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Proprioceptive neuromuscular facilitation

Neurophysiology basis, uses, basic principles,techniques, patterns of PNF and PNF stretching.

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Proprioceptive neuromuscular facilitation

  2. 2. includes• PNF definition• Neurophysiologic basis of PNF• Uses of PNF• 9 basic principles of PNF• Techniques of PNF• PNF stretching• Patterns of PNF
  3. 3. DEFINITION• Proprioceptive: having to do with any of the sensory receptors that give information concerning movement and position of the body• Neuromuscular: involving the nerves and muscles• Facilitation: making easier
  4. 4. • Proprioceptive neuromuscular facilitation is exercise based on the principles of functional human anatomy and neurophysiology.• It uses – Proprioceptive – Cutaneous – Auditory input To produce functional improvement in motor output and can be a vital element in the rehabilitation process of sports related injuries.
  5. 5. NEUROPHYSIOLOGICAL BASIS OF PNF• Sherrington.. – Concepts of facilitation and inhibition – Stretch reflex – Neurophysiological phenomena
  6. 6. FACILITATION• Facilitory - an impulse causing the recruitment and discharge of additional motor neurons in the spinal cord – Results in increased excitability in the muscles. – Weak muscles would be aided through facilitation
  7. 7. INHIBITION• Inhibitory - any stimulus that causes motor neurons to drop away from the discharge zone and away from the spinal cord. – Inhibition results in decreased excitability of motor neurons. – Muscle spasticity can be decreased
  8. 8. STRETCH REFLEX• The stretch reflex involves two types of receptorsMuscle spindlesGolgi tendon organs
  9. 9. NEUROPHYSIOLOGICAL PHENOMENA• RECIPROCAL INHIBITION• AUTOGENIC INHIBITION is defined as inhibition mediated by afferent fibers from stretched muscle acting on the alpha motor neurons supplying that muscle, causing it to reflex
  10. 10. Reciprocal inhibition• Is the second mechanism which deals with the relationships of the agonist and antagonist muscles
  11. 11. USES OF PNF• 1. PNF treatment has been used to increase strength, flexibility, coordination and functional mobility.• 2. The main goal of treatment is to facilitate the patient in achieving a movement or posture.• 3. Stretches as well as diagonals and rational exercise patterns are used to improve ADL’s functional mobility and athletic performance
  12. 12. • 4. It is mainly used in orthopedic rehabilitation for musculoskeletal injuries and in neurological rehab.• 5. PNF can be used for any condition, however the patient condition level may require modifications.
  13. 13. BASIC PRINCIPLES OF PNF1. Resistance2. Irradiation and reinforcement3. Manual contact4. Stretch5. Verbal commands6. Traction and approximation7. Timing8. Body positioning and body mechanics
  14. 14. 1. RESISTANCEOpposing force to the patient’s movement is called resistance. The amount of resistance provided during an activitymust be correct for the patient’s condition and the goal of the activity. This is called optimal resistance.
  15. 15. 1. RESISTANCEResistance is used in the treatment to:1. Facilitate the ability of the muscle to contract2. Increase motor control3. Help the patient gain an awareness of motion and its direction4. Increase strength
  16. 16. IRRADIATION & REINFORCEMENT DEFINITIONS• Irradiation : the spread of response to stimulation is called irradiation.• Reinforcement : means “to strengthen by fresh addition, make stronger”
  17. 17. IRRADIATION & REINFORCEMENT Effects :• Maximal resistance may be used to cause irradiation or overflow from stronger patterns to weaker patterns or from stronger groups of muscles within a pattern to weaker groups within the same pattern.
  18. 18. MANUAL CONTACT Effects:1. Stimulates the muscle2. Stimulates the synergistic muscle to reinforce the movement3. Promotes trunk stabilization and indirectly helps the limb motion4. Prevents confusion
  19. 19. Touch or manual contactContributes to facilitation by stimulating the exteroceptors and it should be1. Purposeful2. Directional3. comfortable
  20. 20. 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
  21. 21. STRETCH Effects:1. Stimulates the activity of muscle spindle2. Any contraction of muscle on stretch will result in movement and the brain knows not of muscles but of movement.
  22. 22. Quick Stretch Muscle Spindle + ++ Alpha Motor Neuron
