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Basics Of PNF

By Dwaipayan Pal
BPT

DEFINITION AND PNF PHILOSOPHY

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 muscles FACILITATION: Making easier

PNF philosophy 1. Positive approach: no pain, achievable tasks, set up for success, direct and indirect treatment, strong start. 2. Highest functional level: functional approach, ICF, include treatment on body structure level and activity level. 3. Mobilize potential by intensive training: active participation, motor learning, self-training.

ICF= International Classification Of Functioning, WHO

Consider the total human being: whole person with his/her environmental, personal, physical, and emotional factors. 5. Use of motor control and motor learning principles: repetition in a different context; respect stages of motor control, variability of practice. 4.

The basic facilitation procedures provide tools for the therapist to help the patient gain efficient motor function and increased motor control. Their effectiveness does not depend on having the conscious cooperation of the patient. These basic procedures are used to: Increase the patient s ability to move or remain stable. Guide the motion by proper grips and appropriate resistance. Help the patient achieve coordinated motion through timing. Increase the patient s stamina and avoid fatigue.

The basic procedures for facilitation are:

Resistance: To aid muscle contraction and motor control, to increase strength, aid motor learning. Irradiation and reinforcement: Use of the spread of the response to stimulation. Manual contact: To increase power and guide motion with grip and pressure. Body position and body mechanics: Guidance and control of motion or stability. Verbal (commands): Use of words and the appropriate vocal volume to direct the patient.

Vision: Use of vision to guide motion and increase force. Traction or approximation: The elongation or compression of the limbs and trunk to facilitate motion and stability. Stretch: The use of muscle elongation and the stretch reflex to facilitate contraction and decrease muscle fatigue. Timing: Promote normal timing and increase muscle contraction through timing for emphasis . Patterns: Synergistic mass movements, components of functional normal motion.

Basic neurophysiologic principles By Sherrington, 1947


Afterdischarge: The effect of a stimulus continues after the stimulus stops. Temporal summation: A succession of weak stimuli (subliminal) occurring within a certain (short) period of time combine (summate) to cause excitation. Spatial summation: Weak stimuli applied simultaneously to different areas of the body reinforce each other (summate) to cause excitation.

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. Successive induction: An increased excitation of the agonist muscles follows stimulation (contraction) of their antagonists. Reciprocal innervation (reciprocal inhibition): Contraction of muscles is accompanied by simultaneous inhibition of their antagonists.

The techniques described are:


RHYTHMIC INITIATION COMBINATION OF ISOTONICS REVERSAL OF ANTAGONISTS DYNAMIC REVERSAL OF ANTAGONISTS (INCORPORATES SLOW REVERSAL) STABILIZING REVERSAL RHYTHMIC STABILIZATION REPEATED STRETCH (REPEATED CONTRACTION) REPEATED STRETCH FROM BEGINNING OF RANGE REPEATED STRETCH THROUGH RANGE CONTRACT-RELAX HOLD-RELAX REPLICATION

RHYTHMIC INITIATION
Characterization Rhythmic motion of the limb or body through the desired range, starting with passive motion and progressing to active resisted movement.

Indications Difficulties in initiating motion Movement too slow or too fast Uncoordinated or dysrhythmic motion, i.e., ataxia and rigidity Regulate or normalize muscle tone General tension

COMBINATION OF ISOTONICS
Characterization Combined concentric, eccentric, and stabilizing contractions of one group of muscles (agonists) without relaxation.

For treatment, start where the patient has the most strength or best coordination.

Indications Decreased eccentric control Lack of coordination or ability to move in a desired direction Decreased active range of motion Lack of active motion within the range of motion

Example of combination of isotonics

REVERSAL OF ANTAGONISTS
Dynamic Reversals (Incorporates Slow Reversal)

Characterization

Active motion changing from one direction (agonist) to the opposite (antagonist) without pause or relaxation.

Indications Decreased active range of motion Weakness of the agonistic muscles Decreased ability to change direction of motion Exercised muscles begin to fatigue Relaxation of hypertonic muscle groups

Dynamic Reversals

STABILIZING REVERSALS
Characterization Alternating isotonic contractions opposed by enough resistance to prevent motion. The command is a dynamic command ( push against my hands , or don t let me push you ) and the therapist allows only a very small movement.

