PROPRIOCEPTIVE NEUROMUSCULAR

FACILITATION
Proprioceptive Neuromuscular
Facilitation

 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
History
 Developed in the late 1940's by Herman Kabat,
M.D. Maggie Knott as a means of rehabilitation
for neurological disorder .
 They soon began to teach PNF to graduate
physical therapists from all over theworld.
 Dorothy Voss was one of the first students
It seemed to become more popular in the late 1980s and early 1990s
 PNF

 Definition- A motor learning approach

used in neuromotor development
training to improve motor function and
facilitate maximal muscular contraction
 PNF Philosophy
PNF is an integrated approach:
 Consider the total human being: whole person
with his/her environmental, personal, physical,
and emotional factors
 The primary goal of all treatment is to help
patients achieve their highest level of function
 Positive approach: no pain, achievable tasks,
set up for success, direct and indirect
treatment, strong start.
 Basic neurophysiologic principles

 Afterdischarge -The effect of a stimulus continues after the stimulus

stops. If the strength and duration of the stimulus↑
 Temporal summation- A succession of weak stimuli occurring within
a certain 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.
It occurs when either the number of stimuli or the strength of the
stimuli is increased. (response may be excitation or inhibition)
 Successive induction: An increased excitation of the agonist muscles
follows stimulation (contraction) of their antagonists. Eg- reversal of
antagonists (Induction: stimulation, increased excitability.).
 Reciprocal inhibition: Contraction of muscles is accompanied by
simultaneous inhibition of their antagonists.
 Principles of PNF (The basic
procedures for facilitation)
1. Resistance
2. Irradiation and reinforcement
3. Manual contact
4. Body position and body mechanics
5. Verbal(commands)
6. Vision
7. Traction or approximation
8. Stretch
9. Timing
10. Patterns: Synergistic mass movements, components
Resistance

Therapeutic Goals
 Facilitate the ability of the muscle to
contract.
 Increase motor control and motor learning.
 Help the patient gain an awareness of motion
and its direction.
 Increase strength.
Without causing pain,fatigue,breath holding
Irradiation and Reinforcement
 Irradiation. define Irradiation as the spread of the
response to stimulation.

 Reinforcement.
 Reinforce-defined as “to strengthen by fresh
addition, make stronger.
 The therapist directs the reinforcement of the
weaker muscles by the amount of resistance given
to the strong muscles
(note-resist contraction in sound limb to produce contraction in immobilized
contralateral limb)
 Manual Contact

Therapeutic Goals
 To increase power and guide motion with grip and
pressure.
 Pressure on a muscle to aid that muscle’s ability to
contract 
 To give the patient security and confidence. 
 To promote tactile kinesthetic perception.
*(information on proper direction of motion)
 Contact on the patient’s trunk to help the limb
motion indirectly by promoting trunk stability.
Lumbrical grip
it control movement
Body Position and Body Mechanics
(of therapist)

Therapeutic Goals
 Give the therapist effective control of the
patient’s motion.
 Facilitate control of the direction of the
resistance.
 Enable the therapist to give resistance
without fatiguing.
 Resistance through body wt,wide BOS.
Verbal Stimulation(Commands)
(Use of words and vocal volume to direct the patient)
Therapeutic Goals
 Tells pt about what to do and when to do
 Guide the start of movement or the muscle
contractions.
 Affect the strength of the muscle contractions.
 Give the patient corrections.
 Vision
(guide motion and increase force.)

Therapeutic Goals
 Promote a more powerful muscle contraction.
 Help the patient control and correct position and
motion.
 Influence both the head and body motion.
 Provide an communication and help to ensure
cooperative interaction
 Traction and Approximation
Definition
 Traction=is the elongation of the trunk or an extremity.
 Approximation=is the compression of the trunk or an
extremity.

