Types of Movement

Made by Sajida Mazhar

Consultant Physiotherapist
Lecturer in IPM&R, KMU.
 Types of Movement
• Movement takes place at joints and is
brought about by either the patient's
muscular efforts or by the application of an
external force.
• Movements may be classified as
– passive or
– active
 Passive
• Passive movements are those brought about by an
external force which in the absence of muscle
power
• In the part may be mechanical or via the therapist:
– (1) Mechanical – the pull of gravity causing 'flopping'.
– (2) The therapist performing movements. The
therapist may produce accessory or anatomical
movement at joints.
 Accessory movements
• Accessory movements occur when
resistance to active movement is
encountered and fall into two types.
– The first type: metacarpophalangeal
joints, which do not normally do so,
rotate when grasping an object such as a
hard ball.
– The rotatory movement is not possible
unless resistance is encountered.
 Accessory Movements
• The second type of accessory movement can only
be produced passively.
• It is produced when the muscles acting on the joint
are relaxed and cannot be performed actively in
the absence of resistance.
• An example is distraction of the glenohumeral
joint when the fingers are hooked under a heavy
piece of furniture and the body is pulled upwards.
 Anatomical movements
• Anatomical movements are those which the
patient could perform if his muscles worked
to produce that movement.
• can be subdivided into
– relaxed
– forced and
– Stretching.
 Active
• These are performed by the patient either freely,
assisted or resisted.
1. Freely active – in which case mechanical factors will
play a part offering either resistance or assistance.
2. Assisted active – when the therapist adopts the grips
as for passive movements and assists the patient to
perform the movement.
• The disadvantage of assisted active movements is that
it is impossible for either party to detect how much
work is being performed by each of them.
 Active movements…continued
3. Resisted active– when mechanical or
manual resistance is applied.
• The mechanical resistance may be in the
form of
– weights
– Springs
– Water
– auto loading or the mode of performance of the
activity.
 Range of motion
• Range of motion is a basic technique used for
the examination of movement
• For initiating movement into a program of
therapeutic intervention.
• Movement that is necessary for functional
activities can be viewed in its simplest form
• as muscles or external forces moving bones in
various patterns or ranges of motions
 Range of motion
• The full motion possible is called the range
of motion (ROM).
 TYPES OF ROM EXERCISES

Passive ROM (PROM)

• is movement of a segment within the unrestricted
ROM that is produced entirely by an external force
• there is little to or no voluntary muscle contraction.
• The external force may be from gravity, a machine,
another individual, or another part of the
individual’s own body.
Active ROM (AROM)
• is a movement of a segment within the
unrestricted ROM.
• that is produced by active contraction of the
muscles crossing that joint.
• No external agent is involved.
 Active-Assistive ROM(AAROM)

• is a type of AROM in which assistance is

provided
• The assistance can either be manual or
mechanical by an outside force.
• In case of muscular weakness the prime mover
muscles may need assistance to complete the
motion.
Movements summary
1. Passive movements 2. Active movements
• Accessory Freely
– * e.g rotatory Assisted(disadvantge)
movement of MCP Resisted
joints
– *e.g distraction of the ROM
humerus PROM
• Anatomocal
AROM
– relaxed
– forced and
AAROM
– Stretching
 INDICATIONS N GOALS FOR PROM
Indications for Passive 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 injury or surgery usually lasts 2 to
6 days.
• When a patient is not able to or not supposed to
actively move a segment or segments of the body
• when a patient is comatose, paralyzed, or on complete
bed ridden.
• movement is provided by an external source.
• Goals for PROM
• primary goal for PROM is to decrease
complications that would occur with
immobilization, such as cartilage
degeneration, adhesion and contracture
formation, and sluggish circulation.
Specifically, the goals are to
• 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 and diffusion of materials in the joint
• Decrease or inhibit pain
• Assist with the healing process after injury or
surgery
• Help maintain the patient’s awareness of
movement
 Other Uses for PROM

• When a therapist is examining inner structures, it

used to determine
– limitations of motion,
– joint stability,
– muscle 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 before the passive stretching
techniques.
Active and Active-Assistive ROM
• Indications for AROM
• Whenever a patient is able to contract the
muscles actively and move a segment with
or without assistance AROM is used.
• When a patient has weak musculature and is
unable to move a joint through the desired
range (usually against gravity)
• A-AROM is used to provide enough assistance to the
muscles in a carefully controlled manner so the muscle
can function at its maximum level and strengthened.
• Once patients gain control of their ROM they are
progressed to manual or mechanical resistance
exercises to improve muscle performance for a return
to functional activities
• AROM can be used for aerobic conditioning programs
If a segment immobilized for a period of time
it used on the regions above and below the
immobilized segment to maintain the areas in
as normal a condition as possible and to
prepare for new activities such as walking
with crutches.
 Goals for AROM
• If there is no inflammation or contraindication
to active motion, the same goals of PROM can
be met with AROM.
• In addition, there are physiological benefits
that result from active muscle contraction and
motor learning from voluntary muscle control.
 Goals for AROM
Specific goals are to:
• Maintain physiological elasticity and contractility of
the participating muscles
• Provide sensory feedback from the contracting
muscles
• Provide a stimulus for bone and joint tissue integrity
• Increase circulation and prevent thrombus formation
• Develop coordination and motor skills for functional
activities
 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
Does not increase strength or endurance
Does not assist circulation to the extent that
active voluntary muscle contraction does
 Limitations of Active ROM
• For strong muscles, active ROM does not
maintain or increase strength.
• It also does not develop skill or
coordination except in the movement
patterns used.
 Precautions and contraindications to
Range of Motion Exercises

• when motion is disruptive to the healing

process.
• Carefully controlled motion within the
limits of pain-free motion during early
phases of healing shown benefit healing and
early recovery.
• Signs of too much or the wrong motion
include
• increased pain and inflammation.
 Passive Movements
• Anatomical movements which are performed by the
therapist for the patient are passive movements.
• They may be performed at single joints or at several
joints in sequence covering any or all of the joint
movements and maintaining muscle length.
• They may also be performed to several joints
simultaneously as in many natural and functional
movements.
• Basic Rules
• The following must be observed:
• (1) Those parts not to be moved should be adequately
supported.
• (2) The part(s) to be moved should be comfortably
grasped.
• (3) The sequence of motion should be decided – distal to
proximal or proximal to distal. Each have their
• place, e.g. for giving passive movements to neurological
patients a proximal to distal sequence is used. The
• reverse, a distal to proximal sequence, is more commonly
used to aid venous and lymphatic return.
• (4) At the extremities of the ranges, the grasp on the
stretched skin side should be eased to prevent dragging.
• (5) The grasp should be as near the joint to be moved as
possible.
• (6) As the movement is performed the joint may be given
slight traction, but compression should be exerted
• at the extremities of the range.
• (7) The motion should be smooth and rhythmical and the
repetition rate maintained at even tempo.
• (8) Changes in grasp should be smooth and positioning of
the hands arranged so that minimal changes are necessary.