PNF APPROACH
PROPRIOCEPTIVE NEUROMUSCULAR
FACILITATION

• PNF Therapy is a rehabilitation therapy that aims In
engaging the proprioceptive system there by activating or
facilitating the nervous system and helping in production of
desired movement or motor function.
• In PNF concept we are working in afferent system by
engaging proprioceptive system.

• It 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.`
• PNF stretching was originally developed as a form of
rehabilitation, is a strengthening technique based on
human anatomy, neurophysiology, and kinesiology.

• Proprioceptive, means receiving stimulation within the
tissues of the body.
• Neuromuscular, means pertaining to the nerves and
muscles.
• Facilitation, means the effect produced in nerve tissue
by the passage of an impulse.

• Proprioceptors when fired will lead to the activation of
efferent system which is descending motor control and
there by help the patient in producing the movement that
we require.
• This stimulation results in impulses being sent to the brain,
which leads to the contraction and relaxation of muscles.

HISTORY OF PNF
• PNF Approach 1st develop by Dr.Herman Kabat and
Dr.Margret Knot (1940 s).
• PNF 1st used to treat the patients with polio myelitis as
approach grew it soon become clear that PNF concept can
be utilize in wide variety.
• I.E – Orthopedic, Neurological, cardio-pulmonary, ETC
• Dorothy Voss joined the team and together work on the
concept of PNF

• Dorothy Voss and margret knot wrote a book on PNF
therapy published (1956)
• Year 1956 2020
Many Advances
• This Concept is used by many physiotherapist across the
world

RX CONCEPT AND PHILOSOPHY
• Basic Philosophy says that all human being those with
disability have untabed existing potential
• I.e there is always a scope of further improvement in
terms of functional gains

CORE PRINCIPLES
• They have given 3 core principles for PNF concept.
1- Integrated approach
It states that therapy is targeted to the total human being as
a whole and not to a specific body organ or segment.
2- Positive Approach
It states that therapist is always re-inforcing and utilizing
what the patient can do at physical level and at mental level.

3 – Achieve highest level of function.
PNF approach emphasis that plasticity mechanism not
only applicable to CNS but also to the other system of
human body.
I.E all system have the capability to reorganize and adapt
themselves following any insult or injury.

INDICATIONS
• Muscle Weakness
• Joint Stiffness
• Decrease Rom
• Difficulty initiating movement
• Improve motor function
• Improve coordination
• Decrease fatigue
• Inducing relaxation

NEUROPHYSIOLOGICAL
PRINCIPALS
1. After Discharge
2. Temporal summation
3. Spatial summation
4. Irradiation
5. Successive induction
6. Reciprocal inhibition / innervation

1- After Discharge
This principles states that
Stimulus Response (effect)
Stimulus stops then also response is still persist
for some time.
• This phenomenon of presence of response even after the
cessation of stimulus is known as after discharge.
• Feeling of increase power after completing GYM.

2- Temporal Summation
Temporal – Time , Summation – Addition
It states that when there is single weak stimuli can not
produce response then combining those weak stimuli can
produce response.
STIMULI RESPONSE
I No Responce
II No Responce
III Response
i.e Number of weak stimuli they add up and show responce

3 – Spatial Summation
It States that when weak stimuli are applied
simultaneously in different parts of the body then they can
also add up and produce response.

• 4- Irradiation (Over flow of energy)
• It occurs from stronger group of muscles to the weaker
group of muscles.
• Irradiation occurs when there is either increase in the
number of stimulus or strength of stimulus.
• These principles will help the therapist to strengthen the
weaker muscle group.
• E.g Opening the jammed Lock require involvement of
more muscle group as compare to normal lock.
• This engaging of muscle group for completing task is
called as irradiation.

• 5- Successive induction
• It states that when agonist contract to its fullest then it is
the time for the antagonist to fire.
• Eg. Elbow flexion Biceps completing its contraction then
triceps should have to contract for completing any task.

6 – Reciprocal inhibition / Innervation
• Sir Charles Shrington receives nobel prize for this
concept.
• Excitation or contraction of particular muscle is
simultaneously accompanied by inhibition of antagonist.
• To Perform coordinated movement, we require antagonist
to remain inhibited to perform normal coordinated motion.

BASIC PROCEDURE OF PNF
1. Resistance.
2. Irradiation and reinforcement.
3. Manual contact.
4. Stretch.
5. Verbal commands.
6. Traction and approximation.
7. Timing.
8. Body positioning and body mechanics.

