PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION

(PNF)

Mazyad Alotaibi

Proprioceptive neuromuscular facilitation

(PNF) is an approach to therapeutic exercise that combines functional based diagonal patterns of movement with techniques of neuromuscular facilitation to evoke motor responses and improve neuromuscular control and function

Definition of Terms

Proprioceptive: the sensory receptors that give information concerning movement and position of the body

Neuromuscular: involving the nerves and muscles

Facilitation: making easier

PNF Include

Stimulation for proprioceptive and sensory mechanisms

Feed information to the nervous system

Facilitate the desired response through: – Muscle contraction for strengthening– Muscle relaxation for stretching– Improved balance and equilibrium

BASIC PROCEDURES

1. Resistance2. Irradiation and reinforcement3. Manual contact4. Body positioning and body mechanics5. Verbal commands6. Visual cues7. Traction and approximation8. Stretch9. Timing10. Patterns

RESISTANCEThe amount of resistance provided during an activity must

be correct for the patient’s condition and the goal of the activity. This is called optimal resistance.

Resistance is used in the treatment to:

Facilitate the ability of the muscle to contract

Increase motor control

Help the patient gain an awareness of motion and its direction

Increase strength

IRRADIATION & REINFORCEMENT

Irradiation : the spread of response to stimulation

Reinforcement : means “to strengthen, make stronger”

IRRADIATION & REINFORCEMENT

Increasing the amount of resistance will increase the amount and extent of the muscular response.

Examples:

Resist muscle activity of the sound limb to produce contraction of the muscles in the immobilized contralateral limb.

Resist supination of the forearm to facilitate contraction of the external rotators of that shoulder

MANUAL CONTACT

This refers to how and where the therapist’s hands are placed on the patient.

Effects:

Stimulates the muscle’s extroceptores

Stimulates the synergistic muscle to reinforce the movement

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 therapist’s body weight, while the hands and arms stay comparatively relaxed.

VERBAL STIMULATION (COMMANDS)Tells the patient what to do and when to do

Instructions need to be clear and concise without the use of unnecessary words.

May be combined with passive movement to teach the patient the desired motion

The timing of the command is very important

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.

VISUAL CUES

The feedback from visual sensory system can promote a more powerful muscle contractionHelps the patient to control and correct his position and motionMoving the eyes will influence both the head and body motionEye contact between patient and therapist provides a mode of communication

TRACTION & APPROXIMATION

The therapeutic effects of traction and approximation is due to stimulation of joint receptors.

Traction is applied when the movement is occurring against the gravity

Approximation is applied when the movement occurs in the direction of gravitational pull

APPROXIMATION

Compression through a joint stimulate joint receptors

Facilitate stability

The approximation is always maintained, whether done quickly or slowly

When the therapist feels that the active muscle contraction decreases the approximation is repeated and resistance is given

STRETCHThe 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

Stretching will Stimulate the activity of muscle spindle

TIMINGS

Timing is the sequencing of motions

Normal timing of most coordinated and efficient motions is from distal to proximal

PATTERNSEach pattern has three dimension :

- Flexion or extension - Abduction or adduction- Rotation

Movement occurs in a straight line, in diagonal direction with a rotatory componentPatterns are named according to the direction of movement and therefore finishing, not the starting position.In completing the pattern the muscle contracts through full range from its lengthened to its shortened position

UPPER EXTREMITYUPPER EXTREMITY

F-ABD-ERF-ADD-ER

E-ABD-IR E-ADD-IR

Diagonal One Diagonal Two

F-ABD-ER E-ADD-IRF-ADD-ER E-ABD-IR

F-ADD-ER E-ABD-IR

F-ABD-ER E-ADD-IR

LOWER EXTREMITYLOWER EXTREMITY

F-ABD-IRF-ADD-ER

E-ABD-IR E-ADD-ER

F-ABD-IR F-ADD-ER

F-ADD-ER F-ABD-IR

Bilateral Asymmetrical Bilateral Asymmetrical ‘Chopping’ ‘Lifting’

Bilateral symmetrical patterns