Passive Movements

Presented by
Dr. Anaz A
MPT - MSS
Contents
• Causes of immobility
• Classification of passive movements
• Specific definitions related to passive movements
• Principles of giving passive movements
• Indications
• Contraindications
• Effects of uses
• Techniques of giving passive movements
Causes of immobility
• Acute and chronic diseases
• Arthritis
• Osteoporosis
• hip fracture
• Stroke
• Parkinson's disease
• Traumatic injuries
• Lack of physical activity
• Psychological factors such as fear of falling or getting hurt
Passive movements
Definition
• Movement which are produced by an external force during
muscle inactivity.
• - Dena Gardner
• The movement, which is performed with the help of the external
force whenever the muscles fail to perform the movement by its
own.
• - Laxmi Narayan
Classification of passive movements

Passive
movements

Relaxed Forced Manipulations

I. RELAXED PASSIVE MOVEMENTS.
• A state of relaxation is presupposed, and the joint is moved
through the existing free range, and within the limits of pain.
• Principles
1. Relaxation
• A brief explanation of what is to happen to the patient is given
• Select a suitable starting position which ensures the comfort and
support
2. Fixation
• Fixate the proximal and distal joints by the physiotherapist so that
movement is localized to that particular joint
3. Support
• Full and comfortable support is given to the part to be moved, so
that the patient has confidence and will remain relaxed
4. Traction
• Fixate the proximal bone of the joint, and give a pull by on the
distal bone
5. Range of movement
• The range of movement is done in a pain-free range to avoid
spasms in surrounding muscle
6. Speed and duration
• As relaxation must be maintained throughout the movement, the
speed must be slow and rhythmical, with suitable repetitions of
the movement
7. Physiotherapist stance
• In the direction of line of movement. Commonly used stances are
the walk stance and stride stand

8. Repetitions
• Usually 8-10 repetitions are given twice (02) a day

9. Sequence
• Neurological cases: from proximal to distal joints
• For draining fluids: from distal to proximal
Effects and uses
i. Prevention of adhesion formation
ii. Preserve the memory of the movement pattern by stimulating
the receptors of kinaesthetic sensation
iii. Prevention of adaptive shortening
iv. Improves venous and lymphatic returns
v. Have a soothing effect and cause further relaxation of the
muscle
II. FORCED PASSIVE MOVEMENTS
These movements aim at increasing the existing range of
movement in a stiff joint by tearing or stretching the limiting
structures (adhesions)
Technique
This is similar to that described for the previous type but differs
in range and speed
1. The resistance of the limiting structures may be overcome
by a sudden forceful overpressure at the limit of the
movement
• This must be done once only, with care and control
• Under the direct supervision of a doctor unless the
physiotherapist is experienced in their use.
2. Steady and sustained traction on shortened muscles and
ligaments may succeed in lengthening these structures
without traumatizing them.
• Any passive stretching of a muscle beyond the middle will
elicit the myotatic reflex
• But sustained stretch will relax the muscles and it take the
strain
• Mechanical stretching :

Turnbuckle plaster Balanced traction splint

Effects and uses
• Recently formed adhesion can be broken down
• Accessory movements which cannot be localised actively, can
be freed passively (intercarpal joint)
• Replace or alter the position of intra articular structures
• Steady or a prolonged stretch can overcome the shortened
ligament, fascia. (equino-varus – splint)
III. Manipulations
• These are performed by the surgeon with the patient under a
general or local anaesthetic, which eliminates pain and
protective spasm
• Even well-established adhesions can be broken down
Continues passive motion (CPM)
• continues passive motion device maintains movements of a
joint after limb-sparing surgery. This device is usually called a
CPM
• Continued movement limits stiffness and pain.
• It is very important to keep joints moving following surgery so
that motion will not become limited.
• The CPM will move the involved leg through its full range of
motion.
• It is only used in bed but can be used while relaxing, eating, or
sleeping
BENEFITS OF CPM
• Decreasing the complication of immobilization
• Decreasing the post-operative complications and pain
• Improving the recovery rate and ROM
• Improving the circulation through pumping action
• Prevent adhesions and contracture
• Prevent joint effusion and wound oedema
 Indications
• When a patient is unable to
move a segment of the body
• When a patient is comatose,
paralyzed, or in complete bed
rest
• After arthroscopy or joint
replacement
• When acutely inflamed tissues
are painful
• When muscles are not able to
perform actively
• When joint stiffness is present
Contraindications
• Unhealed fracture
• Recent fracture
• At the site of fracture
• At the site of effusion or
swelling
• Immediately following surgical
procedure to the tendon,
ligaments, joint capsule
• Immediately after recent tear
to the ligament, tendon
THANK YOU