PROPRIOCEPTIVE NEUROMUSCULAR

FACILITATION
( PNF )

SALONI SHETTY
 INTRODUCTION
• PNF was first developed by Margaret Knott and Herman
Kabat in 1940s and 1950s

• It uses proprioceptive, cutaneous and auditory input to produce

functional improvement of motor output and thus plays an
important role in the rehabilitation process of many conditions
and injuries.
 INTRODUCTION
• Proprioception : 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

 DEFINITION OF PNF

Proprioceptive neuromuscular facilitation is an

approach to therapeutic exercise that combines
functionally based diagonal patterns of movement with
techniques of neuromuscular facilitation to evoke
motor responses and improve neuromuscular control
and function (Kisner)
 GOALS OF PNF TECHNIQUES

• To initiate motion

• Learn a motion

• Change rate of motion

• Increase strength

• Increase stability

• Increase coordination and control

GOALS (contd)

• Increase endurance

• Increase ROM

• Relaxation

• Decrease pain
 BASIC NEUROPHYSIOLOGIC
PRINCIPLES OF PNF
• Given by Dr. Sherington in the 1930s.

• These techniques was used as a basis to either induce

voluntary muscle contractions or to reduce abnormal tone.

• PNF applies this principle of motor and sensory system for

manual evaluation and treatment of neuromuscular system.
NEUROPHYSIOLOGIC PRINCIPLES

• After discharge

• Temporal summation

• Spatial summation

• Irradiation

• Successive induction

• Autogenic inhibition

• Reciprocal inhibition
• After discharge: The effect of stimulus continuous
even after the application of stimulus stops.

• Temporal summation: A sequence of weak stimuli

over a short period of time causes excitation and thus
can improve motor response.

• Spatial summation: Weak stimuli applies

simultaneously to various body parts reinforce each
other and summate to cause excitation.
• Irradiation: Extension of response to the surrounding
area due to increase in number of strength of the stimuli.

• Successive induction: Increased excitation of agonist

muscles follows the stimulation of their antagonist
muscles.

• Autogenic inhibition: Relaxation of muscle in response

to high tension, also known as Inverse Myotatic Reflex.
• Reciprocal inhibition: Relaxation of muscle in
response to the contraction of its antagonist
 DIAGONAL PATTERNS OF PNF

• Patterns are composed of multijoint, multiplanar,

diagonal, and rotational movements of the extremities.

• There are two pairs of diagonal patterns for the upper and
lower extremities: diagonal 1 (D1 ) and diagonal 2 (D2 ).

• D1 Flexion or D1 Extension and D2 Flexion or D2

Extension of the upper or lower extremities.
Contd..

• Diagonal patterns can be carried out unilaterally or

bilaterally.
 UPPER EXTREMITY DIAGNAL
PATTERNS
D1 FLEXION D1 EXTENSION D2 FLEXION D2 EXTENSION

SHOULDER F- AD-ER EX-AB-IR F-AB-ER EX-AD-IR

(FADER) (EXABIR) (FABER) (EXADIR)

ELBOW Flexion/ Flexion/ Flexion/ Flexion/

Extension Extension Extension Extension

FOREARM Supination Pronation Supination Pronation

WRIST Flexion, Extension, Extension, Flexion,
Radial Deviation Ulnar Deviation Radial deviation Ulnar Deviation

FINGERS and Flexion, Extension, Extension, Flexion,

THUMB Adduction Abduction Abduction Adduction
 LOWER EXTREMITY DIAGONAL
PATTERNS

D1 FLEXION D1 EXTENSION D2 FLEXION D2 EXTENSION

HIP F- AD-ER EX-AB-IR F-AB-IR EX-AD-ER

KNEE Flexion/ Flexion/ Flexion/ Flexion/

Extension Extension Extension Extension
ANKLE Dorsiflexion, Plantarflexion, Dorsiflexion, Plantarflexion,
Inversion Eversion Eversion Inversion

TOES Extension Flexion Extension Flexion

BASIC PROCEDURES WITH PNF PATTERNS
• Manual contact
• Maximal resistance
• Position and movement of the therapist
• Stretch
• Normal timing
• Traction
• Approximation
• Verbal commands
• Visual cues
MANUAL CONTACTS
• How and where the therapist’s hands are placed on the
patient.

