PASSIVE MOVEMENTS

BY : Dr. Sonali Desai

 Definition
• Passive ROM (PROM) is movement of a
segment within the unrestricted ROM that is
produced entirely by an external force; there is
little to no voluntary muscle contraction.
• The external force may be from :
– Machine
– Another individual
– Another part of the individual’s own body
• PROM and Passive stretching are not
synonymous.
• These movements are produced by an
external force during muscular inactivity or
when muscular activity is voluntary reduced as
much as possible to produce movements.
Classification
 Specific Definitions
• Relaxed passive movements :
– These are movements performed accurately and
smoothly by the physiotherapist
– Joint is moved through existing free range and
within the limits of pain
– Knowledge of anatomy of joint is required
– These movements are performed in the same
range and direction as active movements
 Effect and Uses
• Maintain present free ROM
• Maintain muscle extensibility
• Preserve memory of movement pattern by
stimulating the kinesthetic receptors
• Prevention of adaptive
shortening/contracture
• Prevention of adhesion formation
• Assist healing process
• Assist venous and lymphatic return by mechanical
pressure and by stretching of thin walled vessels
which pass across joint that is moved.
• Enhance cartilage nutrition and diffusion of materials
in the joint
• Enhance relaxation and sleep by soothing effect
• Decrease or inhibit pain
• Decrease edema - used in conjunction with elevation
 Other Uses for PROM
■ During examining inert structures:
– limitations of motion
– joint stability,
– muscle flexibility and other soft tissue elasticity.
■ To teach an AROM
■During stretching: PROM is often used
preceding the passive stretching techniques.
 Goals
• The primary goal for PROM is to decrease the
complications that would occur with
immobilization, such as
– cartilage degeneration,
– adhesion and contracture formation,
– sluggish circulation.
 Indications for PROM
• Acute inflammation of tissue
– Active motion would be detrimental to the healing
process
– Inflammation after injury or surgery usually lasts 2
to 6 days.
• When a patient is not able to or not
supposed to do AROM
– as when comatose, paralyzed, or complete bed
rest
 Principles of giving relaxed passive
movements

• Relaxation
•
•
Fixation
Support
RFSTRS
• Traction
• Range
• Speed and duration
• Relaxation :
– Brief explanation of procedure
– Selection of suitable starting position for comfort
and support
–Free the region from restrictive clothing, linen, splint and
dressing.

– Use : To enhance confidence and cooperation of

patient
• Fixation :
– Proximal joint is fixed by PT as close to the joint line as
possible
– If fixation not given properly normal range is reduced
and masked by compensatory movements occur at
other joint

– Use : To localize the movement to that particular joint

• Support :
– Full and comfortable support is given to the part
to be moved
– Grip : firm but comfortable
– Stance : firm and comfortable . When in standing :
Walk standing position, feet apart (wide BOS) and
in line of movement

– Use : Enhance relaxation and confidence

• Traction:
– Many joints allow their articular surfaces to be
drawn apart by traction
– Traction is always given in the long axis of a joint
– Fixation of proximal joint – provide opposing force
to sustained pull on distal bone

– Use : Facilitate movement and reduce

interarticular friction
• Range :
– ROM must be full without eliciting pain or spasm in
surrounding muscle
• In normal joints slight overpressure can be applied to
ensure full ROM
• But in flail joint avoid taking the joint beyond the normal
anatomical limit
– Special consideration must be given to 2 joint
muscles
– These muscles must be extended over each joint
until they are finally extended to their normal length
over all joints simultaneously
• Eg. Quadriceps fully extended when knee fully flexed and
hip fully extended
• Speed and Duration :
– Speed :
• Uniform
• Slow
• Rhythmical

– Duration : number of repetition depends on

purpose
 Limitations of Passive Motion
• True PROM 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
 Precaution and contraindication

1- Immediately after acute tears, fractures, and surgery.

2- Signs of too much effusion or swelling.

3- Sever sharp and acute joint pain

4- When motion disruptive to the healing process.

5- When bony block limits joint motions

6- Acute arthritis
 Application of Passive Exercises
Technical Principles
• Before performing passive exercises, some of the
technical principles should be remembered

1. Place the patient in proper comfortable position with

proper body alignment and stabilization to perform the
exercise.
2. The therapist should be in a proper position and
effective stance.
3. Free the region from restrictive closes, linen, splints,
and dressings.
4. Drape and cover the patient as necessary.
5. Utilize the proper hand holds or grasps by the
therapist.
6. Perform the exercise slowly, smoothly with rhythm
within the available pain free range of motion
without any force behind the range.
7. Do all ROM exercises smoothly and gently. Never
force, jerk, or over-stretch a muscle. This can hurt
the muscle or joint instead of helping.
8. Stop ROM exercises if the person feels pain. The
exercises should never cause pain or go beyond the
normal movement of that joint.
9. Repeat the exercise 5 to 10 repetitions according to
the patient condition and response