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Proprioceptive

neuromuscular
facilitation
History
Developed by Dr. Herman Kabat in the
1940s
Maggie Knott, PT worked with Dr. Kabat
to create handling techniques and
principles of PNF
Dorothy Voss, PT also collaborated with
Kabat and Knott to further develop PNF
Originally developed for use with patients with
permanent neuromuscular dysfunction

 Before PNF, patients were rehabilitated using


one motion, one joint, one muscle at a time

 Kabat observed normal human motion and


began working with patients to discover
patterns of movement that were consistent
with neuro-physiological theory
Kabat’s research and experimentation led
him to discover that movement occurs in
spiral-diagonal patterns

Kabat and Knott believed that using


natural patterns of movement would
stimulate the nervous system more
normally than would therapy that isolated
each muscle

PNF has continued to develop and


change
Proprioceptive Neuromuscular
Facilitation
 Proprioceptive: refers to stimuli aroused in
an organism through the movement of its
tissues

 Neuromuscular: pertaining to nerves and


muscles

 Facilitation: hastening of any natural


process
Definition
Methods of promoting or hastening the
response of the neuromuscular
mechanism through stimulation of the
proprioceptor (Voss)

 Methods used to place specific demands


on specific muscles in order to elicit a
desired reaction.
 PNF – “A method of treatment to promote or
hasten the response of one neuromuscular
mechanism through the stimulation of various
neurological pathways. This is done by placing
specific demands on the patient’s nervous
system to assure a desired response which is
related to normal function” (Knott and Voss)
When to use PNF
 Used when a deficient neuromuscular
mechanism results in altered patterns of
motion or posture
 Most commonly used in Phase II & III, but
some techniques can even be used in
Phase I.
Proprioceptive Neuromuscular
Facilitation
 Can be used for increasing strength,
flexibility(ROM), and coordination.
 Uses autogenic and reciprocal inhibition to
increase stretch
 Good technique to improve flexibility
 Great technique for strengthening too
Principles of Therapeutic Exercise
 Exercise patient by using voluntary and active
motion. Return the patient to original strength
and ROM
 Pain-free ROM. Patient should be worked
through existing pain-free ROM.
 Use of “maximal” resistance
 Relaxation of body part before strengthening.
 Use diagonal spiral patterns of motion
 Nerve
 Afferent
 Type Ia, Ib, II
 Efferent
 Alpha Motor neuron - Extrafusal fibers
 Gamma Motor neuron - Intrafusal fibers
 Myotatic Reflexes
 Muscle Spindle
 Reciprocal Inhibition
 Golgi Tendon
 Autogenic Inhibition
Muscle spindle -- GTO
Ia and II

alpha

Ib
Neurophysiologic Principles
 Use of reflex activity
 Proprioceptors (muscle spindles, golgi tendon
organs, joint mechanoreceptors)
 Exteroreceptors (touch, pressure)
 Other (righting reflex, extensor reflex)
Neurophysiologic Basis for PNF

Irradiation: Energy is channeled from stronger


to weaker muscle groups or patterns
Sherrington’s Law of Successive Induction
 When a movement is completed in one direction,
the response of the antagonist will be augmented
 Successive induction: An increased response of
the agonist results after contraction of its antagonist
Increased agonist strength following contraction of
antagonist
 Autogenic inhibition –
A reflex muscular relaxation that occurs in
the same muscle where the GTO is
stimulated.
AUTOGENIC INHIBITION

2. Sense organ 3. Primary response


1. Stimulus -
-
Large force exerted excited -Golgi
tendon organs Muscle attached to
on muscle tendon
tendon relaxes
 Reciprocal inhibition -A reflex muscular
relaxation that occurs in the muscle that is
opposite the muscle where the GTO is
stimulated.

