PROPRIOCEPTIVE

NEUROMUSCULAR
FASCILITATION
Abdullah A.
  Memahami teknik dasar terapi PNF
Goals  Memahami macam – macam teknik PNF
 Menerapkan teknik terapi PNF dalam kondisi tertentu
 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: Berhubungan dengan reseptor sensorik yang

memberikan informasi mengenai gerakan dan posisi tubuh
 Neuromuskuler: Melibatkan saraf dan otot
Definition of  Fasilitasi: Mempermudah

PNF  Fasilitasi neuromuskuler propriokeptif (PNF) adalah pendekatan

philosophy untuk latihan terapi yang menggabungkan pola gerakan
diagonal berdasarkan fungsional dengan teknik fasilitasi
neuromuskuler.
 untuk membangkitkan respons motorik dan meningkatkan
kontrol dan fungsi neuromuskuler.

Adler, Beckers, and Buck, 2008 Kisner and Colby, 2007

  This widely used approach to exercise was developed during the
History 1940s and 1950s by the pioneering work of Kabat, Knott, and Voss

Kisner and Colby, 2007

  PNF is an integrated approach: each treatment is directed at a
Principles basic total human being, not just at a specific problem or body segment

to PNF  The primary goal of all treatment is to help patients achieve their
highest level of function.

Adler, Beckers, and Buck, 2008

PNF  develop muscular strength and endurance;
 facilitate stability, mobility, neuromuscular control, and
techniques can coordinated movements;
be used to….  and lay a foundation for the restoration of function

Kisner and Colby, 2007

PNF
techniques are
useful  the early phase of tissue healing when isometric techniques are
throughout appropriate

the continuum  to the final phase of rehabilitation when high-speed, diagonal

movements can be performed against maximum resistance.
of
rehabilitation
from….

Kisner and Colby, 2007

Hallmarks of  the use of diagonal patterns and the application of sensory cues—
specifically proprioceptive, cutaneous, visual, and auditory
this approach stimuli—to elicit or augment motor responses.
to therapeutic  the stronger muscle groups of a diagonal pattern facilitate the
responsiveness of the weaker muscle groups
exercise are….

Kisner and Colby, 2007

 The patterns of movement associated with PNF are composed of
multijoint,
Diagonal multiplanar,
patterns diagonal,
and rotational movements of the extremities, trunk, and neck

Kisner and Colby, 2007

 Manual contact
• refers to how and where the therapist’s hands are placed
on the patient.

Basic Maximal resistance

procedures • To aid muscle contraction and motor control, to increase
strength, aid motor learning.
with PNF
Position and movement of the therapist
patterns
• Guidance and control of motion or stability.

Stretch
• The use of muscle elongation

Adler, Beckers, and Buck, 2008 Kisner and Colby, 2007

 Traction
• to inhibit pain and facilitate movement during execution of
the movement patterns

Basic Approximation
• Gentle compression of joint surface to stimulate contraction,
procedures and muscle mechanoreceptors
with PNF Verbal commands
patterns • to help maintain the patient’s attention.

Visual Cues
• The patient is asked to follow the movement of a limb to
further enhance control of movement throughout the ROM.

Kisner and Colby, 2007

Adler, Beckers, and Buck, 2008
Lumbrical grip

Adler, Beckers, and Buck, 2008

Adler, Beckers, and Buck, 2008
 • 1. Flexion–abduction–external rotation and
The upper extension– adduction–internal rotation
extremity: • 2. Flexion–adduction–external rotation and
extension– abduction–internal rotation

Diagonal
The scapular • anterior elevation – posterior depression
Motion and pelvic: • posterior elevation – anterior depression.

• Flexion–abduction–internal rotation and

The lower extension– adduction–external rotation
extremity: • Flexion–adduction–external rotation and
extension– abduction–internal rotation
 Starting position in:
o shoulder extension, abduction,
and internal rotation;
o elbow extension; forearm
Upper pronation;
o and wrist and finger extension
extremity Ending position:
diagonal  Shoulder flexion, adduction,
external rotation;
patterns  partial elbow flexion; forearm
supination;
 and wrist and finger flexion.

