PASSIVE MOVEMENT

INTRODUCTION
•These movements are produced by an external
force during muscular inactivity or when
muscular activity is voluntarily reduced as much
as possible to permit movements.
CLASSIFICATION
Relaxed passive movements (including accessory
movements)
Passive manual mobilizations techniques
•Mobilizations of joints
•Manipulations of joints
•Controlled sustained stretching of tightened
structures
SPECIFIC DEFINITIONS
RELAXED PASSIVE MOVEMENTS :
•These are movements performed accurately and
smoothly by the physiotherapist.
•A knowledge of the anatomy of joints is
required.
•The movements are performed in the same
range and directions as active movements.
•The joint is moved through the existing free
range and within the limits of pain.
 ACCESSORY MOVEMENTS :
• These occur as part of any normal joint movements
but may be limited or absent in abnormal joint
conditions.
•They consists of gliding or rotational movements
which cannot be performed in isolation as a voluntary
movements but can be isolated by the
physiotherapist.
PASSIVE MANUAL MOBILIZATION TECHNIQUES :
These are usually small
• MOBILISATIONS OF JOINT :
repetitive rhythmical oscillatory, localized
accessory, or functional movements performed
by the physiotherapists in various amplitudes
within the available range, and under the
patient’s control.
•These can be done very gently or quite strongly,
and are graded according to the part of the
available range in which they are performed.
MANIPULATIONS OF JOINTS PERFORMED BY:
•Physiotherapists - these are accurately localized,
single, quick decisive movements of small amplitude
and high velocity completed before the patient can
stop it.
•Surgeon/physician – the movements are performed
under anesthesia by a surgeon, of physician to gain
further range. The increase in movement must be
maintained by the physiotherapist.
CONTROLLED SUSTAINED STRETCHING OF TIGHTENED
STRUCTURE:
•Passive stretching of muscles and other soft
tissues can be given to increase range of
movement.
•Movement can be gained by stretching
adhesions in these structures or by lengthening
of muscle due to inhibitions of the tendon
protective reflex.
PRINCIPLES OF PASSIVE MOVEMNETS
• RELAXATION – a brief explanation of what is to happen is given to the
patient, who is then taught to relax voluntarily, except in case of
flaccid paralysis when this is unnecessary. The selection of a suitable
starting positions ensures comfort and support, and the bearing of the
physiotherapist will do much to inspire confidence and co- operation
in maintaining through the movement.
• FIXATION – where movement is to be limited to a specific joint, the
bone which lies proximal to it is fixed by the physiotherapist as close to
the joint line as possible to ensure that the movement is localized to
that joint; otherwise any decrease in the normal range is readily
masked by compensatory movements occurring at other joints in the
vicinity.
• SUPPORT – full and comfortable support is given to the part to be
moved, so that the patient has confidence and will remain relaxed.
The physiotherapist grasps the part firmly but comfortably in her
hand, or it may be supported by axial suspension in slings. The latter
method is particularly useful for the trunk or heavy limbs, as it frees
the physiotherapist's hands to assist fixation and to perform the
movement. The physiotherapist’s stance must be firm and
comfortable. When standing, her feet are apart and placed in the
line of the movement.
• TRACTION – many joints allow the articular surfaces to be drawn
apart by traction, which is always given in the long axis of a joint, the
fixation of the bone proximal to the joint providing an opposing force
to a sustained pull on the distal bone. Traction is thought to facilitate
the movement by reducing interarticular friction.
• RANGE – the range of movement is as full as the condition of the
joints permits without eliciting pain or spasm in the surrounding
muscles. In normal joints slights over pressure can be given to ensure
full range, but in flail joints care is needed to avoid taking the
movement beyond the normal anatomical limit. As one reason for
giving full-range movement is to maintain the extensibility of
muscles which pass over the joint, special consideration must be
given to muscles which pass over two or more joints. These muscles
must be progressively extended over each joint until they are finally
extended to their normal length over all the joints simultaneously,
e.g. the Quadriceps are fully when the hip joint is extended with the
knee flexed.
• SPEED AND DURATION – as it is essential that relaxation be
maintained throughout the movement, the speed must be uniform,
fairly slow and rhythmical. The number of times the movement is
performed depends on the purpose for which it is used.
 EFFECTS AND USES OF CONTROLLED
PASSIVE MOVEMENTS
•Adhesion formation is prevented and the present free range of
movement maintained. One passive movement, well given and
at frequent intervals, is sufficient for this purpose, but the usual
practice is to put the joint through two movement twice daily.