 Successive Induction
 Voluntary motion of one muscle can be facilitated by
the voluntary motion of another
Basic Concepts
 Movements are goal oriented
 From isolation (single plane) to functional large
patterns (multi plane) – Phase II/III of rehab
 Movements occur in diagonal patterns with
rotational components, not in single plane
 Resemble ADL’s and sport specific activities
 Stimulate muscle spindles and Golgi tendon
organs which in turn contribute to motion and
stimulation of joint receptors
Goals
 To restore or enhance postural responses
or normal patterns of motion in a patient
with a deficient neuromuscular mechanism
 to enhance stability or mobility
 to strengthen or stretch any muscle group
 Restore ROM
 Decrease pain
 to improve posture, balance, and
coordination for functional activities
Component of PNF

Basic of Procedure

 Classification of Techniques

 Diagonal Patterns
Basic Procedures

 Patterns of movement
 Visual stimulus
 Proper mechanics
 Normal timing
Basic Procedures (cont’d)
 Manual contacts
 Commands and communication
 Stretch reflex
 Traction and approximation
 Maximal resistance
 Timing for emphasis
Manual Contacts

 “Pressure” used to give sensory clues to


performing movement and generating
stronger muscular contraction

 Manual contacts .Contact over a muscle


group facilitates that muscle group to
contract
Manual Contacts
 Lumbrical grip aides in keeping contacts
facilitates unidirectional movement

 Placed proximal and distal of joint

 Best point of manual contact varies


slightly with individuals

 Should not cause pain or discomfort


Commands and Communication
 Clinician can actively demonstrate or
passively move patient through desired
pattern of movement

 Cues should be clear, concise, and


appropriate to the patient’s needs and
comprehension
 Tell patient what to do – voice inflection

 Sharp/strong commands increase muscle contraction


 Soft/calm commands promote relaxation
 Moderate tones for directions/instructions

 Terminology (guidelines, not absolutes)

 Flexion pattern – “pull”


 Extension pattern – “push”
 Isometrics – “hold/relax
Stretch Reflex
 Stretch is used as a stimulus

 Start pattern with agonist in lengthened state –


stretch facilitates stronger contraction of
muscle/s

 stretch facilitates muscle spindles

 To initiate stretch reflex, briefly take beyond


lengthened position
 Causes muscle contraction

 May be repeated throughout the pattern

 Does not work on completely flaccid


muscle

 Contraindicated if painful
Traction and Approximation
 Traction facilitates movement – associated with
flexion (“pull”) movements

 Approximation facilitates stability – associated


with extension (“push”) movements

 Contraindicated if painful
 Approximation
 Compression of joint surfaces
 Facilitates co-contraction around joints
 Used to increase stability

 Traction (distraction) movements


 Separation of joint surfaces
 Can decrease pain
 Facilitates movement
Maximal Resistance

 maximal resistance which allows


movement through full desired ROM

 Accommodating resistance is the rule

 Can enhance muscular endurance by


increasing repetitions/sets
 Direction, quality, and quantity of resistance is
adjusted to prompt a smooth and coordinated
response, whether for stability or mobility
 When applying resistance, consider the
treatment goal:
 Power or endurance
 Quality of movement
 Presence of spasticity
Timing for Emphasis
 Normal timing in sequence of joint actions
in order for movements to occur
 Typically move is distal to proximal
relationship
 Timing for Emphasis
 Can be used to correct abnormal
timing/muscle firing patterns
 Irradiation (overflow) occurs from stronger
muscle/s to weaker ones –
 stronger muscle/s augment and reinforce
contraction of weaker ones
Body Position and Mechanics
 Position yourself “in the diagonal”

 Maintain good body mechanics


Visual stimulus
 Promotes more powerful contraction
 Helps to control & correct the motion
 Influences both head and body motion
 Helps in patient / therapist communication
 The PNF patterns combine motion in all
three planes:
 1. The saggittal plane: flexion and
extension.
 2.The coronal or frontal plane: abduction
and adduction of limbs or lateral flexion of
the spine.
 3. The transverse plane: rotation.