Chapter 16
Proprioceptive Neuromuscular
Facilitation
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Proprioceptive Neuromuscular
Facilitation (PNF)
Methods of promoting or hastening the response
of the neuromuscular mechanism through
stimulation of the proprioceptor.
Major Goal – Restore or enhance postural
responses or normal patterns of motion.
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Basic Neurophysiologic Principles of PNF
Diagonals of Movement
Innate path in which maximal response
of the trunk and extremities can be
facilitated.
Components associated with
antagonistic motion:
 Flexion versus extension.
 Abduction versus adduction in extremities and
lateral movement of trunk.
 Internal vs. external rotation.
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Normal coordinated patterns of motion are diagonal in
direction with spiral components – Facilitate
strongest output.
Reflects functional relationship of trunk
and extremities.
Diagonals may be used to identify:
1.
2.
3.
Quality of contractions
Range of motion
Functional impairments/limitations
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Motor Development
PNF is based on 11 principles drawn from:
 Neurophysiology
 Motor learning
 Motor behavior
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Examination and Evaluation
Assessed Areas:
1.
2.
3.
4.
5.
6.
7.
Impaired ROM and muscle length
Impaired muscle power
Impaired muscle endurance
Impaired balance
Impaired posture
Impaired motor control
Pain
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Factors Included During the Evaluation
 Patient’s short-term and long-term
goals.
 Patient’s receptive potential for
language, vision, and manual contacts
to promote cuing.
 Patient’s strengths.
 Patient’s weaknesses.
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Treatment Implementation
Treatment interventions may include:
1.
2.
3.
Modification of environment
Education and compensation for the impairment
Treatment directed at changing the patient’s
neuromuscular capabilities
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Patterns of Facilitation
Manually resistive exercises that create the
diagonals of movement by coupling pairs of
antagonistic patterns, providing a path for
reversing motions, and using the agonist–
antagonist relationship of the nervous system as
techniques are applied.
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Procedures
1.
2.
3.
4.
5.
6.
7.
8.
Body positioning and mechanics
Manual contacts
Manual and maximal resistance
Irradiation
Verbal and visual cuing
Traction and approximation
Stretch
Timing
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Body Positioning and Mechanics
Be positioned in the diagonal plane
or treatment plane whenever
possible.
Shoulders and hips face toward
direction of movement.
Forearms in this plane is important.
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Manual Contacts
Use contacts overlying agonist muscle
group to strengthen contractions and/or
direction of movement.
Use lumbrical grip to provide contact.
Contact the target group (direct effect)
or synergist or antagonist (indirect).
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Manual and Maximal Resistance
Resistance to motion enhances muscle activation.
Direction, quality, and quantity of resistance are
adjusted according to treatment goals.
Resistance should be no greater than the
resistance that allows full ROM.
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Irradiation (Overflow)
Spread of energy from agonist to complimentary
agonists and antagonists within a pattern.
Irradiation is stimulated through clinician’s use of
resistance.
Weaker muscle groups benefit while working in
synergy with more normal partners.
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Verbal Cuing
Should be clear and concise.
Begin by detailing a particular
patient response.
Change to more simple cues for
subsequent repetitions.
Alter tone according to goal (e.g.,
soft voice for inhibition)
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Approximation and Traction
Stimulates receptors to facilitate cocontraction and stability around the joint.
Employed through the use of weight-bearing
developmental postures.
Traction is commonly used with pulling
movements to inhibit compression.
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Stretch
Often performed at the starting position of
a pattern or movement.
Result – Reflex activation.
Resistance through entire range provides
continued stretch through tension.
Stretch can be repeated at start of range
or superimposed during a pattern.
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Techniques of Facilitation
1.
2.
3.
4.
5.
Rhythmic initiation
Repeated contractions
Reversals of
antagonists
Dynamic reversals of
antagonists
Stabilizing reversals
6. Rhythmic stabilization
7. Hold and relax
8. Contract and relax
9. Combination of
isotonics (dynamics)
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Uses of Rhythmic Initiation
Initiate movement.
Define the direction or pattern of
movement.
Set the appropriate rate of movement.
Improve coordination and sense of
motion.
Promote general relaxation.
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Uses of Repeated Contractions
Help to initiate movement.
Strengthen agonist movement
pattern from lengthened range.
Strengthen agonist movement
pattern within available ROM.
Redirect motion within pattern or
task.
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Use of Reversals of Antagonists
To facilitate agonist.
Improve balance between
agonist and antagonist.
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Use of Dynamic Reversals of
Antagonists
Increase active ROM.
Improve strength in the available
ROM.
Improve balance and coordination
of antagonist.
Improve endurance of antagonistic
patterns.
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Use of Stabilizing Reversals
Improve balance and stability.
Improve strength.
Integrate a new posture or ROM into function.
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Use of Rhythmic Stabilization
Improve strength of antagonists.
Improve balance of antagonists.
Improve stability.
Increase active and passive ROM
following technique.
Decrease pain.
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Use of Hold and Relax
Improve PROM.
Provide relaxation.
Reduce pain.
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Use of Contract and Relax
Improve passive ROM.
Provide relaxation.
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Use of Combination of Isotonics
Increase strength of agonist.
Increase active ROM.
Teach functional control.
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Summary
 PNF is a manual therapy approach that applies
postures, movement patterns, contacts, cues,
and goals. All = Maximally facilitating.
 Treatment is based on improving function, and
using functions that are possible to reach those
are attainable goals.
 PNF lends itself to use as an adjunct to other
treatment approaches.
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