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Old 20-10-2011, 09:34 PM   #1
JohnFeilDPT
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Default Proprioceptive Neuromuscular Facilitation

I took a PNF coarse over the weekend through the IPA. I really liked it and have found some of the treatments useful in the clinic this week.

What do you guys think about it? Anyone have any experience with it?
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Old 20-10-2011, 09:47 PM   #2
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I came across it several times in my studies. For some reason I haven't noticed it leading to all of the big changes that it promises.

In his Book Power-Flex Stretching David De Angelis talks about Isometric PNF as being a major flexibility improver but then he goes on to say it will help you build an injury proof physique (flexibility that is).

At least he does do some decent research about stretching, but he goes on to include periodization as a major player and I know some on here would disagree with that.

I have never see it used as a treatment. Doesn't ART use some deriviative of it or vice versa?

I look forward to the discussion.
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Old 20-10-2011, 09:57 PM   #3
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I like PNF because it works with combinations of movements in multiple planes vs. moving in straight planes which is more functional. I do believe there are too many rules and patterns that haven't been validated...but it does have some "good" ideas.
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Old 20-10-2011, 10:28 PM   #4
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John,

I took the IPA* (Institute of Physical Art) PNF course about 10 years ago. At the time I thought it was great stuff. Of course this was before the days of somasimple and the wonderful education that this site grants those willing to put in a little time.

Ultimately I never used the IPA PNF patterns much because it never seemed to make any long term difference in my patients. Knowing what I know now, I would use it much differently. I think the handling skills you can develop with it are useful and it certainly can be a novel way to engage the patient's nervous system.

The IPA system did evolve out of the Kaiser Vallejo system and I'm sure that Greg Johnson was using it with neurologically involved individuals. I'm wondering if the handling is supposed to be similar to thoughtful NDT handling that Barrett witnessed from Bobath. I'm not sure the Pain science is appreciated from that group though. I could be wrong, I did take the course almost a decade ago.


*nowadays I appreciate my IPA chilled and in a tall glass
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Old 20-10-2011, 10:22 PM   #5
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PNF was extensively taught in the 60s and 70s and has now gone out of fashion.
However I think it has quite a strong neurophysiological basis (unknown at the time) which is useful, but it does not compare with the specificity of neurodynamic movements as per Butler and Shacklock.

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Old 20-10-2011, 11:26 PM   #6
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Bobath's handling wasn't remotely like PNF. It resembled Simple Contact.

I've refined it and added an Ohio accent.
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Old 20-10-2011, 11:46 PM   #7
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One similarity that I am beginning to appreciate more with all manual techniques (we can put PNF in this category as you are touching the patient with much of it) is that I am touching skin. And how I approach that skin often makes a difference in my patients.

I utilize PNF type movements, but agree with Joe and do not get too caught up with the strict hand placements (I think the teaching on this has changed some in the PNF community, some hold strong to the stringent hand placements, others are a little more forgiving with the placements).

I would agree as well with Nari and do many PNF movements with a neurodynamic thought process behind it. A D2 UE elevation sure looks a lot like a median nerve mobilization to me.

Learning some of the verbal cues can potential be helpful as well. The nervous system takes input from lots of areas to use in the neuromatrix and we need to be as attentive as possible to all the info we are feeding it during our interaction with the patient.

It has been about 5 years since I took an IPA course and the pain science info had not been introduced yet at that time. As much of the "meso-mothership" that was taught when I took the course, I would be very surprised if much has changed.
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Old 21-10-2011, 12:32 AM   #8
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Barrett, I don't think I was clear in my writing.

What I was implying was that method of handling could be similar regardless of what technique label is attached or what model is used to explain it.

I agree that the PNF that I was taught at IPA does not look anything like the simple contact that I learned from you nor does it look like anything I've seen from NDT practitioners. However, it also doesn’t look like the D1-2 flexion/extension patterns you see in most gyms or drawn on HEP handouts.