Therapeutic Goals
Tractionis used to:
 Facilitate motion, especially pulling and antigravity
motions.
 Aid in elongation of muscle tissue when using the stretch
reflex.
 Helpful in joint pain pt.
Therapeutic Goals
Approximation is used to:
 Promote stabilization(stimulate receptors,
counteraction of muscle)
 Facilitate weight-bearing and the contraction of
antigravity muscles
 Facilitate upright reactions
(treatment of painful & unstable joint)
 Stretch

Therapeutic Goals
 Facilitate muscle contractions.
Timing
Definition
Timing is the sequencing of motions.
Normal timing of most coordinated and efficient motions is
from distal to proximal

Therapeutic Goals
 Normal timing provides continuous, coordinated motion
until a task is accomplished. 
 Timing for emphasis redirects the energy of a strong
contraction into weaker muscles
 Patterns
 Normal functional motion is composed of mass
movement patterns of the limb(motion in diagonal)
 PNF patterns combine motion in all 3 planes
o Sagittal(flex-ext)
o Coronal or front(abd-add)
o Transverse (rot)
 Two types of pattern:
a) Unilateral: one arm or one leg
b) Bilateral: - symmetrical: limbs move in same pattern.
- asymmetrical: limbs move in opp patterns .
PNF Strengthening Diagonal
Patterns
 D1 Flexion Upper Extremity

Taken from Prentice, Rehabilitation Techniques in Sports Medicine,

3rd ed
D1 Flexion Upper Extremity
Joint Specific Movements
Shoulder Flexion
External Rotation
Adduction
Forearm Supination
Wrist Radial Deviation
Fingers Flexion
PNF Strengthening Diagonal
Patterns
 D1 Extension Upper Extremity

Taken from Prentice, Rehabilitation Techniques in Sports Medicine,

3rd ed
D1 Extension Upper Extremity
Joint Specific Movements
Shoulder Extension
Internal Rotation
Abduction
Forearm Pronation
Wrist Ulnar Deviation
Fingers Extension
PNF Strengthening Diagonal
Patterns
 D2 Flexion Upper Extremity

Taken from Prentice, Rehabilitation Techniques in Sports Medicine,

3rd ed
D2 Flexion Upper Extremity
Joint Specific Movements
Shoulder Flexion
External Rotation
Abduction
Forearm Supination
Wrist Radial Deviation
Fingers Extension
PNF Strengthening Diagonal
Patterns
 D2 Extension Upper Extremity

Taken from Prentice, Rehabilitation Techniques in Sports Medicine,

3rd ed
D2 Extension Upper Extremity
Joint Specific Movements
Shoulder Extension
Internal Rotation
Adduction
Forearm Pronation
Wrist Ulnar Deviation
Fingers Flexion
PNF Strengthening Diagonal
Patterns
 D1 Flexion Lower Extremity

Taken from Prentice, Rehabilitation Techniques in Sports Medicine,

3rd ed
D1 Flexion Lower Extremity
Joint Specific Movements
Hip Flexion
Adduction
External Rotation
Ankle Dorsiflexion
Inversion
Toes Extension
PNF Strengthening Diagonal
Patterns
 D1 Extension Lower Extremity

Taken from Prentice, Rehabilitation Techniques in Sports Medicine,

3rd ed
D1 Extension Lower Extremity
Joint Specific Movements
Hip Extension
Abduction
Internal Rotation
Ankle Planar Flexion
Eversion
Toes Flexion
PNF Strengthening Diagonal
Patterns
 D2 Flexion Lower Extremity

Taken from Prentice, Rehabilitation Techniques in Sports Medicine,

3rd ed
D2 Flexion Lower Extremity
Joint Specific Movements
Hip Flexion
Abduction
Internal Rotation
Ankle Dorsiflexion
Eversion
Toes Extension
PNF Strengthening Diagonal
Patterns
 D2 Extension Lower Extremity
D2 Extension Lower Extremity
Joint Specific Movements
Hip Extension
Adduction
External Rotation
Ankle Plantar Flexion
Inversion
Toes Flexion
 PNF Techniques
These techniques may be used in a rehabilitation
program either

