passive exercises lecture for physiotherapy.pdf

passive exercises for physiotherapy students

1. RAAED FAROOQ KHALEEL
B.M.Tech.Physiotherapy , M.Sc. Physiotherapy
Passive Range of Motion

2. Range of motion is a basic technique used for the examination of
movement and for initiating movement into a program of therapeutic
intervention.
Passive ROM. 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 gravity, a machine, another individual, or another
part of the individual’s own body.

3. acute inflamed tissue;
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(s) of the body, as when comatose,
paralyzed, or on complete bed rest, movement is
provided by an external source.
Indications for PROM

4. 1)Decrease the complications that would occur with immobilization,
Goals for PROMthe goals are to:
9)Help maintain the patient’s awareness of movement.
2)Maintain joint and connective tissue mobility.
3)Minimize the effects of the formation of contractures.
4)Maintain mechanical elasticity of muscle.
5)Assist circulation and vascular dynamics.
6)Enhance synovial movement for cartilage nutrition and diffusion
of materials in the joint.
7)Decrease or inhibit pain.
8)Assist with the healing process after injury or surgery.

5. Passive Range Of Motion has been contraindicated
Contraindications of Passive Range of Motion
b)Signs of too much or the wrong motion include
increased pain and inflammation.
a)immediately after acute tears, fractures, and surgery;

6. Principles and Procedures for Applying ROM
Techniques
1. Communicate with the patient. Describe the plan and method of
intervention to meet the goals.
Patient Preparation
2. Free the region from restrictive clothing, linen, splints, and
dressings. Drape the patient as necessary.
3. Position the patient in a comfortable position with proper
body alignment and stabilization but that also allows you to
move the segment through the available ROM.
4. Position yourself so proper body mechanics can be used.

7. 1. To control movement, grasp the extremity around the joints.
If the joints are painful, modify the grip, still providing support
necessary for control.
Application of Techniques
4. Perform the motions smoothly and rhythmically, with 5 to 10
repetitions. The number of repetitions depends on the objectives
of the program and the patient’s condition and response to the
treatment.
3. Move the segment through its complete pain-free range to the
point of tissue resistance. Do not force beyond the available
range. If you force motion, it becomes a stretching technique.
2. Support areas of poor structural integrity, such as a hypermobile
joint, recent fracture site, or paralyzed limb segment.

8. a)During PROM the force for movement is external; it is provided
by a therapist or mechanical device. When appropriate, a patient
may provide the force and be taught to move the part with a
normal extremity.
Application of PROM
b)No active resistance or assistance is given by the patient’s muscles
that cross the joint. If the muscles contract, it becomes an active
exercise.
c)The motion is carried out within the free ROM that is, the range
that is available without forced motion or pain.

9. Shoulder: Flexion and Extension
Hand Placement and Procedure
i.Grasp the patient’s arm under the elbow with your lower hand.
ii.With the top hand, cross over and grasp the wrist and palm of the patient’s hand.
Lift the arm through the available range and return.
ROM Techniques
Upper Extremity

10. Shoulder: Extension (Hyperextension)
To obtain extension past zero, position the patient’s shoulder at the
edge of the bed when supine or position the patient side-lying,
prone, or sitting.

11. Shoulder: Abduction and Adduction
Hand Placement and Procedure
Use the same hand placement as with flexion, but move the arm out
to the side. The elbow may be flexed.
NOTE: To reach full range of abduction, there must be external
rotation of the humerus and upward rotation of the scapula.

12. Shoulder: Internal (Medial) and External (Lateral) Rotation
If possible, the arm is abducted to 90°; the elbow is flexed to 90°; and the forearm is
held in neutral position. Rotation may also be performed with the patient’s arm at the
side of the thorax, but full internal rotation is not possible in this position.
Hand Placement and Procedure
■Grasp the hand and the wrist with your thumb finger between the patient’s thumb
and index finger.
■Place your thumb and the rest of your fingers on either side of the patient’s wrist,
thereby stabilizing the wrist.
■With the other hand, stabilize the elbow.
■Rotate the humerus by moving the forearm.

