PNF techniques in details

1. PNF techniques
Presented to : Dr. Binash Afzal

2. Proprioception Neuromuscular Facilitation
Developed by “Herman Kabat”
Proprioceptive Neuromuscular Facilitation (PNF) is a set of stretching techniques commonly used in clinical
environments to enhance both active and passive range of motion in order to improve motor performance
and aid rehabilitation.
PNF helps to restore normal movement by focusing on the developing sequence of movement and how
the agonist and antagonist muscles work together to produce volitional movement.
PNF uses reflexive movement as a basis for learning more volitional movement. The idea is that one must
be able to roll before he can crawl and crawl before he walks
It relies mainly on stimulation of proprioceptors for increasing the demand made on neuromuscular
mechanism to obtain and facilitate its response.c

3. Theoretical Mechanisms
Four theoretical physiological mechanisms for increasing ROM were identified
• autogenic inhibition
Autogenic Inhibition is what occurs in a contracted or stretched muscle in the form of a decrease in the excitability because of inhibitory signals sent from
the GTOs of the same muscle
• reciprocal inhibition
Reciprocal inhibition is what occurs in the TM when the opposing muscle is contracted voluntarily in the form of decreased neural activity in the TM .

4. Basic Principles

5. Resistance
• Tracking or Light Resistance applied to weak muscles
is facilitatory and is usually applied in combination
with light stretch.
• Maximal Resistance (the greatest amount of resistance
tolerated by the patient) is used to generate
maximal effort and adjusted to ensure smooth, coordinated
movement; maximal resistance varies according
to the individual patient

6. Irradiation
Irradiation is defined as the overflow of excitation from stronger components to weaker or inhibited
components.
This is accomplished through the application of graded resistance to stronger components to facilitate
irradiation and produce an appropriate and enhanced contraction in weaker ones
Example:
In patients where more trunk or neck facilitation is desired maximal resistance is given to the shoulder
girdle to facilitate appropriate irradiation
Indications: Enhance synergistic actions of muscles, increase
strength

7. Manual contact

8. Manual contact

9. Commands for voluntary
movement are always synchronized with stretch to
enhance the response
• Repeated stretch can be applied throughout the range
to reinforce contraction in weak muscles that are fading
out.
Indications: Enhance strength of muscle contraction
and synergistic patterns of movement
STRETCH

10. Approximation
Approximation (compressing the joint surfaces) is used to facilitate extensor/stabilizing muscle contraction and
stability.
It facilitates an increased muscular response and promotes stability, and is often used when facilitating
stability in weight bearing postures or positions
Indications: Weakness, inability of extensor muscle to function in weight bearing for stabilization control
Example. Use of approximation can be used to retrain postural awareness in sitting by facilitating a more stable and
improved response of the trunk musculature and improve trunk stability

12. Traction
Indications: Weakness, inability of flexor muscles to
function in mobilizing or antigravity patterns
Example. Use of general traction when treating a patient with an
acute cervical spine can assist the patient in his/her ability to
perform controlled contractions without pain.

14. Verbal commands
The therapist's verbal command is a primary link between reflex responses and the patient's volitional
response.
Verbal commands allow for the use of well-timed words and appropriate vocal volume to direct the patient’s
movements
• Preparatory commands
• Action commands
• Corrective commands

16. Timings

17. Body positions and body mechanics
Indications: Enhance therapist’s control of the
patient’s movements; reduce therapist fatigue through
effective use of body weight and position.

18. Techniques of PNF

19. Repeated contractions

20. Reversal of Antagonists:
A group of techniques that allow for agonist contraction followed by antagonist contraction without pause or
relaxation
Dynamic Reversals (Slow Reversals): Utilizes isotonic contractions of first agonists, then antagonists
performed against resistance. Contraction of stronger pattern is selected first with progression to the weaker pattern.
The limb is moved through full ROM.
Indications: Impaired strength and coordination between agonist and antagonist, limitations in ROM, fatigue

21. Slow reversal

22. Stabilizing Reversals:
Utilizes alternating isotonic contractions of first agonists, then antagonists against resistance, allowing only very limited
ROM.
Indications: Impaired strength, stability and balance, coordination
Rhythmic Stabilization (RS):
Utilizes alternating isometric contractions of first agonists, then antagonists
against resistance; no motion is allowed.
Indications: Impaired strength and coordination, limitations in ROM; impaired stabilization control and balance

24. Rythmic initiation
Purpose. RI is used to evaluate and treat the patient's
ability:
• to allow passive motion,
• to actively contract in a smooth, rhythmical fashion
• to perform movement at a consistent rhythm against
resistance.
Indications. RI is utilized for the treatment of dysfunctions
which affect the initiation, speed, direction, or quality of
the contraction.
Inability to relax, hypertonicity (spasticity,
rigidity); difficulty initiating movement; motor planning
deficits (apraxia or dyspraxia); motor learning
deficits; communication deficits (aphasia)

25. Combination of Isotonics (Agonist Reversals, AR)
Resisted concentric, contraction of agonist muscles moving through the range is followed by a stabilizing
contraction (holding in the position) and then eccentric, lengthening contraction, moving slowing back to the
start position;
there is no relaxation between the types of contractions. Typically used in antigravity activities/assumption of
postures (i.e., bridging, sit-to stand transitions).
Indications: Weak postural muscles, inability to eccentrically control body weight during movement transitions,
poor dynamic postural control.

26. Resisted Progression (RP):
Stretch, approximation, and tracking resistance is applied manually to facilitate pelvic motion and progression during
locomotion; the level of resistance is light so as to not disrupt the patient’s momentum, coordination, and velocity
RP can also be applied using elastic band resistance.
Indications: Impaired timing and control of lower trunk/ pelvic segments during locomotion, impaired endurance

27. Rhythmic Rotation (RRo)
Relaxation is achieved with slow, repeated rotation of a limb at a point where limitation is noticed. As
muscles relax the limb is slowly and gently moved into the range. As a new tension is felt, RRo is repeated.
The patient can use active movements (voluntary effort) for RRo or the therapist can perform RRo passively.
Voluntary relaxation when possible is important.
Indications: Relaxation of excess tension in muscles (hypertonia) combined with PROM of the range-limiting
muscles

28. Stretching techniques

29. Contract relax
The contraction is
held for 5 to 8 seconds and is then followed by voluntary
relaxation and movement into the new range of the
agonist pattern.

30. Hold relax
Strong isometric contraction of the
restricting muscles (antagonists) is resisted, followed
by voluntary relaxation, and passive movement into
the newly gained range of the agonist pattern.

32. PNF patterns

33. Upper extremity

34. Patterns

36. Lower extremity