Basics Of PNF

By Dwaipayan Pal
BPT

DEFINITION AND PNF PHILOSOPHY

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

PNF philosophy 1. Positive approach: no pain, achievable tasks, set up for success, direct and indirect treatment, strong start. 2. Highest functional level: functional approach, ICF, include treatment on body structure level and activity level. 3. Mobilize potential by intensive training: active participation, motor learning, self-training.

ICF= International Classification Of Functioning, WHO

Consider the total human being: whole person with his/her environmental, personal, physical, and emotional factors. 5. Use of motor control and motor learning principles: repetition in a different context; respect stages of motor control, variability of practice. 4.

These basic procedures are used to: ‡ Increase the patient s ability to move or remain stable. Their effectiveness does not depend on having the conscious cooperation of the patient. ‡ Help the patient achieve coordinated motion through timing.The basic facilitation procedures provide tools for the therapist to help the patient gain efficient motor function and increased motor control. ‡ Guide the motion by proper grips and appropriate resistance. ‡ Increase the patient s stamina and avoid fatigue. .

‡ Manual contact: To increase power and guide motion with grip and pressure. ‡ Verbal (commands): Use of words and the appropriate vocal volume to direct the patient. ‡ Irradiation and reinforcement: Use of the spread of the response to stimulation.The basic procedures for facilitation are: ‡ Resistance: To aid muscle contraction and motor control. . ‡ Body position and body mechanics: Guidance and control of motion or stability. to increase strength. aid motor learning.

. components of functional normal motion. Timing: Promote normal timing and increase muscle contraction through timing for emphasis . Traction or approximation: The elongation or compression of the limbs and trunk to facilitate motion and stability.Vision: Use of vision to guide motion and increase force. Stretch: The use of muscle elongation and the stretch reflex to facilitate contraction and decrease muscle fatigue. Patterns: Synergistic mass movements.

Basic neurophysiologic principles By Sherrington. 1947 ‡ Afterdischarge: The effect of a stimulus continues after the stimulus stops. ‡ Temporal summation: A succession of weak stimuli (subliminal) occurring within a certain (short) period of time combine (summate) to cause excitation. . ‡ Spatial summation: Weak stimuli applied simultaneously to different areas of the body reinforce each other (summate) to cause excitation.

‡ Irradiation: This is a spreading and increased strength of a response. ‡ Successive induction: An increased excitation of the agonist muscles follows stimulation (contraction) of their antagonists. It occurs when either the number of stimuli or the strength of the stimuli is increased. The response may be either excitation or inhibition. . ‡ Reciprocal innervation (reciprocal inhibition): Contraction of muscles is accompanied by simultaneous inhibition of their antagonists.

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The techniques described are: ‡ RHYTHMIC INITIATION ‡ COMBINATION OF ISOTONICS ‡ REVERSAL OF ANTAGONISTS DYNAMIC REVERSAL OF ANTAGONISTS (INCORPORATES SLOW REVERSAL) STABILIZING REVERSAL RHYTHMIC STABILIZATION ‡ REPEATED STRETCH (REPEATED CONTRACTION) REPEATED STRETCH FROM BEGINNING OF RANGE REPEATED STRETCH THROUGH RANGE ‡ CONTRACT-RELAX ‡ HOLD-RELAX ‡ REPLICATION .

RHYTHMIC INITIATION ‡ Characterization Rhythmic motion of the limb or body through the desired range. . starting with passive motion and progressing to active resisted movement.

Indications ‡ Difficulties in initiating motion ‡ Movement too slow or too fast ‡ Uncoordinated or dysrhythmic motion.. ataxia and rigidity ‡ Regulate or normalize muscle tone ‡ General tension .e. i.

. For treatment. eccentric. and stabilizing contractions of one group of muscles (agonists) without relaxation. start where the patient has the most strength or best coordination.COMBINATION OF ISOTONICS ‡ Characterization Combined concentric.

Indications ‡ Decreased eccentric control ‡ Lack of coordination or ability to move in a desired direction ‡ Decreased active range of motion ‡ Lack of active motion within the range of motion .

Example of combination of isotonics .

REVERSAL OF ANTAGONISTS Dynamic Reversals (Incorporates Slow Reversal) ‡ Characterization Active motion changing from one direction (agonist) to the opposite (antagonist) without pause or relaxation. .

Indications ‡ Decreased active range of motion ‡ Weakness of the agonistic muscles ‡ Decreased ability to change direction of motion ‡ Exercised muscles begin to fatigue ‡ Relaxation of hypertonic muscle groups .

Dynamic Reversals .

or don t let me push you ) and the therapist allows only a very small movement.STABILIZING REVERSALS ‡ Characterization Alternating isotonic contractions opposed by enough resistance to prevent motion. The command is a dynamic command ( push against my hands . .

Indications ‡ Decreased stability ‡ Weakness ‡ Patient is unable to contract muscle isometrically and still needs resistance in a one-way direction .

