PROPRIOCEPTIVE

NEUROMUSCULAR
FACILITATION
PNF

DEFINITION
Proprioceptive: having to do with any
of the sensory receptors that give
information concerning movement
and position of the body
Neuromuscular: involving the nerves
and muscles
Facilitation: making easier

Mechanisms of PNF
Autogenic inhibition: It a sudden relaxation
of muscle upon development of high tension. It
is a self-induced, inhibitory, negative feedback
lengthening reaction that protects against
muscle tear. Golgi tendon organs are receptors
for the reflex.
Reciprocal inhibition: contraction of agonist
muscle elicits relaxation of antagonist.
Stretch Reflex: sudden stretch of muscle
spindle causes agonist to contract and
antagonist to relax (ie., patellar tap reflex)

Basic Principles
Patterns of movement - should be taught to
patient
Visual stimulus - look at moving limb
Verbal cues - to coordinate reflex and
voluntary movements
Manual contact - to resist and direct
Proper mechanics - body positioning of
therapist
Resistance - should be maximal
Rotational movement - for maximal ROM

 Normal timing - proper sequence of

muscle contraction
Timing for emphasis - to affect
specific points on a range
Traction or approximation - for extra
proprioceptive response
Quick stretch - facilitates greater
muscular contraction

 Proprioceptive neuromuscular facilitation is

exercise based on the principles of
functional human anatomy and
neurophysiology.
It uses
Proprioceptive
Cutaneous
Auditory input
To produce functional improvement in motor
output and can be a vital element in the
rehabilitation process of sports related injuries.

NEUROPHYSIOLOGICAL BASIS
OF PNF
Sherrington..
Concepts of facilitation and inhibition
Stretch reflex
Neurophysiological phenomena

FACILITATION
Facilitory - an impulse
causing the recruitment
and discharge of
additional motor neurons
in the spinal cord
Results in increased
excitability in the muscles.
Weak muscles would be
aided through facilitation

INHIBITION
Inhibitory - any stimulus
that causes motor
neurons to drop away
from the discharge zone
and away from the spinal
cord.
Inhibition results in
decreased excitability of
motor neurons.
Muscle spasticity can be
decreased

STRETCH REFLEX
The stretch reflex involves two types
of receptors
Muscle spindles
Golgi tendon organs

NEUROPHYSIOLOGICAL
PHENOMENA
RECIPROCAL INHIBITION
AUTOGENIC INHIBITION
is defined as
inhibition mediated by afferent fibers
from stretched muscle acting on the
alpha motor neurons supplying that
muscle, causing it to reflex

Reciprocal
inhibition
Is the
second
mechanis
m which
deals with
the
relationshi
ps of the
agonist
and

USES OF PNF
1. PNF treatment has been used to increase
strength, flexibility, coordination and
functional mobility.
2. The main goal of treatment is to facilitate
the patient in achieving a movement or
posture.
3. Stretches as well as diagonals and
rational exercise patterns are used to
improve ADLs functional mobility and
athletic performance

 4. It is mainly used in orthopedic

rehabilitation for musculoskeletal
injuries and in neurological rehab.
5. PNF can be used for any condition,
however the patient condition level
may require modifications.

BASIC PRINCIPLES OF PNF

1.
2.
3.
4.
5.
6.
7.
8.

Resistance
Irradiation and reinforcement
Manual contact
Stretch
Verbal commands
Traction and approximation
Timing
Body positioning and body
mechanics

1. RESISTANCE
Opposing force to the patients
movement is called
resistance.
The amount of resistance
provided during an activity
must be correct for the
patients condition and the
goal of the activity. This is
called optimal resistance.

1. RESISTANCE
Resistance is used in the treatment to:
1. Facilitate the ability of the muscle to
contract
2. Increase motor control
3. Help the patient gain an awareness
of motion and its direction
4. Increase strength

IRRADIATION &
REINFORCEMENT
DEFINITIONS
Irradiation : the spread of response
to stimulation is called irradiation.
Reinforcement : means to
strengthen by fresh addition, make
stronger

IRRADIATION &
REINFORCEMENT
Effects :
Maximal resistance may be used to
cause irradiation or overflow from
stronger patterns to weaker patterns
or from stronger groups of muscles
within a pattern to weaker groups
within the same pattern.

MANUAL CONTACT
Effects:
1. Stimulates the muscle
2. Stimulates the synergistic muscle to
reinforce the movement
3. Promotes trunk stabilization and
indirectly helps the limb motion
4. Prevents confusion

Touch or manual contact

Contributes to facilitation
by stimulating the
exteroceptors and it
should be
1. Purposeful
2. Directional
3. comfortable

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

STRETCH
Effects:
1. Stimulates the activity of muscle
spindle
2. Any contraction of muscle on stretch
will result in movement and the
brain knows not of muscles but of
movement.

Quick Stretch
Muscle
Spindle

+
+
Alpha Motor Neuron

TRACTION
Traction is elongation of trunk or an
extremity
Traction force is applied gradually,
maintained throughout the
movement, and combined with
appropriate resistance.

