Proprioceptive

neuromuscular
facilitation

History
Developed by Dr. Herman Kabat in the
1940s
Maggie Knott, PT worked with Dr. Kabat
to create handling techniques and
principles of PNF
Dorothy Voss, PT also collaborated with
Kabat and Knott to further develop PNF

Originally developed for use with patients with

permanent neuromuscular dysfunction

Before PNF, patients were rehabilitated using

one motion, one joint, one muscle at a time

Kabat observed normal human motion and

began working with patients to discover
patterns of movement that were consistent
with neuro-physiological theory

Kabats research and experimentation led

him to discover that movement occurs in
spiral-diagonal patterns
Kabat and Knott believed that using
natural patterns of movement would
stimulate the nervous system more
normally than would therapy that isolated
each muscle
PNF has continued to develop and change

Proprioceptive Neuromuscular
Facilitation
Proprioceptive: refers to stimuli aroused in an
organism through the movement of its tissues
Neuromuscular: pertaining to nerves and
muscles
Facilitation: hastening of any natural process

Definition
Methods of promoting or hastening the
response of the neuromuscular
mechanism through stimulation of the
proprioceptor (Voss)

Methods used to place specific demands

on specific muscles in order to elicit a
desired reaction.

PNF A method of treatment to promote or

hasten the response of one neuromuscular
mechanism through the stimulation of various
neurological pathways. This is done by placing
specific demands on the patients nervous
system to assure a desired response which is
related to normal function (Knott and Voss)

When to use PNF

Used when a deficient neuromuscular
mechanism results in altered patterns of
motion or posture
Most commonly used in Phase II & III, but
some techniques can even be used in
Phase I.

Proprioceptive Neuromuscular
Facilitation
Can be used for increasing strength,
flexibility(ROM), and coordination.
Uses autogenic and reciprocal inhibition to
increase stretch
Good technique to improve flexibility
Great technique for strengthening too

Principles of Therapeutic Exercise

Exercise patient by using voluntary and active

motion. Return the patient to original strength
and ROM
Pain-free ROM. Patient should be worked
through existing pain-free ROM.
Use of maximal resistance
Relaxation of body part before strengthening.
Use diagonal spiral patterns of motion

Nerve
Afferent

Type Ia, Ib, II

Efferent

Alpha Motor neuron - Extrafusal fibers

Gamma Motor neuron - Intrafusal fibers

Myotatic Reflexes
Muscle

Reciprocal Inhibition

Golgi

Spindle

Tendon

Autogenic Inhibition

Muscle spindle -- GTO

Ia and II

alpha

Ib

Neurophysiologic Principles

Use of reflex activity

Proprioceptors

(muscle spindles, golgi tendon

organs, joint mechanoreceptors)
Exteroreceptors (touch, pressure)
Other (righting reflex, extensor reflex)

Neurophysiologic Basis for PNF

Irradiation: Energy is channeled from stronger
to weaker muscle groups or patterns
Sherringtons Law of Successive Induction
When

a movement is completed in one direction,

the response of the antagonist will be augmented
Successive induction: An increased response of
the agonist results after contraction of its antagonist
Increased agonist strength following contraction of
antagonist

Autogenic inhibition
A reflex muscular relaxation that occurs in
the same muscle where the GTO is
stimulated.

AUTOGENIC INHIBITION

1.

Stimulus -

Large force exerted

on muscle tendon

Primary response

2. Sense organ

3.

excited -Golgi
tendon organs

Muscle attached to

tendon relaxes

Reciprocal inhibition -A reflex muscular

relaxation that occurs in the muscle that is
opposite the muscle where the GTO is
stimulated.

Successive Induction
Voluntary

motion of one muscle can be facilitated by

the voluntary motion of another

Basic Concepts

Movements are goal oriented

From

isolation (single plane) to functional large

patterns (multi plane) Phase II/III of rehab

Movements occur in diagonal patterns with

rotational components, not in single plane
Resemble

ADLs and sport specific activities

Stimulate muscle spindles and Golgi tendon

organs which in turn contribute to motion and
stimulation of joint receptors

Goals
To restore or enhance postural responses
or normal patterns of motion in a patient
with a deficient neuromuscular
mechanism
to enhance stability or mobility
to strengthen or stretch any muscle group

Restore ROM
Decrease pain
to improve posture, balance, and
coordination for functional activities

Component of PNF
Basic of Procedure
Classification of Techniques
Diagonal Patterns

Basic Procedures
Patterns of movement
Visual stimulus
Proper mechanics
Normal timing

Basic Procedures (contd)

Manual contacts
Commands and communication
Stretch reflex
Traction and approximation
Maximal resistance
Timing for emphasis

Manual Contacts

Pressure used to give sensory clues to

performing movement and generating
stronger muscular contraction

Manual contacts .Contact over a muscle

group facilitates that muscle group to
contract

Manual Contacts

Lumbrical grip aides in keeping contacts

facilitates unidirectional movement

Placed proximal and distal of joint

Best point of manual contact varies

slightly with individuals

Should not cause pain or discomfort

Commands and Communication

Clinician can actively demonstrate or

passively move patient through desired
pattern of movement

Cues should be clear, concise, and

appropriate to the patients needs and
comprehension

Tell patient what to do voice inflection

Sharp/strong

commands increase muscle contraction

Soft/calm commands promote relaxation
Moderate tones for directions/instructions

Terminology (guidelines, not absolutes)

Flexion

pattern pull
Extension pattern push
Isometrics hold/relax

Stretch Reflex

Stretch is used as a stimulus

Start pattern with agonist in lengthened state

stretch facilitates stronger contraction of
muscle/s

stretch facilitates muscle spindles

To initiate stretch reflex, briefly take beyond

lengthened position

Causes muscle contraction

May be repeated throughout the pattern

Does not work on completely flaccid

muscle

Contraindicated if painful

Traction and Approximation

Traction facilitates movement associated with

flexion (pull) movements

Approximation facilitates stability associated

with extension (push) movements

Contraindicated if painful

Approximation
Compression

of joint surfaces
Facilitates co-contraction around joints
Used to increase stability

Traction (distraction) movements

Separation

of joint surfaces
Can decrease pain
Facilitates movement

Maximal Resistance

maximal resistance which allows

movement through full desired ROM

Accommodating resistance is the rule

Can enhance muscular endurance by

increasing repetitions/sets

Direction, quality, and quantity of resistance is

adjusted to prompt a smooth and coordinated
response, whether for stability or mobility
When applying resistance, consider the
treatment goal:
Power or endurance
Quality of movement
Presence of spasticity

Timing for Emphasis

Normal timing in sequence of joint actions

in order for movements to occur
Typically

move is distal to proximal

relationship

Timing for Emphasis

Can

be used to correct abnormal

timing/muscle firing patterns

Irradiation (overflow) occurs from stronger

muscle/s to weaker ones
stronger muscle/s augment and reinforce
contraction of weaker ones

Body Position and Mechanics

Position yourself in the diagonal

Maintain good body mechanics

Visual stimulus
Promotes more powerful contraction
Helps to control & correct the motion
Influences both head and body motion
Helps in patient / therapist communication

The PNF patterns combine motion in

all three planes:
1. The saggittal plane: flexion and
extension.
2.The coronal or frontal plane:
abduction and adduction of limbs or
lateral flexion of the spine.
3. The transverse plane: rotation.