These two poses show the starting and ending positions for the upper extremity movement pattern of PNF D1 using water bells.
Here, the illustration shows the beginning and ending positions for upper extremity movement pattern of PNF D2, again using water bells.

In the early 1950s, physicians and therapists were scrambling to find treatments that might work for a new crop of polio patients. Dr.Herman Kabat first developed a technique called “proprioceptive facilitation” to address the paralysis caused by this dreaded disease. (“Neuromuscular” was added to the name in 1954.)

Within a decade, Kabat’s PNF spiral and diagonal movement patterns were modified and exported to Bad Ragaz, Switzerland, where they further morphed into an aquatic specialty technique known today as the Bad Ragaz Ring Method (see Aquatics International, February 2008 issue, for more on Bad Ragaz).

In this new Ring Method, clients were trained to perform spiral and diagonal movements while a therapist provided a fixed external resistance. The patterns were performed horizontally, making use of the concept of a “floating treatment table.”

However, all PNF did not transform into Bad Ragaz patterns. Many aquatic providers continued to experiment with traditional PNF patterns (D1/D2 flexion and extension) without providing a fixed distal resistance. These movements were performed in all positions, including horizontal, standing, sitting, kneeling and quadrupedal.

Over time, these traditional-looking PNF patterns became known simply as Aquatic PNF.

In 1993, Lynette Jamison and David Ogden co-wrote Aquatic Therapy Using PNF Patterns, the first widely published book on the use of PNF patterns in the aquatic environment.

Aquatic PNF can be performed in any water temperature, though most therapy pools are kept above 89- to 90 degrees Fahrenheit.

In the Bad Ragaz Ring Method, the patient floats horizontally on the pool surface while the therapist stands as a fixed point of contact. In contrast, in the Aquatic PNF, the therapist typically relies on external forces (such as gloves or a dumbbell) to provide resistance or drag to a moving distal part.

In Aquatic PNF, the client is verbally, visually and/or tactilely instructed in a series of functional, spiral mass movement patterns. The patterns may be performed actively — or with assistance or resistance provided by equipment or the therapist.

Today’s clinicians no longer have to haul out the recycled bleach bottles and awkward kickboards to get the workout they desire for their clients. Instead, they can incorporate specially designed aquatic gloves, paddles or bells into upper extremity patterns. Therapists use such equipment during PNF to increase drag andfrontal surface area, or to decrease streamlining.

Resistance devices for the lower extremities have come a long way as well; options now include fins, boots or specially designed aquatic resistance shoes. Therapists who wish to perform PNF in the horizontal position typically also use flotation devices to create a floating plinth.

Therapeutic pools with water depths of 31/2 feet to 5 feet work best for clinicians wanting to provide Aquatic PNF. Therapists with shallower pools (such as 2 feet to 31/2 feet) can make use of alternative workouts for their clients. For instance, at such depths, quadrupedal and kneeling become viable treatment positions. Quiet acoustics are not necessary for Aquatic PNF, though the environment should allow clients to hear the therapist without difficulty.

All health-care providers may integrate Aquatic PNF techniques as they are learned. No aquatic-specific PNF certifications are available, but there are certainly plenty of land-based options.