By Noel L. Poff, Certified Advanced Rolfer™, CSCS, LMT, RYT

ABSTRACT The author introduces proprioceptive neuromuscular facilitation (PNF) and discusses how it can be a supportive movement modality to a Rolfing® Structural Integration (SI) practice because of similar underlying principles.

Rolfing SI  is  an  integrative  approach  of bodywork intended to restore and promote a person’s optimal relationship to gravity. As Rolfers, the effectiveness of our interventions can be measured through observing changes in the client’s quality of movement. Improving range of motion (ROM) and overall ease are elements connecting Rolfing SI with the movement modality proprioceptive neuromuscular facilitation (PNF). Redirecting the focus from structure to function has been shown to be effective in promoting better gravitational relationships. Making the transition from hands-on manipulation  to functional movement work can be a tricky transition to make during sessions. One bridge from table work to movement integration can be found through incorporating PNF principles into our Rolfing sessions; with them together we have more tools with which to help people rediscover healthy movement.

My ‘Movement’ Inviting Movement

While reviewing websites for movement trends amongst people known for their expertise in movement-based work, such as yoga teachers and physical therapists, I noticed that they are often promoting performance. Working in fitness myself, I see this growing in popularity. Personal training is an industry focused on moving people, and I’ve seen a growing interest in getting people off of machines and into feeling the functioning of their bodies. Yet this change isn’t met without resistance.

From the professional’s point of view, encouraging healthy movement practices leads to less chance for injury since most are done using one’s own body weight. It also encourages sustainable success due to the fact that the client is doing most of the work. Performing exercises using one’s own body weight also enhances proprioception, which is essential for such functions as maintaining balance, coordination, strength, and flexibility. It’s also no surprise that many ‘specialists’ capitalize on the increasing public awareness of performance by promoting their services or products by showcasing beautiful displays of mostly younger peoples’ advanced feats of gymnastics and flexibility.

Due to the newer status of my business, as well as my early exposure to computer technology, I’ve also gravitated towards using social media platforms as a means for promoting my work and sharing information with clients. As a result, my feeds are inundated with photos and videos of people demonstrating their movement expertise. Yoga instructors are mostly seen balancing on their hands, personal trainers are mostly seen performing high-intensity exercise, and professional movers showcase their talents for coordination. I can’t tell if  it’s just my screens that are full of this material, but based on the numbers of comments, views, and subscribers, I’m assuming I’m not the only one who’s seeing all of this movement.

Flexibility and mobility are clearly earning higher spots in the hierarchy of goals that attract people to regular exercise. Programs such as Mobility WOD, started by Kelly Starrett, spread like wildfire across the high-intensity crowd because people were feeling changes in their performance as a result of taking an extra bit of time per day to focus simply on the qualities of certain motions (still with an edge but without weights attached). Grey Cook’s Fundamental Movement Systems program also inspired many seasoned trainers  and  coaches  to  reconsider  the essential elements to their training programs; Cook redirected their focus to promoting their ability to perform the tasks they were asking to do through assessing movement patterns (Cook 2012). Keep in mind these are just a couple of popular examples in the fitness arena, there are many others.

Learning by Doing

Before I started teaching yoga and learning Rolfing SI, PNF was one of the resources that supplemented my work as a fitness trainer. I learned the value of PNF from one of my first clients, an eighty-three- year-old man living his life to the fullest. He was competing in swimming meets for seniors, and his coach suggested he get help at the gym with promoting his ROM. Since I had some basic training in massage therapy, he was directed to me. At our first meeting he told me about PNF stretching. I ordered the first home-study course I found on the topic and started exploring the techniques and concepts with him on the gym floor.

Each week he reported more motion and better performance at his meets. He also came each week with new performance goals. He was vying to do at least five bodyweight pull-ups by the time I left the gym and moved out of town. I later reconnected with him  in  Charleston;  he drove over an hour into town so he could keep up with the PNF and mobility training we were doing together. Since  it was so important to him, I felt it could benefit others and started integrating it into my other training sessions where I felt it was appropriate.

Now, ten years later, it seems a  lot more people know about PNF. In  YouTube videos, I see ‘flexibility experts’ incorporate PNF-like contractions to deepen control of certain stretches, movements, or postures. I  also  note  the many stretch clinics – such as Flex- Able and Stretch Zone®  –  popping  up in shopping centers, where people go just for assisted stretching and mobility training. Seeing them  succeed  next door to personal training gyms and yoga studios suggests that existing fitness businesses remain uninterested in flexibility and mobility despite increasing public interest. This may be because flexibility and mobility are among the least researched forms of training in sports medicine, and thus given only a brief section in many certification manuals for trainers and coaches. It’s also the way things have been set up for a long time: it’s not uncommon to see trainers at gyms spend ten minutes warming up a client with aerobic exercise and then focus on various forms of strength training, only to realize they have only five minutes left to guide a sequence of stretches as a cool-down activity. Change would entail a paradigm shift in how gyms operate and how their members view their time at  the  gym.  (You’d  be  hard-pressed  to find someone vying to be the most relaxed person in a weight room, where something as simple as stretching can quickly turn into a competition.)

