Proprioceptive neuromuscular facilitation (PNF) was first described in 1948 by Maggie Knott, a physical therapist at the Kaiser Foundation Rehabilitation Center, Vallejo, California. PNF is a manual treatment method used by physical therapists for treating patients with neuromuscular and musculoskeletal disorders. It is a positive and active approach to treatment, where the body movements of both the therapist and patient are incorporated into patterns that have a specific, purposeful, and functional goal (e.g., sit-to-stand).

PNF uses stronger body movement patterns to facilitate weaker ones, and to increase motor and sensory awareness. Repetition of movement patterns is used to promote functional motor learning. PNF is an intensive program with continuous activity. “Active rest” is an integral part of PNF treatment. Some of the principles and techniques utilized during PNF treatment are outlined below.

“Rhythmic Stabilization” technique utilizes alternating isometric contractions against resistance. There is no motion intended by the patient; the patient maintains his position against manual external resistance. The goal of “Rhythmic Stabilization” is to increase active and/or passive range of motion, strength, stability, and balance, as well as to decrease pain.

“Stabilizing Reversals” technique uses alternating isotonic (concentric and eccentric) contractions against resistance. The patient intends to move, however, the manual resistance applied by the physical therapist prevents this motion. The goal of “Stabilizing Reversals” is to increase stability, balance, strength, and coordination.

Both “Rhythmic Stabilization” and “Stabilizing Reversals” can be used in a variety of patient positions, static or dynamic, depending on their level of independence with functional mobility and on the goal of treatment. As the patient progresses, a more varied treatment environment can be used; differing supportive surfaces (e.g., tile-to-carpet, level surface-to-inclined), differing distractions (e.g., indoor, outdoor).

“Massed Flexion” is an activity designed to improve trunk muscle activation and control, coordinated contractions between fore limb and hind limb muscle groups, and/or independence and quality movement during “bed mobility” activities (e.g., rolling from lateral to sternal recumbency, lateral recumbency to sitting). This technique involves the patient first lying in lateral recumbency. To emphasize a positive approach focused on patient abilities, it is recommended that treatment begin with the patient lying on his “weaker” more involved side, with his “stronger” side up (ie. non-weight bearing). The physical therapist reaches the patient’s fore limb into shoulder and elbow extension, and hind limb into hip and stifle extension, thus elongating the lateral trunk. Successful treatment with this activity requires a coordinated effort by the physical therapist and patient and, therefore, application of appropriate resistance (or assistance, if necessary) must be coordinated with a stimulus for active effort by the patient. The therapist might choose to resist distally, at the fore limb and hind limb paws or proximally, at the scapula and pelvis. The patient is encouraged to look towards his hip, laterally flexing his cervical spine and activating the lateral flexors of his trunk, meanwhile retracting the scapula, flexing the shoulder (and possibly flexing the elbow), bringing the pelvis into a relative cranial ventral position, and hip into flexion (and possibly stifle into flexion). This activity can also be performed in sitting or standing.

The goal of “Resisted Ambulation” is to exaggerate normal ambulation for increased strength and active range of motion of the hind limbs. This procedure should only be applied to a patient who is already independently ambulatory, but when applied to patients with ataxia or dynamic imbalance, it might help to improve the quality of movement. The physical therapist is positioned behind the patient and wraps their fingers from lateral to medial along the proximal cranial aspect of the patient’s thighs. Appropriate resistance is applied to the hind limb, which is being actively flexed during swing phase of gait while the opposite hind limb is being manually approximated during stance, to promote stability and muscular co contraction. A similar procedure can be approximated with the use of a sling or Thera-band. For additional resistance or altered sensory input, distal manual contacts can be used.

PNF is a method of manual treatment that has been found to be efficient and effective in treating both humans and animals with neuromuscular and musculoskeletal disorders. PNF is recommended for use by an experienced physical therapist since these manual techniques can be inhibitory or injurious if applied incorrectly. For training in PNF techniques as well as other neuromuscular rehabilitative treatments, please see www.CanineRehabInstitute.com for a course schedule.