INJURY PREVENTION &

PERFORMANCE ENHANCEMENT Monique Mokha, PhD, ATC, Report Editor

Proprioceptive Neuromuscular Facilitation

for Trunk Mobility and Strength
R. Barry Dale, PhD, PT, ATC, CSCS • University of Tennessee at Chattanooga
and Danny Myers, MS • Siskin Hospital for Physical Rehabilitation

P roprioceptive Neuromuscular Facilitation

(PNF) is a widely accepted technique in sport-
ion, right lateral flexion, and moving into left
rotation when the peak compressive forces
specific rehabilitation;1-3 however, PNF for the occur. Given the magnitude of these forces,
trunk has not been well documented.4,5 Trunk
mobility and strength are requisite for most
if not all athletic maneuvers, and this is espe-
cially true for sports
that require trunk rota-
Key Points tion such as baseball
Proprioceptive neuromuscular facilitation and golf. The purpose
is an effective exercise option for sport- of this report is to pres-
specific rehabilitation. ent “PNF chops” and
bilateral leg movement
Sports with swinging motions place sig- patterns as exercises
nificant stress upon the spine. that address the bio-
mechanical demands
Sport-specific rehabilitation should exer- placed on the spine of
cise trunk musculatur the golfer.

Golf
Golf is a popular recreational and competitive
sport activity that places significant stresses
upon the spine. Vertebral compressive forces
approach 7-8 times one’s body mass during
the golf swing, and the vertebral facet joints
experience shear forces up to 600 N during
the performance of a golf swing.6 Maximal
Figure 1 Pilot data from our lab: The top portion of the
stress occurs during the downswing, just figure shows vertical compressive forces at the lumbar
prior to impact of the club against the ball region, which peak (arrow) shortly before impact (bottom
portion of the figure). The units are in Newtons normalized
(Figure 1). The vertebrae of a right-handed to body mass (peaks over nine times body mass for this
golfer are typically in a position of trunk flex- subject). Negative values denote downward force direction.

© 2009 Human Kinetics - ATT 14(5), pp. 26-29

26  SEPTEMBER 2009 Athletic Therapy Today

 it is not surprising that low back injuries are common
in the sport.7
Various trunk muscles are active during the swing
to provide dynamic stability while simultaneously con-
tributing to swing velocity. Muscles shown to be active
during the full golf swing are the contralateral external
oblique and ipsilateral internal oblique, while the erector
spinae, rectus abdominis, quadratus lumborum, trans-
verse abdominis, and multifidi provide stability.8,9 How-
ever, following bouts of low back pain, the recruitment
of these dynamic spine stabilizers is comprimised.10,11
Golfers who suffer back injury need proper trunk reha-
bilitation for successful return to sport.
PNF for the Trunk
Trunk muscle rehabilitation following back injury
should restore motor control, mobility, strength, and
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endurance. Progression of trunk rehabilitation should
include sport-specific movements as tolerated by the
athlete, and PNF is an excellent adaptable exercise
option. There are multiple applications of PNF for the
golfer. The following sections describe the application
of chops and bilateral lower extremity movement
patterns during the sport-specific phase of rehabilita-
tion. The specific motion patterns presented here are
designed for a right-handed golfer and were chosen
because they produce motions and activate trunk
musculature similar to that which is associated with
the golf downswing.
Chopping Motions
Chopping motions involve a combination movement
patterns of the upper extremities that activate the trunk
musculature (obliques and rectus abdominus).12 The
movement patterns are bilateral, asymmetrical, and
diagonal. Various techniques may be utilized during
their performance, which is similar to other PNF pat-
terns. When chopping to the left, the athlete begins
with the left upper extremity in glenohumeral flexion,
adduction, and external rotation, and moves into
extension, abduction, and internal rotation (Diagonal 1
extension). The right upper extremity moves from
glenohumeral flexion, abduction, and external rota-
tion into extension, adduction, and internal rotation
(Diagonal 2 extension). Resistance should be applied to
the upper extremities as a unit to engage the trunk.12
Manual resistance or exercise equipment (i.e., cable
pulleys or elastic tubing) are options for generation of
resistance to the movement.
Athletic Therapy Today
Chopping Motions With Manual Resistance
Manual resistance provides information about the
athlete’s ability to engage the trunk musculature and
facilitates teaching of the chopping pattern. When
performing the exercise against manual resistance, the
athlete should be in a supine or sitting position. The
athlete’s head follows the hands during the movement.
It is helpful for the right hand to hold the left hand at
the wrist, while resistance is applied to the extremities
by the athletic trainer or therapist (standing on the left
side of the athlete during chops to the left). When the
athlete holds onto the left extremity at the wrist with
the right hand, it requires elbow flexion at the begin-
ning of the pattern, which is a slight modification of the
right arm’s flexion-abduction-external rotation pattern.
Resistance is applied from the left hand of the athletic
trainer or therapist, while the right hand applies resis-
tance to the athlete’s head. Emphasis on activation of
the trunk musculature may occur at the completion of
the pattern, as the athletic trainer or therapist attempts
to move the athlete’s upper extremities and head to
the beginning positions. ( Please see video in the
online version of this article.)
Chopping Motions With Apparatus
Chopping may also be performed against resistance
provided by a cable-pulley system or resistive tubing
(Figures 2 and 3). The athlete begins with both extremi-
ties elevated and then moves them into the chopping
pattern toward the contralateral hip.
Golf-Specific Adaptations
Golf-specific modifications of the chopping motion
replicate movements that normally occur during the
golf-swing. The first modification is to have the athlete
keep the elbow of the lead arm in extension at the
beginning position of glenohumeral flexion, adduc-
tion, and external rotation. Both hands should be in
the proper relationship to one another for gripping a
golf club, which implies that the right elbow is allowed
to flex as it normally would in the backswing. Right
elbow movement described here is consistent with
the manually resisted pattern described previously.
Second, the athlete begins the movement by adduct-
ing the right shoulder, while the left shoulder follows.
This initial motion against resistance is associated with
activation of the right lateral trunk flexors and glenohu-
SEPTEMBER 2009  27