Kisner and Colby, 2007

Adler, Beckers, and Buck, 2008
 Starting position:
 Shoulder flexion, adduction,
external rotation;
 partial elbow flexion; forearm
supination;
 and wrist and finger flexion.
Upper
extremity
diagonal Ending position
patterns  shoulder extension, abduction,
internal rotation;
 elbow extension; forearm
pronation;
 and wrist and finger extension.

Kisner and Colby, 2007

 Starting position:
 shoulder extension, adduction,
and internal rotation;
 elbow extension; forearm
pronation;
 and wrist and finger flexion.
 The forearm should lie across the
umbilicus.
Upper
extremity
Ending position:
diagonal  shoulder flexion, abduction, and
patterns external rotation;
 elbow extension; forearm
supination; and wrist and finger
extension.
 The arm should be 8 to 10 inches
from the ear; the thumb should be
pointing to the floor.

Kisner and Colby, 2007

 Starting position:
 shoulder flexion, abduction, and
external rotation;
 elbow extension; forearm
supination; and wrist and finger
extension.
 The arm should be 8 to 10 inches
from the ear; the thumb should be
Upper pointing to the floor.

extremity
diagonal Ending position:

patterns  shoulder extension, adduction,

and internal rotation;
 elbow extension; forearm
pronation; and wrist and finger
flexion.
 The forearm should cross the
umbilicus.

Kisner and Colby, 2007

Adler, Beckers, and Buck, 2008
 Starting position:
 hip extension, abduction, and
internal rotation;
 knee extension;
 plantar flexion and eversion of
the ankle; and toe flexion
Lower
extremity Ending position:
diagonal  hip flexion, adduction, and external
rotation;
pattern  knee flexion (or extension);
 ankle dorsiflexion and inversion; toe
extension.
 The hip should be adducted across the
midline, creating lower trunk rotation to
the patient’s (L) side.

Kisner and Colby, 2007

Starting position:
 hip flexion, adduction, and
external rotation;
 knee flexion (or extension);
 ankle dorsiflexion and inversion;
toe extension.

Ending position:
 hip extension, abduction, and
internal rotation;
 knee extension or flexion;
 ankle plantarflexion and eversion;
and toe flexion.

Kisner and Colby, 2007

Starting position:
 hip extension, adduction, and
external rotation;
 knee extension;
 ankle plantarflexion and
inversion; and toe flexion.

Ending position:
 hip flexion, abduction, and internal
rotation;
 knee flexion (or extension);
 ankle dorsiflexion and eversion;
and toe extension.

Kisner and Colby, 2007

Starting position:
 hip flexion, abduction, and
internal rotation;
 knee flexion (or extension);
 ankle dorsiflexion and eversion;
and toe extension.

Ending position:
 hip extension, adduction, and
external rotation;
 knee extension;
 ankle plantarflexion and inversion;
and toe flexion.

Kisner and Colby, 2007

Adler, Beckers, and Buck, 2008
  Alternating isometric

 Manual resistance is applied in a

single plane on one side of a body
segment and then on the other.
Specific  The patient is instructed to “hold”
techniques his or her position as resistance is
alternated from one direction to
with PNF the opposite direction.
 No joint movement should occur
 This procedure isometrically
strengthens agonists and
antagonists

Kisner and Colby, 2007

  Rhythmic stabilization

 Rhythmic stabilization is used

as a progression of alternating
isometrics and is designed to
promote stability
 The therapist applies
multidirectional resistance by
placing manual contacts on
opposite sides of the body
 and applying resistance
simultaneously in opposite
directions as the patient holds
the selected position

Kisner and Colby, 2007

  Hold – Relax

 Resisted isometric contraction of

the antagonistic muscles
(shortened muscles) followed by
relaxation

Adler, Beckers, and Buck, 2008

 Direct
 The therapist or the patient
 Contract – relax moves the joint or body segment
to the end of the passive range of
motion
 The therapist asks the patient for
a strong contraction of the
restricting muscle or pattern
 the contraction should be held
for at least 5–8 seconds
 The technique is repeated until
no more range is gained

Indirect
 The technique uses contraction
of the agonistic muscles instead
of the shortened muscles.
 “Don’t let me push your arm
down, keep pushing up.”
Adler, Beckers, and Buck, 2008
 Thank you