D R.
KAVITA M EENA
D EPARTM EN T OF PHYSIOT H ERA P Y
Definition
Passive movement are those movement which are
produced by an external force. External forces
may be manual that is the therapist, the other parts
of patient’s own body or mechanical with the help
of machines.
Ex. OF MANUAL & MECHANICAL
PASSIVE MOVEMENT
Indications of Passive movement
Passive movement can be given in the following
conditions:
- when a patient is not able to or not suppose to
actively move a segment of the body as,
-when commatose
-when paralysed
-on complete bed rest
-in post operative patients following
arthroscopy,joint replacement etc.
Goals of passive movement
The primary goal for passive movement is to
decrease the complications that occur with
immobilisation such as,
-cartilage degeneration
-adhesion formation
-contracture formation
-sluggish circulation etc.
Effects & uses of Passive movement
-To maintain joint & connective tissue mobility
-To minimize the effects of formation of contracture
-To maintain mechanical elasticity of muscles
-To assist circulation
-To enhance synovial fluid movement for cartilage nutrition
-To assist the healing process
-To promote relaxation & reduce pain
-To assist the lymphatic drainage
-To make the patient aware of movement
-To maintain healthy,efficient gliding of skin ,
fascia,muscles,tendon,nerves,blood vessels & joint surfaces.
Other uses of passive movement
1- When a therapist is examining inert structures of
joints passive movement is used to determine:
-the limitation of movement
-the joint stability
-the muscles & soft tissues elasticity
2- When a therapist is teaching an active exercise
programme passive movement is used to demonstrate
the desired movement
3- When a therapist is preparing a patient for stretching
exercises.
Disadvantages or limitations of passive
movement
True passive, relaxed ROM may be difficult to
obtain when muscles is innervated & the patient is
conscious.
Passive movement will not
- prevent muscle atrophy
- increase muscle strength or endurance
- assist circulation to the extent that active
voluntary muscles contraction does.
Contraindications
- Joint pain & inflammation
- Joint effusion
- Infection or fever
- In case of muscle spasm
- In case of fracture
- In case of venous stasis or thrombosis
Classification
1- Relaxed passive movement including
Accessory movement:
a) Relaxed passive movement:
These are movement performed accurately &
smoothly by the physiotherapist in the same range &
direction as active movement. The joint should be
moved in the existing ROM & within the pain limit.
b) Accessory movement:
These occurs as a part of any normal joint
movement but may be limited or absent in abnormal
joint conditions. It consists of gliding or rotational
movement which can’t be performed in isolation as
voluntary movement but can be isolated by the
therapist.
2- Passive manual mobilization techniques:
a) Mobilization of joints:
-These are usually small, repetitive, rhythmical,
oscillatory, localised accessory or functional
movement performed by the therapist.
-These can be done gently or strongly according to
the condition in various small amplitude within the
available range under the control of therapist.
b) Manipulation:-
By physiotherapist:
-These are accurately localised, single, quick
movement of small amplitude & high velocity completed
before the patient can stop it.
By surgeon:
-The movement are performed under anaesthesia by a
surgeon to gain further range.
3- Controlled sustained stretching of tightened
structures:
Passive stretching of muscles & other soft tissues can be
given to increase ROM.
Principles
-Relaxation:-
Communicate with the patient. The movement which
has to be given & its effects should be briefly explained
to the patient. The selection of suitable starting
position ensures comfort & support & counselling by
physiotherapist will inspire confidence & co-operation
in maintaining relaxation through out the movement.
-Fixation:-
When 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 localised to that joint.
Support:-
Full & comfortable support is given to the part to be moved,
so that the patient has confidence & will remain relaxed.
The physiotherapist grasps the part firmly but
comfortably or it may be supported by axial suspension in
slings for trunk & heavy limbs as it freeze the therapist’s hand
to assist fixation & to perform movement.
Traction:-
Many joints allow the articular surfaces to be drawn
apart by traction which is always given in long axis of
joints. Traction is thought to facilitate the movement by
reducing the interarticular friction.
-Range:-
The ROM is as full as the condition of the joint
permits without eliciting pain & spasm in the
surrounding structures.
-Speed & Duration:-
The speed must be uniform, fairly slow &
rythmical. The number of times the movement is
performed depends upon the purpose for which it is
used.
Procedures for applying PROM techniques
Examination, Evaluation & Re-Planning-
-Examine & evaluate the patient’s impairments &
level of function, determine any precaution & then
plan the treatment.
-Determine the ability of the patient to participate in
the ROM activity.
-Determine the amount of motion that can be safely
applied for the condition of the tissues & health of
the individual.
-Monitor the patient’s general condition & responses
during & after the examination & intervention. Note
any change in vital signs, any change in the warmth
& colour of the segment & any change in the ROM,
pain or quality of movement
Preparation of the patient-
-Free the region from restrictive clothing, splints &
dressing. Drop the patient as necessary.
-Position the patient in a comfortable starting
position with proper body alignment & stabilization
that will allow you to move the segment through the
available ROM.
-Position yourself so that proper movement can be
given easily.
Diagram of the Passive movement
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