Patterns of PNF

Basic principles:
• Teach the patterns • Mechanics and
and sequences body positioning
start to finish are essential
• Patient should • Rotational
movement is
look at the limb critical component
• Use verbal cues • Distal movements
• Appropriate occur first
pressure is • Quick stretch
essential before contraction
is facilitory
Patterns
• All patterns have three components:
– Flexion-extension
– Abduction-adduction
– Internal rotation-external rotation
• Upper and lower extremity have 2
diagonal patterns
• Trunk patterns are called chopping and
lifting
• Neck patterns involve flexion/rotation to
one side and extension/rotation to the
other
• There are two diagonals of motion for
each of the major parts of the body

– The head and neck,

– the upper trunk,
– The lower trunk
– the extremities.

• Each diagonal is made up of two

patterns that are antagonistic of each
other
• Each pattern has a major component
of flexion or one of extension

• Their being two flexion and two

extension pattern of the major parts
 
 Patterns
• D1 flexion

• D1 extension

• D2 flexion

• D2 extension
 Two diagonal pattern of upper extremity

1. Flex-add – ER (D1 flex) ∀→ Ext –abd- IR

3. Flex-abd -ER (D2Flex) ∀ → Ext –add- IR

5. Ext-abd - IR (D1 Ext ) ∀ → Flex-add- ER

4. Ext-add - IR (D2 Ext ) ∀ → Flex-abd- ER

D1 Flexion D2 Flexion D1 Extension D2 Extension
Two diagonal pattern of lower extremity

1. Flex-add-ER ( D1 flex) ∀ → Ext-abd- IR

3. Flex –abd-IR ( D2 flex) ∀ → Ext- add- ER

5. Ext-abd-IR (D1 Ext) ∀ → Flex-add-ER

∀ → Flex –abd-IR
7. Ext- add- ER (D2 Ext )
Motion Components

Each spiral and diagonal pattern is 3-

component motion which takes place in
anatomical plain
• Flexion
• Extension
• Abduction
• Adduction
• External – Supination and inversion
• Internal – Pronation and Eversion
Upper / Lower Extremities

• Proximal pivot,

• Intermediate

• Distal
Proximal pivot(Shoulder and hip) Upper Extremity

 Shoulder flexion and Extension are

combined with adduction and
abduction.

 External rotation is consistent with

flexion,

 Internal rotation is consistent with

extension.
In Lower Extremity

• Hip flexion and extension are combined

with adduction and abduction and
external and internal rotation

• Adduction is consistent with external

rotation

• Abduction is consistent with internal

rotation.
 
Intermediate pivots

• The intermediate joints ,

• the elbow and knee,may remain

straight or they may flex or extend
Distal Pivots

• Distal pivots (components of motion are

consistent with proximal components
regardless of intermediate joint action )
Upper Extremity

1. Supination of the forearm and motion of

wrist towards the radial side are
consistent with flexion and external
rotation of the shoulder.

2. Pronation and motion of wrist towards

the ulnar side are consistent with
extension and internal rotation.
     
3. Wrist flexion is consistent with
shoulder adduction.

4. Wrist extension is consistent with

shoulder abduction
 Lower Extremity
 Plantar flexion of the ankle and foot is
consistent with hip extension
 Dorsiflexion of ankle and foot is
consistent with hip flexion
 Inversion of foot and motion toward
tibial side is consistent with hip
adduction & external rotation .
 Eversion of foot and motion to fibular
side is consistent with hip abduction
and internal rotation.
Digital pivots
•  Distal pivot is always Consistent with
proximal joint motion and with those of
wrist and hand or ankle and foot ,
regardless of intermediate joint action
In Upper Extremity

 Flexion with adduction of finger occurs

with flexion of the wrist and shoulder
adduction.

 Extension with abduction of finger occurs

with extension of wrist and shoulder
abduction.
 Finger rotates towards radial side
consistently with radial motion of wrist,
supination, shoulder flexion and
external.

 They rotate to ulnar side with ulnar

motion of wrist, pronation, and shoulder
extension and internal rotation
Lower Extremity
 Extension with abduction of the toes is
combined with dorsiflexion of the foot
and ankle and consistent with hip
flexion.

 Flexion with adduction of toes is

combined with plantar flexion and is
consistent with the hip extension.
 Toes rotate towards the tibial side with
inversion of the foot and hip adduction
and external rotation .

 Toes rotate towards the fibular side

with eversion and hip abduction and
internal rotation .
MAJAOR MUSCLE COMPONENT
• 1. MMC of a given pattern are related by
their topographical alignment upon the
skeleton system and are primarily
responsible for movement.

• e.g. Flexion – Adduction - External of the

lower limb
Extension- Abduction – Internal of
the lower limb.
 
• 2)  The muscles secondarily responsible
for a pattern are those most closely
related by location and function.

