PROPRIOCEPTI

VE
NEUROMUSCU
LAR
-

FACICLITATION
CONTEN
TS
• INTRODUCTION
• DEFINITION
• BENEFITS OF PNF
• DIAGONAL PATTERN
• PRINCIPLE, TECHNIQUES AND PROCEDURE
• SPECIFIC TECHNIQUES WITH PNF
INTRODUCTI
ON
PNF is an approach therapeutic exercise that combines functionally
based diagonal patterns of movement with techniques of
neuromuscular control and function.

PNF techniques also have widespread application for rehabilitation of

patients with musculoskeletal conditions that result in altered
neuromuscular control of the extremities, neck, and trunk.
DEFINITI
ON
Proprioceptive Neuromuscular Facilitation is an approach to
therapeutic exercise that combines functionally based diagonal
patterns of movement with techniques of neuromuscular facilitation to
evoke motor responses and improve neuromuscular control and
function.
BENEFITS OF
PNF
• To develop muscular strength, endurance, and flexibility.
• To facilitate stability and mobility.
• Neuromuscular control.
• Coordination.
• Restoration of function.
DIAGONAL
PATTERN
PNF patterns are composed of multijoint, multiplanar, diagonal, and
rotational movements of the extremities, trunk, and neck.

There are two pairs of diagonal movements that can be used for the
upper and lower extremities :
Diagonal 1 (D1) and
Diagonal 2 (D2)
Within each pattern, flexion or extension is coupled with abduction or
adduction as well as external and internal rotation.

This can be carried out unilaterally or bilaterally.

Bilateral patterns can be done symmetrically or asymmetrically.

 PRINCIPLES, TECHNIQUES AND
APROCEDURE
number of basic procedures that involves the application of multiple
types of sensory cues are superimposed on the diagonal patterns to
elicit the best possible neuromuscular responses.

Although diagonal patterns can be used with various forms of

mechanical resistance , the interaction between the patient and
therapist, a prominent feature of PNF, provides the greatest amount of
and variety of sensory input, particularly in the early phases of re-
establishing neuromuscular.
MANUAL
CONTACT
The manual contact refers to how and where the therapist’s hands are
placed on the patient.

Whenever possible, manual contacts are placed over the agonist

muscle groups or their tendon insertion.
MAXIMAL
RESISTANCE
The amount of resistance applied during dynamic concentric muscle
contraction.

Resistance should be adjusted throughout the pattern to accommodate

strong and weak components of the pattern.
POSITION AND MOVEMENT OF THE
THERAPIST
The therapist remains positioned and aligned along the diagonal planes
of the movement with shoulders and trunk facing in the direction of
the moving limb.

Use of effective body mechanics is essential.

STRET
CH
Stretch stimulus is the act of physically placing the patient’s body
segments in positions that lengthen the muscles that will contract
during the diagonal movement pattern.

This is to stimulate muscle spindles so as to facilitate contraction in the

muscles.
NORMAL
TIMING
A sequence of distal to proximal coordinated muscle contractions and
joint motions occurs during the diagonal pattern.
TRACTI
ON
Traction is the slight separation of joint surfaces, to inhibit pain
facilitate movement during execution of the movement pattern.

Traction is most often applied manually during the movement

pattern.
APPROXIMATI
ON
The gentle compression of joint surfaces by means of manual
compression or weight bearing during the movement patterns
stimulates co-contraction of agonists and antagonists to enhance
dynamic stability and postural control.
VERBAL
COMMANDS
Auditory commands are given to enhance motor output.
VISUAL
CUES
• The patient is asked to follow the movement of a limb with both head
eye motion to further enhance correct movement throughout the full
ROM.
UPPER EXTREMITY DAIGONAL
PATTERNS
D1 FLEXION

Starting position:
Position the upper extremity in shoulder extension, abduction and
internal rotation, elbow extension, forearm pronation, wrist and finger
extension with the hand about 8 to 10 inches from the hip.
Hand placement:
Place the index and the middle finger of your right hand in the palm of
the patient’s hand and your left hand on the volar surface of the distal
forearm or at the cubital fossa of the elbow.
Verbal commands:
Apply a quick stretch to the wrist and finger flexors and tell the patient
to “Squeeze my fingers; turn your palm up; pull your arm up and across
your face,” as you resist the pattern.
End position:
Complete the pattern with the arm across the face in shoulder flexion,
adduction and external rotation; partial elbow flexion; forearm
supination; and wrist and finger flexion
SPECIFIC TECHNIQUES
WITH PNF
• REPEATED CONTRACTIONS
• SLOW REVERSAL
• RHYTHMIC STABILISATION
• HOLD- RELAX
• RHYTHMIC INITIATION
REPEATED
CONTRACTIONS
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 muscles.

Repeated contraction is further divided into:

 Normal timing- isotonic muscle work
 Normal timing – isotonic and isometric muscle work
 Timing for emphasis- isotonic and isotonic muscle work
Normal timing- isotonic muscle
work
A maximal isotonic contraction is obtained in the desired pattern and
when the patient can go no further the stretch reflex is repeated in
order to facilitate contraction of weaker muscle groups.
Normal timing- isotonic and isometric
muscle work
This is more advanced form of repeated contraction

A maximal isotonic contraction is obtained in desired pattern and the

muscles are then held in an isometric contraction.

Then without relaxing, the resistance is reduced slightly, the patient is

instructed to move and the stretch reflex is repeatedly applied to
facilitate movement throughout the remainder of the range.
Timing for emphasis- isotonic and isometric
muscle work
This is used when the specific group of muscle in the pattern is weak.

The joint across which the weak muscle lies is used as pivot and it is at
this joint movement is encouraged.

The movements at the joint distal and proximal to the pivot joint is
restricted so that there is overflow of impulses to the weaker muscle
working at the pivot.
Movement proceeds through the pattern against maximal resistance
throughout the pattern.

Movement is initiated at the pivot to obtain contraction of the weaker

muscles.
SLOW
REVERSAL
This involves dynamic concentric contraction of a stronger agonist
pattern immediately followed dynamic concentric contraction of the
weaker antagonist pattern.

There is no voluntary relaxation patterns.

The reversal of the movement takes place smoothly with normal timing
and no relaxation is allowed as the therapist changes the position of
her hands.
RHYTHMIC
STABILISATION
Isometric contraction of antagonistic muscles is used in this technique
to stabilise joints.

Stability is maintained against resistance by a co-contraction of

antagonistic muscles.
Rhythmic stabilisation can take place at any point on the pathway of
the pattern of movement.

The patient is instructed to ‘HOLD!’ while the therapist applies

maximal
resistance alternating rhythmically from one direction to the other.
HOLD
RELAX
Movement in pattern in the direction of limitation takes place, it
continues to the point at which it is limited either by pain or tension.

Now the patient is asked to hold while therapist applies maximal

resistance where the isometric contraction occurs.

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.
RHYTHMIC
INITIATION
This is relaxation technique for specific application to the rigidity of
Parkinson’s disease.

The limb is 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 the
progression to made to resisted movement.

Finally the therapist’s hands are removed and the patient is encouraged
to maintain a free active movement.
THANK YOU