.

3. • Proprioceptive neuromuscular facilitation is a exercise
based on the principles of the functional human
anatomy and neurophysiology.
• PNF is an approach to patient care, which as
orignated in the 1940’s by Harman Kabat, M.D.
Maggie knott joined him in his effort to discover and
define the approach in the late 1940’s

4. Basic principles of PNF
• PNF is an integrated approach : each treatment is directed at a total
human being, not just at a specific problem or body segment.
• Based on the untapped existing potential of all the a patients,the
therapist will focus on mobilizing the patient’s reserve.
• The treatment approach is always positive, reinforcing and uses that,
which the patient can do, on a physical and psychological value.
• The primary goal of all treatment is to help patients achieve their
highest level of function.
• To reach the highest level of function, the therapist integrates
principles of motor control and motor learning. This includes
treatment on the level of the body structures, on the activity level as
well as on the participation level (ICF, International Classification of
functioning, WHO)

5. Neurophysiologic principles
• The work of Sir Charles Sherrington was important in
the development of the procedures and techniques of
PNF. The following useful definitions were abstracted
from his work (Sherrington 1947)

6. • After discharge: The effect of a stimulus continues
after the stimulus stops. If the strength and duration
of the stimulus increases, the after discharge
increases also. The feeling of increased power that
comes after a maintained a static contraction is a
result of after discharge.
• Temporal summation: A succession of weak
stimuli(subliminal) occuring within a certain period
(Short) of time combine(summate) to cause
excitation.

7. • Spatial Summation: Weak stimuli applied
simultaneously to different areas of the body
reinforce each other (summate) to cause excitation.
Temporal and spatial summation can combine for
greater activity.
• Irradiation: this is spreading and increased strength of
a response. It occurs when either the number of
stimuli or the strength of stimuli is increased. The
response may be excitation or inhibition.

8. • Successive Induction: An increased excitation of the
agonist muscles follows stimulation (contraction) of
their antagonist. Technique involving reversal of
antagonist make use of this property(induction,
stimulation, increased excitability).
• Reciprocal innervation: Contraction of muscles is
accompanied by simultaneous inhibition of their
antagonist. Reciprocal innervation is a neccessory part
of coordinated motion. Relaxation techniques make
use of this property.

9. Basic principles of PNF
• Resistance
• Irradiation and reinforcement
• Manual contact
• Stretch
• Verbal command
• Traction and approximation
• Timing
• Body positioning and body mechanics

10. Resistance
Resistance is used in the treatment to:
• Facilitate the ability of the muscle to contract
• Increase the motor control
• Help the patient gain an awareness of motion and its
strength.
• Increase the strength

11. Irradiation
• Is the spread of the response to stimulation.
• This response can be seen as increased
facilitation(contraction) or inhibition (relaxation) in
the synergistic muscles and patterns of movement.
The responses increases as the stimuli increases in
duration and intensity

12. Reinforcement
• The therapist directs the reinforcement of the weaker
muscles by the amount of resistance given to the
strong muscles.
• Increasing the amount of resistance will increase the
amount and extent of muscular response.

13. Manual contact
Effects:
• Stimulates the muscle.
• Stimulates the synergistic muscle to reinforce the
movement.
• Promotes trunk stabilization and indirectly helps the
limb motion.
• Prevents confusion.

14. Stretch
• The stretch stimulus occurs when the muscle is
elongated.
• The lengthened position of the muscle is the starting
position of each pattern and the stretch is maintained
throughout the movement.
• All the components of a pattern must be stretched
simultaneously.

15. Stretch
Effects:
• Stimulates the activity of muscle spindle.
• Any contraction of muscle on stretch will result in
movement and the brain knows not of muscles but of
movement.

