Therapeutic Practical Notes

Reference (How to Use these Notes)

Positions Reference
 Supine – Lying on the Back

 Prone – Lying on the Stomach

 Sidelying – Lying on the Side, with Inferior Hand under Head & Inferior Lower Limb
flexed at Hip & Knee

 Stride Standing – Standing with Legs far Apart

 Walk Standing – Standing with one Leg backwards & other Leg forwards

Terminology
 Proximal Hand – Hand closer to the Joint, usually used for Stabilization

 Distal Hand – Hand far from the Joint, usually used for Movement

 Proximal Part – Superior Portion. For example, Proximal Part of Forearm refers to the
part below the Elbow Joint.

 Distal Part - Inferior Portion. For example, Distal Part of Arm refers to the part above
the Elbow Joint.

 Plinth – Bed

As a General Rule, the Patient’s feet should be outside the Plinth.

*Text & Pictures are referenced from Dr. Ahmed Abdallah’s videos.
Passive ROM Exercises
Movement must be Smooth, Rhythmical, & within Available ROM.
Cross-Arm Technique
Shoulder Flexion & Extension
 Patient Position – Supine
 Forearm is Supinated
 Elbow is fully Extended

 Therapist Position – Stride Standing

 Grasp “Cross Arm Technique”:

 Proximal Hand – On Wrist
 Distal Hand - Under Elbow

Shoulder Abduction & Adduction

 Patient Position – Supine
 Elbow is Flexed 90 degrees

 Therapist Position – Walk Standing

 Grasp:
 Proximal Hand - Under Elbow
 Distal Hand - On Wrist

Shoulder Internal & External Rotation

 Patient Position – Supine
 Elbow is Flexed 90 degrees
 Shoulder is Abducted 90 degrees

 Therapist Position – Stride Standing

 Grasp:
 Proximal Hand - Under Elbow
 Distal Hand - On Wrist
Shoulder Horizontal Abduction & Adduction
 Patient Position – Supine
 Forearm is Supinated
 Elbow is initially Extended
 Shoulder Abducted 90 degrees

 Therapist Position – Stride Standing, horizontally

facing the Arm of the Patient

 Grasp:
 Proximal Hand - Under Elbow
 Distal Hand - Under Wrist

Shoulder Hyperextension
 Patient Position – Sidelying
 Elbow is flexed

 Therapist Position – Walk Standing

 Grasp:
 Proximal Hand - Stabilizes the Shoulder
 Distal Hand - Under the Forearm, supporting the
Weight of the Patient’s Arm

Elbow Flexion & Extension

 Patient Position – Supine
 Forearm is Supinated

 Therapist Position – Stride Standing

 Grasp:
 Proximal Hand – Under Distal Part of Arm
(above Elbow Joint)
 Distal Hand – Under Wrist
Forearm Pronation & Supination
 Patient Position – Supine
 Elbow is flexed

 Therapist Position – Stride Standing

 Grasp “Shaking Grasp”:

 Proximal Hand – Under Elbow Joint Shaking Grasp
 Distal Hand – Shakes Hands with Patient’s Hand,
to stabilize the Wrist.

 Alternative Grasp (if the Wrist is Weak):

 Proximal Hand – Under Elbow Joint
 Distal Hand – On Wrist Joint

Wrist Flexion, Extension, Ulnar Deviation, & Radial Deviation

 Patient Position – Supine
 Elbow is Flexed
 Forearm is in Midprone Position

 Therapist Position – Stride Standing

 Grasp:
 Proximal Hand – On Distal Part of Forearm
(Above Wrist Joint)
 Distal Hand – On Palm of Hand

Finger Flexion & Extension (MCP Joints)

 Positions – Same as Wrist Movements

 Grasp:
 Proximal Hand – On Palm of Hand
 Distal Hand – On Phalanges of Fingers
Thumb Flexion, Extension, Abduction, & Adduction (MCP Joint of Thumb)
 Positions – Same as Wrist Movements

 Grasp:
 Proximal Hand – On Phalanges of Thumb
(Movement)
 Distal Hand – On MCP Joints of Fingers
(Stabilization)

Hip Flexion & Extension

 Patient Position – Supine
 Knee is usually initially Extended, but may or may not be Flexed alongside the
Hip

 Therapist Position – Stride Standing

 Grasp (with Knee Flexion):

 Proximal Hand – Under Knee Joint, shifting to the side of the knee as the
movement occurs.
 Distal Hand – On Calcaneus Bone

 Note - Hip Extension should be carefully controlled in this position, as sudden Knee
Extension may occur. The Proximal Hand should carefully control the positioning of the
knee.

 Grasp (with Knee Extension):

 Proximal Hand – On Distal Part of Thigh (above Knee Joint)
 Distal Hand – Under Distal Part of Leg (above Ankle Joint)
Hip Abduction & Adduction
 Patient Position – Supine
 Knee is fully Extended

 Therapist Position – Walk Standing

 Grasp:
 Proximal Hand – Under Knee
 Distal Hand – Under Ankle

Hip Internal & External Rotation

 Patient Position – Supine
 Rolling Technique – Hip & Knee are fully Extended
 Alternative Technique – Hip & Knee are flexed 90 degrees

 Therapist Position – Stride Standing

 Grasp “Rolling Technique”:

 Proximal Hand – On Distal Part of Thigh (Above Knee)
 Distal Hand – On Distal Part of Leg (Above Ankle)

 Alternative Grasp:
 Proximal Hand – On Thigh, as Knee is supported on Therapist’s Chest
 Distal Hand – On Distal Part of Leg (Above Ankle)

 Note – In the Alternative Technique, External Rotation is done by moving the Leg
inwards while Internal Rotation is done by moving the Leg outwards.

Rolling Technique
Hip Hyperextension
Method 1

 Patient Position – Prone

 Knee is Flexed 90 degrees

 Therapist Position – Stride Standing

 Grasp:
 Proximal Hand – Stabilizes the Pelvis
 Distal Hand – On Distal Part of Thigh, wrapped around Leg

Method 2

 Patient Position – Half Prone (Lower Limbs outside the Plinth)

 Therapist Position – Stoop Standing (Hips are Flexed)

 Grasp:
 Proximal Hand – Stabilizes the Pelvis
 Distal Hand – On Distal Part of Thigh (above Knee Joint)
Knee Flexion & Extension
 Patient Position – Prone

 Therapist Position – Stride Standing

 Grasp:
 Proximal Hand – On Proximal Part of Thigh (below Hip Joint)
 Distal Hand – Under Distal Part of Leg (above Ankle Joint)

 Note – It’s essential to grasp proximally from the Proximal Part of the Thigh instead of the
Distal because if you grasped from the Distal Part of Thigh you will restrict the ROM with
your Hand.
Cupping Grasp (Dorsiflexion)

Ankle Dorsiflexion & Plantarflexion

 Patient Position – Supine
 Feet are outside the Plinth

 Therapist Position – Stride Standing

 Dorsiflexion Grasp (Cupping Grasp):

 Proximal Hand – On Distal Part of Leg (above Ankle Joint) Plantarflexion
 Distal Hand – Under Calcaneus Bone

 Plantarflexion Grasp:
 Proximal Hand – On Distal Part of Leg
 Distal Hand – On Plantar Surface of Foot

Foot Inversion & Eversion (Subtalar Joints)

 Position – Same as Ankle Movements

 Grasp – Cupping Grasp (Same as Dorsiflexion)