Proprioceptive Neuromuscular Facilitation

Proprioceptive Neuromuscular Facilitation/ Kabat & Knott Approach

PNF Basic Procedures

Patterns of Movement: normal activity occurs in synergistic and functional movement patterns

  • UE Diagonal 1
  • UE Diagonal 2
  • LE Diagonal 1
  • LE Diagonal 2
  • Trunk patterns include chop and lift patterns, bilateral lower extremity (LE) patterns, scapula and pelvis pat- terns, and head/neck patterns.

Timing: normal timing ensures smooth, coordinated movement; distalà proximal movements

Timing for Emphasis: Max resistance is used to facilitate a strong contraction & to allow overflow to occur from strong to weak components within a synergistic pattern

Resistance: facilitates muscle contractions and motor control

  • Tracking or Light Resistanceà facilitates weak muscles and is usually applied with light stretch
  • Maximal Resistanceà generates max effort and is adjusted to ensure smooth, coordinated movement
  • Facilitates weak muscles to contract; enhances kinesthetic awareness of motion; increases strength; increase motor control and motor learning

Overflow or Irradiation: the spread of muscle response from stronger muscles to weaker muscles in a synergistic movement pattern; max resistance is the primary mechanism for overflow or irradiation

Manual Contacts: grips are used to provide pressure to tactile and pressure receptors; pressure is applied opposite of the desired direction of motion

Positioning: muscles at optimal range of function allow for optimal muscle responses (length-tension relationship); muscle tension is the greatest at the mid-range of movement

Therapist Position and Body Mechanics: therapists should be positioned in line with the desired motion for optimal direction of resistance

Verbal Commands: preparatory (used to ready & instruct the patient), action (to guide the patient while in motion), corrective (used to provide feedback for modifications of movement)

  • Directions should be clear/ concise, strong commands should be used when max movement is the goal, and a soft action voice should be used when relaxation is the goal

Vision: used to guide the patient’s movement, enhance muscle contraction and patterns of movement

Stretch: end range stretch facilitates muscle contraction; repeated stretch can be used to reinforce a contraction in weaker muscles

Approximation (compressing joint surfaces): use to facilitate extensor/ stabilizing muscle contraction and stability; applied during upright, weightbearning positions and in PNF extensor patterns

Traction: used to facilitate muscle contraction and motion, especially in flexion/ pulling patterns; gentle distraction is used to reduce joint pain

PNF Techniques

  • Reversal of Antagonists: techniques that promote agonist contractions followed by antagonist muscle contractions
  • Repeated Contractions: isometric contractions from a lengthened range; enhanced by resistance; induced by quick stretches
  • Combination of Isotonics: resisted concentric movementsà agonist movementsà stabilizing contraction THEN eccentric movements à lengthening contractions, moving slowly back to the start position with no relaxation between contractions
  • Rhythmic Initiation: voluntary relaxation followed by passive movements progressing to AAROM then active resistive movements then active movements
  • Contract-Relax: Strong, small range isotonic contraction of the restricting muscles (antagonists) with emphasis on the rotators is followed by an isometric hold.
  • Hold-Relax: Strong isometric contraction of the restricting muscles (antagonists) is resisted, followed by voluntary relaxation, and passive movement into the newly gained range of the agonist pattern.
  • Replication: holding a shortened range/ end position of a movement
  • Resisted Progression: Manually applied stretch, approximation, and tracking resistance used to facilitate pelvic motion and locomotion; resistance is light in order to not disrupt momentum, coordination, and velocity.

Rhythmic Rotation: Relaxation is achieved with slow, repeated rotation of a limb at a point where limitation is noticed. As muscles relax the limb is slowly and gently moved into the range.



Resources for full article “A Detailed Outline of Neurorehabilitation Technique for Post-Stroke Symptoms”:

Corbett, A. (2012). Stroke. Brain Foundation: Headache Australia. Retrieved on December 9, 2012 from

Cuccurullo S, editor. Physical Medicine and Rehabilitation Board Review. New York: Demos Medical Publishing; 2004. Stroke Rehabilitation. Available from:

Dickstein, R., Hocherman, S., & Shaham, R. (1986). Stroke Rehabilitation: Three Exercise Therapy Approaches. Physical Therapy Journal, 66 (8).

Ernst, E. (1990). A review of stroke rehabilitation and physiotherapy. Stoke. Retrieved on December 10, 2012 from

IPNFA. (2012). What is IPNFA? Proprioceptive Neuromuscular Facilitation from facilitation to participation. Retrieved on November 25, 2012 from

Kollen, B., Lennon, S., Lyons, B., Wheatley-Smith, L., Scheper, M., Buurke, J., Halfens, J., Geurts, A., & Kwakkel, G. (2009). Stroke Rehabilitation What is the Evidence? American Heart Association Journals. Retrieved on November 25, 2012 from

Mayo Clinic Staff. (2012). Stroke. Diseases and Conditions. Retrieved on November 25, 2012 from

O’Sullivan, S. & Schmitz, T. (2007). Strategies to Improve Motor Function. Physical Rehabilitation 5th ed. Retrieved on November 25, 2012 from

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