• These muscles provide overlapping

between patterns, having one or two
common components of action.
• e.g. Extension – Adduction – External
rotation –pattern is optimal for gluteus
maximus
Extension – abduction –Internal rotation –
main action is by glutei medius, minimus
and a part of gluteus maximus will
cooperate

3. This type of overlapping is characteristics

of the major muscle component of proximal
pivot.
LINE OF MOVEMENT

1.The spiral and diagonal patterns of

facilitation provide for an optimal
contraction of major muscle component.
2.In a pattern of movement the muscle
contract from their completely
lengthened state to their completely
shortened state.
3.Starting position (lengthened state) of a
given pattern the major muscle
components are in their completely
lengthened state, the fibres of related
muscles are subjected to maximum
stretch for facilitation.
4.When major muscle component
contract., the subject or pattern, moves
the part from the lengthened range
through the available Range Of Motion
to the shortened range.
5.In the shortened range of pattern the
major muscle component have reached
their completely shortened state within
the anatomical structure.
6.The half between lengthening and
shortening range is referred as Middle
Range.
 
Positioning of a pattern
1.Positioning of a pattern in lengthened range of a pattern
requires consideration of all the components of motion
from proximal to distal. E.g. flexion – extension are
considered first.
2.The MMC of flexion or extension are considered first
3.The motion relative to the midline is next considered. If
adduction required is moved to abduction.
4.Rotation is considered last. If external rotation, the part
is place in internal rotation
5. All components are combined for diagonal placement
  
As a pattern of motion initiated

.
• The diagonal line of pattern is refered
as “Groove” of the pattern

• The normal subject readily

demonstrates greater strength when
he performs in the groove of the
pattern
Upper Extremity – D1 Flexion
• Starting position
– Shoulder extension, abduction and internal
rotation; forearm pronation; wrist extension
and ulnar deviation; finger extension
• Hand positions (for R side)
– L hand in palm of patient had, R hand on
distal, anterior/medial arm
• Movements
– Shoulder flexion, adduction and internal
rotation; scapular elevation and abduction;
forearm supination; wrist flexion and radial
deviation; finger flexion
Upper Extremity – D1 Extension
• Starting position
– Shoulder flexion, adduction and external
rotation; forearm supination; wrist flexion
and radial deviation; finger flexion
• Hand positions (for R side)
– L hand on distal, posterior/lateral arm, R
hand on dorsal/ulnar aspect of hand/fingers
• Movements
– Shoulder extension, abduction and internal
rotation; scapular depression and
adduction; forearm pronation; wrist
extension and ulnar deviation; finger
extension
Upper Extremity – D2 Flexion
• Starting position
– Shoulder extension, adduction and internal
rotation; forearm pronation; wrist flexion
and ulnar deviation; finger flexion
• Hand positions (for R side)
– L hand on dorsal aspect of hand, R hand on
posterior arm
• Movements
– Shoulder flexion, abduction and external
rotation; scapular elevation and adduction;
forearm supination; wrist extension and
radial deviation; finger extension
Upper Extremity – D2 Extension
• Starting position
– Shoulder flexion, abduction and external
rotation; forearm supination; wrist extension
and radial deviation; finger extension
• Hand positions (for R side)
– L hand around distal humerus, R hand in
athlete’s palm
• Movements
– Shoulder extension, adduction and internal
rotation; scapular depression and
abduction; forearm pronation; wrist flexion
and ulnar deviation; finger flexion
Lower Extremity – D1 Flexion

• Starting position
– Hip extension, abduction and internal
rotation; ankle plantarflexion; foot eversion;
toe flexion
• Hand positions (for R side)
– L hand on distal, anterior/medial thigh, R
hand on medial dorsal aspect of foot
• Movements
– Hip flexion, adduction and external rotation;
ankle dorsiflexion; foot inversion; toe
extension
Lower Extremity – D1 Extension
• Starting position
– Hip flexion, adduction and external rotation;
ankle dorsiflexion; foot inversion; toe
extension
• Hand positions (for R side)
– L hand on distal, posterior/lateral thigh, R
hand on lateral plantar aspect of foot
• Movements
– Hip extension, abduction and internal
rotation; ankle plantarflexion; foot eversion;
toe flexion
Lower Extremity – D2 Flexion
• Starting position
– Hip extension, adduction and external
rotation; ankle plantarflexion; foot inversion;
toe flexion
• Hand positions (for R side)
– L hand on distal, anterior/lateral thigh, R
hand on dorsal lateral aspect of foot
• Movements
– Hip flexion, abduction and internal rotation;
ankle dorsiflexion; foot eversion; toe
extension
Lower Extremity – D2 Extension
• Starting position
– Hip flexion, abduction and internal rotation;
ankle dorsiflexion; foot eversion; toe
extension
• Hand positions (for R side)
– L hand on distal, posterior/medial thigh, R
hand on plantar medial aspect of foot
• Movements
– Hip extension, adduction and external
rotation; ankle plantarflexion; foot inversion;
toe flexion
Summary
 PNF is a manual therapy approach that
applies postures, movement patterns,
contacts, cues, and goals. All =
Maximally facilitating.

 Treatment is based on improving

function, and using functions that are
possible to reach those are attainable
goals.

 PNF lends itself to use as an adjunct to

other treatment approaches.