Proprioceptive Neuromuscular Facilitation

ESAT 3642 Therapeutic Exercise

Proprioceptive Neuromuscular Facilitation (PNF)

Based on the principles of functional anatomy and neurophysiology Uses proprioceptive, cutaneous, and auditory input Used for increasing strength, flexibility, and ROM Replicates normal movement patterns

History

Knott & Voss, 1968 Emphasized principles rather than specific techniques

Principles of PNF

Patient must be taught the PNF patterns regarding the sequential movements from starting position to terminal position Patient should look at the moving limb

Visual stimuli

Verbal cues Manual contact with appropriate pressure

Principles of PNF Continued

Proper mechanics and body position Amount of resistance given should facilitate a maximal response that allows smooth, coordinated motion Rotational movement Normal timing

Principles of PNF Continued

Timing for emphasis Traction or approximation Stretch reflex

PNF Patterns

Concerned with gross movements as opposed to specific muscle actions Rotational and diagonal patterns

Functional patterns Flexion-extension Abduction-adduction Internal-external rotation

Three component movements

PNF Patterns Continued

Pattern is initiated with the muscle groups in lengthened position Muscle group is contracted, moving the body part through the ROM to shortened position Diagonal 1 (D1) Diagonal 2 (D2)

PNF Pattern

UE Pattern

LE Pattern

PNF Strengthening Techniques

Repeated Contraction

Weakness either at specific point or throughout entire range Correct imbalances Isotonic work to fatigue When weak components are fatigued, stretch at that point in range Push concentric and eccentric agonist

Slow Reversal

Isotonic contraction of antagonist followed by contraction of agonist Develops AROM of the agonists and normal reciprocal timing between antagonist and agonist Push antagonist Pull agonist

Slow Reversal-Hold

Isotonic contraction of agonist followed by isometric contraction, with a hold command Direction of pattern is reversed by using the same sequence of contraction with no relaxation before shifting to the antagonistic pattern Useful for developing strength at specific point in the ROM

Rhythmic Stabilization

Isometric contraction of agonist, followed by isometric contraction of antagonist Produces cocontraction and stability of of the two opposing muscle groups

Rhythmic Initiation

Progression of movement from passive, to active-assistive, to active movement through the agonist pattern Slow through available ROM Avoid quick stretch Useful for patients who cannot initiate movement, have limited ROM, or for teaching movement pattern