2. Proprioceptive: Having to do with any of the
sensory receptors that give information
concerning movement and position of the body
Neuromuscular: Involving the nerves and muscles
Facilitation: Making easier
The technique aims at maximum quantity of
voluntary effort by possible number of repititions
to facilitate the response
A positive reinforcining approach.
Based on motor control and motor learning
theories.
3. PNF is an approach to therapeutic exercise that
combines functionally based diagonal patterns of
movement with techniques of neuromuscular
facilitation to evoke motor responses and improve
neuromuscular control and function.
Kabat, Knott, and Voss.
4. PNF techniques can be used to develop muscular strength
and endurance; to facilitate stability, mobility,
neuromuscular control, and coordinated movements; and
to lay a foundation for the restoration of function.
PNF techniques are useful throughout the continuum of
rehabilitation from the early phase of tissue healing when
isometric techniques are appropriate to the final phase of
rehabilitation when high-velocity, diagonal movements can
be performed against maximum resistance.
5. PNF is an integrated approach: each treatment is directed
at a total human being, not just at a specific problem or
body segment.
Movement is our way to interact with our environment. All
sensory and cognitive processes may be viewed as inputs
that determine future motor outputs.
Due to the damage, the patient oft en can no longer trust
his or her internal information. In these cases the
therapist, and facilitation like PNF, becomes the most
important source of external information.
6. Hallmarks of this approach to therapeutic exercise are
the use of diagonal patterns and the application of
sensory cues— specifically proprioceptive, cutaneous,
visual, and auditory stimuli—to elicit or augment motor
responses.
Embedded in this philosophy and approach to exercise
is that the stronger muscle groups of a diagonal pattern
facilitate the responsiveness of the weaker muscle
groups.
11. Techniques of PNF
Rhythmic initiation
Repeated contractions
Reversal of antagonists
Slow reversal
Slow reversal hold
Alternating isometrics
Rhythmic stabilization
Hold relax
Hold Relax Active Contraction
Combination of agonists reversals
Replication
Resisted progression
Rhythmic Rotation
12. Rhythmic Initiation
Rhythmic motion of the limb or body through the
desired range, starting with passive motion and
progressing to active resisted movement.
Goals
Aid in initiation of motion
Improve coordination and sense of motion
Normalize the rate of motion, either increasing or
decreasing it
Teach the motion
Help the patient to relax
13. Indications
Difficulties in initiating motion
Movement too slow or too fast
Uncoordinated or dysrhythmic motion, i.e.,
ataxia and rigidity
Regulate or normalize muscle tone
General tension
15. Repeated stretch from the beginning
The stretch reflex elicited from muscles under the
tension of elongation.
Goals
Facilitate initiation of motion
Increase active range of motion
Increase strength
Prevent or reduce fatigue
Guide motion in the desired direction
16. Indications
Weakness
Inability to initiate motion due to weakness or
rigidity
Fatigue
Decreased awareness of motion
Contraindications
Joint instability
Pain
Unstable bones due to fracture or osteoporosis
Damaged muscle or tendon
17. Repeated stretch through the range
The stretch reflex elicited from muscles under the
tension of contraction
Goals
Increase active range of motion
Increase strength
Prevent or reduce fatigue
Guide motion in the desired direction
18. Indications
Weakness
Fatigue
Decreased awareness of desired motion
Contraindications
Joint instability
Pain
Unstable bones due to fracture or osteoporosis
Damaged muscle or tendon
19. Contract Relax
Direct method
Resisted isotonic contraction of the restricting
muscles (antagonists) followed by relaxation and
movement into the increased range.
Goals
Increased passive range of motion
Indication
Decreased passive range of motion
20. Hold relax
Direct method
Resisted isometric contraction of the antagonistic
muscles (shortened muscles) followed by relaxation
Goals
Increase passive range of motion
Decrease pain
21. Indications
Decreased passive range of motion
Pain
The patient’s isotonic contractions are too
strong for the therapist to control
Contraindications
The patient is unable to do an isometric contraction
22. Reversal of Antagonists
Dynamic Reversals ( slow reversals)
Active motion changing from one direction (agonist)
to the opposite (antagonist) without pause or
relaxation. In normal life we often see this kind of
muscle activity: throwing a ball, bicycling, walking
etc.
