Proprioceptive neuromuscular facilitation

Neurophysiology basis, uses, basic principles,techniques, patterns of PNF and PNF stretching.

1. PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION Aarti Sareen MSPT ( honours )

2. includes PNF definition Neurophysiologic basis of PNF Uses of PNF 9 basic principles of PNF Techniques of PNF PNF stretching Patterns of PNF

3. DEFINITION P roprioceptive: having to do with any of the sensory receptors that give information concerning movement and position of the body N euromuscular: involving the nerves and muscles F acilitation: making easier

4. Proprioceptive neuromuscular facilitation is exercise based on the principles of functional human anatomy and neurophysiology. It uses Proprioceptive Cutaneous Auditory input To produce functional improvement in motor output and can be a vital element in the rehabilitation process of sports related injuries.

5. NEUROPHYSIOLOGICAL BASIS OF PNF Sherrington.. Concepts of facilitation and inhibition Stretch reflex Neurophysiological phenomena

6. FACILITATION Facilitory - an impulse causing the recruitment and discharge of additional motor neurons in the spinal cord Results in increased excitability in the muscles. Weak muscles would be aided through facilitation

7. INHIBITION Inhibitory - any stimulus that causes motor neurons to drop away from the discharge zone and away from the spinal cord. Inhibition results in decreased excitability of motor neurons. Muscle spasticity can be decreased

8. STRETCH REFLEX The stretch reflex involves two types of receptors Muscle spindles Golgi tendon organs

9. NEUROPHYSIOLOGICAL PHENOMENA RECIPROCAL INHIBITION AUTOGENIC INHIBITION is defined as inhibition mediated by afferent fibers from stretched muscle acting on the alpha motor neurons supplying that muscle, causing it to reflex

10. Reciprocal inhibition Is the second mechanism which deals with the relationships of the agonist and antagonist muscles

11. USES OF PNF 1. PNF treatment has been used to increase strength, flexibility, coordination and functional mobility . 2. The main goal of treatment is to facilitate the patient in achieving a movement or posture . 3. Stretches as well as diagonals and rational exercise patterns are used to improve ADL’s functional mobility and athletic performance

12. 4. It is mainly used in orthopedic rehabilitation for musculoskeletal injuries and in neurological rehab . 5. PNF can be used for any condition, however the patient condition level may require modifications.

13. BASIC PRINCIPLES OF PNF Resistance Irradiation and reinforcement Manual contact Stretch Verbal commands Traction and approximation Timing Body positioning and body mechanics

14. 1 . RESISTANCE Opposing force to the patient’s movement is called resistance. The amount of resistance provided during an activity must be correct for the patient’s condition and the goal of the activity. This is called optimal resistance.

15. 1 . RESISTANCE Resistance is used in the treatment to: Facilitate the ability of the muscle to contract Increase motor control Help the patient gain an awareness of motion and its direction Increase strength

16. IRRADIATION & REINFORCEMENT DEFINITIONS Irradiation : the spread of response to stimulation is called irradiation. Reinforcement : means “to strengthen by fresh addition, make stronger”

17. IRRADIATION & REINFORCEMENT Effects : Maximal resistance may be used to cause irradiation or overflow from stronger patterns to weaker patterns or from stronger groups of muscles within a pattern to weaker groups within the same pattern.

18. MANUAL CONTACT Effects: Stimulates the muscle Stimulates the synergistic muscle to reinforce the movement Promotes trunk stabilization and indirectly helps the limb motion Prevents confusion

19. Touch or manual contact Contributes to facilitation by stimulating the exteroceptors and it should be Purposeful Directional comfortable

20. STRETCH The stretch stimulus occurs when the muscle is elongated The lengthened position of the muscle is the starting position of each pattern and the stretch is maintained throughout the movement. All the components of a pattern must be stretched simultaneously

21. STRETCH Effects: Stimulates the activity of muscle spindle Any contraction of muscle on stretch will result in movement and the brain knows not of muscles but of movement.

22. Alpha Motor Neuron Quick Stretch + Muscle Spindle + +

23. TRACTION Traction is elongation of trunk or an extremity Traction force is applied gradually, maintained throughout the movement, and combined with appropriate resistance.

24. TRACTION Joint separation stimulates joint receptors Muscle stretch stimulates muscle spindle stretch receptor Facilitates Alpha Motor Neuron Facilitates Strength

25. APPROXIMATION Definition: Approximation is the compression of the trunk or an extremity. Compression through a joint stimulate joint receptors Facilitate alpha motor neuron Facilitate stability

26. APPROXIMATION Uses: Promote stabilization Facilitate weight bearing and contraction of postural muscles Facilitate upright reactions Resist some component of motion. E.g., use approximation at the end of shoulder flexion to resist scapula elevation (11)

27. VERBAL STIMULATION (COMMANDS) The volume with which the command is given affects the strength of resulting muscle contraction. Louder command when strong muscle contraction is required. Softer and calmer tone when the goal is relaxation and relief of pain.

