PROPRIOCEPTIVE
NEUROMUSCULAR FACILITATION
(PNF)
Mazyad Alotaibi
Proprioceptive neuromuscular facilitation
(PNF) is an approach to therapeutic exercise that
combines functional based diagonal patterns of
movement with techniques of neuromuscular
facilitation to evoke motor responses and improve
neuromuscular control and function
Definition of Terms
Proprioceptive: the sensory receptors that give
information concerning movement and position
of the body
Neuromuscular: involving the nerves and
muscles
Facilitation: making easier
PNF Include
Stimulation for proprioceptive and sensory
mechanisms
Feed information to the nervous system
Facilitate the desired response through:
– Muscle contraction for strengthening
– Muscle relaxation for stretching
– Improved balance and equilibrium
BASIC PROCEDURES
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Resistance
Irradiation and reinforcement
Manual contact
Body positioning and body mechanics
Verbal commands
Visual cues
Traction and approximation
Stretch
Timing
Patterns
RESISTANCE
The amount of resistance provided during an activity must
be correct for the patient’s condition and the goal of the
activity. This is called optimal resistance.
Resistance is used in the treatment to:
Facilitate the ability of the muscle to contract
Increase motor control
Help the patient gain an awareness of motion and its
direction
Increase strength
IRRADIATION & REINFORCEMENT
Irradiation : the spread of response to stimulation
Reinforcement : means “to strengthen, make stronger”
IRRADIATION & REINFORCEMENT
Increasing the amount of resistance will increase the
amount and extent of the muscular response.
Examples:
Resist muscle activity of the sound limb to produce
contraction of the muscles in the immobilized
contralateral limb.
Resist supination of the forearm to facilitate contraction
of the external rotators of that shoulder
MANUAL CONTACT
This refers to how and where the therapist’s hands
are placed on the patient.
Effects:
Stimulates the muscle’s extroceptores
Stimulates the synergistic muscle to reinforce the
movement
BODY POSTION & BODY MECHANICS
The therapist body should be in line of motion
Shoulder and pelvis face the direction of motion.
Therapist stands in walk standing position.
The resistance comes from the therapist’s body weight,
while the hands and arms stay comparatively relaxed.
VERBAL STIMULATION (COMMANDS)
Tells the patient what to do and when to do
Instructions need to be clear and concise without the use
of unnecessary words.
May be combined with passive movement to teach the
patient the desired motion
The timing of the command is very important
The volume with which the command is given affects the
strength of resulting muscle contraction.
Louder command when strong muscle contraction is
required.
Softer and calmer tone when the goal is relaxation and
relief of pain.
VISUAL CUES
The feedback from visual sensory system can
promote a more powerful muscle contraction
Helps the patient to control and correct his
position and motion
Moving the eyes will influence both the head and
body motion
Eye contact between patient and therapist provides
a mode of communication
TRACTION & APPROXIMATION
The therapeutic effects of traction and
approximation is due to stimulation of joint
receptors.
Traction is applied when the movement is
occurring against the gravity
Approximation is applied when the movement
occurs in the direction of gravitational pull
APPROXIMATION
Compression through a joint stimulate joint
receptors
Facilitate stability
The approximation is always maintained, whether
done quickly or slowly
When the therapist feels that the active muscle
contraction decreases the approximation is
repeated and resistance is given
STRETCH
The stretch stimulus occurs when the muscle is
elongated
The lengthened position of the muscle is the
starting position of each pattern and the stretch is
maintained throughout the movement.
All the components of a pattern must be stretched
simultaneously
Stretching will Stimulate the activity of muscle
spindle
TIMINGS
Timing is the sequencing of motions
Normal timing of most coordinated and efficient
motions is from distal to proximal
PATTERNS
Each pattern has three dimension :
- Flexion or extension
- Abduction or adduction
- Rotation
Movement occurs in a straight line, in diagonal
direction with a rotatory component
Patterns are named according to the direction of
movement and therefore finishing, not the starting
position.
In completing the pattern the muscle contracts through
full range from its lengthened to its shortened position
UPPER EXTREMITY
F-ABD-ER
E-ABD-IR
F-ADD-ER
E-ADD-IR
F-ADD-ER
Diagonal One
E-ABD-IR
F-ABD-ER
Diagonal Two
E-ADD-IR
F-ADD-ER
E-ABD-IR
F-ABD-ER
E-ADD-IR
LOWER EXTREMITY
F-ABD-IR
E-ABD-IR
F-ADD-ER
E-ADD-ER
F-ABD-IR
F-ADD-ER
F-ADD-ER
F-ABD-IR
Bilateral Asymmetrical
‘Chopping’
Bilateral Asymmetrical
‘Lifting’
Bilateral symmetrical patterns