Chapter 3: Proprioceptive Neuromuscular Facilitation

INTRODUCTION

Physical therapists evaluate and manage movement system disorders in order to promote optimal movement and functional recovery. Impairments, activity limitations, and participation restrictions are diagnosed and become the focus of treatment. This chapter focuses on the intervention concepts and techniques of Proprioceptive Neuromuscular Facilitation (PNF).

HISTORY AND OVERVIEW

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 and strengthen effective patterns of movement. Dorothy Voss, also a physical therapist, joined the team in 1952. Together, they refined the practice of PNF, enhancing its focus on promoting functional activities. 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, now in its fourth edition.²

Early on, Kabat and Knott established initial postgraduate training institutes, known as the Kaiser-Kabat Institutes. Currently, graduate training programs (3-, 6-, or 9-month) are offered at Kaiser Permanente in northern California. These programs include both didactic and laboratory instruction and supervised patient treatment. The 9-month course offers advanced course work and residency training with supervised teaching experiences.³ PNF is currently offered in many countries as part of the physical therapy curriculum and in postgraduate training courses. 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. The objectives of the IPNFA and a full range of courses and levels of instruction can be found at their website (www.ipnfa.org).⁴

PNF has been successfully applied to a variety of patient populations undergoing rehabilitation across the lifespan and to a variety of conditions. Applications to neurological populations (e.g., stroke, multiple sclerosis, Parkinson’s disease, incomplete spinal cord injury) include motor control training and synergistic patterns of movement, balance, and gait training. Applications to musculoskeletal populations (e.g., spinal, knee, and ankle injuries and restrictive disorders such as adhesive capsulitis and ankylosing spondylitis) include interventions to improve range of motion, strength, synergistic timing, and stability. Applications to cardiopulmonary populations include interventions to improve chest wall ...