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
Kabat’s 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 patient’s 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 Spindle
Reciprocal Inhibition
Golgi 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
Sherrington’s 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
2. Sense organ 3. Primary response
1. Stimulus -
-
Large force exerted excited -Golgi
tendon organs Muscle attached to
on muscle tendon
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 ADL’s 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 (cont’d)
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 patient’s 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.