28. VERBAL STIMULATION (COMMANDS) The command is divided into three parts: Preparation: readies the pt for action. “ready” Action: tells the pt to start the action. “now pull your leg up and in” Correction: tells the pt how to correct and modify the action. “keep pulling your toes up”

29. Commmads used HOLD PULL/PUSH RELAX

30. TIMINGS Timing is the sequencing of motions Normal timing of most coordinated and efficient motions is from distal to proximal Timing for emphasis involves changing the normal sequencing of motion to emphasis a particular muscle or desired activity

31. BODY POSTION & BODY MECHANICS The therapist body should be in line of motion Shoulder and pelvis face the direction of motion. Therapist stands in walk standing position. The resistance comes from the therapist’s body , while the hands and arms stay comparatively relaxed.

32. TECHNIQUES OF PNF

33. RHYTHMIC INITIATION Progression from( agonist pattern) USED IN Limited ROM due to increase tone Who are unable to initiate movement PASSIVE ACTIVE ASSISTED ACTIVE

34. REPEATED CONTRATION Patient move isotonically against maximum resistance repeatedly until fatigue is evidenced When fatigue is evident then a stretch at that point in the range should facilitate the weaker muscles and results in coordinated movement. USED To develop strength and endurance.

35. SLOW REVERSAL Involves isotonic contraction of the agonist followed immediately by an isotonic contraction of the antagonist. USED For development of active ROM and Normal reciprocal timing b/w agonist and antagonist

36. SLOW REVERSAL HOLD Involves isotonic contraction of the agonist followed immediately by an isometric contraction, with a hold command given at the end of each active movement. USED In developing strength at a specific point in the range of motion.

37. RHYTHMIC STABILIZATION Uses an isometric contraction of the agonist, followed by an isometric contraction of the antagonist. USED To increase strength and endurance

38. STRETCHING TECHNIQUES/PNF STRETCHING It is often a combination of passive stretching and isometrics contractions. encourage flexibility and coordination throughout the limb's entire range of motion. PNF is used to supplement daily stretching and is employed to make quick gains in range of motion to help athletes improve performance. Good range of motion makes better biomechanics , reduces fatigue and helps prevent overuse injuries .

39. CONTRACT-RELAX Moves the body part passively into the agonist pattern . Patient is instructed to push by contracting the antagonist isotonically against the resistance. USED When ROM is limited by muscle tightness.

40. HOLD RELAX Begins with isometric contraction of the antagonist against resistance, followed by concentric contraction of the agonist muscle.

41. PNF STRETCHING The initial movement is in the direction of the stretch Next the athlete pushes in a direction against the stretch The last movement is a repeat of the initial

42. PNF PATTERNS Each pattern has three dimension – Flexion or extension Abduction or adduction Rotation Movement occurs in a straight line, in diagonal direction with a rotatory component

43. UPPER EXTREMITY F-ABD-ER F-ADD-ER E-ABD-IR E-ADD-IR

44. PATTERNS SHOULDER D1 Flexion Shoulder FLEX, ADD, ER Forearm - Sup Wrist - Rad. Flexion Fingers - flexion D2 Flexion Shoulder FLEX, ABD, ER Forearm - Sup Wrist - Rad. Flexion Fingers - Extension D1 Extension Shoulder EXT, ABD, IR Forearm - Pro Wrist - Ulnar. extension Fingers - Extension D2 Extension Shoulder EXT, ADD, IR Forearm - Pro Wrist - Ulnar ext. Fingers - flexion

45. Diagonal One Diagonal Two F-ABD-ER E-ADD-IR F-ADD-ER E-ABD-IR

46. LOWER EXTREMITY F-ABD-IR F-ADD-ER E-ABD-IR E-ADD-ER

47. LOWER EXTREMITY

48. LOWER TRUNK

49. UPPER TRUNK

50. PNF IN SPORTS Here are some other general guidelines when completing PNF stretching: 1. Leave 48 hours between PNF stretching routines. 2. Perform only one exercise per muscle group in a session. 3. For each muscle group complete 2-5 sets of the chosen exercise. 4. Each set should consist of one stretch held for up to 30 seconds after the contracting phase. 5. PNF stretching is not recommended for anyone under the age of 18 . 6. If PNF stretching is to be performed as a separate exercise session, a thorough warm up consisting of 5-10 minutes of light aerobic exercise and some dynamic stretches must precede it.

51. JOURNEL OF ATHLETIC TRAINING PNF techniques are most frequently applied during rehabilitation of the knee, shoulder, and hip, ankle rehabilitation has increased. The most frequently used techniques were contract-relax and hold-relax The use of PNF techniques in the muscle re-education phase of rehabilitation