PNF Flashcards
What does PNF stand for?
proprioceptive neuromuscular facilitation
What is purpose of PNF?
these motions move in a spiral diagonal pattern of facilitation to provide for an optimal contraction
moving from lengthened to shorten position
Why does this movement pattern make sense?
because a single muscle is not solely responsible for one movement so this mimics sport of function
What are other important components of PNF?
sensory, motor and psychological
reinforces what patient can do and promotes it
What is additional benefit of PNF diagonal patterns?
enhances proper sequencing of muscle contraction distal to proximal
this promotes neuromuscular control and coordination
What are the treatment goals for PNF?
mobility, stability, controlled mobility, skill development, coordinated muscle performance (NM control)
Where should body position of PT be during PNF?
the pt should be at a diagonal, in line with the direction of the motion
face head or feet of pt
What is important to remember about communication?
hand placement, engaging a pts vision and verbal instructions are all important
What is position of hand during manual contact?
lumbrical grip
Where should you place hand on pts body?
on muscle that needs facilitation
ex: for elbow flexion hand on biceps
always on skin except for pelvis
Why is resistance important during PNF?
used to recruit motor units and strengthen the response
What is the optimal resistance?
apply just enough to have smooth controlled, pain free movement throughout the ROM, don’t hold breath
What is timing for emphasis?
PT changes normal time of sequence to emphasize a place in the range
ex: greater resistance can be placed at end ranges
What else is timing for emphasis good for?
maximum resistance can provide overflow or irradiation
goal is to increase response and stimulate action at a specific motion within a pattern
What are two other ways to provide sensory feedback?
- traction
- approximation
both are directed at joint receptors, which assist joint position
What is traction?>
seperation of two joint surfaces
assists to promote movement used as a stretch stimulus
What is approximation?
compression of joint surfaces, promotes stability and postural reflexes
directed at GTO
When would these two things be contraindicated?
if pt is having acute symptoms like pain, edema etc.
What are PNF patterns named after?
named according to their finished position of shoulder or hip
Why is the scapula so important?
because you need full control and motion but also need to generate force from it
How are scapula PNF exercises initially performed?
sidelying, edge of plinth, be sure pt has full ROM prior to initiating strength techniques
What are two types of scap D1 patterns?
anterior elevation and posterior depression
Where should PT stand for D1 scap?
stand at patients hips facing head
What muscle are involved in anterior elevation of scap?
upper trap, SA, levator scap
think of reaching into cabinet
What muscles are involved in posterior depression?
rhomboids, lats, lower trap
What are two types of D2 scap PNF patterns?
anterior depression, posterior elevation
think of a throwing mechanism
Where should PT stand for D2 scap?
stand at pt head facing feet
What muscles are being used for D2 anterior depression?
SA, pecs
What are muscles are being used for D2 posterior elevation?
upper trap, levator scap
You need proximal _______ before distal _______?
stability, mobility
What are two UE PNF patterns?
d1, D2
What is the appropriate movement pattern for UE motions?
rotation should be first to be truly diaganol then flexion/extension then ABD/ADD and RD/UD or INV/EVE
What are components of D1 flexion?
Shoulder- Flex, Add, ER
Forearm- sup
wrist- radial flex
fingers- flex
What are components of d1 extension?
Shoulder- Ext, Abd, IR
Forearm- pron
wrist- ulnar ext
finger- ext
What are components of d2 flexion?
shoulder- flex, abd, ER
Forearm- sup
wrist- radial ext
finger- ext
What are components of d2 extension?
shoulder- ext, add, IR
forearm- pronation
wrist- ulnar flexion
finger- flex
What is a PNF technique used to teach a pattern?
rhythmic initiation begin with:
- passive, active assisted, resisted
What are three PNF techniques to increase mobility?
- contract relax/ hold relax
- hold relax active contraction
- agonist contraction
What is contract relax?
resisted sub max isometric contraction for 3-5 seconds followed by relaxation and movement into increased range (autogenic inhibition)
What is autogenic inhibition?
sudden relaxation of muscle after period of high tension, self induced
What is hold relax active contraction?
use hold relax technique for tight muscle, then follow it with a contraction of antagonist muscle
What is agonist contraction?
use principles of reciprocal inhibition, which is slow controlled contraction of opposite ms being stretched
held 3-5 seconds and done 2-4 times
What are PNF techniques used to increase stability?
- alternating isometrics
- rhythmic stabilization
- stabilizing reversals
What are alternating isometrics?
alternating isometric contraction of agonist and antagonist ms
no motion is intended, resistance can be applied in one straight plane but no rotation
What is rhythmic stabilization?
isometric contraction of agonist and antagonist in all 3 planes to produce a co-contraction
hands placed on opposite joint surfaces simultaneously
What are stabilizing reversals?
alternating isotonic contraction opposed by enough resistance to prevent motion with only small movement allowed
used to isolate end or mid range
What are three PNF techniques to increase muscle strength and movement control?
- dynamic reversals
- timing for emphasis (repeated contractions)
- Combination of isotonics
What is dynamic reversals?
active motion changing from one direction to the opposite without pause or relaxation
What is timing for emphasis?
repeated use of stretch reflex to initiate a muscular response or to reinforce and strengthen a pre existing contraction
“quick stretch”
What is combination of isotonics?
- PT resist pt’s through desired range (concentric)
- At end range, PT has pt hold (stabilization)
- After stability, pt slowly moves back to start position (eccentric)
Keep hands on pt (same position), no relaxation between phases
What are scap pivotors?
SA, traps
What are scap stabilizers?
Rhomboids
How can you progress scap exercises?
- start in sidelying
- prone on elbows
- prone going from B UE to single UE
- start WB on wall with shoulders at 90
What is LE D1 flexion?
hip- flex, Add, ER
Ankle- DF/ INV
toes- ext
What is LE D1 extension?
hip- ext, ABD, IR
ankle- PF/ INV
Toe- flex
What is LE D2 flexion?
hip- flex, abd, IR
ankle- DF/ EVE
toe- ext
What is LE D2 extension?
hip= ext, add, ER
foot- PF/ INV
toes- flex
What are D1 pelvic patterns?
anterior elevation and posterior depression
key for weight acceptance/ efficient gait
terminal stance/jumping/steps
What are D2 pelvic patterns?
good for eccentric control like step down
terminal swing phase and loading/kick ball
How are pelvic patterns usually performed?
initially in sidelying with involved extremity towards ceiling
can also be done in sitting, supine, quadriped and standing
motion from trunk not legs