•When active movement is impossible, because of muscular
inefficiency, these movements may help to preserve the
memory of movement patterns by stimulating the receptors of
kinesthetic sense.
•When full-range active movement is impossible the
extensibility of muscle is maintained, and adaptive shortening
prevented.
•The venous and lymphatic return may be assisted slightly by
mechanical pressure and by stretching of the thin-walled
vessels which pass across the joint moved. Relatively quick
rhythmical and continued passive movements are required
to produce this effect. They are used in conjunction which
elevation of the part to relieve edema when the patient is
unable, or unwilling, to perform sufficient active exercise.
•The rhythm of continued passive movements can have a
soothing effect and induce further relaxation and sleep. They
may be tried in training relaxation and, if successful the
movement is made imperceptibly and progressively slower
as the patient relaxes.
EFFECTS AND USES OF ACCESSORY
MOVEMENTS
•Accessory movements contribute to the normal function of
the joint in which they take place or that of adjacent joints.
In abnormal joint conditions there may be limitations of
these movements due to loss of full active range caused by
stiffness of joints from contracture of the soft tissue,
adhesion formation or muscular inefficiency.
• Accessory movements are performed by the physiotherapist
to increase an lost range of movement and to maintain joint
mobility. Hence they form an important part of the
treatment of a patient who is unable to perform normal
active movement.
EFFECTS AND USES OF CONTROLLED
SUSTAINED STRETCHING
•Steady and sustained stretching may be used to overcome
spasticity patterns of limbs, e.g. a hemiplegic patient.
•The slow stretch produces a relaxation and lengthening of
the muscle.
• A steady and prolonged passive stretch can overcome the
resistance of shortened ligaments, fascia and fibrous sheaths
of muscles as, for example, in controlled stretching and
progressive splintage of talipes equinovarus.
INDICTAIONS FOR PROM
•In the region where there is acute, inflamed tissue, passive
motion is beneficial; active motion would be detrimental to
the healing process. Inflammation after surgery or injury
usually last 2 to 6 days.
•When a patient is not able to or not supposed to actively
move a segment(s) of the body, as when comatose,
paralyzed, or on complete bed rest, movement is provided
by an external source.
GOALS FOR PROM
The primary goal for PROM is to decrease the complications
that would occur with immobilization, such as cartilage
degeneration, adhesion and contracture formation and
sluggish contraction.
•Maintain joint and connective tissue mobility.
•Minimize the effects of the formation of contractures.
•Maintain mechanical elasticity of muscle.
•Assist circulation and vascular dynamics.
•Enhance synovial movement for cartilage nutrition.
•Help maintain the patient’s awareness of movement.
USES OF PROM
•When the therapist is examining inert structures, PROM is
used to determine limitations of motion, joint stability,
muscle flexibility and other soft tissue elasticity.
•When a therapist is teaching an active exercise program,
PROM is used to demonstrate the desired motion.
•When a therapist is preparing a patient for stretching, PROM
is often used preceding the passive stretching techniques.
LIMITATIONS OF PASSIVE MOTION
True passive, relaxed ROM may be difficult to obtain
when muscle is innervated and the patient is
conscious. Passive motion does not:
•Prevent muscle atrophy.
•Increase strength or endurance.
•Assist circulation to the extent that active, voluntary
muscle contraction does.
PRINCIPLES AND PROCEDURES FOR
APPLYING ROM TECHNIQUES
EXAMINATION, EVALUATION AND TREATMENT PLANNING:
•Examine and evaluate the patients impairment and level of
function, determine any precautions and their prognosis and
plan the intervention.
•Determine the ability of the patient to participate in the
ROM activity and whether PROM, A-ROM or AROM can meet
the immediate goals.
•Determine the amount of motion that can be applied safely
for the condition of the tissues and the health of the
individual.
• Decide what pattern can best meet the goals, ROM techniques may
be performed in the:
o Anatomic planes of motion: frontal, sagittal, transverse.
o Muscle range of elongation: antagonistic to the line of pull of muscle.
o Combined patterns: diagonal motions or movements that incorporate
several planes of motion.
o Functional patterns: motions used in activities of daily living(ADL).
• Monitor the patients general condition and responses during and
after the examination and intervention; note any change in vital
signs, in the warmth and color of the segment, and in the ROM, pain,
or quality of movement.
• Document and communicate findings and intervention.
• Re-evaluate and modify the intervention as necessary.