Proprioceptive neuromuscular facilitation (PNF) is an exercise technique based on principles of neurophysiology and functional anatomy. It uses patterns of diagonal movements combining flexion, extension, abduction, adduction, and rotation. The 9 principles of PNF include resistance, stretch, timing, and verbal commands. PNF techniques like repeated contractions and hold-relax are used to improve areas like strength, flexibility, and motor control by facilitating agonist and antagonist muscle groups. PNF patterns involve multi-joint diagonal movements of the upper and lower extremities.

1. PROPRIOCEPTIVE NEUROMUSCULAR
FACILITATION

2. Includes
• PNF definition
• Neurophysiologic basis of PNF
• Uses of PNF
• 9 basic principles of PNF
• Techniques of PNF
• PNF stretching
• Patterns of PNF

3. DEFINITION
• Proprioceptive: sensory receptors that give
information concerning movement and
position of the body
• Neuromuscular: involving the nerves and
muscles
• Facilitation: making easier

4. Proprioceptors
Proprioception means "sense of self“
Types
• The muscle spindle is one type of proprioceptor that
provides information about changes in muscle length.
• The Golgi tendon organ is another type of
proprioceptor that provides information about changes
in muscle tension.
• The joint kinesthetic receptor monitor stretch in
synovial fluids and sends information to cerebellum
and spinal reflex arc

5. • Proprioceptive neuromuscular facilitation is
exercise based on the principles of functional
human anatomy and neurophysiology.

6. FUNCTIONAL HUMAN-ANATOMICAL
BASIS OF PNF
• It uses
– Proprioceptive
– Cutaneous
– Auditory input
to produce functional improvement in motor output
and can be a vital element in the rehabilitation
process of sports related injuries.

7. NEUROPHYSIOLOGICAL BASIS OF PNF
• Sherrington..
– Concepts of facilitation and inhibition
– Stretch reflex
– Neurophysiological phenomena

8. FACILITATION
• Facilitory - an impulse
causing the recruitment
and discharge of
additional motor neurons
in the spinal cord
– Results in increased
excitability in the muscles.
– Weak muscles would be
aided through facilitation

9. INHIBITION
• Inhibitory - any stimulus
that causes motor
neurons to drop away
from the discharge zone
and away from the spinal
cord.
– Inhibition results in
decreased excitability of
motor neurons.
– Muscle spasticity can be
decreased

10. STRETCH REFLEX
• The stretch reflex involves two types of
receptors
Muscle spindles
Golgi tendon organs

12. NEUROPHYSIOLOGICAL PHENOMENA
• RECIPROCAL INHIBITION
• AUTOGENIC INHIBITION

13. Reciprocal inhibition
• Is the second
mechanism
which deals
with the
relationships
of the agonist
and
antagonist
muscles

14. Autogenic Inhibition
• Autogenic inhibition reflex is a sudden
relaxation of muscle upon development of
high tension.
• It is a self-induced, inhibitory, negative
feedback lengthening reaction that protects
against muscle tear.
• Golgi tendon organs are receptors for the
reflex.

16. USES OF PNF
• 1. PNF treatment has been used to increase
strength, flexibility, coordination and
functional mobility.
• 2. The main goal of treatment is to facilitate
the patient in achieving a movement or
posture.
• 3. Stretches as well as diagonals and rotational
exercise patterns are used to improve ADL’s
functional mobility and athletic performance

17. • 4. It is mainly used in orthopedic
rehabilitation for musculoskeletal injuries and
in neurological rehab.
• 5. PNF can be used for any condition, however
the patient condition level may require
modifications.

18. BASIC PRINCIPLES 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

19. 1. RESISTANCE
Opposing force to the patient’s
movement is called 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.

20. 1. 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

21. IRRADIATION & REINFORCEMENT
DEFINITIONS
• Irradiation : the spread of response to
stimulation is called irradiation.
• Reinforcement : means “to strengthen by
fresh addition, make stronger”

22. IRRADIATION & REINFORCEMENT
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.

23. 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

24. Touch or manual contact
Contributes to facilitation by
stimulating the exteroceptors
and it should be
1. Purposeful
2. Directional
3. comfortable

25. 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

26. 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.

27. Alpha Motor Neuron
Quick Stretch
+
Muscle Spindle
+
+

28. TRACTION
• Traction is elongation of trunk or an extremity
• Traction force is applied gradually, maintained
throughout the movement, and combined
with appropriate resistance.