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no motion intended.RHYTHMIC STABILIZATION ‡ Characterization Alternating isometric contractions against resistance. .

particularly when motion is attempted ‡ Joint instability ‡ Weakness in the antagonistic muscle group ‡ Decreased balance Contraindications ‡ Rhythmic stabilization may be too diffi cult for patients with cerebellar involvement (Kabat 1950) ‡ The patient is unable to follow instructions due to age. language diffi culty.Indications ‡ Limited range of motion ‡ Pain. cerebral dysfunction .

REPEATED STRETCH (REPEATED CONTRACTIONS) ‡ Repeated Stretch from Beginning of Range ‡ Characterization The stretch reflex elicited from muscles under the tension of ELONGATION. .

Indications ‡ Weakness ‡ Inability to initiate motion due to weakness or rigidity ‡ Fatigue ‡ Decreased awareness of motion Contraindications ‡ Joint instability ‡ Pain ‡ Unstable bones due to fracture or osteoporosis ‡ Damaged muscle or tendon .

Theorem Behind The Technique .

.REPEATED STRETCH THROUGH RANGE ‡ Characterization The stretch reflex elicited from muscles under the tension of CONTRACTION.

Indications ‡ Weakness ‡ Fatigue ‡ Decreased awareness of desired motion Contraindications ‡ Joint instability ‡ Pain ‡ Unstable bones due to fracture or osteoporosis ‡ Damaged muscle or tendon .

.CONTRACT-RELAX ‡ Contract-Relax: Direct Treatment ‡ Characterization Resisted isotonic contraction of the restricting muscles (antagonists) followed by relaxation and movement into the increased range.

Indication ‡ Decreased passive range of motion .

Direct treatment for shortened shoulder extensor and adductor muscles Indirect treatment for shortened shoulder extensor and adductor muscles .

‡ Don t let me push your arm down. keep pushing up. .‡ Contract-Relax: Indirect Treatment Description ‡ The technique uses contraction of the agonistic muscles instead of the shortened muscles.

Indication ‡ Use the indirect method when the contraction of the restricting muscles is too painful or too weak to produce an effective contraction. .

HOLD-RELAX ‡ Hold-Relax: Direct Treatment ‡ Characterization Resisted isometric contraction of the antagonistic muscles (shortened muscles) followed by relaxation .

‡ ‡ ‡ ‡ Indications Decreased passive range of motion Pain The patient s isotonic contractions are too strong for the therapist to control Contraindication The patient is unable to do an isometric contraction .

‡ Hold-Relax: Indirect Treatment ‡ In the indirect treatment with Hold-Relax you resist the synergists of the shortened or painful muscles and not the painful muscles or painful motion. If that still causes pain. resist the synergistic muscles of the opposite pattern instead .

.‡ Indication When the contraction of the restricted muscles is too painful.

Teaching the patient the outcome of a movement or activity is important for functional work (for example sports) and self-care activities .‡ Characterization A technique to facilitate motor learning of functional activities.

passively a short distance back in the opposite direction. ‡ Ask the patient to relax. Move the patient.Description ‡ Place the patient in the end position of the activity where all the agonist muscles are shortened. . ‡ The patient holds that position while the therapist resists all the components. then ask the patient to return to the end position. ‡ Use all the basic procedures to facilitate the patient s muscles.

Change rate of motion ‡ Rhythmic Initiation ‡ Dynamic Reversals ‡ Repeated Stretch from beginning of range ‡ Repeated Stretch through range .SUMMARY ‡ PNF Techniques and Their Goals 1. Learn a motion ‡ Rhythmic Initiation ‡ Combination of Isotonics ‡ Repeated Stretch from beginning of range ‡ Repeated Stretch through range ‡ Replication 3. Initiate motion ‡ Rhythmic Initiation ‡ Repeated Stretch from beginning of range 2.

4. Increase stability ‡ Combination of Isotonics ‡ Stabilizing Reversals ‡ Rhythmic Stabilization 6. Increase strength ‡ Combination of Isotonics ‡ Dynamic Reversals ‡ Rhythmic Stabilization ‡ Stabilizing Reversals ‡ Repeated Stretch from beginning of range ‡ Repeated Stretch through range 5. Increase coordination and control ‡ Combination of Isotonics ‡ Rhythmic Initiation ‡ Dynamic Reversals ‡ Stabilizing Reversals ‡ Rhythmic Stabilization ‡ Repeated Stretch from beginning of range ‡ Replication .

Decrease pain ‡ Rhythmic Stabilization (or Stabilizing ‡ Reversals) ‡ Hold-Relax . Increase range of motion ‡ Dynamic Reversals ‡ Stabilizing Reversals ‡ Rhythmic Stabilization ‡ Repeated Stretch from beginning of range ‡ Contract-Relax ‡ Hold-Relax 9.7. Relaxation ‡ Rhythmic Initiation ‡ Rhythmic Stabilization ‡ Hold-Relax 10. Increase endurance ‡ Dynamic Reversals ‡ Stabilizing Reversals ‡ Rhythmic Stabilization ‡ Repeated Stretch from beginning of range ‡ Repeated Stretch through range 8.