 To strengthen or facilitate a particular agonistic

muscle group
or
 To stretch or inhibit the antagonistic group.
Basic PNF Techniques
 Rhythmic Initiation
 Combination of Isotonic ( Reversal of Agonists)
 Reversal of Antagonists
 Dynamic Reversal of Antagonists(Slow Reversal)
 Stabilizing Reversal
 Rhythmic Stabilization
 Repeated Stretch (Repeated Contraction)
 Repeated Stretch from beginning of range
 Repeated Stretch through range
 Contract-Relax
 Hold-Relax
 Agonist contraction(AC)
Rhythmic Initiation(RI):
 Progression of movement from (once pt voluntarily
relax)
 Passive (several time, so that pt gets familiar with seq of mov)
 To active-assistive,
 To active movement through the agonist pattern
 Slow through available ROM
 Useful for patients who cannot initiate movement, have
limited ROM,
 (Or) for teaching movement pattern and rate of
motion.
 Improve coordination and sense of motion.
Combination of Isotonic(Reversal
of Agonists)

 Combined concentric, eccentric, stabilizing

contraction
 Resisted concentric contraction of agonist muscles
moving through the range is followed by a
stabilizing contraction (holding in the position) and
then eccentric contraction, moving slowing back to
the start position; there is no relaxation between
the types of contractions.
 Indications :↓eccentrically control , poor dynamic
posture control.
Reversal of Antagonists

 A group of techniques that allow for agonist contraction

followed by antagonist contraction without pause or
relaxation
1)Dynamic Reversal-(slow reversal)
The limb is moved through full range of motion. stronger
pattern is selected first with progression to weaker pattern.
 Indications :↓strength and coordination between agonist
and antagonist, ↓ROM.
2) Stabilizing Reversal-
 allowing only very limited range of motion.
 Indications ↓ strength, stability and balance, coordination
3)Rhythmic Stabilization (RS): Utilizes
alternating isometric contractions of agonists,
antagonists; no motion is allowed .
Indications: same as before
 Slow reversal-hold: an isotonic contraction
of the agonist followed immediately by an
isometric contraction.
 Repeated Stretch (Repeated
Contraction)
 Repeated Stretch from beginning of range
 Repeated Stretch through range
 Repeated isotonic contractions ,initiated with rep
quick stretches(3-4)(tap or lengthen)followed by
resistance; performed through the range or part of
range at a point of weakness.
 Indications Impaired strength, initiation of
movement
Contract-Relax
 Resisted isotonic contraction of the restricting muscle
(antagonists)(at the end of PROM)followed by
relaxation and movement into the increased
range( passive)
 Indications Limitation in ROM.
 The patient is instructed to push by contracting the
antagonist(muscle that will be stretched) isotonically
against the resistance .
 The patient then relaxes the antagonist while the
therapist moves the part passively through as much
range as possible to the point where limitation is again
felt.
Hold-relax(HR)
1st muscle is lengthened to the point of limitation
 2nd pt performs isometric contraction(submax) for 5 to
10 sec followed by voluntary relaxation of the muscle.
 3rd then passively moved into the new range.
Agonist contraction(AC)
 Agonist means muscle opp the range limiting muscle
 Antagonist means muscle range limiting muscle
 Concentric contraction of Agonist muscle and hold end
range for several sec.(reciprocal inhibition).
 Avoid ballistic mov and provide rest to avoid cramp.
Hold-relax with Agonist contraction (HR-
AC)
(slow reversal Hold-relax tech )
 1st limb moved till resistance then isometric
followed by relaxation, then immediate
concentric contr of opp muscle.
 Techniques in Strength Training
 Proprioceptive Neuromuscular Facilitation
 Neurophysiological Basis
 Autogenic Inhibition
 Reciprocal Inhibition
Autogenic inhibition
 Techniques in Strength
Training
 Proprioceptive
Neuromuscular
Facilitation
 Neurophysiological Basis
 Autogenic Inhibition
 Reciprocal Inhibition
Reference

 1.SS .Adler D .Beckers PNF in practice.

THANK YOU
Fig a )Irradiation into the trunk flexor muscles when doing bilateral leg patterns
b)Irradiation to dorsiflexion and inversion with the leg pattern flexion-adduction-
external rotation;