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

30. 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

31. APPROXIMATION
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
(11)

32. VERBAL STIMULATION (COMMANDS)
• 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.

33. VERBAL STIMULATION (COMMANDS)
• The command is divided into three parts:
1. Preparation: readies the pt for action.
“ready”
2. Action: tells the pt to start the action. “now
pull your leg up and in”
3. Correction: tells the pt how to correct and
modify the action. “keep pulling your toes
up”

34. Commmads
used
• HOLD
• PULL/PUSH
• RELAX

35. TIMINGS
• Timing is the sequencing of
motions
• Normal timing of most
coordinated and efficient
motions is from distal to
proximal
• Timing for emphasis involves
changing the normal
sequencing of motion to
emphasis a particular muscle
or desired activity

36. 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.

37. TECHNIQUES OF PNF

38. 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.

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

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

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

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

43. PNF PATTERNS

44. • 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

45. Neck pattern
1. Flexion with rotation to right
2. Extension with rotation to left

46. UPPER EXTREMITY
F-ABD-ER
F-ADD-ER
E-ABD-IR E-ADD-IR

47. PATTERNS
SHOULDER
D1 Flexion
Shoulder FLEX, ADD, ER
Forearm - Sup
Wrist - Rad. Flexion
Fingers - flexion
D2 Flexion
Shoulder FLEX, ABD, ER
Forearm - Sup
Wrist - Rad. Flexion
Fingers - Extension
D1 Extension
Shoulder EXT, ABD, IR
Forearm - Pro
Wrist - Ulnar. extension
Fingers - Extension
D2 Extension
Shoulder EXT, ADD, IR
Forearm - Pro
Wrist - Ulnar ext.
Fingers - flexion

48. Diagonal One Diagonal Two
F-ABD-ER E-ADD-IR
F-ADD-ER E-ABD-IR

49. UPPER LIMB
D1 FLEXION PATTERN
Shoulder Flexion
Adduction
External Rotation
Forearm Supination
Wrist Radial Deviation
Fingers Flexion

51. D1 EXTENSION
Shoulder Extension
Abduction
Internal Rotation
Forearm Pronation
Wrist Ulnar Deviation
Fingers Extension

53. D2 FLEXION
Shoulder Flexion
Abduction
External Rotation
Forearm Supination
Wrist Radial Deviation
Fingers Extension

55. D2 EXTENSION
Shoulder Extension
Adduction
Internal Rotation
Forearm Pronation
Wrist Ulnar Deviation
Fingers Flexion

57. Unilateral patterns
• UE D1 flexion: hand-to-mouth motion in
feeding, combing hair on right side with
left hand
• UE D1 extension: pushing a car door to
open from inside
• UE D2 flexion: combing hair on right side
with right hand
• UE D2 extension: pitching a baseball

62. LOWER EXTREMITY
F-ABD-IR
F-ADD-ER
E-ABD-IR E-ADD-ER

63. LOWER LIMB
D1 FLEXION PATTERN
Hip Flexion
Adduction
External Rotation
Ankle Dorsiflexion
Inversion
Toes Extension

65. D1 EXTENSION PATTERN
Hip Extension
Abduction
Internal Rotation
Ankle Planar Flexion
Eversion
Toes Flexion

67. D2 FLEXION PATTERN
Hip Flexion
Abduction
Internal Rotation
Ankle Dorsiflexion
Eversion
Toes Extension

69. D2 EXTENSION PATTERN
Hip Extension
Adduction
External Rotation
Ankle Plantar Flexion
Inversion
Toes Flexion

71. • LE D1 flexion: putting on a shoe with leg
crossed
• LE D1 extension: putting leg into pants
• LE D2 flexion: climbing a bike
• LE D2 extension: long sitting with legs
crossed

76. UPPER TRUNK

78. • Upper trunk:

79. LOWER TRUNK

81. • Lower trunk:

82. PNF IN SPORTS
• Here are some other general guidelines when completing PNF
stretching:
• 1. Leave 48 hours between PNF stretching routines.
• 2. Perform only one exercise per muscle group in a session.
• 3. For each muscle group complete 2-5 sets of the chosen exercise.
• 4. Each set should consist of one stretch held for up to 30 seconds
after the contracting phase.
• 5. PNF stretching is not recommended for anyone under the age of
18.
• 6. If PNF stretching is to be performed as a separate exercise
session, a thorough warm up consisting of 5-10 minutes of light
aerobic exercise and some dynamic stretches must precede it.

83. • JOURNEL OF ATHLETIC TRAINING
• PNF techniques are most frequently applied during
rehabilitation of the knee, shoulder, and hip, ankle
rehabilitation has increased.
• The most frequently used techniques were contract-
relax and hold-relax
• The use of PNF techniques in the muscle re-
education phase of rehabilitation