16. Traction
• Traction is elongation of trunk or an extremity
• Traction force is applied gradually, maintained
throughout the movement, and combined with
appropriate resistance.
• Joint separation stimulates joint receptors
• Muscle stretch stimulates muscle spindle stretch
receptor
• Facilitates Alpha Motor Neuron
• Facilitates Strength

17. Approximation
Definition:
• Approximation is the compression of the trunk or an
extremity.
• Compression through a joint stimulate joint receptors
• Facilitate alpha motor neuron
• Facilitate stability

18. Uses:
• Promote stabilization
• Facilitate weight bearing and contraction of postural
muscles
• Facilitate upright reactions
• Resist some component of motion. E.g., use
approximation at the end of shoulder flexion to resist
scapula elevation

19. Verbal stimulation
• The volume with which the command is given affects
the strength of resulting muscle contraction.
• Louder command when strong muscle contraction is
required. Softer and calmer tone when the goal is
relaxation and relief of pain.

20. Verbal stimulation (commands)
The command is divided into three parts:
• Preparation: readies the pt for action. “ready”
• Action: tells the pt to start the action. “now pull your
leg up and in”
• Correction: tells the pt how to correct and modify the
action. “keep pulling your toes up”

21. Timings
• Timing is the sequencing of motions
• Normal timing of most coordinated and efficient
motions is from distal to proximal
• Timing for emphasis involves changing the normal
sequencing of motion to emphasis a particular muscle
or desired activity

22. Body positioning and mechanics
• The therapist body should be in line of motion
• Shoulder and pelvis face the direction of motion.
• Therapist stands in walk standing position.
• The resistance comes from the therapist’s body, while
the hands and arms stay comparatively relaxed.

23. Techniques of PNF
• Rhythmic initiation
• Repeated contraction
• Slow reversal
• Slow reversal-hold
• Rhythmic stabilization
Strengthening
techniques
• Contract relax
• Hold relax
Stretching
techniques

24. RHYTHMIC INITIATION
• Progression from( agonist pattern)
Passive
Active assisted
Active
USED IN
• Limited ROM due to increase tone
• Who are unable to initiate movement

25. REPEATED CONTRACTION
• Patient move isotonically against maximum resistance
repeatedly until fatigue is evidenced
• When fatigue is evident then a stretch at that point in
the range should facilitate the weaker muscles and
results in coordinated movement.
USED
• To develop strength and endurance.

26. SLOW REVERSAL
• Involves isotonic contraction of the agonist followed
immediately by an isotonic contraction of the
antagonist.
USED :
• For development of active ROM and
• Normal reciprocal timing b/w agonist and antagonist

27. SLOW REVERSAL HOLD
• Involves isotonic contraction of the agonist followed
immediately by an isometric contraction, with a hold
command given at the end of each active movement.
USED:
• In developing strength at a specific point in the range
of motion.

28. RHYTHMIC STABILIZATION
• Uses an isometric contraction of the agonist, followed
by an isometric contraction of the antagonist.
USED:
• To increase strength and endurance

29. STRETCHING TECHNIQUES/PNF STRETCHING
• It is often a combination of passive stretching and
isometrics contractions.
• encourage flexibility and coordination throughout the
limb's entire range of motion.
• PNF is used to supplement daily stretching and is
employed to make quick gains in range of motion to
help athletes improve performance.
• Good range of motion makes better biomechanics,
reduces fatigue and helps prevent overuse injuries.

30. CONTRACT-RELAX
• Moves the body part passively into the agonist
pattern.
• Patient is instructed to push by contracting the
antagonist isotonically against the resistance.
USED:
• When ROM is limited by muscle tightness.

31. HOLD RELAX
• Begins with isometric contraction of the antagonist
against resistance, followed by concentric contraction
of the agonist muscle.

32. PNF PATTERNS
Each pattern has three dimension –
1. Flexion or extension
2. Abduction or adduction
3. Rotation
• Movement occurs in a straight line, in diagonal
direction with a rotatory component

33. UPPER EXTREMITY

35. SCAPULA

36. LOWER EXTREMITY

38. HIP