Proprioceptive

Neuromuscular Facilitation
Techniques in
Rehabilitation
Fall 2013
Erica and Kaitlyn

Basic Principles of PNF

Keep instructions brief and simple
Move them through the pattern once to show how its
done
Verbal cues such as push, pull, hold
Appropriate resistance is applied for maximal response

Prentice: Ch. 14, 297-298

Basic Principles of PNF

Rotation is critical for PNF movements = maximal
contraction
Normal timing of muscle contractions
Distal segment moves first
Emphasis on isotonic contractions

Prentice: Ch. 14, 297-298

Basic principles of PNF

Specific joints can use traction or approximation
(moving closer together)
Quick stretch of muscle before contraction = greater
force through the mechanism of the stretch reflex

Prentice: Ch. 14, 297-298

Basic Stretching Techniques

Rhythmic Initiation
Repeated Contraction
Slow Reversal
Slow-Reversal-Hold
Rhythmic Stabilization

Rhythmic Initiation
Movement is slow, goes through the available ROM
Used for patients who are unable to initiate movement
and have limited ROM (early phase of rehab)
Also used to teach the pattern

Repeated Contraction
Used for whenever there is weakness at a specific point
in ROM or for the entire range.
Good for correcting imbalances that occur with in ROM
by repeating the WEAKEST part of the total range.
Patient moves isotonically against maximal resistance
until fatigue is apparent in the weakest components of
ROM

Follow up with stretching

Slow Reversal
Isotonic contraction of agonist followed by isotonic
contraction of the antagonist
Used for developing AROM, timing of agonists and
antagonists (critical for normal coordinated motion)
Direct patient to push against max. resistance by using
the antagonist then pulling with the agonist

Slow-Reversal-Hold
Isotonic contraction of the agonist, followed by an
isometric contraction
Hold command at the end of each active movement
Pattern is then reversed using the same sequence of
muscle contractions with NO RELAXATION
Good for developing strength at point in ROM

Rhythmic Stabilization
Isometric contraction of the agonist, followed by
isometric contraction of the antagonist to produce cocontraction and stability of the two muscle groups
Command is- hold and movement is resisted in each
direction
Results in an increase in holding power where the
position cant be broken

Treating specific problems with

PNF techniques
Not limited by machines, all done by practitioner
Movements can occur in 3 planes, most closely
resembles functional movement patterns
Resistance applied by ATC can be adjusted for
patients needs
Pick and choose what to concentrate on
Entire ROM or specific point

PNF Patterns- D1 & D2

Diagonal 1 and Diagonal 2
Uses 3 components:

Flexion-Extension
Abduction-Adduction
Internal-External Rotation
Muscles are spiral in nature, human movement uses patterns;
rarely follows a straight motion

Upper/Lower Extremity

Named according to the proximal pivot points (i.e. shoulder or

hip)

Upper Extremity- D1
D1 moving into EXTENSION Start Position (shoulder):

Shoulder- Flexed, Adducted, External Rotation

Forearm- Supinated
Wrist- Radial deviation
Fingers- Flexed
Heisman

D1 moving into FLEXION Starting postion:

Shoulder- Extended, Abducted, Internal Rotation

Forearm- Pronated
Wrist- Ulnar Deviation
Fingers- Extended
Reverse of Heisman

Upper Extremity- D2
D2 moving into EXTENSION Starting postion:

Shoulder- Flexed, Adducted, External Rotation

Forearm- Supinated
Wrist- Radial Deviation
Fingers- Extended
Drawing the Sword

D2 moving into FLEXION Starting postion:

Shoulder- Extended, Abducted, Internal Rotation

Forearm- Pronated
Wrist- Ulnar Deviation
Fingers- Extended
Sword in the Sheath

Lower Extremity- D1
D1 moving into EXTENSION Starting Position:

Hip- Flexed, Adducted, External Rotation

Ankle- Dorisflexion, Inversion
Toes- Extended
Figure 4

D1 moving into FLEXION Starting Position:

Hip- Extended, Abducted, Internal Rotation
Foot- Plantar flexion, Eversion
Toes- Flexed

Lower Extremity- D2
D2 moving into EXTENSION Starting Position

Hip- Flexed, Abducted, Internal Rotation

Foot- Dorsiflexion, Eversion
Toes- Extended
Fire Hydrant

D2 moving into FLEXION Starting Position

Hip- Extension, Adducted, External Rotation
Foot- Plantar Flexion, Inversion
Toes- Flexed

PNF Stretching to improve ROM

Uses the Stretch Reflex
Muscle Spindles
Golgi Tendon Organs (GTOs)

Autogenic Inhibition: Inhibition mediated by afferent fibers

from a stretched muscle acting on the alpha motor
neurons, causing the muscle to relax
Reciprocal Inhibition: Relationship of agonist/antagonist
muscles, excitatory impulses are received by afferent
nerves, nerves that go to antagonist muscles are INHIBITED
by the afferent impulses.

Stretching Techniques
Contract-Relax
Hold-Relax
Slow-Reversal-Hold-Relax

Muscle Energy Techniques

Five Components:
Active muscle contraction by the patient
A muscle contraction oriented in a specific direction
Some patient control of contraction intensity
ATC control of joint position
ATC provides application of appropriate counter-force