When I hosted a PNF workshop for a group of personal trainers a couple of years ago, I asked how many “touch” their clients. No one raised a hand. Perhaps the question was misinterpreted, but it is my impression that there is an overwhelming lack of touch in a profession that should be more open to putting hands on people than it is about putting weights on them. This is not to suggest that many trainers don’t touch their clients for the sake of facilitating healthier movement, but the trend in the fitness world and elsewhere where movement could be supported through touch is to have minimal contact. Yet clients are craving intelligent hands, and they’re craving assistance with movement because they feel it’s both challenging and dangerous to do it on their own with little to no guidance. Contact is one of the main reasons why cookie- cutter stretch clinics are succeeding in retaining and gaining new members. I feel that my use of PNF as a trainer was a gateway to being comfortable with contact as a Rolfer, based on similarities in both principles and techniques.

A Brief History of PNF

Dr. Herman Kabat and Margaret Knott are the innovators of the PNF method commonly taught today in physical therapy programs (Sandel 2013). The reason for developing PNF wasn’t sport performance; rather it was in response to polio, one of the biggest health crises for the US in the early twentieth century. Poliomyelitis is a highly contagious viral infection of the grey matter of the spinal cord leading to disease within the central nervous system. There are various symptoms but the most commonly known are paralysis and death. This devastating epidemic, which peaked in the US in the 1940s to1950s, led health professionals to scramble for solutions and vaccines (Wikipedia 2019a). It was difficult to know how to treat the afflicted, as connections between different body parts were deeply disturbed. Treament sometimes included immobilization, including plastering limbs and securing bodies to stretchers to prevent uncoordinated movement from producing uncontrollable spasms (Neumann 2004). Others were treated with the opposite approach – rather than securing and supporting neurologically disabled limbs, there were attempts at mobilizing them with heat compresses, cold packs, and movement with whatever strength  patients  had   available.   All of these things were applied with a

 By definition, PNF means the promotion or hastening of natural processes, stimulating the sensory receptors of nerves and muscles to make movement easier.

therapist’s guiding support. One style of this latter approach was known as the Kenny Method, named after ‘Sister’ Elizabeth Kenny (Verville 2009; Olson 2002).

I didn’t learn about Kenny until after my second presentation of  PNF  stretching to a group of peers. In reading an article about Kabat, there was mention of his experiences observing an unusual nurse (Kenny) work with patients in her house, just a stone’s throw from the nearest hospital.  She  was  both  a  paragon   and a pariah among members of the medical community: her success  with  an unconventional yet intuitive treatment approach brought lines of people to her door and clinics founded in her name, yet her lack of formal medical training brought chagrin from doctors, who considered her a quack nurse from “the bush of Australia” (Verville 2009). Still, she mentored many health professionals (including Kabat and Fred Mitchell, DO), earned an audience with Franklin D. Roosevelt [a polio victim confined to a wheelchair (Olson 2002)], and was lionized in a Hollywood film characterizing her as a strong woman shunned and outnumbered by the patriarchal medical community (Wikipedia 2019b). Her lack of mention in many books and articles concerning PNF began to make more sense to me and appeared less coincidental. In any event, Jonas Salk introduced the polio vaccine in 1952, making much of Kenny’s manual work with polio patients obsolete; nevertheless, she raised the bar for bedside medicine and physical therapy (Lerner 2013).

Despite Kabat deriving inspiration from Kenny for the development of PNF, he was dismissive (Verville 2009). Kenny had acquired most of her medical training on ships transporting wounded soldiers from England to Australia during the height   of World War I. In contrast, Kabat had been professionally educated within the comfort of the University of Minnesota. Kabat had the science, and would turn the ambiguous Kenny Method into a method of interventions based on research and empirical theories. Gaining the support of Henry J. Kaiser, a well-known industrialist whose son he successfully treated for polio (Sandel 2013), Kabat founded clinics. He recruited Margaret Knott, a physical therapist, and Dorothy Voss, another student of their program, and those two women produced the first manuals on the PNF method, which spread through the physical therapy world like wildfire. Its popularity derived from utilizing methods that worked with patients’ strengths, rather than their weaknesses, to produce normal kinesthetic functioning.

