PROPRIOCEPTIVE NEUROMUSCULAR

FACILITATION

Aarti Sareen
MSPT (honours )

includes

PNF definition
Neurophysiologic basis of PNF
Uses of PNF
9 basic principles of PNF
Techniques of PNF
PNF stretching
Patterns of PNF

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

 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.

NEUROPHYSIOLOGICAL BASIS OF PNF

Sherrington..
Concepts of facilitation and inhibition
Stretch reflex
Neurophysiological phenomena

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

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

STRETCH REFLEX
The stretch reflex involves two types of
receptors
Muscle spindles
Golgi tendon organs

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

Reciprocal inhibition
Is the second
mechanism
which deals
with the
relationships
of the agonist
and
antagonist
muscles

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 ADLs
functional mobility and athletic performance

 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.

BASIC PRINCIPLES OF PNF

1.
2.
3.
4.
5.
6.
7.
8.

Resistance
Irradiation and reinforcement
Manual contact
Stretch
Verbal commands
Traction and approximation
Timing
Body positioning and body mechanics

1. RESISTANCE
Opposing force to the patients
movement is called resistance.
The amount of resistance
provided during an activity
must be correct for the patients
condition and the goal of the
activity. This is called optimal
resistance.

1. RESISTANCE
Resistance is used in the treatment to:
1. Facilitate the ability of the muscle to contract
2. Increase motor control
3. Help the patient gain an awareness of motion
and its direction
4. Increase strength

IRRADIATION & REINFORCEMENT

DEFINITIONS
Irradiation : the spread of response to
stimulation is called irradiation.
Reinforcement : means to strengthen by
fresh addition, make stronger

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.

MANUAL CONTACT
Effects:
1. Stimulates the muscle
2. Stimulates the synergistic muscle to reinforce
the movement
3. Promotes trunk stabilization and indirectly
helps the limb motion
4. Prevents confusion

Touch or manual contact

Contributes to facilitation by
stimulating the exteroceptors
and it should be
1. Purposeful
2. Directional
3. comfortable

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

STRETCH
Effects:
1. Stimulates the activity of muscle spindle
2. Any contraction of muscle on stretch will
result in movement and the brain knows not
of muscles but of movement.

Quick Stretch
Muscle Spindle

+
+
Alpha Motor Neuron

TRACTION
Traction is elongation of trunk or an extremity
Traction force is applied gradually, maintained
throughout the movement, and combined
with appropriate resistance.

TRACTION
Joint separation stimulates joint receptors
Muscle stretch stimulates muscle spindle
stretch receptor
Facilitates Alpha Motor Neuron
Facilitates Strength

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

APPROXIMATION
Uses:
1. Promote stabilization
2. Facilitate weight bearing and contraction of
postural muscles
3. Facilitate upright reactions
4. Resist some component of motion. E.g., use
approximation at the end of shoulder flexion
to resist scapula elevation
(11)

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.

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

Commmads
used
HOLD
PULL/PUSH
RELAX

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

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
therapists body, while the hands
and arms stay comparatively
relaxed.

TECHNIQUES OF PNF
Strengthening
techniques

Stretching
techniques

Rhythmic initiation
Repeated contraction
Slow reversal
Slow reversal-hold
Rhythmic stabilization

Contract relax
Hold relax

RHYTHMIC INITIATION
Progression from( agonist pattern)
PASSIVE
ACTIVE ASSISTED
ACTIVE

USED IN
Limited ROM due to increase tone
Who are unable to initiate movement

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.

SLOW REVERSAL
Involves isotonic contraction of the agonist
followed immediately by an isotonic contraction
of the antagonist.

USED
1. For development of active ROM and
2. Normal reciprocal timing b/w agonist and
antagonist

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.

RHYTHMIC STABILIZATION
Uses an isometric contraction of the agonist,
followed by an isometric contraction of the
antagonist.

USED
To increase strength and endurance

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.

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.

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

PNF STRETCHING

The initial movement is in the direction of the stretch

Next the athlete pushes in a direction against the stretch

The last movement is a repeat of the initial

PNF PATTERNS

1.
2.
3.

Each pattern has three dimension

Flexion or extension
Abduction or adduction
Rotation
Movement occurs in a straight line, in
diagonal direction with a rotatory
component

UPPER EXTREMITY
F-ABD-ER

E-ABD-IR

F-ADD-ER

E-ADD-IR

PATTERNS
D1 Flexion

D2 Flexion

Shoulder FLEX, ADD, ER

Shoulder FLEX, ABD, ER

Forearm - Sup

Forearm - Sup

Wrist - Rad. Flexion

Wrist - Rad. Flexion

Fingers - flexion

Fingers - Extension
SHOULDER

D1 Extension
D2 Extension

Shoulder EXT, ABD, IR

Shoulder EXT, ADD, IR

Forearm - Pro

Forearm - Pro

Wrist - Ulnar. extension

Wrist - Ulnar ext.

Fingers - Extension

Fingers - flexion

F-ADD-ER

Diagonal One

E-ABD-IR

F-ABD-ER

Diagonal Two

E-ADD-IR

LOWER EXTREMITY
F-ABD-IR

E-ABD-IR

F-ADD-ER

E-ADD-ER

LOWER EXTREMITY

LOWER TRUNK

UPPER TRUNK

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.

 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 contractrelax and hold-relax
The use of PNF techniques in the muscle reeducation phase of rehabilitation