PNF patterns – upper and lower extremity PNF patterns

Welcome to physiogain community, here we are again going to discuss a new topic – pnf patterns, upper extremity pnf patterns, and lower extremity pnf patterns.

What is proprioceptive neuromuscular facilitation (PNF)?

It is a therapeutic approach that uses cutaneous, proprioceptive, and auditory input to produce functional improvement in motor output and can play a vital role in the rehabilitation of many injuries.

It is used to decrease pain, restore range of motion, increase strength and endurance, improve coordination, facilitate proximal stability and begin the functional progression.

PNF patterns

These exercises involve 3 things:-

• Flexion – extension
• Abduction – adduction
• Internal – external rotation

Pnf pattern involves the diagonal movement of the upper extremity, lower extremity, upper trunk, and neck.

The upper and lower extremity have two patterns:- D1 and D2 targeting flexion and extension.

Basic knowledge of pnf patterns

• A patient needs to learn the pnf pattern movement from starting to end.
• While gaining knowledge of those patterns, the affected person wishes to cautiously watch the motion of the arm and course of the palm.
• The therapist should give clear and simple commands to the patient – push, pull, or hold.
• The therapist needs to use proper body mechanics.
• Vital components of pnf patterns are the rotational movements.
• Stability increases on pressing the joints together and traction makes the joint apart and facilitates movement.
• Physical therapist assistant (PTA)’s position:-
  • PTA should face in the direction of motion.
  • Shoulder and pelvis face the line of movement
• Patient’s position
  • Close to the PTA
  • Starting position is one of the optimal elongations
• Manual contacts
  • Combination of proximal and distal
• Quick stretch to initiate
  • Use your body weight in the quick stretch and don’t let it use your arm strength.

Upper extremity PNF patterns

Scapular anterior elevation

Purpose

• Strengthening of levator scapula, serratus anterior, and scalene muscles in the diagonal plane of the scapula.

Position

• Client is asked to lie in side-lying position.
• PTA standing behind the patient’s hip in the line of motion, facing the patient’s head.
• Both of the hands seem to be overlapping on the anterior glenohumeral joint and acromion.

Procedure

• The patient anteriorly elevates the scapula against appropriate resistance.
• Movement should be in a diagonal arc up towards the patient’s nose.

Scapula posterior depression

Purpose

• Strengthening of rhomboids and latissimus dorsi muscles in the diagonal plane of the scapula.

Position

• The client is asked to lie down in side-lying position.
• PTA standing behind the client’s hip in the line of motion, facing the client’s head.
• Both of the hands are flat-palmed on the middle to lower scapula, along the vertebral border.

Procedure

• Movement is down to ipsilateral ischial tuberosity.

Scapula posterior elevation

Purpose

• Strengthening of trapezius and levator scapulae muscles in the diagonal plane of the scapula.

Position

• The client is asked to lie down in the side-lying position.
• PTA stands at the client’s head, facing the hips.
• Manual contacts in the distal edge of the upper trapezius, close to the acromion.

Procedure

• Movement is in an arc as the client shrugs up towards the ear.

Scapula anterior depression

Purpose

• Strengthening the rhomboid and pectoralis minor and major muscles in the diagonal plane of the scapula.

Position

• Client lying in the side-lying position.
• PTA stands at the client’s head, facing the hips.
• Manual contacts on the pectoral muscles and coracoid process anteriorly and on the lateral border of the scapula posteriorly.

Procedure

• Client pulls shoulder down towards umbilicus.

Upper extremity: flexion-adduction-external rotation (D1 Flexion)

Purpose

• Strengthening

• control of shoulder flexion and adduction

• scapular anterior elevation
• wrist flexion.

Position

• The client is in the supine position.
• Begins with the client’s shoulder in slight extension with the hand near the hip.
• PTA standing at the client’s elbow, facing feet.
• Distal manual contact – on the palm provides most of the traction and rotatory control.
• Proximal contact – on the biceps or onto the pectoralis.

Procedure

• The client was told to “turn and squeeze my hand,” then “pull up and across your nose.”
• PTA pivots towards the client’s head as the arm moves past.
• It Ends with the client’s elbow crossing midline around the nose.

Upper extremity: extension-abduction-internal rotation (D1 extension)

Purpose

• Strengthening

• range of motion

• control of shoulder extension and abduction

• scapular depression

• internal rotation

• wrist extension

Position

• The client is in the supine position.
• PTA standing at the client’s side near the head.
• The client’s arm flexed and adducted.
• Manual contacts on the dorsal surface of hands (distal) and posterior surface of humerus or scapula (proximal).

Procedure

• Quick stretch is applied simultaneously to the hand and shoulder.
• The client was told to “pull your wrist up and push your arm down to your side.”
• As the arm moves past the PTA, traction can be switched to approximation to increase proximal recruitment.
• End with the wrist extended and arms at the client’s hip.

Upper extremity: flexion-abduction-external rotation (D2 flexion)

Purpose

• Strengthening

• range of motion

• control of shoulder flexion and abduction

• scapular anterior elevation

• wrist extension.