As success grew for practitioners working with clients who had varying issues, not just severe neurological pathologies, more and more professionals within the health and fitness industry began experimenting with the original methods and adding their own creative spins to them. With this burgeoning interest, the PNF method has gained a broad audience, proving useful to treat everyday aches, pains, and movement dysfunction. Not many tools are required or necessary, which makes the work highly accessible to practitioners. Moreover, with only a basic understanding of its principles (I first learned about it through a home-study continuing-education course for personal trainers), a variety of professionals are able to incorporate PNF into their practices. I’ve seen it utilized successfully by personal trainers, athletic coaches, yoga teachers, and massage therapists with an entry-level understanding of anatomy and physiology. The same principles apply regardless of what population is being served.

By definition, PNF means the promotion or hastening of natural processes, stimulating the sensory receptors of nerves and muscles to make movement easier (Hindle et al. 2012). Therapists serve as facilitators, they aren’t meant to perform the activity for the patient/client, they are simply there to make the processes of contraction, relaxation, and coordination easier for the person wishing to access healthier movement. How practitioners do this varies depending on what conditions present with the client, but PNF has  common  principles  such  as stabilization, irradiation, timing, and integration (Brody and Hall 2017).

The Moral of the Story

The main takeaway from studying the history of functional medicine is that it hasn’t always been a field reserved for specialists. That said, I’m more likely to pay a trained professional for a higher quality of service, rather than someone working ‘intuitively’. The body, on its own, organizes toward  health  every day. Yet recovering from trauma and injury, or simply rediscovering our innate movement potential, may involve re- educating ourselves  to  be  well.  This  is what inspired Kenny’s mobilization approach: she saw the contrast to the immobilization techniques popularly used in her day.

Writing about and teaching the method of PNF, Kabat and Knott helped to streamline physical medicine and make  it more digestible to the academic types, while Kenny’s success was with the people – she had strong clinical outcomes and changed lives one individual at a time despite not having traditional medical training. Kenny looked at what was in front of her in the moment and allowed the patient to move in whatever ways were possible. She continually adjusted her techniques to meet the needs of each and every patient, which some say consisted of over 7,800 cases (Wikipedia 2019c). PNF eventually adopted easier to follow patterns, such as Upper D1 Flexion and Lower D2 Extension, which are rotational patterns accessible for most bodies (McAtee 2013).

An issue with  prescribed  patterns  is the potential for facilitators to confine movement to such patterns and create   a cognitive ‘splint’ that fixates the client. Movement is a lot more than abduction, flexion, internal rotation, or some combination. It also includes such things as resistance, intensity, expression, and intention. By keeping our mind open, we see what part of someone’s movement needs assistance, and what parts  we  can help a person utilize. Then we will be successful in facilitating positive changes.

When I forgo the musculoskeletal focus and apply PNF to another system such as the fascial web, then I feel as though I have a larger handle with which to direct changes in a client’s potential for integrative movement.

The story of PNF and the history of physical therapy echo the story and history of Rolfing SI.  Both  Kenny  and Dr. Rolf were wise and knowledgeable women with strong personalities; they knew how to defend their work in the face of criticism. For both, their successful results drew the attention of hundreds  of people seeking help that they hadn’t been able to find elsewhere. They both caught the attention of a wide variety of professionals, in the medical field and beyond. Both became mentors for some the biggest names in movement-based medicine yet were at the same time dismissed as not having the science to back up their claims.

Principles Before Practice

The key principles of PNF and Rolfing SI are similar. Rolfing students are taught that the person they are working with possesses all s/he needs to heal. Rolfers intelligently redirect the body towards its most natural organized gravitational state. PNF has the same idea in mind, especially with people who have been severely stricken with neurological disorders. When limb movement is severely unavailable, the PNF style will train movement to begin from where the strength exists (Brody and Hall 2017). Through training these patterns over  and over again, patients could regain an empowering level of function. And it is with the mobilizing fascial work of Rolfing SI that Rolfers systematically empower structure to return to the ‘Line’.

The Rolfing SI principles of adaptability, support, and holism (Maitland  2016)  pair with the PNF focus on development of motor behavior. In PNF, behavior is facilitated in an orderly sequence of movement patterns that include the whole body, with a focus on posture. PNF interventions follow a step-wise fashion of movement, much like the Rolfing ‘First Hour’ focuses on opening the tissue to being adaptable to the changes that will follow in the rest of the Ten Series. PNF supports the idea that the person has some capacity ‘to pull themselves up by their bootstraps’. which is facilitated, not done for them (Sandel 2013). The person experiencing PNF will be led progressively through movement that supports the changes to remain long after the session is over. Holism for PNF is not physiological, it is philosophical. PNF purports that all human beings have potentials that aren’t fully developed (Brody and Hall 2017). Those potentials are influenced by every aspect of the person.

