Active and passive movement

Chapter 4 of Therapeutic exercise handout
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https://doi.org/10.5281/zenodo.6349232

1. CHAPTER- 4



Active & passive
Movement

2. CHAPTER: 4 ACTIVE & PASSIVE MOVEMENT


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ACTIVE MOVEMENT

FREELY ACTIVE MOVEMENT/ ACTIVE MOVEMENT

Definition: Freely active movements are those which are performed by the patient's
muscular efforts without the assistance or resistance of any external force.

Types:
 Localized: Localized movement is designed primarily to produce some local &
specific effects. (To mobilize a particular joint or to strengthen particular muscle
groups.)
E.g. Flexion or extension exercises of UL
 General: In general exercise involves the use of many joints & muscles all over the
body & the effect in wide spread.
E.g. Running
(Principles of exercise therapy)

Indication of freely active movement:
1. Accomplish the same goals of passive movement with the added benefits that result
from muscle contraction.
2. Maintain physiologic elasticity & contractility of the participating muscles.
3. Provide sensory feedback from the contracting muscles.
4. Provide a stimulus for bone & joint tissue integrity.
5. Increase circulation & prevent thrombus formation.
6. Develop coordination & motor skills for functional activities.
[Therapeutic exercise foundation & technique]

Contraindication:
1. Any condition that disrupt the healing process.
2. Acute tear, fracture, surgery.
3. Some diseases condition as-Myocardial infarction (Ml), Coronary artery bypass
grafting (CABG), or Percutaneous transluminal coronary angioplasty (PTCA).
4. High blood pressure.
5. In unstable condition. (ICU patient).
(Therapeutic exercise foundation & technique)

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Techniques of application:
1. Select a starting position.
2. Teach the patient with care to ensure the maximum postural efficiency as a basis
for movement.
3. Give such type of instruction that will create an interest & co-operation among the
patient & therapist & lead the patient to understand the pattern & purpose of
movement.
4. The speed of exercise is done depends on the effects required. (Slow
movement during the learning period)
5. The duration of exercise depends on the patient's capacity.
(Principles of exercise therapy)


Factors affecting the effects of freely active movement:
 Nature of exercise.
 The extent of exercise.
 The intensity of exercise.
 Duration of exercise.

Effects of freely active movement:
A. Relaxation:
 Relaxation of hypertonic muscle ( Due swinging & pendular exercise)
 Reduce wasteful tension in muscle
 Achieve reciprocal relaxation of the opposing group
B. Joint mobility: When joint ROM is limited, rhythmical swinging exercise with over
pressure at the limit of free range may serve to increase joint ROM.
C. Muscle power/ tone: Muscle power & endurance is increased by creating tension in
them. This tension is greater when the exercise is performed.
D. Neuromuscular co-ordination: It is improved by the repetition of an exercise.
E. Confidence: The achievement of coordinated & efficient movement assures the patient
of his ability to maintain subjective control of his body, giving him confidence to
attempt other & new activities.
F. Circulatory & respiratory cooperation: Doing prolonged exercise it will increase the
body circulation.
(Principles of exercise therapy)

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ACTIVE ASSISTED MOVEMENT
Definition: This movement is performed by the voluntary action of muscles with the help
of external force.

Techniques of application:
1. Starting position: Stabilized the body part.
2. Pattern of movement: Taught the patient by passive movement or by active
movement in contra lateral side.
3. Support: The part of the body moved is supported throughout to reduce the load on the
weakened muscles by counterbalancing the effects of the force of gravity.
4. The antagonist muscles: Every effort must be made to reduce tension in the muscles
which are antagonistic to the movement. The starting position of the movement
should be chosen to ensure, that tension in these muscles is minimal. E.g.: A position in
which the knee is flexed, which is suitable for assisted dorsi flexion of the foot.
5. Traction: Preliminary stretching of the weak muscles to elicit the myotatic reflex
provides a powerful stimulus to contraction.
6. The assisting force: The assistive force performed by the therapist’s hands, which
should be placed in such a way that they rest on the surface of the patient's skin which
is in the direction of the movement. The ROM is as full as possible, but as the power of
muscles varies in different parts of their range, so more assistance will be necessary in
some parts than the others.
7. The character of movement: Movement should be smooth in response to patient's
voluntary muscle contraction.
8. Repetition: Repetition of movement should be maintained & it depends on the
injurious site, the cause
Principles of exercise therapy
Effects of active assisted exercise:
 The working muscle can cooperate in the production of movement, which they are
incapable of achieving without aid.
 The memory of the correct pattern of coordinated movement is unable for the
patient to achieve, without assistance.
 Assisted exercise is helpful for training coordination.
 Increase joint ROM.
 Establish confidence to the patient.
 When movement is compulsory in spite of pain in any joint than assisted exercise
are very useful. E.g.: in RA patient.
[Principles of exercise therapy]

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RESISTED MOVEMENT

Definition: This movement is performed by the voluntary action of muscles against the
application of opposite force or any resistance (weight).






