Proprioceptive Neuromuscular Facilitation (PNF)
Proprioceptive Neuromuscular Facilitation (PNF)
Proprioceptive Neuromuscular Facilitation (PNF)
Facilitation (PNF)
Methods of promoting or hastening the response of the
neuromuscular mechanism through stimulation of the
.proprioceptor
Contraindicated if painful.
Patterns of Facilitation
Initiate movement.
Define the direction or pattern of
movement.
Set the appropriate rate of movement.
Improve coordination and sense of
motion.
Promote general relaxation.
Repeated contraction: Patient moves
limb isotonically through resistance until
fatigue is present. Help to initiate
movement.
Strengthen agonist movement pattern from
lengthened range.
Strengthen agonist movement pattern
within available ROM.
Redirect motion within pattern or task.
Slow reversal: isotonic contraction of
agonist and immediate contraction of
antagonist.
Improve PROM.
Provide relaxation.
Reduce pain.
http://www.youtube.com/watch?
v=SIyGpF_XDgs&feature=related
Use of Contract and Relax
Provide relaxation.
http://www.youtube.com/watch?
v=L6YDDWdarSk&feature=related
Use of Combination of Isotonics
Object:
To examine the effects of 2 proprioceptive neuromuscular
facilitation (PNF) programs on trunk muscle endurance,flexibility,
and functional performance in subjects with chronic, low back
pain (CLBP).
Subjects:
86 women (40.2±11.9 years of age) who had complaints of CLBP
were randomly assigned to 3 groups:
1.Rhythmic stabilization training,
2.Combination of Isotonic exercise.
3.Control.
2 1 D1 EXTENSION
D2 EXTENSION Shoulder
Shoulder- Ext. Shoulder- Ext.
extension
Add. Add.
Int.Rot Internal Int.Rot
Forearm-Pron. rotation Forearm- Pron.
Wrist- Ulnar Ext. Wrist- Ulnar Ext.
Wrist Fingers- Ext.
Fingers- Flex. pronation
PNF lower extremities pattern
D1 FLEXION
Hip - Flex. D2 FLEXION
Hipflexion
Hip flexion
Add. Hip - Flex.
Foot
Foot Abd.
Ext.Rot
dorsiflexion
dorsiflexion Int.Rot.
Foot - Dorsi.
Inver. Toe Foot - Dorsi.
Toe
Toes - Ext. extension
extension Ever.
Toes - Ext.
Hip
Hipadduction
adduction Hipabduction
abduction
Hip
External HIP
Externalrotation
rotation Internalrotation
Internal rotation
PIVOT
Foot
Footinversion
inversion Footeversion
eversion
Foot
D2 EXTENTION D1 EXTENSION
Hip
Hipextension
extension
Hip - Ext. Hip - Ext.
Add. Foot
Footplantar
plantar Abd.
Ext.Rot. flexion
flexion Int.Rot.
Foot - Plant. Flex. Toe
Toeflexion
flexion
Foot - Plant. Flex
Inver. Ever.
Toes - Flex. Toes - Flex.
D1 upper extremity movement pattern
moving into flexion.
.Starting position
D1 upper extremity movement pattern moving into
flexion.
.Ending position
D2 upper extremity movement
pattern moving into flexion.
Starting position.
D2 upper extremity movement moving
into extension.
.Ending position
Diagonal Patterns
The patterns of movement associated with PNF are composed
of multijoint, multiplanar, diagonal, and rotational
movements of the extremities, trunk, and neck.
Multiple muscle groups contract simultaneously.
There are two pairs of diagonal patterns for the upper and
lower extremities:
diagonal 1 (D1)
diagonal 2 (D2).
Each of these patterns can be performed in either flexion or
extension. Hence, the terminology used is D1Flexion or
D1Extension and D2Flexion or D2Extension of the upper or
lower extremities.
Diagonal Patterns
The patterns are identified by the motions that occur at
proximal pivot points—the shoulder or the hip joints.
In other words, a pattern is named by the position of the
shoulder or hip when the diagonal pattern has been
completed.
Flexion or extension of the shoulder or hip is coupled with
abduction or adduction as well as external or internal
rotation. Motions of body segments distal to the shoulder
or hip also occur simultaneously during each diagonal
pattern.
Diagonal Patterns
Table 6.9 summarizes the component motions of each of the
diagonal patterns.
As mentioned, the diagonal patterns can be carried out
unilaterally or bilaterally.
Bilateral patterns can be done symmetrically (e.g., D1Flexion
of both extremities); asymmetrically (D1Flexion of one
extremity coupled with D2Flexion of the other extremity);
or reciprocally (D1Flexion of one extremity and D1
Extension of the opposite extremity).
