Part 1 - The 10 PNF Basic Principles
The PNF basic principles can serve as a professional checklist and can also be considered principles of Manual Therapy. These principles become the corner stone of EVERY treatment plan and problem solving opportunity for both the neurological and orthopedic manual therapist. In the “stethoscopic” hands of a skilled clinician, these principles could also be highly effective assessment tools. Dr. Kabat and Maggie Knott developed PNF extremity patterns AFTER all of the other basic principles were established, yet PNF patterns are the first thing we think about when we hear the term PNF isn’t it? So let’s talk about the ‘other’ PNF principles, the ones people rarely know, the ones that came before the extremity patterns.
There are 3 major categories:
1. VISUAL INPUT:
Maggie Knott would say “Where the eyes go, the head goes. Where the head goes, the trunk goes.” Basically vision facilitates head and trunk movements and it can allow the head and trunk to move easier in the desired direction of movement.
You’re also indirectly stimulating the vestibular system, via eye and head movements, which has an intricate interplay with postural tone. For real life application, just cueing the eyes when having someone turn their head can be a game changer depending on your goal.
Try turning your head to the right while keeping your eyes looking straight ahead.
Now drive your eyes to the right and actually try looking over your right shoulder while turning your head to the right.
Usually you can turn your head a lot further when you’re actually trying to look over your right shoulder. Let’s say you are using segmental rolling as a ‘corrective exercise’:
Whether you’re a neuro therapist helping someone with bed mobility or clinician/trainer using it as a means to improve single leg stance. Try cueing the eyes and the head to lead the movement by asking them to look in the desired direction of movement and see what happens.
If you're an orthopedic manual therapist, ask the client to look up or down while you test upper cervical joint play. Eye position greatly effects cranio-cervical muscular tone and might have you rethink between choosing a joint mobilization vs. "muscle energy"/PNF technique.
2. VERBAL INPUT:
Our commands have to be SIMPLE, precise, audible, and specific for the desired activity. Obviously that is a lot easier said than done. Reflecting on your own verbal cueing and checking yourself with this basic principle in mind after each session can be very humbling.
You should check out some of the motor learning research out there regarding internal vs external coaching cues.
Also keep in mind that tone/rhythm/fluctuation of our voice can highly influence the motor response of our clients. To tie this in with PNF philosophy #3: “A Positive Approach”: starting with positive feedback is a great segway into addressing some of the things that you would like to help them change.
That’s not to say that we don’t address and guide mistakes, but STARTING with positive feedback has been found to be highly effective psychologically (PNF philosophy #2: Whole Person: Physical, Emotional, and Intellectual).
One of my other PNF mentors, Terry Grzybowski, PT, DPT, OCS, NCS, ATC, IPNFAI, taught me a valuable clinical application of this basic principle. Terry always use to remind me:
“Unless they are doing something unsafe, try not to use the word ‘no’ when teaching someone how you want them to move. Instead, state what they are doing and then ask them to try it ‘your’ way.”
For example: you ask someone to squat and they squat with their knees shooting forward and their heels come right off the ground. Instead of saying:
"No, don't let your knees go forward and keep your heels down."
Try saying this:
“so that’s squatting with your knees going forward, try it with your hips going back and keeping your heels on the ground.”
Terry would always remind me that the word ‘no’ has a negative subconscious influence on the sensorimotor system and can greatly influence the patient’s motor response. As she made me more aware of my constant use of the word “no”, I started practicing what she was suggesting and I noticed a drastic difference.
I asked myself “can something that simple, make that much of a difference?”
Terry would say "don't trust me, try it yourself"
The answer for me was yes, something that simple can make a drastic difference.
Next I will begin to break down the PNF Basic Principles of Proprioceptive Input .