PROPRIOCEPTIVE NEUROMUSCULAR

FACILITATION

UNIT 8
 OBJECTIVES
At the end of the lesson, students will be able to:
1. Define proprioceptive neuromuscular facilitation and
discuss the basic components of PNF.
2. List the basic techniques involved in PNF.
3. Describe the methods of performance of PNF techniques.
4. Discuss the effects and uses of different PNF techniques.
 INTRODUCTION TO FACILITATION
• The neuromuscular mechanism initiates and
achieves movement in response to a demand for
activity.
• To “Facilitate” is to “make easier”.
• Neuromuscular facilitation is the process by which
the response of the neuromuscular mechanism is
made easier.
• The technique
P N F
of proprioceptive neuromuscular
facilitation rely mainly on:
• Stimulation of the proprioceptors for increasing the
demand made on the neuromuscular mechanism to
obtain and facilitate its response.
PNF techniques were developed by Dr. Herman
Kabat and Ms. Margaret Knott.
 Introduction to the Technique of PNF
• Resistance and stretch are applied manually to muscles
working to perform patterns of mass movements along with
the dynamic commands given by verbal stimulation to the
patient’s voluntary effort.
• Maximal resistance is considered to be the most important
means of stimulating the proprioceptors
• There are certain technique of application in patterns of
mass movements
• These techniques are designed to correct imbalances.
 Basic Principles in the application
of PNF Techniques
1. PATTERNS OF FACILITATION:
n The patterns of movement used are spiral and diagonal and
are closely allied to normal functional movement and are used
in daily living.
n Each pattern has three components; Two components are
angular and third one is rotatory.
E.g., Flexion-adduction with lateral rotation of the leg
 2. MANUAL CONTACTS
n Pressure of the physiotherapist’s manual contact with the
patient contributes facilitation by stimulating the
exteroceptors.
n Manual contacts must be :
1. Purposeful -
2. Directional
3. Comfortable
 3. THE STRETCH STIMULUS AND THE
STRETCH REFLEX:
n Proprioceptors situated in the muscles – the muscle spindle
are stimulated by stretching, which increases the
intramuscular tension. The stimulation of the muscle spindle
elicits a reflex contraction of the muscle.
 4. TRACTION AND APPROXIMATION:
n Manual contacts make it possible to maintain
traction throughout the range of movement. It is
most effective when used in flexion movements.
n Compression of joint surfaces against each other
stimulates the normal circumstances which arise
during weight bearing or pushing and is mostly used
in extension movements.
 5. COMMANDS TO THE PATIENT:
n Physiotherapist’s voice is used as a verbal stimulus to demand the
patient’s maximum voluntary effort.
n Brief, simple accurate and well-timed instructions suitable for his age,
character and ability to cooperate, demand the patient’s attention and
effort at the right time and indicate the type of attention required from
him, even if he does not understand the language.
6. NORMAL TIMING:
n Timing is defined as the sequence of muscle contraction occurring in
motor activity and the production of coordinated movement to
achieve normal rhythm and timing.
 7. MAXIMAL RESISTANCE:
n It is the greatest amount or degree of resistance which can be given to
muscular contraction.
n By applying the maximal resistance all the available motor units are
activated throughout the range of movement.
8. REINFORCEMENT:
n The proprioceptive stimulation which results from tension in strongly
contracting muscles leads to a spread or overflow of excitation in the
CNS by the process of irradiation, recruiting allied muscles, by
contracting them as synergists, increasing the efficiency of the
movement
TECHNIQUES OF PNF

• REPEATED CONTRACTIONS:
• Repetition of activity against resistance is essential for the
development of muscle strength and endurance.
• The contraction of specific weak muscles or weaker components of
a pattern is repeated in this technique while they are being
reinforced by maximal isotonic or isometric contraction of stronger
allied muscle group.
• Resistance, Reinforcement from the other stronger group muscles
and timing are used in this technique.
 EFFECTS AND USES
• Rectifies the imbalances of muscle strength
• To demand relaxation of antagonistic muscles
• To gain range of movement in the treatment of stiff
joints.
 2. SLOW REVERSALS
• Movement in a strong agonistic pattern against
maximal resistance is followed immediately and
without relaxation by a reversal of the movement
into the antagonistic pattern., which is also resisted
maximally.
• The reversals of the movement takes place
smoothly with normal timing and no relaxation is
allowed as the physiotherapist changes the position
of her hands
 Effects and uses
n The technique is used to strengthen and build up
endurance of weaker muscles or of two antagonistic
patterns (both agonist and the opposing group)
n To develop co-ordination and establish the normal
reversal of antagonistic muscles in the performance
of movement.
 3. RHYTHMIC STABILIZATION