Goals
Increase active range of motion
Increase strength
Develop coordination (smooth reversal of motion)
Prevent or reduce fatigue
Increase endurance
Decrease muscle tone
23. Indications
Decreased active range of motion
Weakness of the agonistic muscles
Decreased ability to change direction of motion
Exercised muscles begin to fatigue
Relaxation of hypertonic muscle groups
24. Slow reversal hold
Slow reversal hold adds an isometric contraction
at the end of the range of a pattern to enhance
end-range holding of a weakened muscle. With
no period of relaxation, the direction of movement
is then rapidly reversed by means of dynamic
contraction of the agonist muscle groups quickly
followed by isometric contraction of those same
muscles.
This is one of several techniques used to
enhance dynamic stability, particularly in proximal
muscle groups.
25. Stabilizing reversals
Alternating isotonic contractions opposed by
resistance to prevent motion.
Goals
Increase stability and balance
Increase muscle strength
Increase coordination between agonist and
antagonist
26. Indications
Decreased stability
Weakness
Patient is unable to contract muscle isometrically
and still needs resistance in a one-way direction
27. Combination of isotonics
Combined concentric, eccentric, and stabilizing
contractions of one group of muscles (agonists)
without relaxation. For treatment, start where the
patient has the most strength or best coordination.
Goals
Active control of motion
Coordination
Increase the active range of motion
Strengthen
Functional training in eccentric control of
movement
28. Indications
Decreased eccentric control
Lack of coordination or ability to move in a
desired direction
Decreased active range of motion
Lack of active motion within the range of motion
29. Rhythmic stabilization
Alternating isometric contractions against
resistance, no motion intended
Goals
Increase active and passive range of motion
Increase strength
Increase stability and balance
Decrease pain
30. Indications
Limited range of motion
Pain, particularly when motion is attempted
Joint instability
Weakness in the antagonistic muscle group
Decreased balance
Contraindications
Rhythmic stabilization may be too difficult for patients
with cerebellar involvement
The patient is unable to follow instructions due to age,
language difficulty, cerebral dysfunction
31. Replication
A technique to facilitate motor learning of
functional activities. Teaching the patient the
outcome of a movement or activity is important for
functional work (for example sports) and self-care
activities.
Goals
Teach the patient the end position (outcome) of the
movement.
Assess the patient’s ability to sustain a contraction
when the agonist muscles are shortened.
32. Resisted progression
Stretch, approximation, tracking resistance is
applied manually to faciliate the pelvic motion and
progression during motion 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
33. Rhythmic rotation
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 (hypenonia) combined with PROM of the
range-limiting muscles
34. Pnf techniques and their goals
1. Initiate motion
Rhythmic Initiation
Repeated Stretch from beginning of range
2. Learn a motion
Rhythmic Initiation
Combination of Isotonics
Repeated Stretch from beginning of range
Repeated Stretch through range
Replication
35. 3. Change rate of motion
Rhythmic Initiation
Dynamic Reversals
Repeated Stretch from beginning of range
Repeated Stretch through range
4. Increase strength
Combination of Isotonics
Dynamic Reversals
Rhythmic Stabilization
Stabilizing Reversals
Repeated Stretch from beginning of range
Repeated Stretch through range
36. 5. Increase stability
Combination of Isotonics
Stabilizing Reversals
Rhythmic Stabilization
6. Increase coordination and control
Combination of Isotonics
Rhythmic Initiation
Dynamic Reversals
Stabilizing Reversals
Rhythmic Stabilization
Repeated Stretch from beginning of range
Replication
37. Increase endurance
Dynamic Reversals
Stabilizing Reversals
Rhythmic Stabilization
Repeated Stretch from beginning of range
Repeated Stretch through range
8. Increase range of motion
Dynamic Reversals
Stabilizing Reversals
Rhythmic Stabilization
Repeated Stretch from beginning of range
Contract-Relax
Hold-Relax