RESISTANCE.
Resistance is used in the treatment to:
1. Facilitate the ability of the muscle to contract.
2. Increase motor control.
3. Help the patient gain an awareness of motion and its
direction.
4. Increase strength.

IRRADIATION & REINFORCEMENT
DEFINITIONS:
• Irradiation : the spread of response to stimulation is called
irradiation.
• Reinforcement : means “to strengthen by fresh addition,
make stronger”
• Effects:
Maximal resistance may be used to cause irradiation or
overflow from stronger patterns to weaker patterns or from
stronger groups of muscles within a pattern to weaker
groups within the same pattern.

MANUAL CONTACT:
Effects:
1. Stimulates the muscle.
2. Stimulates the synergistic muscle to reinforce the
movement.
3. Promotes trunk stabilization and indirectly helps the
limb motion.
4. Prevents confusion.

STRETCH:
Effects:
• 1. Stimulates the activity of muscle spindle
• 2. Any contraction of muscle on stretch will result in
movement and the brain knows not of muscles but of
movement.

TRACTION
• Joint separation stimulates joint receptors.
• Muscle stretch stimulates muscle spindle stretch
receptor.
• Facilitates Alpha Motor Neuron.
• Facilitates Strength.

APPROXIMATION
Definition:
• Approximation is the compression of the trunk or an
extremity.
• Compression through a joint stimulate joint receptors.
• Facilitate alpha motor neuron.
• Facilitate stability.

Uses:
1. Promote stabilization.
2. Facilitate weight bearing and contraction of postural
muscles.
3. Facilitate upright reactions.
4. Resist some component of motion. E.g., use
approximation at the end of shoulder flexion to resist
scapula elevation.

VERBAL STIMULATION
(COMMANDS)
• The volume with which the command is given affects the
strength of resulting muscle contraction.
• The command is divided into three parts:
1. Preparation.
2. Action.
3. Correction.

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, while
the hands and arms stay comparatively relaxed.

TECHNIQUES OF PNF
• Rhythmic initiation.
• Repeated contraction.
• Slow reversal.
• Slow reversal-hold.
• Rhythmic stabilization.
Strengthening
techniques
• Contract relax.
• Hold relax.
Stretching
techniques

RHYTHMIC INITIATION:
• Progression from( agonist pattern)
USED IN:
• Limited ROM due to increase tone.
• Who are unable to initiate movement.
PASSIVE
ACTIVE ASSISTED
ACTIVE

REPEATED CONTRATION:
• Patient move isotonically against maximum resistance
repeatedly until fatigue is evidenced.
• When fatigue is evident then a stretch at that point in the
range should facilitate the weaker muscles and results in
coordinated movement.
USED:
• To develop strength and endurance.

• SLOW REVERSAL:
• Involves isotonic contraction of the agonist followed
immediately by an isotonic contraction of the antagonist.
USED:
1. For development of active ROM.
2. Normal reciprocal timing b/w agonist and antagonist.

SLOW REVERSAL HOLD:
• Involves isotonic contraction of the agonist followed
immediately by an isometric contraction, with a hold
command given at the end of each active movement.
USED:
• In developing strength at a specific point in the range of
motion.

RHYTHMIC STABILIZATION:
• Uses an isometric contraction of the agonist, followed by
an isometric contraction of the antagonist.
USED:
• To increase strength and endurance

STRETCHING TECHNIQUES/PNF
STRETCHING
• It is often a combination of passive stretching and isometrics
contractions.
• Encourage flexibility and coordination throughout the limb's
entire range of motion.
• PNF is used to supplement daily stretching and is employed to
make quick gains in range of motion to help athletes improve
performance.
• Good range of motion makes better biomechanics, reduces
fatigue and helps prevent overuse injuries.

CONTRACT-RELAX:
• Moves the body part passively into the agonist pattern.
• Patient is instructed to push by contracting the
antagonist isotonically against the resistance.
USED:
• When ROM is limited by muscle tightness.

• HOLD RELAX:
• Begins with isometric contraction of the antagonist
against resistance, followed by concentric contraction of
the agonist muscle.

PNF STRETCHING
• The initial movement is in the direction of the stretch
• Next the athlete pushes in a direction against the stretch
• The last movement is a repeat of the initial

PNF PATTERNS
Each pattern has three dimension:
1. Flexion or extension.
2. Abduction or adduction.
3. Rotation.
• Movement occurs in a straight line, in diagonal direction
with a rotatory component.

REF
Ref.
• Dena Gardiner
• PNF in practice by Susan s adler 3rd edition (springer)