PNF

Proprioceptive Neuromuscular Facilitation

Tina Recalde, DPT, MS, ATC, CSCS

2012

Primary Goal

Promote functional movement through use of facilitation, inhibition, strengthening, and relaxation of muscle groups

Used to make functional motion easier through use of proprioceptive signals to nerves and muscles

Tina Recalde, DPT, MS, ATC, CSCS

2012

History

Developed at Kabat-Kaiser Institute

1946-1951 Based on neurophysiology and motor development Emphasis placed on application of maximal resistance throughout ROM Used many combinations of motions

Primitive patterns Postural and righting reflexes

Tina Recalde, DPT, MS, ATC, CSCS 2012

Components

Positioning of a part was valuable

Created stronger contraction in desired muscle groups First in strongest part of range Progressing toward weaker parts of range Usually synergists for greater proprioceptive stimulation
Tina Recalde, DPT, MS, ATC, CSCS 2012

Motion performed

Stretch applied to groups of muscles

Components Continued

Process of overflow (reinforcement)

Used throughout in combination of motions Used to increase ROM and improve endurance

Repeated contractions

Tina Recalde, DPT, MS, ATC, CSCS

2012

Sherringtons Law of Successive Induction

1949 Having pt isometrically contract agonist, then antagonist, resulted in increased response of the agonist rhythmic stabilization Applying same procedure of alternating resistance to isotonic contractions of antagonist and agonist also had a facilitating effect slow reversal
Tina Recalde, DPT, MS, ATC, CSCS 2012

Combinations of Motions

1951 Combinations which permitted maximum elongation of related muscle groups so that stretch reflex could be elicited throughout a pattern were most effective Patterns were spiral and diagonal in character with similarity to normal, functional patterns of motion
Tina Recalde, DPT, MS, ATC, CSCS 2012

Definitions

Proprioceptive

Receiving stimulation within the tissues of the body Pertaining to nerves and muscles

Neuromuscular

Tina Recalde, DPT, MS, ATC, CSCS

2012

Proprioceptors

Corpuscles of Ruffini Muscle Spindles Golgi Tendon Organs (GTOs)

Tina Recalde, DPT, MS, ATC, CSCS

2012

Corpuscles of Ruffini

Located within skin, ligaments, and joint capsules Respond to distension

Tina Recalde, DPT, MS, ATC, CSCS

2012

Muscle Spindles

Located in skeletal muscle Respond to changes in length

Excitatory synapses with motorneurons of stretched muscle Inhibitory synapses with motorneurons of antagonist muscles

Tina Recalde, DPT, MS, ATC, CSCS

2012

Golgi Tendon Organs

Located in muscles and tendons Protect against harmful levels of tension development

Tina Recalde, DPT, MS, ATC, CSCS

2012

Definitions

Facilitation

Promotion or hastening of any natural process Effect produced in nerve tissue by passage of an impulse Resistance of nerve is diminished so that a 2nd application of stimulus evokes reaction more easily

Tina Recalde, DPT, MS, ATC, CSCS

2012

Definitions

PNF

Methods of promoting or hastening normal responses of neuromuscular mechanism through stimulation of proprioceptors placing specific demands in order to secure a desired response

Tina Recalde, DPT, MS, ATC, CSCS

2012

Principles

Knowledge of normal neuromuscular mechanisms

Motor development, anatomy, neurophysiology, and kinesiology

Tina Recalde, DPT, MS, ATC, CSCS

2012

Normal Neuromuscular Mechanism

Capable of a wide range of motor activities within limits of:

Anatomical structure Developmental level Inherent and previously learned neuromuscular responses

Integrated and efficient without awareness of individual muscle action, reflex activity, and a multitude of other neurophysiological reactions Tina Recalde, DPT, MS, ATC, CSCS

2012

Deficient Neuromuscular Mechanism

Inadequate to meet demands of life in proportion to degree of deficiency Response may be limited as a result of faulty development, trauma, or disease of nervous or musculoskeletal systems Specific demands placed by PT/PTA have a facilitating effect upon pts neuromuscular mechanism to reverse pts limitations
Tina Recalde, DPT, MS, ATC, CSCS 2012

PNF Objectives

Increase ability to move or remain stable Guide movement through use of proper grips and appropriate resistance Achieve coordinated movement through use of timing Increase stamina Avoid fatigue
Tina Recalde, DPT, MS, ATC, CSCS 2012

Limitation

Avoid causing or increasing pain

Tina Recalde, DPT, MS, ATC, CSCS

2012

Basic Procedures

Patterns Resistance Irradiation and reinforcement Manual contact Traction and approximation Stretch Timing
Tina Recalde, DPT, MS, ATC, CSCS 2012

Patterns of Facilitation

Mass movement patterns

Brain knows nothing of individual muscle action but knows only movement

Combining specific components of motion that allow consistent activation Spiral and diagonal in character in keeping with spiral and rotary characteristics of skeletal system
Tina Recalde, DPT, MS, ATC, CSCS 2012

