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
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
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
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
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