SAĞLIKLI BİREYLERDE PROPRİOSEPTİF NÖROMÜSKÜLER FASİLİTASYON PATERNLERİ SIRASINDA KAS AKTİVASYONUNUN ELEKTROMİYOGRAFİK KANITI: KAPSAMLI BİR İNCELEME

Öz

Amaç: Proprioseptif Nöromüsküler Fasilitasyon (PNF) konsepti, rehabilitasyon müdahalelerini vücut fonksiyonları/yapıları ve aktivite kısıtlılıklarını hedef alacak şekilde yapılandırır. Bu kapsamlı derleme çalışmasının amacı, sağlıklı bireylerde PNF paternleri sırasında kas aktivitesine ilişkin mevcut elektromiyografik araştırmaları belirlemek ve özetlemektir. Yöntem: PubMed, PEDro, SCOPUS ve Web of Science veri tabanlarında 1980 ile Ekim 2025 tarihleri arasında yayımlanan çalışmalar kapsamlı bir şekilde taranmıştır. Çalışmalar, aşağıdaki kriterleri karşılamaları durumunda dâhil edilmiştir: (i) 18–65 yaş arası sağlıklı bireylerin dâhil edilmesi, (ii) PNF diyagonal paternlerinin ve temel fasilitasyon prensiplerinin uygulanması ve (iii) kas aktivitesinin değerlendirilmesinde elektromiyografinin kullanılması. Çalışma kalitesi, Uluslararası Sağlık Enstitüleri Gözlemsel Kohort ve Kesitsel Çalışmalar için Kalite Değerlendirme Aracı kullanılarak tanımlayıcı biçimde incelenmiştir. Bulgular: Toplam 250 katılımcıyı içeren 11 kesitsel çalışma dâhil edilmiştir. Çalışmaların kalitesi zayıf ile iyi arasında değişmekte olup, çoğunlukla düşük kaliteli bulunmuştur. Yetersiz örneklem büyüklüğü hesaplaması, çalışma popülasyonunun net tanımlanmaması, uygun bireylerin katılım oranının belirtilmemesi ve olası karıştırıcı değişkenlerin ölçülmemesi gibi nedenlerle yanlılık riski gözlenmiştir. Bulgular, üst ekstremitede Fleksiyon-Abduksiyon-Eksternal Rotasyon paterninde anterior, orta ve alt trapezius ile serratus anterior kaslarının önemli rol oynadığını göstermiştir. Sonuç: Elektromiyografik veriler, PNF paternlerinin seçilen paternin özelliğine bağlı olarak hedef kaslarda farklı düzeylerde aktivasyon oluşturduğunu göstermektedir. Bununla birlikte, bu derlemenin bulguları, standartlaştırılmış tasarımlara sahip ileri araştırmalara duyulan ihtiyacı vurgulamaktadır.

Anahtar Kelimeler

• Elektromiyografi
• Hareket
• Kas Aktivasyonu
• Proprioseptif Nöromüsküler Fasilitasyon
• Derleme

ELECTROMYOGRAPHIC EVIDENCE OF MUSCLE ACTIVATION DURING PROPRIOCEPTIVE NEUROMUSCULAR FACILITATION PATTERNS IN HEALTHY INDIVIDUALS: A SCOPING REVIEW

Öz

Purpose: The Proprioceptive Neuromuscular Facilitation (PNF) concept structures the rehabilitation intervention, addressing both body function/structures and activity limitations. This scoping review aimed to identify and summarize existing research on electromyographic muscle activity during PNF patterns in healthy individuals. Methods: A comprehensive search was conducted in PubMed, PEDro, SCOPUS, and Web of Science databases for studies published between 1980 and October 2025. Studies were included if they: (i) involved healthy individuals aged 18–65 years, (ii) applied PNF diagonal patterns and basic facilitation principles, and (iii) used electromyography to assess muscle activity. Study quality was examined descriptively using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: A total of 11 cross-sectional studies with 250 participants were included. The included studies had poor to good quality. They were primarily low-quality and had some bias due to a lack of sample size calculation, insufficient definition of the study population, unspecified participation rate of eligible individuals, and failure to measure key potential confounding variables. Findings showed that the anterior, middle, and lower trapezius muscles and the serratus anterior muscle were found to play a significant role in the Flexion-Abduction-External Rotation pattern in the upper limb. Conclusion: Based on electromyographic data, PNF patterns tend to induce varying degrees of muscle activity in the target muscles, depending on the choice of pattern. However, the findings of this scoping review underscore the need for further research with a standardized design.

