Part 2 - PNF Basic Principles - Proprioceptive Input

Delivering proprioceptive input to the sensorimotor system in PNF is a very intricate process that requires a great deal of awareness and mindfulness.

Remember Part 1 we discussed verbal and visual input. There are 8 principles that we need to respect while delivering proprioceptive input to our patients/clients:

1.     Tactile input
       a. Patient Position
       b. Manual Contact
2.     Therapist Position / Body Mechanics
3.     Appropriate “Resistance” 
4.     Approximation and Traction
5.     Quick Stretch/Stretch Stimulus
6.     Irradiation
7.     Normal Timing
8.     Patterns of Facilitation

1.   TACTILE INPUT

Any surface that touches the patient’s body can significantly influence the motor response. Those who have intricately studied fascial tissue, its influence on movement, and how to manipulate it manually (i.e Thomas Myers), tell us that fascia and the skin are flooded with proprioceptive receptors.

A paradigm shift occurred when I learned that there are significantly more sensory receptors in the skin and fascia than there are in muscle tissue itself.  So this means that the sensorimotor system gets more input from skin and fascia than it does from muscle tissue.  An important principle I learned while  studying material from Dr. Herman Kabat, Dr. Vladimir Janda, and Gray Cook, PT, OCS, CSCS is that if we want to influence movement as fast as possible, Input is always more important than Output.

So with that in mind, there are two principles we need to consider when delivering purposeful tactile input to the sensorimotor system:

a.     Patient Position
b.     Manual Contact

1a. Patient Position: We have to be mindful about what surface of the body is being influenced when we have our patients in certain positions and how that surface may ultimately influence the goal of our treatment.  

For example, let’s say we’re trying to facilitate sagittal plane stabilization with our patient, or in other words trying to teach them how to PREVENT trunk extension.

So we have the patient lying on their back for the exercise, which is a good starting place, but some people still struggle there… Why? 

Well, the sensory receptors of the skin and fascia that cover the trunk extensors are being stimulated and influenced since the patient is lying on his/her back. So we’re trying to tell the conscious motor system to prevent extension, yet the subconscious motor system is getting flooded with extensor input.

If someone is already neurologically locked into their extensor tone, it would make sense why that individual would not be quickly successful at preventing extension when he / she is laying on the extensors.

Extensor tone is a very well know clinical manifestation in a patient who has suffered from trauma to their brain. In this clinical scenario, an experienced neuro therapist would advise you not to put this patient in supine if the goal of your treatment is trunk flexor activity. That is the common thought process and practice in neuro rehab, and it is very helpful to adopt this type of thinking in an orthopedic/fitness setting as well.

Next I will finish discussing the principle of tactile input by discussing the importance/intricacy of the PNF Basic Principle: Manual Contact.