Patterns of PNF

Basic principles:
Teach the patterns and sequences start to finish Patient should look at the limb Use verbal cues Appropriate pressure is essential Mechanics and body positioning are essential Rotational movement is critical component Distal movements occur first Quick stretch 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)
2. Flex-abd -ER (D2Flex) 3. Ext-abd - IR (D1 Ext )

Ext abd- IR

Ext add- IR Flex-add- ER Flex-abd- ER

4. Ext-add - IR (D2 Ext )

D1 Flexion D2 Flexion D1 Extension D2 Extension

Two diagonal pattern of lower extremity

1. Flex-add-ER ( D1 flex)
2. Flex abd-IR ( D2 flex) 3. Ext-abd-IR (D1 Ext)

Ext-abd- IR
Ext- add- ER Flex-add-ER

4. Ext- add- ER (D2 Ext )

Flex abd-IR

Motion Components
Each spiral and diagonal pattern is 3component 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 athletes 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.