13. Shoulder: Horizontal Abduction (Extension) and Adduction
(Flexion)
To reach full horizontal abduction, position the patient’s shoulder at the
edge of the table. Begin with the arm either flexed or abducted 90°.
Hand Placement and Procedure
Hand placement is the same as with flexion, but turn your body and
face the patient’s head as you move the patient’s arm out to the side
and then across the body.

14. Scapula: Elevation/Depression, Protraction/ Retraction, and
Upward/Downward Rotation
Position the patient prone, with his or her arm at the side, or side-lying, facing
toward you. Drape the patient’s arm over your bottom arm.
Hand Placement and Procedure
■Cup the top hand over the acromion process and place the other hand around the inferior
angle of the scapula.
■For elevation, depression, protraction, and retraction, the clavicle also moves as the scapular
motions are directed at the acromion process.
■For rotation, direct the scapular motions at the inferior angle of the scapula while
simultaneously pushing the acromion in the opposite direction to create a force couple turning
effect.

15. Elbow: Flexion and Extension
Hand Placement and Procedure
Hand placement is the same as with shoulder flexion except the
motion occurs at the elbow as it is flexed and extended.
NOTE: Control forearm supination and pronation with your fingers
around the distal forearm. Perform elbow flexion and extension with
the forearm pronated as well as supinated. The scapula should not
tip forward when the elbow extends, as it disguises the true range.

16. Hand Placement and Procedure
■Grasp the patient’s wrist, supporting the hand with the index finger and placing
the thumb and the rest of the fingers on either side of the distal forearm.
■Stabilize the elbow with the other hand.
■The motion is a rolling of the radius around the ulna at the distal radius.
Alternate Hand Placement
Sandwich the patient’s distal forearm between the palms of both hands
NOTE: Pronation and supination should be performed with the elbow both
flexed and extended.
Forearm: Pronation and Supination

17. Wrist: Flexion (Palmar Flexion) and Extension (Dorsiflexion);
Radial (Abduction) and Ulnar (Adduction) Deviation
Hand Placement and Procedure
For all wrist motions, grasp the patient’s hand just distal to the
joint with one hand and stabilize the forearm with your other hand.

18. Joints of the Thumb and Fingers: Flexion and
Extension and Abduction and Adduction
The joints of the thumbs and fingers include the metacarpophalangeal and
interphalangeal joints.
Hand Placement and Procedure
■Depending on the position of the patient, stabilize the forearm and hand on the
bed or table or against your body.
NOTE: To accomplish full joint ROM, do not place tension on the extrinsic
muscles going to the fingers. Tension on the muscles can be relieved by altering the
wrist position as the fingers are moved.

19. To reach full range of hip flexion, the knee must also be flexed to release tension on
the hamstring muscle group. To reach full range of knee flexion, the hip must be
flexed to release tension on the rectus femoris muscle.
Hand Placement and Procedure
■Support and lift the patient’s leg with the palm and fingers of the top hand under
the patient’s knee and the lower hand under the heel.
■As the knee flexes full range, swing the fingers to the side of the thigh
Lower Extremity
Combined Hip and Knee: Flexion and Extension

20. Prone or side-lying must be used if the patient has near normal or normal motion.
Hand Placement and Procedure
■If the patient is prone, lift the thigh with the bottom hand under the patient’s knee;
stabilize the pelvis with the top hand or arm.
■If the patient is side-lying, bring the bottom hand under the thigh and place the
hand on the anterior surface; stabilize the pelvis with the top hand. For full range of
hip extension, do not flex the knee full range, as the two-joint rectus femoris would
then restrict the range.
Hip: Extension (Hyperextension)

21. Hand Placement and Procedure
■Support the patient’s leg with the upper hand under the knee and
the lower hand under the ankle.
■For full range of adduction, the opposite leg needs to be in a
partially abducted position.
■Keep the patient’s hip and knee in extension and neutral to rotation
as abduction and adduction are performed.
Hip: Abduction and Adduction

