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: c omponents: – 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
∀→
Flex-add-ER
∀→
Flex –abd-IR
(D1 Ext)
7. Ext- add- ER (D2 Ext )
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 g luteus 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; a bduction; 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; a dduction; 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 a spect 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.
