PNF Philosophy #4: Movement must be Specific, Purposeful, and Directed toward a Functional Goal.
Plain and simple this philosophy is looking at a pre-post test before and after treatment, as well as making the short and long term goals specific to the client’s goals.
If you want responsiveness from the client/patient, there has to be a functional purpose in the treatment that the client can feel and see how it is relating back to their function. It has to be salient or it has to matter to them.
It also helps when you can quickly explain and show the client how what you’re doing relates to their goals.
An important side note to always keep in mind is that the client’s movements will be dependent upon 2 fundamental things:
Their former experience of how to do what you’re asking
The environment in which you are asking them to do it in
Let’s practice some treatment planning logic that I learned from my PNF mentors in Vallejo, CA.
Let’s use single leg stance as our pre-post test. We notice that to initiate right single leg stance, the client clearly does not shift their weight onto their right leg.
Sometimes what helps in catching this dysfunction is using the head as a point of reference to see if the client’s head crosses midline and stacks the head over their right leg. I learned this from my PNF mentor Chris Pappas PT, IPNFAI.
Notice in Figure 1 below the client’s head stays midline rather than crossing the midline like in Figure 2 and stacking over the right leg. It’s a lot harder to balance using the single leg strategy in figure 1 compared to figure 2, and believe it or not we see this dysfunction quite often.
Assuming the client does not have a neuro-anatomical pathology and has no significant joint/tissue mobility dysfunctions (Think of our hypermobile 14 year old female soccer player for example), let’s quickly treatment plan, solely based off this information.
Based on our movement analysis we think that the main movement problem is:
Poor weight shifting strategy to the right for R single leg stance.
The pre-post test: Right single leg stance
The goal of treatment would be to re-teach the client’s system how to weight shift or cross midline to properly stack the body over the right leg.
Let’s assume that simple coaching and manual cues didn’t work, because sometimes if you just ask them to do what you want, they can do it, "don’t keep it a secret!" another clinical pearl from Chris Pappas PT, IPNFAI (who's nick name is "the King" in Vallejo).
But just follow my treatment planning logic here.
3 basic activities that progress from easy to hard:
1) Upper extremity rolling from your back to your stomach to the right with the head initiating the movement (see diagram below). Why rolling? Because that is the most fundamental and safest way for the system to weight shift/cross midline to the right. Think about it, you can’t fall and the base of support is huge.
2. Quadruped bird dogs. Here the base of support is a little smaller than rolling, and you could actually fall, so it’s a little more challenging than rolling. This is the first time the hips are introduced to weight bearing and it requires an automatic weight shift in order to be successful.
3. The transition of tall kneeling to ½ kneeling. Now your base of support is even smaller than being on your hands & knees, and there is an even great risk of falling, it’s a progressive challenge. It’s almost impossible to do this effortlessly without first weight shifting and stacking your head over the down leg first.
There are a million different treatment ideas to be used here and ultimately the best answer is the treatment that makes R single leg stance improve at the end of the session and more importantly at the beginning of the next session to demonstrate retention, which is a true measure of motor learning.
Remember from philosophy #1, it didn’t matter which cochlear implant was used, just find a way to deliver quality sensory input to the brain and it will do the rest for us.
What does matter is the logic behind identifying the main problem and the logic behind the treatment plan. The combination of that logic plus the feedback we get from our pre-post test provides us with the soil we need to help our clients grow. As Gray Cook PT, OCS, CSCS says "Whether we make a change or not, we learn something, and that's how we grow as professionals."
The approach needs to be specific, purposeful, and directed toward a functional goal.
Next I will take a break from PNF philosophies (there are a total of 9) and I will begin discussing PNF Basic Principles, which in my eyes are essentially the basic principles of both orthopedic and neurological manual therapy.