Indications Decreased stability Weakness Patient is unable to contract muscle isometrically and still needs resistance in a one-way direction

RHYTHMIC STABILIZATION
Characterization Alternating isometric contractions against resistance, no motion intended.

Indications Limited range of motion Pain, particularly when motion is attempted Joint instability Weakness in the antagonistic muscle group Decreased balance Contraindications Rhythmic stabilization may be too diffi cult for patients with cerebellar involvement (Kabat 1950) The patient is unable to follow instructions due to age, language diffi culty, cerebral dysfunction

REPEATED STRETCH (REPEATED CONTRACTIONS)


Repeated Stretch from Beginning of Range

Characterization The stretch reflex elicited from muscles under the tension of ELONGATION.

Indications Weakness Inability to initiate motion due to weakness or rigidity Fatigue Decreased awareness of motion Contraindications Joint instability Pain Unstable bones due to fracture or osteoporosis Damaged muscle or tendon

Theorem Behind The Technique

REPEATED STRETCH THROUGH RANGE Characterization The stretch reflex elicited from muscles under the tension of CONTRACTION.

Indications Weakness Fatigue Decreased awareness of desired motion Contraindications Joint instability Pain Unstable bones due to fracture or osteoporosis Damaged muscle or tendon

CONTRACT-RELAX
Contract-Relax: Direct Treatment

Characterization Resisted isotonic contraction of the restricting muscles (antagonists) followed by relaxation and movement into the increased range.

Indication Decreased passive range of motion

Direct treatment for shortened shoulder extensor and adductor muscles

Indirect treatment for shortened shoulder extensor and adductor muscles

Contract-Relax: Indirect Treatment


Description The technique uses contraction of the agonistic muscles instead of the shortened muscles. Don t let me push your arm down, keep pushing up.

Indication Use the indirect method when the contraction of the restricting muscles is too painful or too weak to produce an effective contraction.

HOLD-RELAX
Hold-Relax: Direct Treatment Characterization Resisted isometric contraction of the antagonistic muscles (shortened muscles) followed by relaxation

Indications Decreased passive range of motion Pain The patient s isotonic contractions are too strong for the therapist to control Contraindication The patient is unable to do an isometric contraction

Hold-Relax: Indirect Treatment

In the indirect treatment with Hold-Relax you resist the synergists of the shortened or painful muscles and not the painful muscles or painful motion. If that still causes pain, resist the synergistic muscles of the opposite pattern instead

Indication When the contraction of the restricted muscles is too painful.

Characterization A technique to facilitate motor learning of functional activities. Teaching the patient the outcome of a movement or activity is important for functional work (for example sports) and self-care activities

Description Place the patient in the end position of the activity where all the agonist muscles are shortened. The patient holds that position while the therapist resists all the components. Use all the basic procedures to facilitate the patient s muscles. Ask the patient to relax. Move the patient, passively a short distance back in the opposite direction, then ask the patient to return to the end position.

SUMMARY
PNF Techniques and Their Goals

1. Initiate motion Rhythmic Initiation Repeated Stretch from beginning of range 2. Learn a motion Rhythmic Initiation Combination of Isotonics Repeated Stretch from beginning of range Repeated Stretch through range Replication 3. Change rate of motion Rhythmic Initiation Dynamic Reversals Repeated Stretch from beginning of range Repeated Stretch through range

4. Increase strength Combination of Isotonics Dynamic Reversals Rhythmic Stabilization Stabilizing Reversals Repeated Stretch from beginning of range Repeated Stretch through range 5. Increase stability Combination of Isotonics Stabilizing Reversals Rhythmic Stabilization 6. Increase coordination and control Combination of Isotonics Rhythmic Initiation Dynamic Reversals Stabilizing Reversals Rhythmic Stabilization Repeated Stretch from beginning of range Replication

7. Increase endurance Dynamic Reversals Stabilizing Reversals Rhythmic Stabilization Repeated Stretch from beginning of range Repeated Stretch through range 8. Increase range of motion Dynamic Reversals Stabilizing Reversals Rhythmic Stabilization Repeated Stretch from beginning of range Contract-Relax Hold-Relax 9. Relaxation Rhythmic Initiation Rhythmic Stabilization Hold-Relax 10. Decrease pain Rhythmic Stabilization (or Stabilizing Reversals) Hold-Relax

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