Proprioceptive Neuromuscular
Facilitation (PNF) Techniques in
Rehabilitation
Chapter 14
Introduction
The method:
Patient contract isometrically resulted in
increased response of the agonist, this was
named rhythmic stabilization. Following using
this stabilization, it was found slow reversal
technique, alternate resistance to isotonic
contractions of antagonist and agonist also
had a facilitating effect.
Introduction
Definitions of PNF:
Proprioceptive, means receiving stimulation
within the tissues of the body.
Neuromuscular, means pertaining to the nerves and
muscles.
Facilitation, means the effect produced in nerve tissue
by the passage of an impulse.
Introduction
Definitions of PNF:
Therefore, PNF can be defined as, methods of
promoting or hastening the response of the
neuromuscular mechanism through
stimulation of the proprioceptors.
Introduction
To perform PNF exercises, it is important to remember
the following
principles:
• Patient must be taught the pattern.
• Have the patient watch the moving limb moved
passively.
• The patient must give proper verbal command.
• Manual contact with appropriate pressure is very
important.
Introduction
Principles:
•Contraction of the muscle group is facilitated by
hand placement.
•Apply maximal resistance throughout ROM.
•Resistance will change.
•Rotation of movement will change throughout
ROM.
•Distal movement should occur first .
Introduction
Plan of volume:
1.Patterns of motion
2.Various techniques used to promote the
desired response
3.Application of the method for improvement of
vital and related functions.
4.Suggestions for evaluation of the patient
performance and for planning treatment
program.
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
Taken from Prentice, Rehabilitation Techniques in Sports Medicine, 3rd ed
D2 Extension Lower Extremity
Joint Specific Movements
Hip
Extension
Adduction
External Rotation
Ankle
Plantar Flexion
Inversion
Toes
Flexion
Proprioceptive Training for upper
Extremities
Types of exercises used for upper extremity
proprioceptive training:
1. Balance training. One major category of
proprioceptive exercise is balance training. These
exercises help to train the proprioceptive system in
a mostly static activity. Activities or exercises in
weight bearing using unstable supporting surface,
profitter, swiss ball, balance board are example of
balance training in the upper extremity.
2. Kinetic chain exercises . Open-chain manual
resistance exercises with rhythmic stabilization
are also considered proprioceptively enriched.
In either case, resistance can be modified,
depending on pain, as the patient progresses
Quadruped stabilization on a
balance
Four closed-chain exercises have been described
to stimulate co-activation in the shoulder: pushups,
horizontal abduction on a slide board, and tracing
circular motions on a slide board with the dominant
and non-dominant arms. These exercises accommodate for the individual's tolerance to joint
loads by progressing from a quadruped to a push-up
position
Wall push-ups are also useful and can be
proprioceptively enhanced by having a
physical therapist or resistance band
provide resistance to the patient's back.
3. Sport-specific maneuvers. Rehabilitation is
incomplete until maneuvers specific to the sport
and the athlete's position in the sport can be
performed maximally and without pain or loss
of function.
Starting sport-specific maneuvers with weighted
resistance (eg, swinging a weighted tennis racket
or baseball bat), Functional positions, such as
overhead throwing, should be incorporated and
are more sport-specific.
4. PNF (Proprioceptive neuromuscular facilitation):
These techniques may be defined as methods of
promoting or hastening the response of the
neuromuscular mechanism through stimulation of
the proprioceptors. Emphasis is placed on the
application of maximal resistance through out the
range of motion, using many combinations of
motions in a pattern format. Motion is first
performed in the strongest part of the range, with
progression toward the weaker parts of the range
of motion. The patterns used are spiral and
diagonal in character and closely resemble the
movements used in sports and in occupational
activities.
5. Plyometrics. It is a quick powerful movement
involving pre-stretching of a muscle, followed by
a shortening cycle. The stretch shortening cycle
occurs when elastic loading, through a quick
eccentric muscular contraction, is followed by a
burst of concentric muscular contraction.
6. Ballistic stretching uses the momentum of a
moving body or a limb in an attempt to force it
beyond its normal range of motion. This is
stretching, or "warming up", by bouncing into
(or out of) a stretched position, using the
stretched muscles as a spring which pulls you
out of the stretched position.
Proprioceptive Training for Lower Extremities
Proprioceptive training improves a patient's static and dynamic
equilibrium. The static proprioceptive re-education is begun when
patients proceed to weight bearing without crutches and consists of
six stages:
1-Recovery of sense of body position muscle contraction and joint
movement.
2-Transition from bilateral to unilateral activities
3-Transition from eyes-open to eyes-closed activities.
4-Transition from activities on a stable support, such as the ground,
to unstable surfaces, such as a soft mattress, a trampoline and
Freeman's boards, or more modern equipment, such as the
kinesthetic ability trainer
5-Throwing and catching a football to take the patient's mind off
active control of his balance.
6-Balance recovery exercises are carried out different joint positions
to evoke different responses from the tendon and muscle receptors.
The dynamic proprioceptive re-education consists
of seven stages:
1. Slow exercises followed by quicker movement
2. Exercise with limited effort followed by exercise
requiring greater strength
3. Exercises requiring volition, followed by exercises
done freely
4. Progress from walking to jogging
5. Running and sprinting
6. Jumping and changes of direction
7. Twirling and twisting around the injured or
operated knee
Balance and control proprioceptive exercise
1. Stand on one leg.
2. Stand on one leg with eyes closed.
3. Stand on one leg – throw and catch a ball.
4. Stand on one leg – bend and straighten knee
5. Stand on one leg- pick up item from floor.
6. Hold knee dip – throw and catch a ball.
7. Stand on one leg – move other leg to side, front and back.
8. Push up onto toes (2 legs) and hold.
9. Push up onto toes with eyes closed.
10. Push back onto heels, balance and hold.
11. Push up on toes on one leg.
Walking proprioceptive exercises
13. Walk forward along a straight line.
14. Walk on tip toes along straight line.
15. Walk backwards along straight line.
16. Side step along straight line.
17. Walk sideways crossing one foot over other
(Cariocas).
18. Walk fast in one direction, quickly changing
direction at intervals.
Running proprioceptive exercises
19. Run fast in one direction.
20. Run backwards and do sidesteps.
21. Fast crossovers (Cariocas).
22. Run in figure of eight – make it smaller and
smaller.
23. Hopping on spot.
24. Hop forwards and backwards – stop
between hops.
25. Hop in zigzags.
26. Hop on and off step.
27. Do triple jump - run, hop, jump and land.