This document defines and describes different types of passive range of motion (PROM) exercises. It begins by defining PROM as movements produced by an external force during muscular inactivity or reduced range of motion. There are three main types of PROM discussed: relaxed PROM, forced PROM, and continuous passive motion (CPM). Relaxed PROM is performed slowly through pain-free range by a therapist, while forced PROM exerts external force to end range. CPM uses a machine to passively move the joint continuously after surgery. The goals of PROM are to maintain range of motion, mobility, and prevent contractures while allowing for healing. Precautions are discussed as well as limitations compared to active exercises.

1. BY SANKARI NEDUNSALIYAN
DIP IN PT(MAL), BSC HONS APPLIED REHAB
(UK)

2. DEFINITION
• These movements are produced by an external force during
muscular inactivity or when range of motion is reduced for
any cause
• Carried out either by the therapist or a machine
INDICATIONS
In acute, inflamed tissues, where active movements is painful
In comatose, paralytic, or complete bed redden patient.
In muscle re-education as a first step

3. GOALS AND USES
• Maintain joint and connective tissue mobility
• Maintain the physiological properties of the muscle (extensibility, elasticity, etc.) and minimize the formation of
contracture
• Assist circulation and enhance synovial movement and diffusion of materials in the joint
• Maintain range of motion and prevent formation of adhesions
• Maintain the patient's awareness of movements by stimulating the kinaesthetic receptors
• Decrease or inhibit pain

4. PRECAUTIONS AND
CONTRAINDICATIONS
• Immediately after acute tears, fractures, and surgery.
• Signs of too much effusion or swelling (DVT)
• Sever sharp and acute joint pain
• When motion disruptive to the healing process.
• When bony block limits joint motions
• Acute infection around or in the joint ( arthritis)
• In case of increased joint’s hypermobility or hematoma

5. LIMITATIONS OF PROM
Passive ROM will not:
• Prevent muscle atrophy
• Increase muscle strength and endurance
• Assist circulation as active exercises

6. CLASSIFICATION OF PASSIVE
MOVEMENTS
1. Relaxed Passive Movements, including accessory
movements
2. Forced Passive Movements
3. Continuous Passive Movements

8. RELAXED PASSIVE MOVEMENTS -
DEFINITION
• These are movements performed accurately, rhythmically and
smoothly by the physiotherapist through available range of
motion (according to anatomy of joints).
• The movements are performed in the same range and direction as
active movements.
• The joint is moved through the free range and
within the limits of pain.

9. PRINCIPLES OF RELAXED PASSIVE
MOVEMENTS
1. Relaxation
The selection of a suitable starting position ensures comfort
and support, for both patient and physiotherapist through the
movements
2. Fixation
Good fixation for the proximal and distal joint by the
physiotherapist to ensure that the movement is localized to
the movable joint
3. Support
Full and comfortable support is given to the part to be moved,
so that the patient has confidence and will remain relaxed

10. PRINCIPLES OF RELAXED PASSIVE
MOVEMENTS
4. Traction
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 inter-articular
friction.
5. Range of Movement
The range of movements is done in painless range to avoid
spasm in the surrounding muscles
6. Speed and Duration
As it is essential that relaxation is maintained throughout the
movement, the speed must be slow and rhythmical, with suitable
repetitions of the movement

11. 7. Physiotherapist stance
In the direction of line of movement. Commonly used stances
are the walk stance and stride stand
8. Repetitions
Usually 8-10 repetitions are given twice (02) a day
9. Sequence
- Neurological cases: from proximal to distal joints
- For draining fluids: from distal to proximal
PRINCIPLES OF RELAXED PASSIVE
MOVEMENTS

12. FORCED PASSIVE MOVEMENTS -
DEFINITION
• An exercise performed on a subject by a partner who exerts
an external force not only to produce a passive movements of
a joint.
• The partner presses the joint into its end-position (i.e. end of
range), while the subject’s muscles that normally carry out the
movements are completely relaxed.
• There is a danger of overextension beyond the range of
movement and damage to the joint if the exercise is not
carried out carefully

13. EFFECTS AND USES OF FORCED
PASSIVE MOVEMENTS
• As in relaxed passive movements (same effect and uses), but
specially increasing the limited range of motion

14. CONTINUES PASSIVE MOTION (CPM) -
DEFINITION
• A continues passive motion device maintains movements of a
joint after limb sparing surgery. This device is usually called a
CPM
• Continues movement limits stiffness and pain.
• It is very important to keep joints moving following surgery so
that motion will not become limited.
• The CPM will move the involved leg through its full range of
motion.
• It is only used in bed, but can be used while relaxing, eating,
or sleeping

15. BENEFITS OF CPM
1. Decreasing the complication of immobilization
2. Decreasing the post operative complication and pain
3. Improving the recovery rate and ROM
4. Improving the circulation through pumping action
5. Prevent adhesions and contracture
6. Prevent joint effusion and wound oedema

16. PROCEDURE OF CPM
• Therapist adjust the device to fit before surgery
• CPM used right after surgery
• Therapist has to give instructions and monitor how to use the
device
• CPM is allowed to set at 45 degrees of motion right after
surgery
• Generally, motion is allowed to be increased 15 degrees a
day

17. CONTINUES PASSIVE MOTION
(CPM)

18. THANK YOU