Component Motions of PNF Patterns:
Upper Extremities
(D2Ext) (D2Flx) (D1Ext) (D1Flx) Joints or
Segment
s
Ext-add, IR Fl-abd ER Ext- abd, IR Flex-add, ER Shoulder
Ending Position
Finish the pattern in shoulder extension,
abduction, internal rotation; elbow
extension; forearm pronation; and wrist
and finger extension.
D2Flexion
Starting Position
Position the upper extremity in shoulder extension,
adduction, and internal rotation; elbow extension;
forearm pronation; and wrist and finger flexion.
The forearm should lie across the umbilicus.
Hand Placement
Grasp the dorsum of the patient’s hand with your (L)
hand using a lumbrical grip. Grasp the dorsal
surface of the patient’s forearm close to the elbow
with your (R) hand.
Verbal Commands
As you apply a quick stretch to the wrist and finger
extensors, tell the patient, “Open your hand and
turn it to your face”; “Lift your arm up and out”;
“Point your thumb out.”
D2Flexion
Ending Position
Finish the pattern in shoulder flexion, abduction,
and external rotation; elbow extension; forearm
supination; and wrist and finger extension.
The arm should be 8 to 10 inches from the ear; the
thumb should be pointing to the floor.
D2Extension
Starting Position
Begin as described for completion of
D2Flexion.
Hand Placement
Place the index and middle fingers of your (R)
hand in the palm of the patient’s hand and
your (L) hand on the volar surface of the
forearm or distal humerus.
Verbal Commands
As you apply a quick stretch to the wrist and
finger flexors, tell the patient, “Squeeze
my fingers and pull down and across your
chest.”
D2Extension
Ending Position
Complete the pattern in shoulder extension,
adduction, and internal rotation; elbow extension;
forearm pronation; and wrist and finger flexion.
The forearm should cross the umbilicus.
Lower Extremity Diagonal
Patterns
NOTE:
• Follow the same guidelines with regard to
rotation and resistance as previously
described for the upper extremity.
• All descriptions of hand placements are for
the patient’s (R) lower extremity.
D1Flexion
Starting Position
Position the lower extremity in hip extension,
abduction, and internal rotation; knee extension;
plantar flexion and eversion of the ankle; and toe
flexion.
Hand Placement
Place your (R) hand on the dorsal and medial surface
of the foot and toes and your (L) hand on the
anteromedial aspect of the thigh just proximal to
the knee.
Verbal Commands
As you apply a quick stretch to the ankle dorsiflexors
and invertors and toe extensors, tell the patient,
“Foot and toes up and in; bend your knee; pull
your leg over and across.”
D1Flexion
Ending Position
• Complete the pattern in hip flexion, adduction, and
external rotation; knee flexion (or extension); ankle
dorsiflexion and inversion; toe extension.
• The hip should be adducted across the midline,
creating lower trunk rotation to the patient’s (L)
side.
D1Extension
Starting Position
Begin as described for completion of D1Flexion.
Hand Placement
Place your (R) hand on the plantar and lateral
surface of the foot at the base of the toes. Place
your (L) hand (palm up) at the posterior aspect
of the knee at the popliteal fossa.
Verbal Commands
As you apply a quick stretch to the plantarflexors of
the ankle and toes, tell the patient, “Curl (point)
your toes; push down and out.”
D1Extension
Ending Position
Finish the pattern in hip extension,
abduction, and internal rotation; knee
extension or flexion; ankle plantarflexion
and eversion; and toe flexion.
D2Flexion
Starting Position (Fig. 6.39A)
Place the lower extremity in hip extension, adduction,
and external rotation; knee extension; ankle
plantarflexion and inversion; and toe flexion.
Hand Placement
Place your (R) hand along the dorsal and lateral
surfaces of the foot and your (L) hand on the
anterolateral aspect of the thigh just proximal to
the knee. The fingers of your (L) hand should
point distally.
Verbal Commands
As you apply a quick stretch to the ankle dorsiflexors
and evertors and toe extensors, tell the patient,
“Foot and toes up and out; lift your leg up and
out.”
D2Flexion
Ending Position
Complete the pattern in hip flexion, abduction,
and internal rotation; knee flexion (or
extension); ankle dorsiflexion and eversion;
and toe extension.
D2Extension
Starting Position
Begin as described for the completion of D2Flexion.
Hand Placement
Place your (R) hand on the plantar and medial
surface of the foot at the base of the toes and
your (L) hand at the posteromedial aspect of the
thigh, just proximal to the knee.
Verbal Commands
As you apply a quick stretch to the plantarflexors
and invertors of the ankle and toe flexors, tell the
patient, “Curl (point) your toes down and in;
push your leg down and in.”
D2Extension
Ending Position
Complete the pattern in hip extension,
adduction, and external rotation; knee
extension; ankle plantarflexion and
inversion; and toe flexion.
Head and Neck
Flexion with rotation to the right
Head and Neck
Extension with Rotation to the left
Head and Neck
Rotation to the right
References: