Proprioceptive Neuromuscular Facilitation (PNF) For Lower

Extremities

ENGİN ÇETİNPhyscal Theraphy and Rehabilitation Faculty4.Course 5.Group

The method:Patient contract isometrically resulted in increased response of the agonist, this was named rhythmic stabilization. Following using this stabilization, it was found slow reversal technique, alternate resistance to isotonic contractions of antagonist and agonist also had a facilitating effect.Definitions of PNF:Proprioceptive, means receiving stimulationwithin the tissues of the body.Neuromuscular, means pertaining to the nerves and muscles.Facilitation, means the effect produced in nerve tissue by the passage of an impulse.

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 patient must give proper verbal command.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 .

Patterns

All patterns have three components:◦Flexion-extension◦Abduction-adduction◦Internal rotation-external rotation

Upper and lower extremity have 2 diagonal patterns

Trunk patterns are called chopping and liftingNeck patterns involve flexion/rotation to one

side and extension/rotation to the other

There are two diagonals of motion for each of the major parts of the body ◦The head and neck,◦ the upper trunk, ◦The lower trunk ◦the extremities.

Each diagonal is made up of two patterns that are antagonistic of each other

Each pattern has a major component of flexion or one of extension Their being two flexion and two extension

pattern of the major parts 

D1 Flexion D2 Flexion D1 Extension D2 Extension

Motion Components

Each spiral and diagonal pattern is 3-component motion which takes place in anatomical plain

FlexionExtensionAbductionAdductionExternal – Supination and inversionInternal – Pronation and Eversion

Upper / Lower Extremities

Proximal pivot,

Intermediate

Distal

Proximal pivot In Lower Extremity Hip flexion and extension are combined with adduction

and abduction and external and internal rotation Adduction is consistent with external rotation Abduction is consistent with internal rotation.  Intermediate pivots The intermediate joints , the elbow and knee , may remain straight or they may flex

or extend

Distal pivots (components of motion are consistent with proximal components regardless of intermediate joint action )

Distal Pivots

Digital pivots  Distal pivot is always Consistent with proximal joint

motion and with those of wrist and hand or ankle and foot , regardless of intermediate joint action

Lower Extremity

Plantar flexion of the ankle and foot is consistent with hip extension

Dorsiflexion of ankle and foot is consistent with hip flexion

Inversion of foot and motion toward tibial side is consistent with hip adduction & external rotation .

Eversion of foot and motion to fibular side is consistent with hip abduction and internal rotation.

Lower Extremity

Extension with abduction of the toes is combined with dorsiflexion of the foot and ankle and consistent with hip flexion.

Flexion with adduction of toes is combined with plantar flexion and is consistent with the hip extension.

Toes rotate towards the tibial side with inversion of the foot and hip adduction and external rotation .

Toes rotate towards the fibular side with eversion and hip abduction and internal rotation .

MAJAOR MUSCLE COMPONENT 1. MMC of a given pattern are related by

their topographical alignment upon the skeleton system and are primarily responsible for movement.

e.g. Flexion – Adduction - External of the lower limb

Extension- Abduction – Internal of the lower limb.

 

2)  The muscles secondarily responsible for a pattern are those most closely related by location and function.

These muscles provide overlapping between patterns, having one or two common components of action.

e.g. Extension – Adduction – External rotation –pattern is optimal for gluteus maximus

Extension – abduction –Internal rotation – main action is by glutei medius, minimus and a part of gluteus maximus will cooperate

3. This type of overlapping is characteristics of the major muscle component of proximal pivot.

LINE OF MOVEMENT

1.The spiral and diagonal patterns of facilitation provide for an optimal contraction of major muscle component.

2.In a pattern of movement the muscle contract from their completely lengthened state to their completely shortened state.

3.Starting position (lengthened state) of a given pattern the major muscle components are in their completely lengthened state, the fibres of related muscles are subjected to maximum stretch for facilitation.

4.When major muscle component contract., the subject or pattern, moves the part from the lengthened range through the available Range Of Motion to the shortened range.

5.In the shortened range of pattern the major muscle component have reached their completely shortened state within the anatomical structure.

6.The half between lengthening and shortening range is referred as Middle Range.

 

Positioning of a pattern

1.Positioning of a pattern in lengthened range of a pattern requires consideration of all the components of motion from proximal to distal. E.g. flexion – extension are considered first.

2.The MMC of flexion or extension are considered first

3.The motion relative to the midline is next considered. If adduction required is moved to abduction.

4.Rotation is considered last. If external rotation, the part is place in internal rotation

5. All components are combined for diagonal placement

Lower Extremity – D1 Flexion

Starting position◦Hip extension, abduction and internal rotation;

ankle plantarflexion; foot eversion; toe flexionHand positions (for R side)

◦L hand on distal, anterior/medial thigh, R hand on medial dorsal aspect of foot

Movements◦Hip flexion, adduction and external rotation;

ankle dorsiflexion; foot inversion; toe extension

Lower Extremity – D1 Extension

Starting position◦Hip flexion, adduction and external rotation;

ankle dorsiflexion; foot inversion; toe extension

Hand positions (for R side)◦L hand on distal, posterior/lateral thigh, R

hand on lateral plantar aspect of footMovements

◦Hip extension, abduction and internal rotation; ankle plantarflexion; foot eversion; toe flexion

Lower Extremity – D2 Flexion

Starting position◦Hip extension, adduction and external rotation;

ankle plantarflexion; foot inversion; toe flexionHand positions (for R side)

◦L hand on distal, anterior/lateral thigh, R hand on dorsal lateral aspect of foot

Movements◦Hip flexion, abduction and internal rotation;

ankle dorsiflexion; foot eversion; toe extension

Lower Extremity – D2 Extension

Starting position◦Hip flexion, abduction and internal rotation;

ankle dorsiflexion; foot eversion; toe extensionHand positions (for R side)

◦L hand on distal, posterior/medial thigh, R hand on plantar medial aspect of foot

Movements◦Hip extension, adduction and external rotation;

ankle plantarflexion; foot inversion; toe flexion