Proprioceptive neuromuscular

facilitation
 DEFINITION
• Proprioceptive: Sensory receptors that give
information concerning movement and
position of the body
• Neuromuscular: Nerves and muscles
• Facilitation: making movement easier
PNF combined functionally-based
diagonal/spiral patterns of movement (isotonic-
isometric) with techniques of neuromuscular
facilitation.
The sensory input (auditory: push, pull, hold,
relax), (visual), (somatosensory cues from:
muscle spindle, Golgi tendon organ [GTOs] and
joint receptors) to help motor function by
evoking alpha motor neuron responses and
improve neuromuscular control and function
(immediately & in future movements).
-PNF techniques: used to Assess/Improve-facilitate:
1-Muscular performance: strength, power and
endurance.
2- Stability-Mobility.
3-Neuromuscular control, and coordinated
movements.
4-Restoration of function.
-PNF use diagonal patterns of motion facilitated by
the application of sensory cues to elicit or augment
motor responses:
a-Directly to the involved area: by increasing strength
(increased recruitment/discharge of motor neurons )
of certain muscles and enhancing relaxation (decrease
the excitement) of certain muscles.
b-Indirectly to the uninvolved area [painful, weak or
immobilized] through overflow excitation/irradiation
to enhance excitation (strength)or
inhibition(relaxation).
 Principles of mechanisms
1-After discharge response: last longer if
stimulus was practiced longer.
2-Temporal summation: accumulation of
successive weak stimuli to increase excitation.
3-Spatial summation: many weak stimuli round
the body join together to enhance excitation.
4-Irradiation: increased excitation/inhibition
may spread to other parts.
5-Receprocal inhibition: agonist/antagonist
action.
6-Traction targeting alpha motor neurons to
promote strength & motion/Approximation
targeting joint receptors to enhance stability.
7-Timing: normal sequence of motion during
activities.
8-Resistance: overloading to enhance strength.
-stronger muscle groups of a diagonal pattern
facilitate the responsiveness of the weaker
muscle groups.
• PNF patterns for the extremities can be
performed unilaterally or bilaterally and in a
variety of weight-bearing and non-weight-
bearing positions.
 TECHNIQUES OF PNF
• Rhythmic initiation
Strengthening • Repeated contraction
• Slow reversal
techniques • Slow reversal-hold
• Rhythmic stabilization

• Hold relax
Stretching • Agonist contraction
• Hold relax with agonist
techniques contraction
 PNF MAIN FEATURES

• Diagonal pattern of movemnet----these are

the patterns needed during functional
activities Stronger muscle group of a diagonal
pattern will facilitate the
responsiveness of the weaker ones

• The application of sensory cues

– Proprioceptive
Augment the motor response
– Cutaneuos
– Audioutory stimuli
Facilitation
 USES of PNF
• To develope
– Strength
– Endurance
– Facilitate stability and mobility
– Neuromuscular control
– Coordination
• It has applications in:
– Neurorehabilitation
– Musculoskeletal conditions
 USES of PNF
• PNF techniques are useful through the
continuem of rehabilitation:
– Early phases/ isometric techniques
– Final phases/ high speed diagonal movemnet
performed against maximum resistance
 BASIC PRINCIPLES OF PNF

1. Diagonal patterns
2. Manual contact
3. Resistance
4. Stretch
5. Verbal commands
6. Traction and approximation
7. Timing
8. Body positioning and body mechanics
 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
 PNF PATTERNS
Two pairs of diagonal patterns are associated for the upper
and lower extremities; diagonal 1 (D1), diagonal 2 (D2)
-Each of these patterns can be performed in either flexion
or extension
-Terminology used D1 flexion; D1 extension; D2 flexion; D2
extension.
-Patterns are identified by the motion that occurs at the
proximal pivot points (hips or shoulders)
-Pattern is named by the ending position of the hip or the
shoulder.
 D1 Flexion-Extension patterns
D1 Shoulder flexion
Shoulder Jt: Flexion-adduction-external Rotation.
Scapula: Elevation, abduction, upward rotation.
Elbow: Flexion or extension.
Forearm: Supination.
Wrist: Flexion, radial deviation
Fingers & Thumb: Flexion, adduction.
D1 Shoulder extension
Shoulder Jt: Extension-abduction-internal Rotation.
Scapula: Depression, adduction, downward rotation.
Elbow: Flexion or extension.
Forearm: Pronation.
Wrist: Extension, ulnar deviation.
Fingers & Thumb: Extension, abduction.
D1 Hip flexion
Hip: Flexion-adduction-external Rotation.
Knee: Flexion or extension.
Ankle: Dorsiflexion, Inversion.
Toes: Extension
D1 Hip extension
Hip: Extension-abduction-internal Rotation.
Knee: Flexion or extension.
Ankle: planter-flexion, Eversion.
Toes: Flexion
 D2 Flexion-Extension patterns
D2 Shoulder flexion D2 Hip flexion

Shoulder: Flexion-abduction-external Rotation. Hip: Flexion-abduction-internal Rotation.

Scapula: Elevation, abduction, Knee: Flexion or extension.
upward rotation. Ankle: Dorsiflexion, Eversion.
Elbow: Flexion or extension. Toes: Extension
Forearm: Supination.
Wrist: Extension, radial Deviation.
Fingers: Extension, abduction.

D2 Shoulder extension D2 Hip extension

Shoulder: Extension-adduction-internal Rotation. Hip: Extension-adduction-external Rotation.

Scapula: Depression, adduction Knee: Flexion or extension.
downward rotation. Ankle: Plantarflexion, Inversion.
Elbow: Flexion or extension. Toes: Flexion.
Forearm: Pronation.
Wrist: Flexion, ulnar Deviation.
Fingers and Thumb: Flexion, adduction.
 UPPER EXTREMITY

F-ABD-ER
F-ADD-ER

E-ABD-IR E-ADD-IR
 PATTERNS
D2 Flexion D1 Flexion
Shoulder FLEX, ABD, Shoulder FLEX, ADD,
ER ER
Forearm - Sup Forearm - Sup
Wrist - Rad. Flexion Wrist - Rad. Flexion
Fingers - Extension Fingers - flexion
R/ 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
 PNF techniques
1-Rhythmic initiation: teaching tech then pt alone.
2-Repeated contractions/Stretch: initiation of movement (quick stretches in weak points throughout
resisted movement pattern arch- for weak endurance).
3-Rhythmic Rotation: Passive rotation or rolling of the part agonist/antagonist to relax.
4-Contract relax: increase ROM- from lengthened muscle position resistance at the end ROM then
relax-move through the rest to gain more range..
5-Hold-Relax: increase ROM, decrease pain- isometric contraction from lengthened position then
relax-move through the rest to gain more range..
6-Combination of Isotonics. strength, coordination and eccentric strength(combination of
contraction patterns: isometric, isotonic concentric or eccentric).
7-Dynamic Slow reversal: strength, coordination and endurance. Resistance both directions; no rest.
8-Slow reversal/Hold: same as (7) but with isometric hold at the end then change the direction.
9-Alternating Isometric/Stabilizing reversals: as in (7) but very little movement is allowed: alternating
isotonic contractions opposed by enough resistance to prevent movement: stability, strength,
coordination.(trunk, neck) both hands in the same direction then change one by one.
10-Rythmic Stabilization: alternating isometric strength/stability. Resist both agonist then
antagonist(trunk rot). No movement allowed.
11-Stabilizing reversals: Smaller ROM till ossilation/static on weak part.
12-Replication: facilitate motor learning: resistance at end range then relax-move limb a bit
backwards in ROM then apply resistance then relax and go further.