Passive movements

SOURCE : DENA GARDINER

1. PASSIVE MOVEMENT
Prof. Dr. M. Rajesh, PT, M.P.T(cardio), BCRC
TRINITY MISSION AND MEDICAL FOUNDATION
MADURAI

2. INTRODUCTION
Thesemovementsareproducedbyanexternalforceduring
muscularinactivityorwhenmuscularactivityisvoluntarily
reducedasmuchaspossibletopermitmovements.

3. CLASSIFICATIONS
Relaxed passive movements (including accessory movements)
Passive manual mobilizations techniques
Mobilizations of joints
Manipulations of joints
Controlled sustained stretching of tightened structures

4. SPECIFIC DEFINITIONS

5. RELAXED PASSIVE MOVEMENTS
RELAXEDPASSIVEMOVEMENTS –thesearemovements
performedaccuratelyandsmoothlybythephysiotherapist.A
knowledgeoftheanatomyofjointsisrequired.Themovements
areperformedinthesamerangeanddirectionsasactive
movements.Thejointismovedthroughtheexistingfreerange
andwithinthelimitsofpain.

6. ACCESSORYMOVEMENTS–theseoccuraspartofanynormal
jointmovementsbutmaybelimitedorabsentinabnormaljoint
conditions.Theyconsistsofglidingorrotationalmovements
whichcannotbeperformedinisolationasavoluntary
movementsbutcanbeisolatedbythephysiotherapist.

7. PASSIVE MANUAL
MOBILISATION TECHNIQUES
MOBILISATIONSOFJOINT–theseareusuallysmallrepetitive
rhythmicaloscillatory,localizedaccessory,orfunctional
movementsperformedbythephysiotherapistsinvarious
amplitudeswithintheavailablerange,andunderthepatient’s
control.Thesecanbedoneverygentlyorquitestrongly,and
aregradedaccordingtothepartoftheavailablerangeinwhich
theyareperformed.

8. MANIPULATIONSOFJOINTSPERFORMEDBY
Physiotherapists-theseareaccuratelylocalized,single,quick
decisivemovementsofsmallamplitudeandhighvelocity
completedbeforethepatientcanstopit.
Surgeon/physician–themovementsareperformedunder
anesthesiabyasurgeon,ofphysiciantogainfurtherrange.The
increaseinmovementmustbemaintainedbythe
physiotherapist.

9. CONTROLLEDSUSTAINEDSTRETCHINGOFTIGHTENEDSTRUCTURES
Passivestretchingofmusclesandothersofttissuescanbegivento
increaserangeofmovement.Movementcanbegainedby
stretchingadhesionsinthesestructuresorbylengtheningofmuscle
duetoinhibitionsofthetendonprotectivereflex.

10. PRINCIPLES OF GIVING RELAXED
PASSIVE MOVEMENTS
RELAXATION–abriefexplanationofwhatistohappenisgiven
tothepatient,whoisthentaughttorelaxvoluntarily,exceptin
caseofflaccidparalysiswhenthisisunnecessary.Theselection
ofasuitablestartingpositionsensurescomfortandsupport,
andthebearingofthephysiotherapistwilldomuchtoinspire
confidenceandco-operationinmaintainingthroughthe
movement.

11. FIXATION–wheremovementistobelimitedtoaspecificjoint,
thebonewhichliesproximaltoitisfixedbythephysiotherapist
asclosetothejointlineaspossibletoensurethatthe
movementislocalizedtothatjoint;otherwiseanydecreasein
thenormalrangeisreadilymaskedbycompensatory
movementsoccurringatotherjointsinthevicinity.

12. SUPPORT–fullandcomfortablesupportisgiventothepartto
bemoved,sothatthepatienthasconfidenceandwillremain
relaxed.Thephysiotherapistgraspsthepartfirmlybut
comfortablyinherhand,oritmaybesupportedbyaxial
suspensioninslings.Thelattermethodisparticularlyusefulfor
thetrunkorheavylimbs,asitfreesthephysiotherpist’shands
toassistfixationandtoperformthemovement.The
physiotherapist’sstancemustbefirmandcomfortable.When
standing,herfeetareapartandplacedinthelineofthe
movement.

13. TRACTION–manyjointsallowthearticularsurfacestobe
drawnapartbytraction,whichisalwaysgiveninthelongaxis
ofajoint,thefixationoftheboneproximaltothejoint
providinganopposingforcetoasustainedpullonthedistal
bone.Tractionisthoughttofacilitatethemovementby
reducinginterarticularfriction.

14. RANGE–therangeofmovementisasfullastheconditionofthe
jointspermitswithoutelicitingpainorspasminthesurrounding
muscles.Innormaljointsslightsoverpressurecanbegivento
ensurefullrange,butinflailjointscareisneededtoavoidtaking
themovementbeyondthenormalanatomicallimit.
Asonereasonforgivingfull-rangemovementistomaintainthe
extensibilityofmuscleswhichpassoverthejoint,special
considerationmustbegiventomuscleswhichpassovertwoor
morejoints.Thesemusclesmustbeprogressivelyextendedover
eachjointuntiltheyarefinallyextendedtotheirnormallength
overallthejointssimultaneously,e.g.theQuadricepsarefully
whenthehipjointisextendedwiththekneeflexed.