Granted it was coercive and choreographed but it was also about appreciating the patient’s nervous system as it responded to your handling. However, back then, that didn't stop me from treating the patient like a bunch of meat I thought I could push around (again, pre-somasimple days).

Now, my big question is why would you use this method for someone with persistent pain? I wouldn't choose it over simple contact given what I know now.
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Old 30-10-2011, 01:58 AM   #9
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Quote:
Originally Posted by Barrett Dorko View Post
Bobath's handling wasn't remotely like PNF. It resembled Simple Contact.

I've refined it and added an Ohio accent.

I'm curious of your observations on Bobath.

Joni
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Old 21-10-2011, 01:09 AM   #10
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Quote:
Now, my big question is why would you use this method for someone with persistent pain? I wouldn't choose it over simple contact given what I know now.
The primary difference to me is the fact that PNF is operator-intensive and SC is purely inter-active. Given that premise, its value in persistent pain is dubious to say the least.
But for those PTs who like to be operative, it probably beats stretching, core stuff and ball-wobbling.

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Old 21-10-2011, 02:38 AM   #11
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I have taken PNF courses in the early 80's and I have not used it accurately since the early 90's. The precise choreography and directionality of handling seemed too contrived, even in those OMT days of my professional life.
I do not use it now.
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Old 21-10-2011, 02:46 AM   #12
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Personally, for me I was looking @ using PNF for improving function not necessarily easing pain. But if using proprioeption to get proper pelvic muscle firing to improve mobility and in turn increasing activity or just basic motion of a pt, then I like the idea.

Some of my pts in the SNF are stroke pts and pain is not always a big factor but getting initiation or better facilitation of certain muscles is very important.

I have found the scap patterns are helping relieve some upper T/S pain and mid scapular pain, although is it coming from specific mvmt or just general movement of that usually immobile area?

I just like it as another tool I can use to improve a pts ease of mvmt to get them more active. I feel a lot pts don't move alot once they leave after tx and are very sedentary. and that's a big problem why they have almost the same complaints on each visit.

What I did like about this course is that they did not beat it into your head that what they are doing will fix their pain like some NIOMPT based classes I took talking about maninpulations being a quick fix to resolve pain. The IPA is built around improving fucntion because not all pts are dealing with pain as a primary issue.

I do think the IPA is a more mesodermal approach but to date I like the results of some of my pts i have used IPA techniques on.

They still talk about MF adhesions when truly I think they are doing more of a DNM to loosen "restrictions".

Either way PNF can be a helpful tool in the right situation but I would never put all my eggs in one basket anyway.
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Old 30-10-2011, 02:36 AM   #13
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Joni,

Look at this.
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Old 05-11-2011, 02:16 PM   #14
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I've always heard NDT taught as a dance. In my certification process it was not presented that way. The demos would get there sometimes, but that part wasn't taught. It is easier to dance with the little ones, they're not interested in what you're there to do as a therapist. They're just there there to play. You don't need them to take that leap of faith to trust you and participate in a way where movement rules rather than being given a set of exercises.
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Old 05-11-2011, 02:26 PM   #15
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Quote:
Donaldson's premise is that "play" is distinct from contest, and that its attributes are essential for a great deal of personal growth and for the most therapeutic forms of human relationship. In play, he posits, "we don't know that we are different than each other," and that this field of interaction engenders self-revelation, authenticity, and insights across generations and cultural divisions.

From my review of this book here.
I’ve written about the distinction between “fun” and “play” in my blog posts as well.
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Old 05-11-2011, 04:08 PM   #16
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Hi Barrett,


I really enjoyed your Bobath story.
As part of several techniques, I use NDT (gentle graded) weight bearing for my CRPS pt's. I use trunk mov't to create gentle proprioceptive input into the limb.

I'm sure you have done this. What are your thoughts??


Mike
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Old 05-11-2011, 04:35 PM   #17
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Mike,

Look at Cory Blickenstaff's last two videos. It's all there. I would catylize ideomotion's expression via Simple Contact as well.
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