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PROPRIOCEPTIVE NEUROMUSCULAR PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION (PNF)FACILITATION (PNF)
Harpreet Singh, AIIMSHarpreet Singh, AIIMS
MPT (Neurosciences),MPT (Neurosciences),
Trained-IPNFA, California, USATrained-IPNFA, California, USA
Move
ment
is o
ur
way
to in
tera
ct w
ith
our
envi
ronm
ent
Philosophy…Philosophy…
Life is a series of response to series of Life is a series of response to series of demandsdemands
Efficient mechanism - varietyEfficient mechanism - variety
LimitedLimited
DeficiencyDeficiency unable to respond unable to respond
PNFPNF
Active participation in life develops abilitiesActive participation in life develops abilities Hidden potentials existHidden potentials exist
Repetition is important for learningRepetition is important for learning
Philosophy…Philosophy…
Purposeful movements are directed to a goalPurposeful movements are directed to a goal Tangential activity may be interesting but…Tangential activity may be interesting but…
Effort is directed & channeled – “Goals” Effort is directed & channeled – “Goals” (in treatment, (in treatment, purposeful movements; specific combination of motions)purposeful movements; specific combination of motions)
Hinder optimum functionHinder optimum function
Survival of the fittest OR……………Survival of the fittest OR…………… Strong help the weakStrong help the weak
Main
ideas
Main
ideas
Humans respond in
Humans respond in
accordance with the
accordance with the
demandsdemands Existing
potentials
Existing potentials
may be developed
may be developed
more fullymore fullyMovements must be
Movements must be
specific & directed
specific & directed
towards a goal
towards a goalActivity is necessary
Activity is necessary
for best development
for best development
of strengthof strengthCooperation
Cooperation
S.A.I.D.
PRINCIPLE
Specific adaptations to imposed demands
Body adapts to stress and strain placed on it
Success of the athlete depends on the ability to meet demands
Constructive stress + opportunities for input & integration
Normal Normal vs vs AbnormalAbnormal
Capable of wide range of activitiesCapable of wide range of activities Developmental patterns & learning situationsDevelopmental patterns & learning situations
Endowed with reserves of power (stress Endowed with reserves of power (stress situations)situations)
Development of potentialsDevelopment of potentials Environmental influence & volitionEnvironmental influence & volition
Integrated & efficient without awarenessIntegrated & efficient without awareness
Variations occur but do not prevent FunctionVariations occur but do not prevent Function
Proportional inadequacy – to demands as a Proportional inadequacy – to demands as a result of development; disease; traumaresult of development; disease; trauma
Philosophical principles…Philosophical principles…
Focus on mobilizing the patient’s reserves
An “Integrated” ApproachAn “Integrated” Approach
Approach is always “Positive”Approach is always “Positive”
Helps achieve “highest level” Helps achieve “highest level”
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DefinitionDefinition
A method of placing specific “DEMAND” in A method of placing specific “DEMAND” in order to secure a desired “RESPONSE” order to secure a desired “RESPONSE”
OROR
May be defined as “methods of promoting May be defined as “methods of promoting or hastening the response of the or hastening the response of the neuromuscular mechanism through neuromuscular mechanism through stimulation of the proprioceptors”stimulation of the proprioceptors”
Definition…..Definition…..
