Proprioceptive Neuromuscular Facilitation, or otherwise known
as PNF, is a strengthening technique used in therapeutic exercise that is based on human
anatomy and neurophysiology. It is used to increase strength, flexibility,
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. These also overflow.
To perform PNF exercises, it is important to remember the following principles:
Patient must be taught the pattern.
Have the patient watch the moving limb moved passively.
The athletic trainer must give proper verbal cues.
Manual contact with appropriate pressure is very important.
Contraction of the muscle group is facilitated by hand placement.
Apply maximal resistance throughout ROM.
Resistance will change.
Rotation of movement will change throughout ROM.
Distal movement should occur first and before halfway through movement.
Use maximal contraction to promote overflow of strength.
D1 upper extremity movement pattern moving into flexion. Starting position.
D1 upper extremity movement pattern moving into flexion. Ending position.
D2 upper extremity movement pattern moving into flexion. Starting position.
D2 upper extremity movement moving into extension. Ending position.
Four types of PNF Strengthening:
Rhythmic initiation: includes progression from passive to active-resistive, then
followed by active movement. This is used when a patient cannot start a range of motion,
and to teach the patient the movement.
Repeated contraction: Patient moves limb isotonically through resistance until fatigue
Slow reversal: isotonic contraction of agonist and immediate contraction of antagonist. It
helps to develop AROM and coordination between agonist and antagonist. This helps to increase strength
of a specific ROM.
Rhythmic stabilization: isometric contraction of agonist followed by isometric contraction of antagonist.
It increases the holding power of a specific ROM.