Indication of resisted movement:
 Increase strength of muscles.
 Hypertrophy & recruitment of muscle fibers.
 Increase muscle endurance.
 Increase muscle power.
 Maintain normal length of muscle fibers & as well as prevent contracture.
(Therapeutic exercise foundation & techniques!
Precautions & Contraindications:
 Cardiovascular disease
 Unstable situation (high BP)
 Osteoporosis
 Acute inflammation
 Chronic pain
(Therapeutic exercise foundation & techniques)
Techniques of application of resisted movement:
 The starting position should be comfort & stable so that patient's can concentrate
the pattern of movement.
 The pattern of movement must be well known to the patient & it should be based
on a natural pattern of purposeful movement.
 Stabilization of the bone or bones of origin of the muscle to be resisted to be
improves their efficiency.
 Preliminary stretching of muscles to elicit the myotatic (stretch) reflex provides a
powerful stimulus to contraction.
 The character of movement should be smooth & controlled.
 Repetition should be maintained.
 The cooperation of the patient should be maintained.
(Principles of exercise therapy)

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Resistance may be provided by:
 The physiotherapist
 By the patient
 Resistance by weight
 Weight & pulley circuits
 Springs & other elastic structures
 Substances which are malleable
 By water

Effects & use of resisted exercise:
 Maintain or increase the muscle power.
 Increase the strength & hypertrophy the muscle.
 Increase power & endurance.
 Increase the blood flow.
(Principles of exercise therapy!

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Illustration of Resisted movement


[Resisted Shoulder flexion] [Resisted Shoulder extension]

[Resisted Shoulder abduction] [Resisted Shoulder adduction]

[Resisted Shoulder lateral rotation] [Resisted shoulder medial rotation]

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[Resisted Shoulder elevation] [Resisted Shoulder protraction]

[Resisted elbow flexion] [Resisted elbow extension]

[Resisted Fore arm supination] [Resisted Fore arm pronation]

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[Resisted Wrist flexion] [Resisted Wrist extension]

[Resisted MCP extension] [Resisted PIP flexion]


[Resisted MCP abduction] [Resisted thumb abduction]

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[Resisted Hip flexion] [Resisted Hip extension]



[Resisted Hip abduction] [Resisted Hip adduction]

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[Resisted Hip medial rotation] [Resisted Hip lateral rotation]

[Resisted Knee extension] [Resisted Knee flexion]


[Resisted Ankle Dorsi flexion] [Resisted Ankle planter flexion ]

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[Resisted Neck flexion] [Resisted Neck extension]


[Resisted Neck rotation] [Resisted Neck side flexion]

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PASSIVE MOVEMENT

RELAXED PASSIVE MOVEMENT/ PASSIVE PHYSIOLOGICAL MOVEMENT

Definition: This is a rhythmic passive movement with the help of external force. This
movement is performed within the unrestricted range by an external force.

Indications of passive physiological movement:
 When the patient is unable to perform active full ROM
 During unconsciousness
 Weak or De-nervated muscles
 Spinal cord injury
 Due to pain
 Neurological disease

Contraindications of passive physiological movement:
 Acute injury stage
 Early stage of fracture (#) healing
 Where pain may be beyond the patient's tolerance level
 Muscles or ligaments incomplete tear(May cause further damage)

Techniques of application of passive physiological movement:
 The part should be comfortable, supported, & located.
 The patient should be comfortable, warm, & supported.
 Hand hold should be as near to the joint as possible.
 The motion should be smooth & rhythmical.
 Speed & duration should be appropriate.
 Range should be maximum available without stretching or causing pain.
Human movement
Effects of passive physiological movement:
 Maintain ROM
 Prevent contracture
 Maintain integrity of soft tissue & muscle elasticity
 When active movement is impossible, because of muscular insufficiency, this
movement is help to preserve the memory of movement pattern by stimulating the
receptors of kinesthetic sense

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 Increase venous circulation
 Increase synovial fluid production
 Increase joint cartilage nutrition
 Increase kinesthetic awareness.
 Maintain functional movement pattern
 Reduce pain.



Illustration of Passive Physiological movement


[Passive Shoulder flexion] [Passive Shoulder extension]



[Passive Shoulder abduction] [Passive Shoulder medial & lateral rotation]

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[Passive Elbow flexion] [Passive Elbow extension with Shoulder extension]


[Passive Fore arm supination & pronation] [Passive Wrist movement]


[Passive Finger extension] [Passive Finger flexion]

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[Passive Hip flexion] [Passive Hip extension]


[Passive Hip abduction & adduction] [Passive Hip medial & lateral rotation]


[Passive Ankle dorsi flexion] [Passive Ankle planter flexion]

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[Passive Ankle inversion & eversion] [Passive finger flexion & extension]


[Passive Neck flexion] [Passive Neck rotation]



[Passive Lumbar flexion] [Passive lumbar rotation]

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Accessory movement:
Accessory movement are those movements of the joint which a person cant perform
actively, but which can be performed on that person by an external force, but he can able to
stop or restrict the movement (Maitiand 1986)
A full range of accessory movement is essential for normal active & passive joint
movements. A loss of an accessory movement produces a restriction in the normal range of
joint motion.
Indications of accessory movement:
Contraindications of accessory movement:
Techniques of application of accessory movement:
Effects & uses of accessory movement:
 Correction of bony block in the joint
 Loss the stiffness in any joint
 Restore the limited ROM
Clinical importance of accessory movement:
1. They play an essential role in the production of normal joint movement
2. Loss of accessory movement is associated with loss of normal joint movement
3. Normal or restricted accessory movements can be detected by appropriate clinical
testing
4. They are used to treat painful or stiff joints by a passive movement techniques
(Mobilization)