• Isometric contractions of antagonistic muscles (both agonist and the

opposing group) is used in this technique to stabilize the joints.
Stability is maintained against resistance by a co-contraction of
antagonistic muscles.
Application of Rhythmic Stabilization:
• Rhythmic Stabilization can take place at any point on the pathway of
the pattern of movement.
• The patient is instructed to ‘HOLD!’ while the physiotherapist applies
maximal resistance alternating rhythmically from one direction to
another.
 Effects and Uses
• Builds up excitation; the response of the muscles is facilitated and
their strength increased.
• Circulation is improved following Rhythmic Stabilizations,
• The energy of the contraction is being released as heat as there is no
movement.
• Any part of the range of movement can be used for this technique,
the part selected varies according to the circumstances.
• When there is joint stiffness the point at which movement is
limited is selected and Rhythmic Stabilization is followed by
an attempt to increase the free range.
• When treated for pain, the pain free range is chosen.
• All parts of the range are used successively when postural
in co-ordination is present and the technique is repeated at
each point to improve stability.
 4. Hold-Relax
• This is a relaxation technique designated to obtain
a lengthening reaction of muscles whose action is
antagonistic to the movement limited in range.
• It is effective, simple and pain free.
Technique of application of Hold-Relax
• Isometric contraction of the hyper tonic muscles:
• Movement in pattern in the direction of limitation
takes place either passively or actively.
• When movement is active it is resisted maximally
with normal timing but, whether active or passive, it
continues to the point at which it is limited either by
tension or pain.
• Having made sure that the position is pain free, the
physiotherapist changes the position of her hands and
commands the patient to ‘HOLD!’ while she applies maximal
resistance to the hypertonic muscles.
• This isometric contraction is held to obtain a build up of
excitation and then followed by the patient’s voluntary
relaxation of all the muscles. ‘Let go’ or ‘Relax’.
• Time is allowed for relaxation to take place, then an attempt is
made to move in the direction of limitation to gain an increase
in range.
• Isometric contraction of the reciprocal
muscles: The technique is applied in a similar
way to the muscles working antagonistically to the
hypertonic group are made to contract
isometrically, in order to gain reciprocal
relaxation of the hypertonic group.
 Effects and Uses
• Immediately following the isometric contraction of the hypertonic
muscles the activity of their antagonists is facilitated
(Successive induction).
• When the antagonists are facilitated, the lengthening reaction of
the hypertonic muscles is increased (reciprocal innervation).
• Hold-relax is used as a means of increasing the range of
movement in joint or of obtaining pain-free movement when
pain is a limiting factor.
 5. RHYTHMIC INITIATION
• This is a relaxation technique for specific application to the
rigidity of Parkinson’s Disease.
• Application of Rhythmic Initiation
• The limb is taken passively and rhythmically through the
range of a pattern and when some relaxation has occurred the
patient is instructed to assist in the movement.
• Several repetitions of active assisted movement are carried
out and progression is made to resisted movement.
• Finally the therapist’s hands are removed and the patient is
encouraged to maintain a free active movement.
• The rhythm must not be lost during the changes from passive to
active assisted to resisted and finally free active movement.
• Effects and Use
The rhythmical movement of this technique produces relaxation
and thus helps the Parkinson patients to improve their ability to
initiate movement.
REFERENCES:

1.Kissner, C., and Colby, L.A. (2000). Therapeutic Exercise

Foundations and techniques. Info Access and Distributions Pte. Ltd.
2.Gardiner, D. (2001). The principles of Exercise Therapy. G. Bells
and Sons Ltd.