• Whenever possible, manual contacts are placed over the

agonist muscle groups or their tendinous insertions.

• These contacts allow the therapist to apply resistance to

the appropriate muscle groups and cue the patient as to
the desired direction of movement
MAXIMAL RESISTANCE

• Resistance should be adjusted throughout the pattern

to accommodate to strong and weak components of
the pattern.
STRETCH

• Stretch stimulus: The stretch stimulus is the placing of body

segments in positions that lengthen the muscles that are to
contract during the diagonal movement pattern.

• Stretch reflex: The stretch reflex is facilitated by a rapid

stretch (overpressure) at the point of tension to an already
elongated agonist muscle.
NORMAL TIMING

• A sequence of distal to proximal, coordinated

muscle contractions occurs during the diagonal
movement patterns.

• Correct sequencing of movements promotes

neuromuscular control and coordinated
movement.
TRACTION

• Traction is most often applied during flexion

(antigravity) patterns
APPROXIMATION

• The gentle compression of joint surfaces by means of

manual compression or weight bearing stimulates co-
contraction of agonists and antagonists to enhance
dynamic stability and postural control.
VERBAL COMMANDS

• Auditory cues are given to enhance motor output.

VISUAL CUES

• The patient is asked to follow the movement of a limb

to further enhance control of movement throughout
the ROM.
 TECHNIQUES

• Mobility: Contract relax, Hold relax, Rhythmic initiation.

• Strengthening: Slow reversals, repeated contractions,

timing for emphasis, rhythmic stabilization.

• Stability: Alternating isometric, rhythmic stabilization.

• Skill: Timing for emphasis, resisted progression.

• Endurance: Slow reversals, agonist reversal

 RHYTHMIC INITIATION
• Rhythmic initiation is used to promote the ability to
initiate a movement pattern.
• After the patient voluntarily relaxes, the therapist moves
the patient’s limb passively through the available range of
the desired movement pattern several times so the patient
becomes familiar with the sequence of movements within
the pattern.
• It also helps the patient understand the rate at which
movement is to occur
 RHYTHMIC STABILIZATION
• Rhythmic stabilization is typically performed in
weight-bearing positions to incorporate joint
approximation into the procedure, hence further
facilitating co-contraction.

• Used for stability through co-contraction of muscles

surrounding target joint; resistance applied to
isometric contraction alternately using rotation
 RHYTHMIC STABILIZATION

• Rhythmic stabilization is typically performed in

weight-bearing positions to incorporate joint
approximation into the procedure, hence further
facilitating co-contraction.
 HOLD RELAX

• Passive stretch>> Isometric(6-10 sec)>> Relax

 CONTRACT RELAX

• Passive stretch>> Contract while moving>> Relax

 SLOW REVERSALS

• It involves dynamic concentric contraction

of a stronger agonist pattern immediately
followed by dynamic concentric contraction
of the weaker antagonist pattern.
• There is no voluntary relaxation between
patterns.
 SLOW REVERSALS

• It involves dynamic concentric contraction of a

stronger agonist pattern immediately followed by
dynamic concentric contraction of the weaker
antagonist pattern.

• There is no voluntary relaxation between patterns.

 REPEATED CONTRACTION

• Repeated, dynamic contractions, initiated with

repeated quick stretches followed by resistance, are
applied at any point in the ROM to strengthen a weak
agonist component of a diagonal pattern.
 ALTERNATING ISMOTERICS
• Used to strengthen muscles and increase stability

• Resistance with isometric contractions against

agonist and antagonist in an alternate fashion to
increase stability
 RESISTED PROGRESSION

• Increase strength or endurance

• PRE

• Motion is resisted during walking, creeping or

crawling.
 AGONIST REVERSAL

• Concentric contraction of agonist group resisted

then patient is asked to perform eccentric
contraction of agonist against resistance.
THANK YOU