Proprioceptive Neuromuscular Facilitation
Proprioceptive neuromuscular facilitation (PNF) is a rehabilitation technique that was initiated over 50 years ago. It is used to stimulate the neuromuscular system in an effort to excite proprioceptors (sensory organs in muscles, tendons, bones and joints) in order to produce a desired movement.
An individual with a neuromuscular disorder may have dyscoordinated movement; that is, movement that is jerky or unsteady. PNF is a specific treatment approach that attempts to make movement more efficient and to improve function during activities of daily living.
When using PNF, care must be taken during the movements. Injuries to tendons, muscles, or ligaments can occur if movement is not indicated or is too aggressive.
PNF involves many combinations of motions. The goal is to incorporate postural and righting reflexes, which are important for maintaining balance. Usually during PNF motions or patterns, resistance is given, first during the stronger part of the range and followed by the weakest part of the range. Other techniques in PNF have the patient isometrically contract the involved muscle or muscle group (agonist), followed by immediately contracting the muscle or muscle group opposite the involved group (antagonist). This technique is called rhythmic stabilization. Another technique incorporates rhythmic stabilization alternately. Contraction of agonist and antagonist in an alternating fashion is called slow reversal.
PNF is based on flexion and extension, but is performed in diagonal patterns. This practice maximizes neuromuscular facilitation by lengthening the muscle or muscle group as much as possible, thus incorporating the stretch reflex.
There are various types of movement patterns in PNF, including unilateral and bilateral patterns. Unilateral patterns are usually based on one limb, either upper or lower, and can incorporate head and trunk movement. Bilateral patterns are done on either both upper or lower limbs at the same time. There are other techniques within the scope of PNF that are used to facilitate. Facilitatory techniques used to stimulate the neuromuscular system include stretch, traction, approximation, and maximal resistance. Other techniques that require significant participation by the patient are rhythmic stabilization, contract-relax, hold-relax, slow reversal, and repeated contractions.
Which PNF technique is used in therapy depends on a patient's needs. For example, it would not be advisable to apply a stretch technique to an area of known muscle tearing or around a fracture area. Overstretching a limb with known hypertonicity may cause significant muscle or tendon damage. Care must be taken to minimize stresses placed on muscle, tendon, or joints when known pathology is present.
Agonist—The muscle that contracts to create movement or tension. For example, the quadriceps muscles are the agonists in knee extension.
Antagonist—The muscle that opposes the movement being completed. The hamstrings are antagonists to the quadriceps during knee extension.
Dyscoordinated—Movement that is asynchronous, jerky, and unsteady.
Extension—The act of straightening a joint to bring the bones more in line, e.g., straightening the knee or elbow.
Flexion—Bending of a joint, such as bending or flexing the knee.
Postural—Pertaining to the position of the head, neck, trunk and lower limbs in relation to the ground and the vertical.
Proprioceptors—Sensory organs in muscle, tendon, bone, and joint that provide information to the brain about the surrounding environment, such as position.
Righting—The ability to maintain one's head and center of gravity within one's base of support. For example, while standing on a moving bus, an individual adjusts to maintain an upright posture as the bus comes to a stop.
The goal of PNF is to restore neuromuscular function to an individual who presents with impairment to the neuromuscular system. By restoring neuromuscular function, the individual can improve gait, mobility, and self-care. Thus, the goal of PNF is to restore movement, control posture and body awareness, improve coordination, and improve muscle function.
Health care team roles
PNF techniques are typically used by physical and occupational therapists. Nurses and other allied health care professionals must realize that PNF alone does not restore neuromuscular function. Activities of daily living (ADL) must be integrated within the total construct of rehabilitation; that is, during self-care, recreation, and socialization. Nurses and other allied health care professionals must provide an environment that facilitates this integration of rehabilitation with other activities.
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Hertling D., R.M. Kessler. Management of Common Musculoskeletal Disorders. Baltimore, MD: Lippincott, Williams & Wilkins, 1996.
Voss D.E., M.K. Ionata, B.J. Myers. Proprioceptive Neuromuscular Facilitation. Philadelphia: Harper and Row, 1985.
Mark Damian Rossi, Ph.D, P.T., C.S.C.S.