  23. 23. TRACTION• Traction is elongation of trunk or an extremity• Traction force is applied gradually, maintained throughout the movement, and combined with appropriate resistance.
  24. 24. TRACTION• Joint separation stimulates joint receptors• Muscle stretch stimulates muscle spindle stretch receptor• Facilitates Alpha Motor Neuron• Facilitates Strength
  25. 25. 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
  26. 26. APPROXIMATION Uses:1. Promote stabilization2. Facilitate weight bearing and contraction of postural muscles3. Facilitate upright reactions4. Resist some component of motion. E.g., use approximation at the end of shoulder flexion to resist scapula elevation (11)
  27. 27. VERBAL STIMULATION (COMMANDS) • 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.
  28. 28. VERBAL STIMULATION (COMMANDS)• The command is divided into three parts:1. Preparation: readies the pt for action. “ready”2. Action: tells the pt to start the action. “now pull your leg up and in”3. Correction: tells the pt how to correct and modify the action. “keep pulling your toes up”
  29. 29. Commmads used• HOLD• PULL/PUSH• RELAX
  30. 30. 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
  31. 31. BODY POSTION & BODY 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.
  32. 32. TECHNIQUES OF PNF • Rhythmic initiationStrengthening • • Repeated contraction Slow reversal techniques • Slow reversal-hold • Rhythmic stabilization Stretching • Contract relax • Hold relax techniques
  33. 33. RHYTHMIC INITIATION• Progression from( agonist pattern) PASSIVE ACTIVE ASSISTED ACTIVEUSED IN• Limited ROM due to increase tone• Who are unable to initiate movement
  34. 34. REPEATED CONTRATION• 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.
  35. 35. SLOW REVERSAL• Involves isotonic contraction of the agonist followed immediately by an isotonic contraction of the antagonist.• USED1. For development of active ROM and2. Normal reciprocal timing b/w agonist and antagonist
  36. 36. 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.
  37. 37. RHYTHMIC STABILIZATION• Uses an isometric contraction of the agonist, followed by an isometric contraction of the antagonist.• USED• To increase strength and endurance
  38. 38. STRETCHING TECHNIQUES/PNF STRETCHING• It is often a combination of passive stretching and isometrics contractions.• encourage flexibility and coordination throughout the limbs 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.
  39. 39. 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.
  40. 40. HOLD RELAX• Begins with isometric contraction of the antagonist against resistance, followed by concentric contraction of the agonist muscle.
  41. 41. PNF STRETCHINGThe initial movement is in the direction of the stretchNext the athlete pushes in a direction against the stretch The last movement is a repeat of the initial
  42. 42. PNF PATTERNS• Each pattern has three dimension –1. Flexion or extension2. Abduction or adduction3. Rotation• Movement occurs in a straight line, in diagonal direction with a rotatory component
  44. 44. PATTERNSD1 Flexion D2 FlexionShoulder FLEX, ADD, ER Shoulder FLEX, ABD, ERForearm - Sup Forearm - SupWrist - Rad. Flexion Wrist - Rad. FlexionFingers - flexion Fingers - Extension SHOULDER D1 ExtensionD2 Extension Shoulder EXT, ABD, IRShoulder EXT, ADD, IR Forearm - ProForearm - Pro Wrist - Ulnar. extensionWrist - Ulnar ext. Fingers - ExtensionFingers - flexion
  45. 45. F-ADD-ER E-ABD-IR F-ABD-ER E-ADD-IRDiagonal One Diagonal Two
  48. 48. LOWER TRUNK
  49. 49. UPPER TRUNK
  50. 50. PNF IN SPORTS• Here are some other general guidelines when completing PNF stretching:• 1. Leave 48 hours between PNF stretching routines.• 2. Perform only one exercise per muscle group in a session.• 3. For each muscle group complete 2-5 sets of the chosen exercise.• 4. Each set should consist of one stretch held for up to 30 seconds after the contracting phase.• 5. PNF stretching is not recommended for anyone under the age of 18.• 6. If PNF stretching is to be performed as a separate exercise session, a thorough warm up consisting of 5-10 minutes of light aerobic exercise and some dynamic stretches must precede it.
  51. 51. • JOURNEL OF ATHLETIC TRAINING• PNF techniques are most frequently applied during rehabilitation of the knee, shoulder, and hip, ankle rehabilitation has increased.• The most frequently used techniques were contract- relax and hold-relax• The use of PNF techniques in the muscle re- education phase of rehabilitation