Lec 2 Passive Movements (techniques, types, effects and principles).pptx

This presentation explores passive movements, where an external force moves a joint without active muscle contraction. It covers types of passive movement, including manual, mechanical, and continuous passive motion (CPM), along with their benefits, indications, and contraindications in rehabilitation. Clear explanations, illustrations, and clinical applications make it a valuable resource for students, physiotherapists, and healthcare professionals. Learn how passive movements help maintain joint mobility, prevent contractures, and reduce stiffness. Download now to enhance your understanding of this essential concept in kinesiology and therapeutic exercise!

1. PASSIVE MOVEMENTS Dr. Duaa Javed (PT) Lecturer

2. Learning Outcomes By the end of this lecture, students should have a clear understanding of: Types of PROM The principles, types, techniques and effects of passive exercises Passive manual mobilization and manipulations Controlled sustained stretching, Principles and Effects and uses

3. Types of ROM Exercises

4. Definition Type of movement produced by an external force during muscular inactivity or when muscular activity is voluntarily reduced. The external force may be gravity, a machine, physical therapist or another part of the individual’s own body.

5. Types Of Passive Movement Relaxed Manual Passive Movements performed by PT in same range and direction as active movements Accessory Movements occur as a part of any normal joint movement which cannot be performed voluntarily like gliding and rotational movements.

6. Passive Manual Mobilization Movements Joint Mobilization small repetitive oscillatory movements performed in various amplitudes within available ROM Joint Manipulation thrust of small amplitude high velocity movements beyond the range, sometimes given under anesthesia Controlled sustained stretching of tightened structures passive stretching of soft tissues to increase ROM Mechanical Passive Movements (Continuous Passive Movements - CPM)

7. Type Of Movements Physiological movement: traditional movements performed by the patient's voluntary muscle contraction, such as flexion, abduction. ROM can be measured in degrees using Goniometer.

8. Accessory movements: movements within normal ROM of the joint and surrounding tissue but cannot be actively performed by the patient. They can be further classified into: Component motion: motions that accompany active motion but are not under voluntary control e.g. scapular upward rotation during shoulder flexion. Joint play: motions that occurs between the joint surfaces as well as the joint capsule, which allows the bones to move. This movements occurs passively but cannot occur actively by the patient .e.g. distraction, gliding, spinning of the joint.

9. Joint Play/Arthrokinematics These are small movements and independent of voluntary muscle contraction that occur within a synovial joint (between bony surfaces) during movement through ROM. 5 types: roll, slide/glide, spin, compression and traction

10. Roll occurs when series of points on one articulating surface comes into contact with series of point on other surface. E.g. Ball rolling on ground. Slide occurs when one specific point on one articulating surface comes into contact with series of point on other surface. Slide in joint is called glide. E.g. box moving on ground Spin occurs when object rotates around its axis. E.g. fan Compression is decrease in space between two ends. Distraction/traction is increase in space between two ends .

11. Principles of giving Relaxed Passive Movements Relaxation Fixation Support Traction Range Speed and Duration

12. Effects and Uses of relaxed passive Relaxation of spastic muscles Maintain joint and connective tissue mobility and range. Maintain the physiological properties of the muscle (extensibility, elasticity, etc.) and minimize the formation of contracture and adhesion

13. Assist circulation and enhance synovial movement and diffusion of materials in the joint Maintain the patient's awareness of movements by stimulating the kinesthetic receptors. Decrease or inhibit pain

14. Indications When active movements is painful or impossible In comatose, paralytic, or complete bedridden patient. In muscle re-education as a first step

15. Contraindications Immediately after acute tears, fractures, and surgery. Signs of too much effusion or swelling. Severe sharp and acute joint pain When motion is disruptive to the healing process.

16. When bony block limits joint motions Acute infection In case of increased joint’s hypermobility or hematoma

17. Limitations Passive movement will not : Prevent muscle atrophy Increase muscle strength and endurance

18. Effect And Uses Of Accessory Movements These movements contribute to the normal function of the joint in which they take place or that of adjacent joint. In abnormal joint conditions, there may be limitation of these movements due to loss of full active range caused by stiffness of joints from contractures of soft tissue, adhesion formation or muscular inefficiency.

19. Principles and Techniques

20. Maitland Joint Mobilization Grading Scale Grade I(for pain and spasm) Small amplitude rhythmic oscillating movement at the beginning of ROM. Grade II(for pain and spasm) Large amplitude rhythmic oscillating movement within midrange of ROM.

21. Grade III(to gain motion within the joint) Large amplitude rhythmic oscillating movement up to point of limitation (PL) in ROM Grade IV(to gain motion within the joint) Small amplitude rhythmic oscillating movement at very end range of movement Grade V – (thrust technique) - Manipulation Small amplitude, quick thrust at end of range

22. Effects of Joint Mobilization Stimulates mechanoreceptors to decrease pain Increase in awareness of position & motion because of afferent nerve impulses Distraction or small gliding movements – cause synovial fluid movement, hence improves nutrient exchange Improve mobility of hypomobile joints (adhesions & thickened CT from immobilization – loosens) Maintains extensibility & tensile strength of articular tissues

23. Indications for Joint Mobilization Pain and muscle spasm Joint hypo-mobility Progressive limitation of ROM Functional immobility Positional fault as a result of traumatic injury, immobility or muscle weakness.

24. Precautions and Contraindications for Mobilization Inflammatory arthritis Malignancy Tuberculosis Osteoporosis Ligamentous rupture Herniated disks with nerve compression Neurological involvement Unhealed Bone fracture Congenital bone deformities Vascular disorders Joint effusion Bone disease

25. Limitations of Joint Mobilization The outcome are based on skill of the therapist and patient condition Mobilization cannot change the disease process of disorders (Rheumatoid arthritis) but help in minimizing pain and increasing ROM.

26. Joint Traction Technique involving pulling one articulating surface away from another – creating separation Performed perpendicular to treatment plane Used to decrease pain or reduce joint hypo-mobility

27. Effect And Uses Of Controlled Sustained Stretching In hemiplegic patient to reduced spasticity pattern of limb Slow stretch produces relaxation and lengthening of muscles. Overcome the resistance of shortened ligaments, fascia, fibrous sheath of muscles.

28. Continuous Passive Motion( CPM) Slow movement performed by mechanical device through a controlled Rom without patient’s effort. Benefits of CPM: Lessening the negative effects of joint immobilization. Prevent adhesions and contracture formation. Stimulate the healing process of tendons and ligament. Increase synovial fluid lubrication of the joint. Decrease post operative pain. Improve recovery rate and ROM following surgical procedures

29. Questions?

30. Thank you