Effectiveness of Proprioceptive Neuromuscular Facilitation (PNF) – conclusion

PNF is a common physiotherapeutic approach for post-stroke patients. Despite its use in clinical settings, evidence on its efficacy remains equivocal. The current paper reviews literature on PNF to identify evidence of its efficacy in stroke rehabilitation for adults. The literature review included studies carrying out primary evaluations, a literature review based on meta-analysis of prior research, and a narrative literature review. The evidence provided was not conclusive on the efficacy of PNF.

Various studies carrying out empirical assays indicated that PNF improved patients outcomes especially with regard to enhancing ROM. Despite such indications, the approach was not found to have significant advantages over other methods that are used for physiotherapy, including traditional approaches. Lack of such advantages may however be a factor of limitations present in the methodologies of the studies reviewed. One such limitation is the use of methods that do not allow for effective inter-study comparisons, use of a small sample, and ambiguous descriptions of approaches against which PNF was compared. Despite such limitations, studies combining PNF approaches with other approaches such as FES and Butler’s neuromobilizations indicated such mixed approaches to have enhanced effect when compared with stand-alone PNF approaches.


Ashburn, A. 1997. Physical recovery following stroke. Physiotherapy, 83(9), 480-490

Bohannon, R. W. & Smith, M. B. 1987. Interrater reliability of a modified Ashworth scale of muscle spasticity. Physical Therapy, 67(2), 206-207.

Chen, J. C. & Shaw, F. Z. 2006. Recent progress in physical therapy of the upper-limb rehabilitation after stroke: emphasis on thermal intervention. Journal of Cardiovascular Nursing, 21(6), 469-473.

Chiappa, K. H. 1997. Evoked potentials in clinical medicine. 3rd edn. Philadelphia, PA: Lippincott Williams & Wilkins.

Wade, D.T. & Collin, C. 1988. The Barthel ADL index: a standard measure of physical disability? Disability and Rehabilitation, 10(2), 64-67.

Davidson, I. & Waters, K. 2000. Physiotherapists working with stroke patients: A national survey. Physiotherapy, 86(2), 69-80.

Dickstein, R., Hocherman, S., Pillar, T. & Shaham, R. 1986. Stroke rehabilitation: three exercise therapy approaches. Physical Therapy, 66(8), 1233-1238.

Ernest, E. 1990. A review of stroke rehabilitation and physiotherapy. Stroke, 21, 1081-1085.

Ferber, R., Osternig, L. R. & Gravelle, D.C. (2002). Effect of PNF stretch techniques on knee flexor muscle EMG activity in older adults. Journal of Electromyography and Kinesiology, 12, 391-397

Munih, M., Obreza, P., Sega, J., Bajd, T. & Savrin, R. 2004. Proprioceptive neuromuscular facilitation in combination with electrical stimulation: combined treatment in comparison to each treatment alone. Neuromodulation, 7(1), 48-55.

Natarajan, P. Oelschlager, A., Agah, A., Pohl, P. S., Ahmad, S. O. & Liu, W. 2008. Current clinical practices in stroke rehabilitation: regional pilot survey. Journal of Rehabilitation Research & Development, 45(6), 841-850.

Gunendi, Z., Taskiran, O.O. & Beyazova, M. 2005. What is the optimal repetition number in electromyographic reaction time studies? Clinical Biomechanics, 20(7), 754-758, doi:10.1016/j.clinbiomech.2005.02.010

Pollock, A., Baer, G. D., Langhorne, P. & Pomeroy, V. M. 2008. Physiotherapy treatment approaches for stroke. Stroke, 39, 519-520, doi: 10.1161/​STROKEAHA.107.492710.

Pollock, A. Baer, G. Pomeroy, V. M. & Langhorne, P. 2007. Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke. Cochrane Database of Systematic Reviews 2001(1). Art. No.: CD001920, doi: 10.1002/14651858.CD001920.pub2.

Richards, C. L. & Olney, S. J. 1996. Hemiparetic gait following stroke. part II: recovery and physical therapy. Gait Posture, 4, 179-162.

Rihvk, I., Clough, A. & Clough, P. 2010. Investigation to compare static stretching and proprioceptive neuromuscular facilitation contract-relax stretching effects on the visco-elastic parameters of the biceps femoris muscle. International Musculoskeletal Medicine, 32(4), 157- 162, doi:10.1179/1753615410Y.0000000004.

Sharman, M. J., Cresswell, A. G. & Riek, S. 2006. Proprioceptive neuromuscular facilitation stretching: mechanisms and clinical implications. Sports Medicine, 36(11), 929-939.

Sheard, P.W. 2010. Proprioceptive neuromuscular facilitation: time for a paradigm shift? Physical Therapy Reviews, 15(2), 117-118, doi:10.1179/174328810X12719009060182

Shimura, K. & Kasai, T. 2002. Effects of proprioceptive neuromuscular facilitation on the initiation of voluntary movement and motor evoked potentials in the upper limb muscles. Human Movement Science, 21, 101 – 113.

Solomon, E. P., Berg, L. R. & Martin, D. W. 2004. Biology. 7th edn. Belmont, CA: Cengage Learning

Wang, R. Y. 1994. Effect of proprioceptive neuromuscular facilitation on the gait of patients with hemiplegia of long and short duration. Physical Therapy, 74(12), 1108-1115.

Westwater-wood, S., Adams, N. & Kerry, R., 2010. The use of proprioceptive neuromuscular facilitation in physiotherapy practice. Physical Therapy Reviews, 15(1), 23-28, doi: 10.1179/174328810X12647087218677

Wolny, T., Saulicz, E., Gnat, R. & Kokosz, M. 2010. Butler’s neuromobilizations combined with proprioceptive neuromuscular facilitation are effective in reducing of upper limb sensory in late-stage stroke subjects: a three-group randomized trial. Clinical rehabilitation, 24, 810-821, doi: 10.1177/0269215510367561.

Wolny, T., Saulicz, E., Gnat, R., Kokosz, M., Mysliwiec, A. & Kuszewski, M. 2011. Influence of proprioceptive neuromuscular facilitation on the degree of spasticity in late-stage stroke patients. Fizjoterapia Polska, 11(4), 1-8.

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