PNF is a treatment approach based on the principle that all patients have untapped potential. It integrates principles of motor control and motor learning. The basic procedures of PNF include applying resistance, using irradiation and reinforcement, providing manual contact and verbal cues, and incorporating body positioning, vision, traction, approximation, stretching, timing, and movement patterns. The goal is to facilitate muscle contractions and motor control through optimal resistance applied in different ways like resisting specific motions or muscle groups.

1. Proprioceptive
Neuromuscular
Facilitation (PNF)
Aditya Johan .R, M.Fis

2. Introduction
• Proprioceptive Neuromuscular Facilitation (PNF) is a concept of
treatment.
• Its underlying philosophy is that all human beings, including those
with disabilities, have untapped existing potential (Kabat 1950)

3. Basic principles to PNF
• PNF is an integrated approach, not just at a specific problem or body
segment
• Based on the untapped existing potential of all patients, the
therapist will always focus on mobilizing the patient’s reserves
• The treatment approach is always positive, reinforcing and using
that, which the patient can do, no pain, achievable tasks, set up for
success, direct and indirect treatment, strong start
• The primary goal of all treatment is to help patients achieve their
highest level of function
• Integrates principles of motor control and motor learning, repetition
in a different context, respect stages of motor control, variability of
practice

4. Basic Procedures for Facilitation
• Resistance: To aid muscle contraction and motor control, to increase
strength, aid motor learning.
• Irradiation and reinforcement: Use of the spread of the response to
stimulation.
• Manual contact: To increase power and guide motion with grip and pressure.
• Body position and body mechanics: Guidance and control of motion or
stability.
• Verbal (commands): Use of words and the appropriate vocal volume to direct
the patient.

5. • Vision: Use of vision to guide motion and increase force.
• Traction or approximation: The elongation or compression of the limbs and
trunk to facilitate motion and stability.
• Stretch: The use of muscle elongation and the stretch reflex to facilitate
contraction and decrease muscle fatigue.
• Timing: Promote normal timing and increase muscle contraction through
“timing for emphasis”.
• Patterns: Synergistic mass movements, components of functional normal
motion.
 Combine these basic procedures to get a maximal response from the patient

6. Resistance
• The amount of resistance provided during an activity must be correct for the
patient’s condition and the goal of the activity (optimal resistance)
• When a muscle contraction is resisted, that muscle’s response to cortical
stimulation increases
• The active muscle tension produced by resistance is the most effective
proprioceptive facilitation
• The magnitude of that facilitation is related directly to the amount of
resistance
• It is important that the resistance does not cause pain, unwanted fatigue, or
unwanted irradiation

7. Irradiation and Reinforcement
• Irradiation is the spread of the response to stimulation
• Reinforcement/Reinforce, as defined in Webster’s Ninth New Collegiate
Dictionary, is “to strengthen by fresh addition, make stronger.”

8. Examples of the use of resistance in
patient treatment:
• Resist muscle contractions in a sound limb to produce contraction of
the muscles in the immobilized contralateral limb.
• Resist hip flexion to cause contraction of the trunk flexor muscles.
• Resist supination of the forearm to facilitate contraction of the
external rotators of that shoulder.
• Resist hip flexion with adduction and external rotation to facilitate
the ipsilateral dorsiflexor muscles to contract with inversion.
• Resist neck flexion to stimulate trunk and hip flexion. Resist neck
extension to stimulate trunk and hip extension.

9. Manual Contact
• Pressure on a muscle to aid that muscle’s ability to contract
• To give the patient security and confidence.
• To promote tactile-kinesthetic perception.
• Pressure that is opposite to the direction of motion on any point of a
moving limb stimulates the synergistic limb muscles to reinforce the
movement.

10. Lumbrical Grip
• To control movement and resist rotation the therapist uses a
lumbrical grip.
• In this grip the pressure comes from flexion at the
metacarpophalangeal joints, allowing the therapist’s fingers to
conform to the body part.
• The lumbrical grip gives the therapist good control of the three
dimensional motion without causing the patient pain due to
squeezing or putting too much pressure on bony body parts

11. Body Position and Body Mechanics
• Give the therapist effective control of the patient’s motion.
• Facilitate control of the direction of the resistance.
• Enable the therapist to give resistance without fatiguing.
• The therapist’s body should be in line with the desired motion or force.
• To line up properly, the therapist’s shoulders and pelvis face the direction of the
motion.
• The arms and hands also line up with the motion
• The resistance comes from the therapist’s body while the hands and arms stay
comparatively relaxed

12. Verbal Stimulation (Commands)
• Guide the start of movement or the muscle contractions.
• Affect the strength of the resulting muscle contractions.
• Give the patient corrections
• The verbal command tells the patient what to do and when to do it
• Preparatory instructions need to be clear and concise, without
unnecessary words
For example, the command for the lower extremity pattern of flexion-
adduction-external rotation with knee flexion might be [preparation]
“ready, and”; [action] “now pull your leg up and in”; [correction] “keep
pulling your toes up” (to correct lack of dorsiflexion)

13. Vision
• Promote a more powerful muscle contraction.
• Help the patient control and correct position and motion.
• Influence both the head and body motion.
• Provide an avenue of communication and help to ensure cooperative
interaction
• The feedback (and –forward) system can promote a much stronger
muscle activity
• Using vision helps the patient control and correct his or her position
and motion

14. Traction
• Traction is the elongation of the trunk or an extremity
• Facilitate motion, especially pulling and antigravity motions.
• Aid in elongation of muscle tissue when using the stretch reflex.
• Resist some part of the motion. For example, use traction at the
beginning of shoulder flexion to resist scapula elevation.
• Traction of the affected part is helpful when treating patients with
joint pain

15. Approximation
• Approximation is the compression of the trunk or an extremity
• Promote stabilization
• Facilitate weight-bearing and the contraction of antigravity muscles
• Facilitate upright reactions
• Resist some component of motion. For example, use approximation at
the end of shoulder flexion to resist scapula elevation

16. Stretch
• The response to a stretch of the muscle chain given by the therapist
can lead to a stretch reflex
• Sometimes a stretch activity is contraindicated when the muscles,
tendons, bones, or joint are injured
• Facilitate muscle contractions.
• Facilitate contraction of associated synergistic muscles
• The stretch reflex is elicited from muscles that are under tension,
either from elongation or from contraction

17. Timing
• Normal timing provides continuous, coordinated motion until a task
is accomplished.
• Timing for emphasis redirects the energy of a strong contraction into
weaker muscles.
• Normal movement requires a smooth sequence of activity, and
coordinated movement requires precise timing of that sequence

18. PNF Patterns

19. PNF UPPER EXTREMITY

20. PNF LOWER EXTREMITY

21. THANKS