TRACTION
Joint separation stimulates joint
receptors
Muscle stretch stimulates muscle
spindle stretch receptor
Facilitates Alpha Motor Neuron
Facilitates Strength

APPROXIMATION
Definition:
Approximation is the
compression of the trunk
or an extremity.
Compression through a
joint stimulate joint
receptors
Facilitate alpha motor
neuron
Facilitate stability

APPROXIMATION
Uses:
1. Promote stabilization
2. Facilitate weight bearing and
contraction of postural muscles
3. Facilitate upright reactions
4. Resist some component of motion.
E.g., use approximation at the end
of shoulder flexion to resist scapula
(11)
elevation

VERBAL STIMULATION
(COMMANDS)
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.

VERBAL STIMULATION
(COMMANDS)

The command is divided into three

parts:
1. Preparation: readies the pt for
action. ready
2. Action: tells the pt to start the
action. now pull your leg up and in
3. Correction: tells the pt how to
correct and modify the action.
keep pulling your toes up

Commmads
used
HOLD
PULL/PUSH
RELAX

TIMINGS
Timing is the sequencing of
motions
Normal
timing
of
most
coordinated
and efficient
motions is from distal to
proximal
Timing for emphasis involves
changing
the
normal
sequencing of motion to
emphasis a particular muscle
or desired activity

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 therapists body, while
the hands and arms stay
comparatively relaxed.

TECHNIQUES OF PNF
Strengtheni
ng
techniques
Stretching
techniques

Rhythmic initiation
Repeated contraction
Slow reversal
Slow reversal-hold
Rhythmic stabilization

Contract relax
Hold relax

RHYTHMIC INITIATION
Progression from( agonist pattern)
PASSIVE
ACTIVE ASSISTED
ACTIVE

USED IN
Limited ROM due to increase tone
Who are unable to initiate movement

REPEATED CONTRATION
Patient move isotonically against maximum
resistance repeatedly until fatigue is
evidenced
When fatigue is evident then a stretch at
that point in the range should facilitate the
weaker muscles and results in coordinated
movement.
USED
To develop strength and endurance.

SLOW REVERSAL
Involves isotonic contraction of the
agonist followed immediately by an
isotonic contraction of the antagonist.

USED
1. For development of active ROM and
2. Normal reciprocal timing b/w agonist
and antagonist

SLOW REVERSAL HOLD

Involves isotonic contraction of the agonist
followed immediately by an isometric
contraction, with a hold command given at
the end of each active movement.

USED
In developing strength at a specific point in
the range of motion.

RHYTHMIC
STABILIZATION
Uses an isometric contraction of the
agonist, followed by an isometric
contraction of the antagonist.

USED
To increase strength and endurance

STRETCHING TECHNIQUES/PNF
STRETCHING
It is often a combination of passive stretching and
isometrics contractions.
encourage flexibility and coordination throughout the
limb's entire range of motion.
PNF is used to supplement daily stretching and is
employed to make quick gains in range of motion to
help athletes improve performance.

Good range of motion makes better biomechanics,

reduces fatigue and helps prevent overuse injuries.

CONTRACT-RELAX
Moves the body part passively into
the agonist pattern.
Patient is instructed to push by
contracting the antagonist
isotonically against the resistance.
USED
When ROM is limited by muscle
tightness.

HOLD RELAX
Begins with isometric contraction of
the antagonist against resistance,
followed by concentric contraction of
the agonist muscle.

PNF STRETCHING

The initial movement is in the direction of the stretch

Next the athlete pushes in a direction against the stret

The last movement is a repeat of the initial

PNF PATTERNS

1.
2.
3.
.

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

UPPER EXTREMITY
F-ABD-ER

E-ABD-IR

F-ADD-ER

E-ADD-IR

PATTERNS
D2
Flexion

D1 Flexion
Shoulder
Shoulder FLEX,
FLEX, ADD,
ADD,
ER
ER
Forearm
Forearm -- Sup
Sup

Shoulder
Shoulder FLEX,
FLEX,
ABD,
ABD, ER
ER

Wrist
Wrist -- Rad.
Rad. Flexion
Flexion

Forearm
Forearm -- Sup
Sup

Fingers
Fingers -- flexion
flexion

D2
Extension

SHOULDE
SHOULDE
R
R

Wrist
Wrist -- Rad.
Rad. Flexion
Flexion
Fingers
Fingers -- Extension
Extension

D1
Extension
Shoulder
Shoulder EXT,
EXT, ABD,
ABD, IR
IR

Shoulder
Shoulder EXT,
EXT, ADD,
ADD, IR
IR

Forearm
Forearm -- Pro
Pro

Forearm
Forearm -- Pro
Pro

Wrist
Wrist -- Ulnar.
Ulnar.
extension
extension

Wrist
Wrist -- Ulnar
Ulnar ext.
ext.

F-ADD-ER

Diagonal One

E-ABD-IR

F-ABD-ER

Diagonal Two

E-ADD-IR

LOWER EXTREMITY
F-ABD-IR

E-ABD-IR

F-ADD-ER

E-ADD-ER

LOWER EXTREMITY