15. SPEEDANDDURAION–asitisessentialthatrelaxationbe
maintainedthroughoutthemovement,thespeedmustbe
uniform,fairlyslowandrhythmical.Thenumberoftimesthe
movementisperformeddependsonthepurposeforwhichitis
used.

16. EFFECTS AND USES OF RELAXED
PASSIVE MOVEMENTS
Adhesionformationsipreventedandthepresentfreerangeof
movementmaintained.Onepassivemovement,wellgivenand
atfrequentintervals,issufficientforthispurpose,buttheusual
practiceistoputthejointthroughtwomovementtwicedaily.
Whenactivemovementisimpossible,becauseofmuscular
inefficiency,thesemovementsmayhelptopreservethe
memoryofmovementpatternsbystimulatingthereceptorsof
kinaestheticsense

17. Whenfull-rangeactivemovementisimpossibletheextensibility
ofmuscleismaintained,andadaptiveshorteningprevented.
Thevenousandlymphaticreturnmaybeassistedslightlyby
mechanicalpressureandbystretchingofthethin-walledvessels
whichpassacrossthejointmoved.Relativelyquickrhythmical
andcontinuedpassivemovementsarerequiredtoproducethis
effect.Theyareusedinconjunctionwhichelevationofthepart
torelieveoedemawhenthepatientisunable,orunwilling,to
performsufficientactiveexercise.

18. Therhythmofcontinuedpassivemovementscanhavea
soothingeffectandinducefurtherrelaxationandsleep.They
maybetriedintrainingrelaxationand,ifsuccessfulthe
movementismadeimperceptiblyandprogressivelysloweras
thepatientrelaxes.

19. PRINCIPLES OF GIVING
ACCESSORY MOVEMENTS
Thebasicprinciplesofrelaxationandfixationapplytoaccessory
movementsastorelaxedpassivemovements.Fulland
comfortablesupportisgivenandtherangeofthemovementis
asfullastheconditionofthejointpermits.Theyare
comparativelysmallmovements.

20. EFFECTS AND USES OF
ACCESSORY MOVEMENTS
Accessorymovementscontributetothenormalfunctionofthe
jointinwhichtheytakeplaceorthatofadjacentjoints.
Inabnormaljointconditionstheremaybelimitationsofthese
movementsduetolossoffullactiverangecausedbystiffness
ofjointsfromcontractureofthesofttissue,adhesionformation
ormuscularinefficiency.Accessorymovementsareperformed
bythephysiotherapisttoincreaseanlostrangeofmovement
andtomaintainjointmobility.Hencetheyformanimportant
partofthetreatmentofapatientwhoisunabletoperform
normalactivemovement.

21. PRINCIPLES OF PASSIVE
MANUAL MOBILISATIONS AND
MANIPULATIONS
Manipulationsperformedbyasurgeonorphysicianareusually
givenunderageneralorlocalanaestheticwhicheliminatespain
andprotectivespasm,andallowstheofgreaterforce.Even
well-establishedadhesionscanbebrokendown;butwhenthese
arenumerous,itisusualtoregainfullrangeprogressively,bya
seriesofmanipulations,toavoidexcessivetraumaandmarked
exudation.Maximumeffortonthepartofthepatientandthe
physiotherapistmustbeexertedaftermanipulationtomaintain
therangeofmovementgainedateachsession,otherwise
fibrousdepositsfromtheinevitableexudationwillformnew
adhesions.

22. PRINCIPLES OF GIVING CONTROLLED
SUSTAINED STRETCHING OF TIGHTENED
STRUCTURES
Thepatientiscomfortablysupportedandasrelaxedaspossible
inanappropriateposition.Withsuitablefixationthepartis
graspedbythephysiotherapistandmovedinsuchawaythata
sustainedstretchcanbeappliedtothecontractedstructuresfor
aperiodoftimewithinafunctionalpatternofmovement.
Mechanicalmeanscanbeused,e.g.turnbuckleplaster

23. EFFECTS AND USES OF CONTROLLED
SUSTAINED STRETCHING
Steadyandsustainedstretchingmaybeusedtoovercome
spasticitypatternsoflimbs,e.g.ahemiplegicpatient.Theslow
stretchproducesarelaxationandlengtheningofthemuscle.
Asteadyandprolongedpassivestretchcanovercomethe
resistanceofshortenedligaments,fasciaandfibroussheathsof
musclesas,forexample,incontrolledstretchingand
progressivesplintageoftalipesequinovarus.

24. THANK YOU
Prof. Dr. M. RAJESH, PT,M.P.T(cardio),B.C.R.C
TRINITY MISSIOIN AND MEDICAL FOUNDATION
MADURAI.
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