22. Hand Placement and Procedure with the Hip and Knee Extended
■Grasp just proximal to the patient’s knee with the top hand and just proximal to
the ankle with the bottom hand.
■Roll the thigh inward and outward.
Hip: Internal (Medial) and External (Lateral)
Rotation

23. Hand Placement and Procedure for Rotation with the Hip and Knee Flexed
■Flex the patient’s hip and knee to 90°; support the knee with the top hand.
■If the knee is unstable, cradle the thigh and support the proximal calf and knee with the
bottom hand.
■Rotate the femur by moving the leg like a pendulum.
■This hand placement provides some support to the knee but should be used with caution
if there is knee instability.
Hip: Internal (Medial) and External (Lateral)
Rotation

24. (Hand Placement and Procedure)
■Stabilize around the malleoli with the top hand.
■Cup the patient’s heel with the bottom hand and place the forearm along the
bottom of the foot.
■Pull the calcaneus distal ward with the thumb and fingers while pushing upward
with the forearm
Hand Placement and Procedure
■Support the heel with the bottom hand.
■Place the top hand on the dorsum of the foot and push it into plantarflexion.
Ankle: Dorsiflexion
Ankle: Plantarflexion

25. Subtalar (Lower Ankle) Joint: Inversion and Eversion
Hand Placement and Procedure
■Using the bottom hand, place the thumb medial and the fingers
lateral to the joint on either side of the heel.
■Turn the heel inward and outward.

26. Joints of the Toes: Flexion and Extension and Abduction and
Adduction (Metatarsophalangeal and Interphalangeal Joints)
Hand Placement and Procedure
■Stabilize the bone proximal to the joint that is to be moved with
one hand, and move the distal bone with the other hand.
■The technique is the same as for ROM of the fingers.
■Several joints of the toes can be moved simultaneously if care is
taken not to stress any structure.

27. Procedure
■Lift the head as though it were nodding (chin toward larynx) to flex the head on
the neck.
■Once full nodding is complete, continue to flex the cervical spine and lift the head
toward the sternum.
Cervical Spine
Stand at the end of the treatment table, securely grasp the patient’s
head by placing both hands under the occipital region.
Flexion (Forward Bending)

28. Procedure
Tip the head backward.
NOTE: If the patient is supine, only the head and upper cervical spine can be
extended; the head must clear the end of the table to extend the entire cervical
spine. The patient may also be prone or sitting.
Extension (Backward Bending or Hyperextension)

29. Procedure
Maintain the cervical spine neutral to flexion and extension as you direct the
head and neck into side bending (approximate the ear toward the shoulder) and
rotation (rotate from side to side).
•Lateral Flexion (Side Bending) and Rotation

30. Hand Placement and Procedure
■Bring both of the patient’s knees to the chest by lifting under the knees (hip and knee
flexion).
■Flexion of the spine occurs as the hips are flexed full range and the pelvis starts to
rotate posteriorly.
■Greater range of flexion can be obtained by lifting under the patient’s sacrum with
the lower hand.
Lumbar Spine
Flexion

31. Position the patient prone for full extension (hyperextension).
Hand Placement and Procedure
With hands under the thighs, lift the thighs upward until the pelvis
rotates anteriorly and the lumbar spine extends.
Extension

32. Position the patient in hook-lying with hips and knees flexed and feet resting on
the table.
Hand Placement and Procedure
■Push both of the patient’s knees laterally in one direction until the pelvis on the
opposite side comes up off the treatment table.
■Stabilize the patient’s thorax with the top hand.
■Repeat in the opposite direction
•Rotation

34. 1.TherapeuticExercise:FoundationsandTechniques(TherapeuticExercise:
Foundations&Techniques)Hardcover–2Apr2007.byCarolyn
Kisner(Author), LynnAllenColby(Author).
2.Therapeutic Exercise: Foundations and TechniquesBy Carolyn Kisner,6th
edition,17 Oct 2012
3.Exercise and Physical Functioning in Osteoarthritis Medical,
Neuromuscular and Behavioral Perspectives, Editor
JoostDekker
4.EXERCISE THERAPY Prevention and treatment of disease, Edited by John
Gormleyand Juliette Hussey,2005
Refrences