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 ADL’s
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. Resistance
2. Irradiation and reinforcement
3. Manual contact
4. Stretch
5. Verbal commands
6. Traction and approximation
7. Timing
8. Body positioning and body mechanics
 1. RESISTANCE
Opposing force to the patient’s
movement is called resistance.

The amount of resistance

provided during an activity
must be correct for the patient’s
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
therapist’s body, while the hands
and arms stay comparatively
relaxed.
 TECHNIQUES OF PNF
• Rhythmic initiation
Strengthening •
•
Repeated contraction
Slow reversal
techniques • Slow reversal-hold
• Rhythmic stabilization

Stretching • Contract relax

• Hold relax
techniques
 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
• 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
 UPPER EXTREMITY

F-ABD-ER
F-ADD-ER

E-ABD-IR 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 E-ABD-IR F-ABD-ER E-ADD-IR

Diagonal One Diagonal Two

 LOWER EXTREMITY

F-ABD-IR
F-ADD-ER

E-ABD-IR 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 contract-
relax and hold-relax
• The use of PNF techniques in the muscle re-
education phase of rehabilitation