Straight Motion

Pattern of Facilitation

Flexion

Flexion

Flexion

Pivot of Action

Pivot of Action

Extension Extension

Extension

Tina Recalde, DPT, MS, ATC, CSCS

2012

Major Parts of Body

Head and neck Upper trunk Lower trunk UE LE

Tina Recalde, DPT, MS, ATC, CSCS

2012

Diagonals

2 diagonals of motion for each major part of body Each diagonal has:

2 patterns

Antagonistic to each other

Major component of flexion or extension

Major component combined with 2 other components

Motion toward or away from midline Rotation

Tina Recalde, DPT, MS, ATC, CSCS 2012

Diagonals
Flexion Flexion

Pivot of Action

Extension

Extension
Tina Recalde, DPT, MS, ATC, CSCS 2012

LE PNF Patterns
D2 Hip flxn Hip abdn Hip IR Ankle DF Foot eversion Toe extn D1 Hip flxn Hip addn Hip ER Ankle DF Foot inversion Toe extn

Hip extn Hip abdn Hip IR Ankle PF Foot eversion Toe flxn

Hip extn Hip addn Hip ER Ankle PF Foot inversion Toe flxn
Tina Recalde, DPT, MS, ATC, CSCS 2012

UE PNF Patterns
D2 Shoulder flxn Shoulder abdn Shoulder ER Scap elevation & addn Forearm supination Radial wrist extn Finger extn D1 Shoulder flxn Shoulder addn Shoulder ER Scapular elevation & abdn Forearm supination Radial wrist flxn Finger flxn

Shoulder extn Shoulder abdn Shoulder IR Scapular depression & addn Forearm pronation Ulnar wrist extn Finger extn
Tina Recalde, DPT, MS, ATC, CSCS 2012

Shoulder extn Shoulder addn Shoulder IR Scapular depression and abdn Forearm pronation Ulnar wrist flexion Finger flxn

Naming of Patterns

Each pattern is named either:

1.

2.

For position of the proximal jt. at the end of the pattern OR For the motions being performed at the proximal jt.

Tina Recalde, DPT, MS, ATC, CSCS

2012

Naming of Diagonals

D1 or D2 Or for the 2 patterns that comprise the diagonal (ex: flex/abd/ER ext/add/IR

Tina Recalde, DPT, MS, ATC, CSCS

2012

Resistance

Used to:

Facilitate ability of muscles to contract Increase motor control Help pt gain awareness of motion Increase strength

Amount should be appropriate for injury or goal of activity Should allow smooth, coordinated mvmt to occur
Tina Recalde, DPT, MS, ATC, CSCS 2012

Irradiation and Reinforcement

Occurs with appropriately applied resistance Facilitation spreads both distally and proximally Used to increase response to stimulation

Tina Recalde, DPT, MS, ATC, CSCS

2012

Manual Contact

Use of PT/PTAs hands with varying grip and pressure to guide mvmt and increase strength Stimulates mechanoreceptors in skin Allows pt to adjust motion based upon grip and pressure applied Should relay info about proper and expected direction of mvmt Applied in opposite direction of desired motion
Tina Recalde, DPT, MS, ATC, CSCS 2012

Traction

Stimulates sensory receptors within joints Elongation of trunk or extremities and acts as a stimulus by elongating muscles Used to facilitate pulling and antigravity motions Applied gradually and maintained throught motion

Tina Recalde, DPT, MS, ATC, CSCS

2012

Approximation

Stimulates sensory receptors within joints Compression of trunk or extremities Facilitates contraction of muscles to correct applied pressure Used to promote stabilization, facilitate wtbearing, and correct antigravity muscles

Tina Recalde, DPT, MS, ATC, CSCS

2012

Stretch Reflex

Elongation of muscles Used to facilitate contraction and decrease muscle fatigue

Tina Recalde, DPT, MS, ATC, CSCS

2012

Timing

Sequence of motions that is required to allow smooth, coordinated movements to occur Normal timing for most coordinated activities begins distally and moves proximally

Distal portion moves through full ROM first and holds position Other components move together and complete their motion Rotation is the only motion resisted throughout entire pattern Tina Recalde, DPT, MS, ATC, CSCS

2012

References

Adler, S. S., Beckers, D., & Buck, M. (1993). PNF in practice: An illustrated guide. New York: Springer-Verlag. Knott, M. & Voss, D. E. (1968). Proprioceptive Neuromuscular Facilitation Patterns and Techniques. New York: Harper & Row. Previte, J. J. (1983). Human physiology. New York: McGrawHill. Roy, M. A., Sylvestre, M., Katch, F. I., Katch, V. L., & Lagasse, P. P. (1990). Proprioceptive facilitation of muscle tension during unilateral and bilateral knee extension. International Journal of Sports Medicine, 11(4), 289-292.
Tina Recalde, DPT, MS, ATC, CSCS 2012