Proprioceptive Neuromuscular Facilitation (PNF) is a therapeutic exercise approach that enhances neuromuscular control through specific movement patterns and techniques. It involves key principles such as optimal resistance, manual contact, and timing, emphasizing the interaction of sensory feedback to improve strength and coordination. PNF techniques are applicable in various rehabilitation settings, aiding recovery in neurorehabilitation and musculoskeletal conditions.

1. Dr. Quazi Ibtesaam Huma
MPT Neurosciences
Assistant Professor
Proprioceptive Neuromuscular
Facilitation

3. DEFINITION
• 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

4. DEFINITION
• 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
• PNF techniques can be
muscular strength and endurance; to facilitate
stability, mobility, neuromuscular control, and
coordinated movements; and to lay a foundation
for the restoration of function

5. Definitions of PNF:
Therefore, PNF can be defined as, methods of
promoting or hastening the response of the
neuromuscular mechanism through stimulation
of the proprioceptors.
Principles:
• Patient must be taught the pattern.
• Have the patient watch the moving limb moved
passively.
• The patient must give proper verbal
command.
• Manual contact with appropriate pressure is very
important.

6. PNF MAIN
FEATURES
(Hallmarks)
• ---
these are the patterns needed
during
functional
activities
• The application of
– Proprioceptive
– Cutaneous
–
Stronger muscle group
of a diagonal pattern
will

7. Physiology
- PNF exercises are based on the stretch reflex
which is caused by stimulation of the Golgi
tendon and muscle spindles.
- This stimulation results in impulses being sent to
the brain, which leads to the contraction and
relaxation of muscles.
-When a body part is injured, there is a delay in the
stimulation of the muscle spindles and Golgi
tendons resulting in weakness of the muscle.
PNF exercises help to re-educate the motor units
which are lost due to the injury

8. • :
– Neurorehabilitation
– Musculoskeletal
conditions

9. –
–
– PNF can be used in active and passive
ROM, and to improve flexibility
• PNF techniques are useful through
the
:
/ isometric techniques
/ high speed diagonal
movement performed against maximum
resistance

10. The method of PNF:
Greatest emphasis was placed on the application
of maximal resistance throughout the
range of motion using many combinations of
motions, which allowed for two component
actions at two or more joints.

11. BASIC PROCEDURES
1. Resistance
2. Irradiation and reinforcement
3. Manual contact
4. Body positioning and body mechanics
5. Verbal commands
6. Visual cues
7. Traction and approximation
8. Stretch
9. Timing
10. Patterns

12. RESISTANCE
The 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

13. IRRADIATION & REINFORCEMENT
Irradiation : the spread of response to stimulation
Reinforcement : means “to strengthen, make stronger”

14. 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

15. MANUAL CONTACT
This refers to how and where the therapist’
hands are placed on the patient.
Effects:
Stimulates the muscle’s extroceptores
Stimulates the synergistic muscle to
reinforce the movement

16. 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.

17. 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.

18. VISUAL CUES
The feedback from visual sensory system can
promote a more powerful muscle contraction
Helps the patient to control and correct his
position and motion
Moving the eyes will influence both the head and
body motion
Eye contact between patient and therapist provides
a mode of communication

19. 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

20. APPROXIMATION
Compression through a joint stimulate
receptors
joint
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

21. STRETCH
The 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

22. TIMINGS
Timing is the sequencing of motions
Normal timing of most coordinated and efficient
motions is from distal to proximal

23. DIAGONAL
• Patterns of movement associated with
PNF are:
– Multiplanner, diagonal, rotational
of extremities, trunk and neck
– Two pairs of diagonal patterns are associated
for the upper and lower extremities; diagonal
1 (D1), diagonal 2 (D2)

24. •
1
.
•
Each pattern has three dimension
– Flexion or extension
2. Abduction or adduction
3. Rotation
Movement occurs in a straight line,
in diagonal direction with a rotatory
component

25. •
•
•
•
•
are associated for
the upper and lower extremities; diagonal 1 (D1),
diagonal 2 (D2)
Each of these
patterns can be performed in either flexion or
extension
Terminology used D1
flexion; D1 extension; D2 flexion; D2 extension
Patterns are
identified by the motion that occurs at the
proximal pivot points (hips or shoulders)
Pattern is named by
the ending position of the hip or the shoulder

26. UPPER EXTREMITY

27. PATTERNS
Shoulder FLEX, ADD,
ER Forearm - Sup
Wrist - Rad.
Flexion Fingers -
flexion
Shoulder FLEX,
ABD, ER
Forearm - Sup
Wrist - Rad.
Flexion Fingers -
Extension
Shoulder EXT, ABD,
IR Forearm - Pro
Wrist - Ulnar. extension
Fingers - Extension
Shoulder EXT, ADD, IR
Forearm - Pro
Wrist - Ulnar
ext. Fingers -

28. Diagonal
One
Diagonal Two

29. LOWER EXTREMITY

30. LOWER EXTREMITY

35. Thank you!!!!!!!!!