Position

• The client is in the supine position.
• PTA standing at the client’s shoulder facing the client’s feet with a wide base of support in the diagonal of movement.
• The client’s extremity starts from across the body, in an elongated, extended position, with the elbow crossing the body near the hip.
• Distal manual contact – on the dorsal hand
• Proximal contact – It should be on the proximal humerus or scapula.

Procedure

• PTA takes the client’s limb to a fully extended position, taking up all the slack in the muscle groups, and gently applies quick stretch.
• The client is told to pull his wrist up and reach.
• Wrist completes extension.

Upper extremity: extension-adduction-internal rotation (D2 extension)

Purpose

• Strengthening

• control of shoulder extension and adduction

• scapula depression

• wrist flexion.

Position

• Client lying supine
• PTA standing near client’s shoulder.
• Distal manual contact – palm to palm with the client
• Proximal contact – on pectoral muscles or proximal humerus

Procedure

• Elongation and quick stretch were applied.
• The client told to squeeze and turn my wrist.
• Then pull down and across.
• PTA pivots slightly as the limb passes the PTA’s center of gravity.
• It ends in shoulder extension, forearm in pronation, elbow across the midline.

Upper extremity: bilateral symmetric flexion-abduction

Purpose

• Strengthening of shoulder flexion

• trunk extension

Position

• Client lying supine
• PTA standing at client’s head, arms crossed.
• Manual contact on the dorsum of the wrist.

Procedure

• The client lifts both arms straight overhead against resistance.

Upper extremity: bilateral symmetric extension-adduction

Purpose

• Strengthening

• shoulder extension and adduction

• upper trunk flexion

Position

• Client lying supine
• Manual contact at wrists.

Procedure

• The client is told to “squeeze and pull down and across”, as illustrated in the picture above.

Upper extremity: bilateral symmetric extension-abduction (with pulleys)

Purpose

Strengthening, increase range of motion, or control of shoulder extension, the extension of the trunk, and stabilization.

Position

• While sitting on the chair, the client grasp pulley handles with arms crossed, in a position of shoulder adduction, flexion, and external rotation; wrist in flexion and radial deviation.

Procedure

• The client is told to straighten your wrist and then pull both arms to your sides.

Lower extremity pnf patterns

Lower extremity: flexion-adduction-external rotation (D1 flexion)

Purpose

• Strengthening
• Range of motion
• Control of hip flexion
• Abduction
• External rotation
• Ankle dorsiflexion
• Inversion

Position

• The client is asked to lie down in a supine position.
• PTA starts moving the limb in an extended position of the hip and knee.
• The leg is slightly off the plinth.
• The limb is in internal rotation.
• The ankle is in plantarflexion with eversion.
• Manual contact – proximally on the anterior distal femur
• Manual contact – distally on the dorsum of the foot

Procedure

• Corkscrew-like elongation is given to the entire pattern.
• Ankle goes in dorsiflexion and inversion initiates the motion.
• This provides PTA a handle for traction.
• As the limb starts to go in flexion. Knee and ankle cross midline.

Lower extremity: extension-abduction-internal rotation (D1 extension)

Purpose

• Strengthening
• Range of motion
• Control of hip extension
• Abduction
• Internal rotation
• Ankle plantarflexion
• Eversion

Position

• The client is asked to lie down in a supine position.
• PTA is standing with a wide base of support facing the client in line of motion.
• The client’s extremity is in the position of hip and knee flexion.
• The ankle is in full dorsiflexion and inversion.
• Knee and foot are at or slightly across the midline.
• Manual contact on hamstring and foot (ball of the foot).

Procedure

• Quick stretch is applied simultaneously on hip and knee as a client was told to point your foot down and kick down and out to me.
• Ankle goes into plantarflexion and eversion.
• And finally into full hip and knee extension.

Lower extremity: flexion-abduction-internal rotation (D2 flexion)

Purpose

• Strengthening
• Control of motion of hip flexion
• Range of motion
• Abduction
• Internal rotation
• Ankle dorsiflexion and eversion

Position

• The person is in a supine lying position.
• PTA is standing at the client’s hip facing his feet.
• Both of the legs are placed slightly away from the PTA.
• The limb is in an adducted, externally rotated position.
• Proximal manual contact on the dorsum of the foot.
• Distally on anterior distal femur just above the knee.

Procedure

• The client was told to bring his toes up and out. (swing your heel out towards the PTA)
• It ends with the heel close to the lateral buttocks.
• Hp and knee get aligned with each other.

Lower extremity: extension-adduction-external rotation (D2 extension)

Purpose

• Range of motion
• Control of hip extension
• Strengthening
• Adduction
• External rotation
• Ankle plantarflexion
• Inversion

Position

• The client is lying in a supine position.
• PTA is standing in a groove, facing the client’s feet.
• Manual contact – distally on the instep of the foot
• Manual contact – proximally on the medial femur

Procedure

• Limb extends with knee finishing across the midline.
• PTA may elect to stand at the end of the pattern to better manually resist extension and adduction.

This is all about upper and lower extremity PNF patterns.

if you have any queries regarding this article then please let me know in the comments below.