PNF & JOINT MOBILISATION

Dr. V. PAVITHRALOCHANI
MPT( NEURO),MMTFI,MIAP.
FACULTY OF PHYSIOTHERAPY.
 SYNOPSIS

• Techniques of PNF
• PNF patterns
• Types of movements (joint mobility)
• Indications, contra-indications & treatment.
• Proprioceptive:Sensory receptors that give
information concerning movement and position
of the body.
• Neuromuscular:Involving the nerve and
muscles.
• Facilitation: Making easier.
• PNF is a concept of treatment. Its underlying
philosophy is that all human being, including
those with disabilities have a untapped existing
potential.
 Uses of PNF
• It uses
– Proprioceptive
– Cutaneous
– Auditory input
To produce functional improvement in motor
output and can be a vital element in the
rehabilitation process of sports related injury.
 Techniques of PNF

• Repeated
contraction
• Slow reversal
Strengthening
• Rhythmic
& stretching stabilization
techniques • Hold relax
• Rhythmic initiation
 1.Repeated contraction
• Patient moves isotonically against maximum
resistance repeatedly until fatigue is evidenced.
• When fatigue is evident then a stretch at that
point in the range should facilitate the weaker
muscles and results in coordinated movements.
USED IN:
• To develop strength & endurance.
 2.Slow reversal
• Involves isotonic contraction of the agonist
followed immediately by an isotonic
contraction of the antagonist.

USED IN:
• For development of active ROM
• Normal reciprocal timing b/w agonist &
antagonist.
 3. Rhythmic stabilization

• Uses as an isometric contraction of the agonist,

followed by an isometric contraction of the
antagonist.

USED IN:
• To increase strength and endurance.
 4.Hold relax

• Begins with isometric contraction of the

antagonist against resistance, followed by
contraction of the agonist muscle.
 5.Rhythmic initiation
• Progression from ( agonist pattern)
Passive
Active assisted

Active

USED IN :
• Limited ROM due to increase tone.
• Those who are unable to initiate movement.
 PNF PATTERNS
• Each pattern has three dimension-
1. Flexion or extension
2. Abduction or adduction
3. Rotation
• Movement occurs in a straight line, in diagonal
direction with a rotatory component.
UPPER EXTREMITY
LOWER EXTREMITY
 TYPES OF MOVEMENTS

• Physiological movement
• Accessory movements
• Physiological movements:
Movements you see (osteokinematics)
• Accessory movements:
Movements you feel (Arthrokinematics)
 Arthrokinematics movements

Arthro - Joint, Kinematics – motion

The movement which occur in the joint surface is
called arthrokinematics.
• The arthrokinematic movements are called as
“joint play movements”.
 Types of Arthrokinematic
movements
It is of the following types:
• Rolling
• Sliding (gliding)
• Spinning
• Traction
• Compression
 ROLLING

• Rolling occurs when the new equidistant point

of moving surface comes into contact with the
new equidistant points on the stable surface.
• It occurs between the flat and curved surface.
Eg: ball rolling on the floor.
• Joint surface is incongruent.
• Rolling results in angular motion.
• It combines with gliding, spinning during
physiological movement.
 GLIDING

• Gliding occurs between the surface when the

same point of the moving surface comes into
contact with the new point on the stable
surface.
• Gliding occurs between either the flat or
curved surface.
Eg: Square box moving on an oblique floor.
• Joint surfaces are congruent.
• Direction of gliding depends on whether the
moving surface is convex or concave.
 CONVEX- CONCAVE RULE
• More the congruent surface, more the sliding
occurs and more the incongruent surface,
more the rolling occurs.
• While concave surface moves on convex
surface gliding rolling occurs towards the
angular movement.
• While convex surface moves on concave
surface rolling occurs towards the angular
movement and gliding occurs opposite to that.
 SPINNING
• Moving surface rotates on stable surface.
• Rotation occurs in stationary mechanical axis.
• Spinning combines with
rolling and gliding and results
in rotatory type
of physiological movements.
Eg: Radio humeral joint
pronation and supination
movements.
 TRACTION
• Articular surfaces are drawn or pulled apart
• Normally, distal bony surface is pulled apart at
right angle.
• The joint space
increases during traction.
• It reduces joint friction.
• Enhances joint play
movement.
 COMPRESSION
• Articular parts are pushed towards each other.
• Distal articular surface moves towards the
proximal articular surface.
• More common in weight bearing
joints.
• Articular surface will be having more
contact with each other.
• Over compression leads to joint
structure deterioration.
 AIMS OF JOINT MOBILISATION
 Restores normal ROM
 Pain gate theory
 Descending inhibition
 Increased local blood flow
 Synovial sweep
 INDICATIONS
• Post traumatic stiffness of the joint.
• Post operative stiffness of the joint.
• Post immobilization stiffness of the joint.
• Adhesion formation around the joint.
• Atrophy of the capsule.
• Atrophy of synovial membrane.
• Painful joint.
• Disuse atrophy of the joint structure.
 CONTRAINDICATIONS
• Synovial effusion
• Hemarthrosis
• Recent fractures around joints
• Dislocation
• Recent injuries around joints
• Acute RA
• Malignant tumors
• TJR
• Scoliotic spin
• spondylolisthesis
 TREATMENT GLIDES
• To improve glenohumeral flexion:
Apply posterior glide.
• To improve GH extension:
Apply anterior glide.
• To improve GH internal rotation:
Apply posterior glide.
• To improve GH external rotation:
Apply anterior glide.
• To improve GH abduction:
Apply inferior glide.
• To improve tibiofemoral flexion:
Apply posterior glide.
• To improve tibiofemoral extension:
Apply anterior glide.
• Patellofemoral glide:
Apply superior glide to improve extension;
inferior glide to improve flexion.
• To improve ankle plantarflexion:
Apply anterior glide (talocrural jt.)
• To improve ankle dorsiflexion:
Apply posterior glide (talocrural jt.)
• To improve inversion:
Apply lateral glide (subtalar jt.)
• To improve eversion:
Apply medial glide (subtalar jt.)
• To improve wrist flexion:
Apply dorsal (posterior) glide
• To improve wrist extension:
Apply volar (anterior) glide.
• To improve radial deviation:
Apply medial glide.
• To improve ulnar glide:
Apply lateral glide.
• To improve elbow flexion:
Apply humeral-ulnar distal glide.
• To improve elbow extension:
Apply humeral-radial posterior glide.
 REFERENCE

• M. Dena Gardiner, The principles of exercise therapy,

4th edition.
• Kisner and Colby. Therapeutic exercise: Foundations
and techniques, 4th edition.
• Cynthia C. Norkin, D. Joyce White, 4th edition.
• Lakshmi Narayanan, Textbook of Therapeutic
Exercises.
THANK YOU…!!!