SOURCE : DENA GARDINER

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

2. INTRODUCTION
 These movements are produced by an external force during
muscular inactivity or when muscular activity is voluntarily
reduced as much as possible to permit movements.

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
 RELAXED PASSIVE MOVEMENTS – these are movements
performed accurately and smoothly by the physiotherapist. A
knowledge of the anatomy of joints is required. The movements
are performed in the same range and directions as active
movements. The joint is moved through the existing free range
and within the limits of pain.

6.  ACCESSORY MOVEMENTS – these occur as part of any normal
joint movements but may be limited or absent in abnormal joint
conditions. They consists of gliding or rotational movements
which cannot be performed in isolation as a voluntary
movements but can be isolated by the physiotherapist.

7. PASSIVE MANUAL
MOBILISATION TECHNIQUES
 MOBILISATIONS OF JOINT – these are usually small repetitive
rhythmical oscillatory, localized accessory, or functional
movements performed by the physiotherapists in various
amplitudes within the available range, and under the patient’s
control. These can be done very gently or quite strongly, and
are graded according to the part of the available range in which
they are performed.

8. MANIPULATIONS OF JOINTS PERFORMED BY
 Physiotherapists - these are accurately localized, single, quick
decisive movements of small amplitude and high velocity
completed before the patient can stop it.
 Surgeon/physician – the movements are performed under
anesthesia by a surgeon, of physician to gain further range. The
increase in movement must be maintained by the
physiotherapist.

9. CONTROLLED SUSTAINED STRETCHING OF TIGHTENED STRUCTURES
 Passive stretching of muscles and other soft tissues can be given to
increase range of movement. Movement can be gained by
stretching adhesions in these structures or by lengthening of muscle
due to inhibitions of the tendon protective reflex.

10. PRINCIPLES OF GIVING RELAXED
PASSIVE MOVEMENTS
 RELAXATION – a brief explanation of what is to happen is given
to the patient, who is then taught to relax voluntarily, except in
case of flaccid paralysis when this is unnecessary. The selection
of a suitable starting positions ensures comfort and support,
and the bearing of the physiotherapist will do much to inspire
confidence and co- operation in maintaining through the
movement.

11.  FIXATION – where movement is to be limited to a specific joint,
the bone which lies proximal to it is fixed by the physiotherapist
as close to the joint line as possible to ensure that the
movement is localized to that joint; otherwise any decrease in
the normal range is readily masked by compensatory
movements occurring at other joints in the vicinity.

12.  SUPPORT – full and comfortable support is given to the part to
be moved, so that the patient has confidence and will remain
relaxed. The physiotherapist grasps the part firmly but
comfortably in her hand, or it may be supported by axial
suspension in slings. The latter method is particularly useful for
the trunk or heavy limbs, as it frees the physiotherpist’s hands
to assist fixation and to perform the movement. The
physiotherapist’s stance must be firm and comfortable. When
standing, her feet are apart and placed in the line of the
movement.

13.  TRACTION – many joints allow the articular surfaces to be
drawn apart by traction, which is always given in the long axis
of a joint, the fixation of the bone proximal to the joint
providing an opposing force to a sustained pull on the distal
bone. Traction is thought to facilitate the movement by
reducing interarticular friction.

14.  RANGE – the range of movement is as full as the condition of the
joints permits without eliciting pain or spasm in the surrounding
muscles. In normal joints slights over pressure can be given to
ensure full range, but in flail joints care is needed to avoid taking
the movement beyond the normal anatomical limit.
As one reason for giving full-range movement is to maintain the
extensibility of muscles which pass over the joint, special
consideration must be given to muscles which pass over two or
more joints. These muscles must be progressively extended over
each joint until they are finally extended to their normal length
over all the joints simultaneously, e.g. the Quadriceps are fully
when the hip joint is extended with the knee flexed.

15.  SPEED AND DURAION – as it is essential that relaxation be
maintained throughout the movement, the speed must be
uniform, fairly slow and rhythmical. The number of times the
movement is performed depends on the purpose for which it is
used.

16. EFFECTS AND USES OF RELAXED
PASSIVE MOVEMENTS
 Adhesion formation si prevented and the present free range of
movement maintained. One passive movement, well given and
at frequent intervals, is sufficient for this purpose, but the usual
practice is to put the joint through two movement twice daily.
 When active movement is impossible, because of muscular
inefficiency, these movements may help to preserve the
memory of movement patterns by stimulating the receptors of
kinaesthetic sense

17.  When full-range active movement is impossible the extensibility
of muscle is maintained, and adaptive shortening prevented.
 The venous and lymphatic return may be assisted slightly by
mechanical pressure and by stretching of the thin-walled vessels
which pass across the joint moved. Relatively quick rhythmical
and continued passive movements are required to produce this
effect. They are used in conjunction which elevation of the part
to relieve oedema when the patient is unable, or unwilling, to
perform sufficient active exercise.

18.  The rhythm of continued passive movements can have a
soothing effect and induce further relaxation and sleep. They
may be tried in training relaxation and, if successful the
movement is made imperceptibly and progressively slower as
the patient relaxes.

19. PRINCIPLES OF GIVING
ACCESSORY MOVEMENTS
 The basic principles of relaxation and fixation apply to accessory
movements as to relaxed passive movements. Full and
comfortable support is given and the range of the movement is
as full as the condition of the joint permits. They are
comparatively small movements.

20. EFFECTS AND USES OF
ACCESSORY MOVEMENTS
 Accessory movements contribute to the normal function of the
joint in which they take place or that of adjacent joints.
 In abnormal joint conditions there may be limitations of these
movements due to loss of full active range caused by stiffness
of joints from contracture of the soft tissue, adhesion formation
or muscular inefficiency. Accessory movements are performed
by the physiotherapist to increase an lost range of movement
and to maintain joint mobility. Hence they form an important
part of the treatment of a patient who is unable to perform
normal active movement.

21. PRINCIPLES OF PASSIVE
MANUAL MOBILISATIONS AND
MANIPULATIONS
 Manipulations performed by a surgeon or physician are usually
given under a general or local anaesthetic which eliminates pain
and protective spasm, and allows the of greater force. Even
well-established adhesions can be broken down; but when these
are numerous, it is usual to regain full range progressively, by a
series of manipulations, to avoid excessive trauma and marked
exudation. Maximum effort on the part of the patient and the
physiotherapist must be exerted after manipulation to maintain
the range of movement gained at each session, otherwise
fibrous deposits from the inevitable exudation will form new
adhesions.

22. PRINCIPLES OF GIVING CONTROLLED
SUSTAINED STRETCHING OF TIGHTENED
STRUCTURES
 The patient is comfortably supported and as relaxed as possible
in an appropriate position. With suitable fixation the part is
grasped by the physiotherapist and moved in such a way that a
sustained stretch can be applied to the contracted structures for
a period of time within a functional pattern of movement.
Mechanical means can be used, e.g. turnbuckle plaster

23. EFFECTS AND USES OF CONTROLLED
SUSTAINED STRETCHING
 Steady and sustained stretching may be used to overcome
spasticity patterns of limbs, e.g. a hemiplegic patient. The slow
stretch produces a relaxation and lengthening of the muscle.
 A steady and prolonged passive stretch can overcome the
resistance of shortened ligaments, fascia and fibrous sheaths of
muscles as, for example, in controlled stretching and
progressive splintage of talipes equinovarus.

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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