Proprioceptive Neuromuscular Facilitation

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).

• 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 the muscles.
• Facilitation – Making easier.

1. After discharge

The effect of a stimulus continues after the stimulus stops. If the strength and duration of the stimulus increase, the after discharge increases as well. The feeling of increased power that comes after a maintained static contraction is the result of after discharge.

2. Temporal summation

A succession of weak stimuli (subliminal) occurring (summate) to cause excitation.

3. Spatial summation

Weak stimuli applied simultaneously to different areas of the body reinforce each other (summate) to cause excitation. Temporal and spatial summation can combine for greater activity.

4. Irradiation

This is a spreading and increased strength of a response. It occurs when either the number of stimuli or the strength of the stimuli is increased. The response may be either excitation or inhibition.

5. Successive induction

An increased excitation of the agonist muscle follows stimulation (contraction) of their antagonists. Techniques involving reversal of agonists make use of this property (Induction: stimulation, increased excitability).

6. Reciprocal innervation (reciprocal inhibition)

Contraction of muscles is accompanied by simultaneous inhibition of their antagonists. Reciprocal innervation is a necessary part of coordinated motion. Relaxation techniques make use of this property.

1. Resistance
• Gellhorn showed that 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 (Gellhorn 1949; Loofbourrow and Gellhorn 1949). Used to aid muscle contraction and motor control, to increase strength, aid motor learning.
2. Irradiation and reinforcement
• Irradiation is defined as the spread of the response of nerve impulses of a given stimulation.
• Reinforcement Reinforce, as defined in Webster’s Ninth New Collegiate Dictionary, is to strengthen by fresh addition, make stronger. The therapist directs the reinforcement of the weaker muscles by the amount of resistance given to the strong muscles.
• Used to spread the response to stimulation.
3. Manual contact
• The therapist’s grip stimulates the patient’s skin receptors and other pressure receptors. This contact gives the patient information about the proper direction of motion. The therapist’s hand should be placed to apply the pressure opposite the direction of motion.
• Used to increase power and guide motion or movement with proper grip and pressure.
4. Body position and body mechanics
• 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. If the therapist cannot keep the proper body position, the hands and arms maintain alignment with the motion.
• The resistance comes from the therapist’s body while the hands and arms stay comparatively relaxed. By using body weight the therapist can give prolonged resistance without fatiguing. The relaxed hands allow the therapist to feel the patient’s responses.
• Proper body mechanics and proper positioning of the therapist enable him to provide a specific and well-aimed guidance to better control motion, movement, or stability.
5. Auditory stimulation (commands)
• The verbal command tells the patient what to do and when to do it.
• The volume with which the command is given can affect the strength of the resulting muscle contractions (Johansson et al. 1983). The therapist should give a louder command when a strong muscle contraction is desired and use a softer and calmer tone when the goal is relaxation or relief of pain.
• Use of words and the appropriate vocal volume to direct the patient.
• The command is divided into three parts:
1. Preparation: readies the patient for action
2. Action: tells the patient to start the action
3. Correction: tells the patient how to correct and modify the action.
6. Visual stimulation
• Visual feedback promotes muscular activity, by helping with coordination, strength, and stability.
• The visual contact between the patient and the therapist provides an important nonverbal avenue of communication, which can improve the patient’s motivation and coordination.
• Use of vision to guide motion and increase force. The visual feedback simplifies motion. This is because the patient tracks and controls movement and position with his eyes. By having eye contact, the therapist and the patient receive feedback about the performed movement.
7. Traction or approximation
• Traction is the elongation of the trunk or an extremity by the therapist. Traction also acts as a stretch stimulus by elongating the muscles. Apply the traction force gradually until the desired result is achieved. The traction is maintained throughout the movement and combined with appropriate resistance.
• Approximation is the compression of the trunk or an extremity. There are three ways to apply the approximation:
1. Quick approximation: the force is applied quickly to elicit a reflex-type response.
2. Slow approximation: the force is applied gradually up to the patient’s tolerance.
3. Maintained approximation: After either a quick or slow approximation, the pressure will be maintained as long as necessary for the muscles to build up the proper muscle tension.
• The elongation or compression of the limbs and trunk to facilitate motion and stability.
8. Stretch
• The stretch stimulus occurs when a muscle is elongated under optimal tension.
• The use of muscle elongation and the stretch reflex to facilitate contraction and decrease muscle fatigue.
• The stretch reflex is elicited from muscles that are under tension, either from elongation or from contraction.
9. Timing
• Timing is the sequencing of motions. In adults, normal timing of most coordinated and efficient motions is from distal to proximal.
• Promote normal timing and increase muscle contraction with proper inputs and through timing for emphasis.
• Timing for emphasis involves changing the normal sequencing of motions to emphasize a particular muscle or a desired activity.
10. Patterns
• The patterns of facilitation may be considered one of the basic procedures of PNF.
• Synergistic mass movements, components of functional normal motion.

1. Rhythmic Initiation
2. Combination of Isotonics (G. Johnson and V. Saliba, unpublished handout 1979) (also called Reversal of Agonists; Sullivan et al. 1982)
3. Reversal of Antagonists
– Dynamic Reversal of Antagonists (incorporates Slow Reversal)
– Stabilizing Reversal
– Rhythmic Stabilization
4. Repeated Stretch (Repeated Contraction)
– Repeated Stretch from beginning of range
– Repeated Stretch through range
5. Contract–Relax
6. Hold–Relax
7. Replication