Chapter 3: Proprioceptive Neuromuscular Facilitation

History and Overview

Motor function can be improved in a wide range of patients using proprioceptive neuromuscular facilitation (PNF). The philosophy, principles, and techniques of this approach were initially developed by Dr. Herman Kabat, a neurophysiologist and physician, and Maggie Knott, a physical therapist, in the 1940s and early 1950s. Their early focus was on developing a hands-on treatment that could be used to facilitate effective patterns of movement in patients with neurological impairments, especially multiple sclerosis and poliomyelitis. The approach was later successfully applied to patients with musculoskeletal impairments. Dorothy Voss, also a physical therapist, joined the team in 1952. Together, they refined the practice of PNF, enhancing its functional focus. Maggie Knott and Dorothy Voss authored the first PNF book, Proprioceptive Neuromuscular Facilitation, in 1956 as well as two subsequent editions appearing in 1968 and 1985.¹ Adler, Beckers, and Buck are the authors of a more recent comprehensive text, PNF in Practice.²

Early on, Kabat and Knott established postgraduate training institutes, known as the Kaiser-Kabat Institutes. One of these institutes, Kaiser Permanente in Vallejo, California, still exists today. It offers 3-, 6-, and 9-month residency programs. Participants receive classroom and laboratory instruction together with individualized instruction and extensive hours of supervised patient treatment.³ Numerous additional postgraduate courses are available and have led to worldwide adoption of PNF. In 1985 the International PNF Instructor Group was formed, leading to the formation of the International PNF Association (IPNFA) in 1990. Its members consist of instructors and persons interested in PNF and in maintaining continuity and standards in PNF instruction, practice, and research. A full range of courses and levels of instruction can be found at their website (www.ipnfa.org).⁴

Key components of PNF include:

• Emphasis on functional outcomes

• Techniques to facilitate and enhance coordinated muscle activity

• Use of developmental postures and transitions to facilitate and enhance coordinated muscle activity

• Use of synergistic patterns of movement

• Inclusion of motor learning principles to promote skilled motor behavior

Synergies represent an important organizational element of the central nervous system (CNS) that serve to stabilize performance variables.⁵ With practice, synergistic performance improves. In PNF, the synergist patterns are rotational and diagonal in nature rather than straight plane movements. This is an important concept that mirrors normal movement. The overall goal is to facilitate proximal stability of the trunk for distal controlled mobility of the extremities and to improve voluntary control and coordination of muscles both within and among patterns. Extremity patterns are unilateral or bilateral placing greater emphasis on the trunk and varied in difficulty by combining them with functional activities and postures (e.g., hooklying, rolling, sitting, quadruped, kneeling, modified plantigrade, standing, and locomotion). Techniques, largely proprioceptive, are used to facilitate or enhance movement, and motor learning principles (e.g., practice, repetition, feedback) are incorporated to promote acquisition, retention, and transfer of learning of new motor ...