Definition of PNF
Proprioceptive Neuromuscular Facilitation (PNF) is a set of stretching,
strengthening, and movement facilitation techniques that utilize
proprioceptive input to improve neuromuscular control, muscle
flexibility, and functional movement patterns.
Principles of PNF
1. Use of diagonal and spiral movement patterns (mimic
functional activities)
2. Irradiation – Spread of muscular activity from stronger to weaker
muscles
3. Successive induction – Activation of antagonist enhances agonist
contraction
4. Use of stretch reflex and proprioception – For muscle activation
and flexibility
5. Verbal cues, visual guidance, and manual contact – To enhance
response
6. Timing of movement – Distal to proximal sequencing (e.g., hand
→ arm → shoulder)
PNF Patterns of Movement
Movements are performed in diagonal (D1, D2) patterns for upper
limb, lower limb, and trunk.
Limb D1 Flexion D1 Extension
Shoulder flexion, adduction, external Shoulder extension,
Upper
rotation (e.g., combing hair on abduction, internal
Limb
opposite side) rotation
Lower Hip flexion, adduction, external Hip extension,
Limb D1 Flexion D1 Extension
abduction, internal
Limb rotation
rotation
Limb D2 Flexion D2 Extension
Shoulder extension,
Upper Shoulder flexion, abduction, external
adduction, internal
Limb rotation (e.g., drawing sword)
rotation
Hip extension,
Lower Hip flexion, abduction, internal
adduction, external
Limb rotation
rotation
Common PNF Techniques
Technique Description Example Use
Rhythmic Passive → active-assistive → Improve mobility in
Initiation active movement Parkinson’s disease
Alternating isotonic
Improve trunk control
Slow Reversals contractions of agonist and
in stroke
antagonist
Isometric contraction of tight
Increase hamstring
Hold-Relax muscle, then relaxation and
flexibility
stretch
Isotonic contraction of tight
Increase shoulder
Contract-Relax muscle, then relaxation and
ROM
stretch
Isometric contractions of
Rhythmic Improve scapular
agonist and antagonist to
Stabilization stability
improve stability
Repeated Repeated isotonic contractions Strengthen weak
Contractions through weak range shoulder muscles
Alternating Isometric holds on one side, Improve trunk/postural
Isometrics then the other stability
Agonist Concentric contraction → Improve lower limb
Technique Description Example Use
eccentric contraction of
Reversals control in sit-to-stand
agonist
Uses of PNF (Indications)
Condition PNF Use
Stroke, Cerebral palsy, Spinal cord injury (to
Neurological
improve coordination, strength)
Shoulder impingement, Frozen shoulder (to
Orthopaedic
improve ROM, strength)
Sports Muscle tightness (PNF stretching for flexibility),
physiotherapy Proprioception training post-ACL injury
Balance and postural
Parkinson’s disease, Elderly population
control
Muscle weakness Post-polio syndrome, General deconditioning
Advantages of PNF
Improves strength, ROM, coordination
Enhances functional movement patterns
Increases neuromuscular control and proprioception
Can be modified for different patient abilities (passive to
resisted)
Contraindications
Acute inflammation/injury
Joint instability
Severe pain
Uncontrolled cardiovascular conditions (for strong isometrics)
Demonstration Example (Contract-Relax for Hamstring)
Step Description
Patient
Supine with hip flexed to stretch hamstring
position
Therapist
Passively stretch hamstring to mild resistance
action
Isotonically contract hamstring (push against resistance)
Patient action
for 5–10 sec
Relax Patient relaxes
Stretch Therapist moves limb further into stretch
Repeat 3–5 times
Conclusion
PNF is a powerful technique in physiotherapy to improve mobility,
strength, and function using specific movement patterns and
neuromuscular facilitation principles.