Figure 2 The beginning position for PNF chops to the left using a basic
Downloaded by York Univ Libraries on 09/19/16, Volume 14, Article Number 5
cable pulley system.
Figure 3 The ending position for PNF chops to the left using a basic
cable pulley system.
meral adductors, while the pelvis naturally rotates open
toward the target, which replicates the club dropping
“into the slot.”13 The final motion involves both arms
moving toward the left hip; the left hand moves into
supination, while the right hand moves into prona-
tion. These motions should allow the hands to be in
a neutral position when crossing midline to replicate
the “squaring” of the hands and clubface at impact.13
Lateral Trunk Bending
Bilateral lower extremity patterns are also useful for
activating the trunk musculature. There are several
28  SEPTEMBER 2009
patterns from which to choose, but the one that best
replicates motions associated with the golf swing is a
modified trunk lateral bending pattern. This pattern
engages lateral trunk flexors as the hips rotate.12 A
modification to this pattern can be performed in a
side-lying position (the athlete should perform these
exercises on each side).
The trunk lateral bending pattern in a side-lying
position activates the quadratus lumborum, latissi-
mus dorsi, and the abdominal oblique muscles.12 The
athlete flexes the hips and knees to 90 degrees, while
the head is supported with a pillow. Movement begins
with the heels lifted off the surface, which requires the
athlete to bring the top lower extremity into internal
hip rotation, while the bottom lower extremity moves
into external hip rotation. Because the muscles that
perform these motions are often relatively weak, the
athletic trainer or therapist may not need to provide
manual resistance.
A possible progression in exercise difficulty is to
have the athlete combine the chopping and bilateral
lower extremity trunk flexion movements while lying
on a plinth. Resistance to the upper extremities can
be provided by resistive tubing or manual force. An
example of how this exercise can be performed with
tubing involves the athletic trainer or therapist stand-
ing at the athlete’s head and facing the athlete’s feet.
The athlete and athletic trainer or therapist hold onto
to opposite ends of the tubing, while the athlete moves
into the modified chopping pattern. For example, the
right-handed athlete would lie on his or her left side
with the knees and hips flexed to 90 degrees, move
the hips into rotation by lifting the heels off the mat,
and then position the upper extremities for chopping to
the left. The tubing resists the chopping motion while
the athlete maintains isometric hip rotation with the
heels lifted off the mat.
Conclusion
We have presented PNF chopping and lateral bend-
ing exercises for the trunk. These patterns replicate
motions associated with the golf swing and challenge
the musculature that provides trunk stability. 
Acknowledgment
The authors would like to thank Clint Odom for his
assistance with the video preparation.
Athletic Therapy Today
 References
1. Sharman MJ, Cresswell AG, Riek S. Proprioceptive neuromuscular
facilitation stretching: mechanisms and clinical implications. Sports
Med. 2006;36(11):929-939.
2. Panariello R. Arm deceleration training for the baseball pitcher.
Strength and Cond. 1992;14(6):19-25.
3. Surburg PR, Schrader JW. Proprioceptive neuromuscular facilita-
tion techniques in sports medicine: a reassessment. J Athl Train.
1997;32(1):34-39.
4. Kofotolis N, Kellis E. Effects of two 4-week proprioceptive neuro-
muscular facilitation programs on muscle endurance, flexibility, and
functional performance in women with chronic low back pain. Phys
Ther. 2006;86(7):1001-1012.
5. Johnson G, Johnson V. The application of the principles and procedures
of PNF for the care of lumbar spinal instabilities. J Man Manip Ther.
2002;10(2):83-105.
6. Hosea TM, Gatt CJ, Jr. Back pain in golf. Clin Sports Med. Jan
1996;15(1):37-53.
7. Fradkin AJ, Cameron PA, Gabbe BJ. Golf injuries--common and poten-
tially avoidable. J Sci Med Sport. Jun 2005;8(2):163-170.
Downloaded by York Univ Libraries on 09/19/16, Volume 14, Article Number 5
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Athletic Therapy Today
8. Andersson EA, Grundstrom H, Thorstensson A. Diverging intramus-
cular activity patterns in back and abdominal muscles during trunk
rotation. Spine. 2002;27(6):E152-160.
9. McHardy A, Pollard H. Muscle activity during the golf swing. Br J Sports
Med. 2005;39(11):799-804; discussion 799-804.
10. Hodges PW, Richardson CA. Inefficient muscular stabilization of the
lumbar spine associated with low back pain. A motor control evalu-
ation of transversus abdominis. Spine. 1996;21(22):2640-2650.
11. Hodges PW, Richardson CA. Altered trunk muscle recruitment in
people with low back pain with upper limb movement at different
speeds. Arch Phys Med Rehabil. 1999;80(9):1005-1012.
12. Adler SS, Beckers D, Buck M. PNF in Practice: An Illustrated Guide. 2nd
ed. New York: Springer; 2003.
13. Newell S. The Golf Instruction Manual. New York: Dorling Kindersley;
2001.
R. Barry Dale is with the Physical Therapy Department at the University
of Tennessee, Chattanooga.
Danny Myers is with the Siskin Physical Rehabilitation Hospital Fitness
Center in Chattanooga.
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