Anahtar Kelimeler

• Electromyography
• Movement
• Muscle Activation
• Proprioceptive Neuromuscular Facilitation
• Review

Kaynakça

1. Levine MG, Kabat H. Proprioceptive facilitation of voluntary motion in man. J Nerv Ment Dis. 1953;117(3):199-211.
2. Shumway-Cook A, Woollacott M. Motor control: translating research into clinical practice (4th ed.). Philadelphia, PA: Lippincott Williams & Wilkins, 2011
3. Westwater-Wood S, Adams N, Kerry R. The use of proprioceptive neuromuscular facilitation in physiotherapy practice. Phys Ther Rev. 2010;15(1):23-28.
4. International Proprioceptive Neuromuscular Facilitation Association [Internet]. [cited 2025 October 24]. Available from: https://www.ipnfa.org/
5. Smedes F, Heidmann M, Schäfer C, Fischer N, Stępień A. The proprioceptive neuromuscular facilitation-concept; the state of the evidence, a narrative review. Phys Ther Rev. 2016;21(1):17-31.
6. Alexandre de Assis IS, Luvizutto GJ, Bruno ACM, Sande de Souza LAP. The proprioceptive neuromuscular facilitation concept in parkinson disease: a systematic review and meta-analysis. J Chiropr Med. 2020;19(3):181-187.
7. Ling-Xin L, Ke-Yao H, Rui Z, Zuo-Yan L, Li-Hui P. Efficacy and safety of proprioceptive neuromuscular facilitation for chronic low back pain: A meta-analysis of randomized controlled trials. Turk J Phys Med Rehabil. 2022;68(3):439-446.
8. Nguyen PT, Chou LW, Hsieh YL. Proprioceptive neuromuscular facilitation-based physical therapy on the improvement of balance and gait in patients with chronic stroke: a systematic review and meta-analysis. Life. 2022;12(6):882.

9. Bujar-Misztal M, Chciałowski A. Influence of proprioceptive neuromuscular facilitation on lung function in patients after coronary artery bypass graft surgery. Adv Exp Med Biol. 2018;1116:11-17.
10. Gunning E, Uszynski MK. Effectiveness of the proprioceptive neuromuscular facilitation method on gait parameters in patients with stroke: a systematic review. Arch Phys Med Rehabil. 2019;100(5):980-986.
11. Silva MC, Oliveira MT, Azevedo-Santos IF, DeSantana JM. Effect of proprioceptive neuromuscular facilitation in the treatment of dysfunctions in facial paralysis: a systematic literature review. Braz J Phys Ther. 2022;26(6):100454.
12. Campanini I, Disselhorst-Klug C, Rymer WZ, Merletti R. Surface EMG in clinical assessment and neurorehabilitation: barriers limiting its use. Front Neurol. 2020;11:934.
13. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.
14. National Institutes of Health. Study quality assessment tools. [Internet]. [cited 2025 October 24]. Available from: https://www.nhlbi.nih.gov/health-topics/study-qualityassessment-tools
15. Sullivan PE, Portney LG. Electromyographic activity of shoulder muscles during unilateral upper extremity proprioceptive neuromuscular facilitation patterns. Phys Ther. 1980;60(3):283-288.
16. Swanik KA, Huxel Bliven K, Swanik CB. Rotator-cuff muscle-recruitment strategies during shoulder rehabilitation exercises. J Sport Rehabil. 2011;20(4):471-486.
17. Witt D, Talbott N, Kotowski S. Electromyographic activity of scapular muscles during diagonal patterns using elastic resistance and free weights. Int J Sports Phys Ther. 2011;6(4):322-332.
18. Youdas JW, Arend DB, Exstrom JM, Helmus TJ, Rozeboom JD, Hollman JH. Comparison of muscle activation levels during arm abduction in the plane of the scapula vs. proprioceptive neuromuscular facilitation upper extremity patterns. J Strength Cond Res. 2012;26(4):1058-1065.
19. Kim JJ, Ann SY, Park SY. Comparison of diagonal shoulder exercises with and without visual trace. Int J Athl Ther Train. 2015;20(1):52-56.
20. Youdas JW, Adams KE, Bertucci JE, Brooks KJ, Steiner MM, Hollman JH. Magnitudes of gluteus medius muscle activation during standing hip joint movements in spiral-diagonal patterns using elastic tubing resistance. Physiother Theory Pract. 2015;31(6):410-417.
21. Comel JC, Nery RM, Garcia EL, et al. A comparative study on the recruitment of shoulder stabilizing muscles and types of exercises. J Exerc Rehabil. 2018;14(2):219-225.
22. Dionisio VC, de Baptista CRJA, Rodrigues AS, de Souza LAPS. Is it possible to stabilize the trunk using rhythmic stabilization in the upper limb? A cross-sectional study of asymptomatic individuals. J Man Manip Ther. 2018;26(4):212-217.
23. Park DJ, Hwang YI. Comparison of the Intrinsic Foot Muscle Activities between Therapeutic and Three-Dimensional Foot-Ankle Exercises in Healthy Adults: An Explanatory Study. Int J Environ Res Public Health. 2020;17(19):7189.
24. Marchese RR, Severo do Pinho A, Mazutti C, et al. Proprioceptive neuromuscular facilitation induces muscle irradiation to the lower limbs - A cross-sectional study with healthy individuals. J Bodyw Mov Ther. 2021;27:440-446.
25. Ferro JKO, de Moura Filho AG, de Amorim KCS, et al. Electromyographic analysis of pelvic floor muscles during the execution of pelvic patterns of proprioceptive neuromuscular facilitation-concept: An observational study. Neurourol Urodyn. 2022;41(6):1458-1467.