If you have nagging joint pain in your hip or shoulder or suffer from mobility problems due to a neurological condition, such as Parkinson’s disease or complications from a stroke, there is an approach used by physical therapists that you should know about…but probably don’t.

Its official name, proprioceptive neuromuscular facilitation, is a bit of a mouthful, so it’s known simply as PNF.

How PNF works: PNF-trained physical therapists use the brain and nervous system’s complex feedback system to facilitate optimum patterns of movement and posture. The key to PNF is using the input from the skin, muscles and other sensory organs to influence the brain’s ability to activate the right muscles and movement patterns, especially the proprioceptors, which tell the brain where your body is in space.

With PNF, practitioners observe and assess how problems in a patient’s posture (such as a forward head position due to computer use) and/or movement such as walking without properly engaging the pelvis and trunk, may be causing or worsening an underlying condition. Performed repeatedly, such postures and movements not only place undue stress on our fascia (connective tissue) muscles and joints but also become ingrained in our “muscle memory.” Eventually, these ingrained patterns can lead to pain and injury.

Once the problem is identified by the PNF-trained physical therapist, he/she designs a plan to retrain the patient’s brain and body to move in safer, more effective ways.

This plan combines specific positioning with manual resistance and active stretching to remind the brain of the healthy alignment it used to know—before it was compromised by injury, disease or repetitive poor movements.

How PNF has evolved: The technique was originally developed in the 1940s by neurophysiologist and medical neurologist Dr. Herman Kabat and physical therapist Maggie Knott to address postural control and movement deficiencies in patients with neurological disorders. The practice later expanded to include head injuries, Parkinson’s disease and more.

Over time, PNF has become an approach used for all patients, including orthopedic patients with knee, hip, neck, shoulder and ankle pain. More physical therapists are seeking this specialized training.

Scientific evidence: An important study published in the Journal of Human Kinetics found that PNF improves range of motion and increases muscle strength—both of which play a significant role in curbing pain and improving mobility.

How PNF may help you…


At the root of PNF theory is a principle called “overflow.” When an area of the body has physical pressure applied to it with appropriate resistance and with proper manual contact, the brain responds by sending neurological impulses to the muscles of that area.

If the therapist continues to apply the appropriate amount of pressure over time, these impulses begin to overflow into the nerves that stimulate other muscles. PNF allows the therapist to direct this overflow to the weaker or inhibited muscles.

For example, a patient who has suffered a stroke or spinal cord injury may find it difficult to simply turn over in bed. In this case, the physical therapist might resist the hip flexors or shoulder extensors, which tend to be stronger, and direct the overflow toward the person’s core muscles, which are probably weak as a result of the neurological event. Eventually, the brain will remember what it used to do to direct the body to roll over.

The length of treatment and the patient’s ability to participate are dependent upon the injury and the patient’s mental capacity. Most patients are given a home program for repetition to promote motor learning. An orthopedic patient with no neurological damage may need only a few treatment sessions. Patients who have neurological issues will require more sessions. Some insurance plans cover the cost of treatment.


There are easy tests you can do on your own to help you determine whether you’re a candidate for PNF. For example, you can try the following if you are affected by…

Low-back pain. Try standing on one leg at a time. If you feel that you do not have good balance or your back arches while trying to stand on one leg, you are probably not using your pelvis to effectively connect your core to your legs. The low-back pain you are feeling is being aggravated with every step you take when your core is disconnected from your legs.

• Shoulder pain. Stand with your back against a wall. Press your lower back against the wall, then your middle and upper back. Now pull your shoulder blades together and rotate your palms forward. You should be able to keep your back flat against the wall.

If your back begins to arch as you do this, it indicates one of two things: Poor range of motion is compromising your ability to move the shoulder blade on the rib cage…or the brain cannot properly connect with the muscles needed to move the shoulder blade on the rib cage. In either case, a PNF-trained physical therapist will restore the brain’s ability to connect with the muscles and create appropriate positioning of the shoulder blade.

Stroke. If you have been discharged from medical care but everyday activities, such as getting out of bed or walking short distances, still feel challenging, PNF could help.

PNF is always done in conjunction with other physical therapy techniques. Depending on the problem, acupuncture and acupressure might also be appropriate.

To find a PNF clinician near you: Consult The Institute of Physical Art (InstituteofPhysicalArt.com), which provides certification that ensures each certified therapist (CFMT) uses PNF in the most effective manner.

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