As a Rolfer with PNF training, I value  movement work with my clients, though many of them don’t quite connect structural work with movement work. Their ‘movement work’ takes place elsewhere – such as in the gym class or yoga studio. Granted it’s on me to educate them as to the structural benefits of refining everyday movement patterns and postural habits in the context of a bodywork session. They’re already sold on the idea that they need ease of movement if they are going to perform well and live healthy lives. This ease comes from having optimal ROM in all joints. As an athletic trainer, my flexibility and mobility training had been my main means of  addressing ROM concerns. Now, as a Rolfer I find myself incorporating PNF-like principles into my SI work as a hybrid of these two valuable modalities.

Application of PNF

PNF works with a variety of patterns in which both client and practitioner apply variable tension to the working muscles. Verbal and visual cues are emphasized as well as timing. Variations of tasks,  directions, and cueing are combined with movement patterns requiring coordination of all the joint motions in the lower and upper girdles. The rotational directions of the patterns are said to account for the spiraling arrangement of muscle origin and insertion (McAtee 2013).

There are several sequences used for facilitating neuromuscular coordination such as Contract-Relax, Hold-Relax, Hold-Relax-Contract-Relax. It is up to a practitioner’s discretion to decide what type of sequence would be fitting for the client’s current needs. Depending on the area being addressed, periods of tension may be held for three to ten seconds (Hindle et al. 2012). Some  even  work on maintaining contractions for much longer periods as a way to strengthen  the muscle while getting it comfortable at a more elongated position. Below are some basic steps to a PNF intervention, but keep in mind this is just one of many ways advanced practitioners utilize PNF (Adler et al. 2013):

1. Determine the client’s movement baseline and assess the quality of a movement (e.g. squat, walk, leg swing, breath).
2. Determine any limiting factors for the movemet in question. Observe where the lines of a movement are incongruent. For example, when a client reaches overhead, see if there are any disruptions in the continuity of joint motions required for the action of reaching.
3. Find a comfortable, stable, safe, and noninvasive position for both people to be supported and put the joint(s) to its soft end range.
4. Hold for twenty to thirty seconds or five to six cycles of breath.
5. Ask for resistance of 5%-20% maximum effort for three to ten seconds.
6. Let the joint recoil before taking it back into its soft end range and reapplying pressure to get more range.
7. Hold the next position for fifteen to thirty seconds or three to four cycles of breath.
8. Repeat as needed; two to three sets is often enough for most people feel a significant change.
9. Retest baseline and check for improvements.

Because of its engaging effects, I’ve enjoyed threading PNF into my SI sessions as part of the integration process. I don’t adhere to the PNF patterns or protocols but definitely utilize the principles to adjust techniques to needs at hand. When I forgo the musculoskeletal focus and apply PNF to another system such as the fascial web, then I feel as though I have a larger handle with which to direct changes in a client’s potential for integrative movement. One example of this type of adaptation would be in applying the PNF pattern model to something like Tom Myers’ Anatomy Trains models (Myers 2014). In this way, when I perform a PNF intervention, I can adapt it to fit the fascial lines with which I’m working and the client can have a better feel for the planes of movement with which I’m attempting to connect them.

When Is It Not Rolfing SI?

In our Rolfing SI community, we are practitioners with diverse backgrounds like yoga, dance, Pilates, academics, medicine, athletics, and physical therapy, to name a few. If a Rolfer incorporates what they know from these movement practices into their Rolfing SI sessions, when does is cease to be Rolfing SI? It’s like the age-old philosophical question: “When does something cease to be what it was as you change its parts?” I don’t think we need worry about variations in technique. The important thing is staying congruent with the Rolfing Principles of Intervention. As long as the alternative modalities applied in Rolfing sessions can support the principles of Rolfing SI then why not make use of them? Clients pay us to be a resource. We owe it to our clients to apply all our best knowledge in our Rolfing sessions.

I found PNF long before my Rolfing career, and at the time it seemed to be far away from Rolfing SI. When I became a Rolfer, I gave up PNF to work with what I was taught during my Basic Training. As I gained more experience as a Rolfer in the real world, I learned the value of what I already knew, and how to combine the two together. The more practice I had using the tools of both modalities, the more similarities I found in their outcomes. When it comes to manual therapy and promoting flexibility, many common elements are also found with PNF stretching, which is a foundational pillar of physical therapy. The shared elements with Rolfing SI for me have been a foundational pillar in how I execute movement work with my clients. This blend needs to be done with balance and I encourage you to consider how your SI practice could be enhanced with PNF concepts.

Noel Poff is a Certified Advanced Rolfer in Charleston, South Carolina. He started his career in promoting health and wellness through personal training, massage therapy, and yoga. In 2016 he melded these activities into the foundation of Lowcountry Rolfing where he practices Rolfing SI and hosts workshops on assisted stretching. Noel can be contacted at [email protected].

Bibliography

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