Proprioception Receiving stimulus from tissues within bodyReceiving stimulus from tissues within body Information regarding posture & movementInformation regarding posture & movement
NeuromuscularNeuromuscular Motor innervation/muscle strengthMotor innervation/muscle strength
Facilitation Promotion of a natural processPromotion of a natural process In the Nerve TissueIn the Nerve Tissue
Rela
ted a
spect
s of
Rela
ted a
spect
s of
moto
r behavi
or
moto
r behavi
or Development of motor
Development of motor
behavior is expressed as
behavior is expressed as
pattern movement
pattern movementOrdered sequence of motor
Ordered sequence of motor
acts emerges in normal
acts emerges in normal
process of growth
process of growth
Use of Use of developmental developmental
sequencesequence
Fundamental motor activities are interrelated Fundamental motor activities are interrelated and universaland universal
Every human being has experienced and learnt Every human being has experienced and learnt behavior in same waybehavior in same way
Primitive to mature but retain aspectsPrimitive to mature but retain aspects
The ingredients of normal movements provides The ingredients of normal movements provides a basis for development/ restoration of motor a basis for development/ restoration of motor functionfunction
Function & development
Function is a spectrum of ADLs
Different for different tasks, people
Fundamental elements observed during developmental progression Foundation of function
Foundation of basic motor control
Sequence gives insight into original acquisition of skill
Deve
lopm
enta
l
Deve
lopm
enta
l Ski
lls:
Ski
lls:
Sta
ges
Of
Moto
r
Sta
ges
Of
Moto
r C
ontr
ol
Contr
ol
Mobility Mobility Initial mobility
Initial mobility Stability (static postural control)
Stability (static postural control)
Tonic holding
Tonic holding Co-contraction
Co-contractionControlled mobility (dynamic
Controlled mobility (dynamic
postural control)
postural control) Static- dynamic control
Static- dynamic control
Skill Skill
Prin
ciple
s of
Prin
ciple
s of
deve
lopm
enta
l act
ivit
ies
deve
lopm
enta
l act
ivit
ies
Useful for patients of all
Useful for patients of all
agesages Activates postural
&
Activates postural
&
righting reflexes
righting reflexes Appropriate “sensory cues”
Appropriate “sensory cues”
Repetition & resistance
Repetition & resistance
Use of developmental rules
Use of developmental rules
Component patterns of total
Component patterns of total
patterns are converted into
patterns are converted into
spiral & diagonal patterns
spiral & diagonal patterns
of facilitation for selectivity
of facilitation for selectivity
Recapitulate developmental
Recapitulate developmental
sequence – one activity
sequence – one activity
foundation for
next
foundation for
next
advancedadvanced Primitive before complex -
Primitive before complex -
abilityability
Basic ConceptsBasic ConceptsAspects of motor behaviorAspects of motor behavior
Total to individuatedTotal to individuated
Proximal distal to distal proximalProximal distal to distal proximal
Reflexive to deliberateReflexive to deliberate
Motile to stableMotile to stable
Overlapping to integrativeOverlapping to integrative
Gross to selectiveGross to selective
Incoordinate to coordinateIncoordinate to coordinate
Timed & sequential action of musclesTimed & sequential action of muscles
Movements occur in diagonal patternsMovements occur in diagonal patterns with with rotational components, not in single planerotational components, not in single plane Resemble ADL’s and sport specific activitiesResemble ADL’s and sport specific activities
Neuro
phys
iolo
gy
Neuro
phys
iolo
gy
…… AfterdischargeAfterdischarge
Temporal Temporal summationsummation
Spatial Spatial summationsummation
IrradiationIrradiation
Successive inductionSuccessive induction
Reciprocal innervationReciprocal innervation
NEU
RO
MU
SCU
LAR S
YSTE
M
Coordinated muscular activity Dynamic joint stability
Postural control
Optimal movement patterns
Sensory system
CNS & PNS
Sk. Muscle
Injury – vicious circle
Ove
rflow
O
verfl
ow
Spread of facilitation
Spread of facilitation Synergists to prime
Synergists to prime movermoverAlso termed
Also termed associated associated movementsmovementsAssociated reactions –
Associated reactions –
abnormal inhibitory
abnormal inhibitory controlcontrol
Sum
mary
Sum
mary
1)Positive Approach
1)Positive Approach2) Everyone has the
2) Everyone has the
potentialpotential3) PNF is an integrated
3) PNF is an integrated
approach aimed at
approach aimed at
physical, intellectual and
physical, intellectual and
emotionalemotional4) Objectives functional
4) Objectives functional
PNF uses the most
PNF uses the most powerful parts of the body
powerful parts of the body
to facilitate and
to facilitate and strengthen the most
strengthen the most
vulnerable.vulnerable.5) Facilitating the
5) Facilitating the maximum response of the
maximum response of the
patientpatient6) Repeat6) Repeat7) Activity continues
7) Activity continues
8) Optimize a function
8) Optimize a function