What is Passive Movement – Technique in Physiotherapy ?
Passive exercise/movement, simply defined as the manipulation of the body or a limb (e.g. leg) without voluntary effort or muscle contraction or the movements which are done using external force during inactivity.
Here is a reference book for your further knowledge on Active and Passive Movement Testing by Cheryl Petersen (Author), Russell Foley (Author).
Classification of Passive Movement
- Relaxed Passive movements
- Passive manual mobilisation techniques
- Mobilisation
- Manipulation
- Controlled sustained stretching techniques.
Relaxed Passive movements
- Relaxed Passive movements are performed by therapists.
- Relaxed Passive movements are performed in the same range and direction, as otherwise.
- In Relaxed Passive technique movements are done within the free range and within the limit of pain.
Principles of Relaxed Passive movements
Relaxation
- In the Relaxation the whole procedure which is to be performed on the patient is well explained to the patient and taught him how to relax, but in cases of flaccid paralysis, it is unnecessary, because muscle tone is flaccid.
- Select the suitable starting position which ensures comfort and support. In addition to it, holding of the therapist ensures the patient and inspires the confidence in maintaining relaxation in movement.
Fixation
- In fixation principle, the movement should be localized to only to the specific joint where required, so in order to achieve it, proximal joint is to be fixed from as close as to the joint line as possible.
Support
- In this principle full and comfortable support is given to the patient.
- The therapist grasp should be firm but relaxed.
- In some cases, slings can be used as in heavy limbs or trunk.
- Therapist stance should be comfortable and feet should be apart.
Traction
- In Traction principle, articular surfaces are drawn apart from each other.
- Traction should facilitate the movement by reducing the inter-articular friction.
- Traction should be maintained through-out the movement.
Range
- In relaxed passive movement range of the movement is as full as the join allows, without any pain, means the therapist should not cross the limit of pain, but in normal joints, slight overpressure can be given.
Speed And Duration
- While doing relaxed passive movement, relaxation should be maintained throughout the movement and speed must be uniform, fairly slow and rhythmical.
Techniques of Passive Movements
- Techniques of Shoulder Flexion
Position of Patient: Supine lying with shoulder in neutral position, elbow extended, forearm supinated, wrist neutral, finger extended.
Position of Therapist:
- Therapist stance should be Walk standing facing the patients shoulder, inner hand of the therapist stabilizes the elbow joint of patient while the outer hand stabilizes the wrist joint of a patient with a lumbrical grip so as to make a cross.
- Then the relaxed passive movement of shoulder flexion is performed by the therapist from 0 degree of shoulder flexion to 180 degree of shoulder flexion or according to the patient’s condition.
- This movement is performed considering the principles of applying relaxed passive movement. I.e. Relaxation, fixation, support, traction, range, speed and duration.
Relaxation
Fixation
The proximal joint with the scapula is fixed due to the subjects position and distal joint (Elbow Joint), is fixed by therapist inner hand
Support
The Subject is fully supported in the supine lying position and will thus remain relaxed. The physiotherapist grasps the part firmly but comfortably in her or his hand.
Traction
Traction is given in the long axis of humerus to the joint. This traction is maintained throughout the movement. Traction facilities the movement by reducing intra-articular friction.
Range
The Range of movement of shoulder flexion is 0 degree to 180 degree. The R.O.M achieve is either full or as the condition of the joints permit without eliciating pain or spasm in the surrounding muscles. In case of the normal joint slight over pressure can be given to ensure full range but in flial joints care is needed to avoid taking the movement beyond the normal anatomical limit.
Speed and Duration
The speed is uniform fairly slow slow and rhythmical the number of times the movement is performed depends upon the purpose for which it is done.
Shoulder Extension
Position of Patient
Side Lying with shoulder slight flexion, elbow flexed, forearm ….. and fingers extended.
Position of the Therapist
Standing behind the patient facing the shoulder joint; outer hand holds the patients elbow and forearm and fix the wrist and inner hand stabilzed the shoulder joint of the patient.
Procedure
Therapist performs the extension movement…. by taking the elbow behind. in this case hyperextension can be performed.
This movement is performed considering the principles of applying relaxed passive movement. I.e. Relaxation, fixation, support, traction, range, speed and duration.
SHOULDER ABDUCTION AND ADDUCTION
the movement of shoulder abduction is done and reversal of shoulder abduction is shoulder adduction.
Position of Patient: Supine lying with shoulder in 90 degrees of abduction , elbow flexed, forearm in mid prone position, wrist neutral, finger extended.
Position of Therapist:
- Therapist stance should be in stride standing facing the patients face, inner hand of the therapist stabilizes the wrist joint of patient while the outer hand stabilizes the elbow joint of a patient .
- Then the relaxed passive movement of shoulder abduction is performed by the therapist from 90 degree of shoulder abduction to 180 degree of shoulder abduction or according to the patient’s condition.
- This movement is performed considering the principles of applying relaxed passive movement. I.e. Relaxation, fixation, support, traction, range, speed and duration.
Relaxation
Fixation
The proximal joint with the scapula is fixed due to the subjects position and distal joint (Elbow Joint), is fixed by therapist outer hand.
Support
The Subject is fully supported in the supine lying position and will thus remain relaxed. The physiotherapist grasps the part firmly but comfortably in her or his hand.
Traction
Traction is given in the long axis of humerus to the joint. This traction is maintained throughout the movement. Traction facilities the movement by reducing intra-articular friction.
Range
The Range of movement of shoulder abduction is from 90 degree to 180 degree,as the starting position is from 90 degrees but if range of motion is less it can be initiated from that range. The R.O.M achieve is either full or as the condition of the joints permit without eliciating pain or spasm in the surrounding muscles. In case of the normal joint slight over pressure can be given to ensure full range but in flial joints care is needed to avoid taking the movement beyond the normal anatomical limit.
Speed and Duration
The speed is uniform fairly slow slow and rhythmical the number of times the movement is performed depends upon the purpose for which it is done.
Shoulder internal and external rotation
Position of Patient: Supine lying with shoulder in 90 degrees of abduction , elbow flexed to 90 degrees, forearm in mid prone position , wrist neutral, finger extended.
Position of Therapist:
- Therapist stance should be stride standing facing the patients shoulder, inner hand of the therapist stabilizes the lower end of the humerus while the outer hand stabilizes the wrist joint of a patient with a lumbrical grip.
- Then the relaxed passive movement of shoulder internal rotation is performed by the therapist from taking the elbow from 90 degrees towards gravity in the same plane for medial rotation and taking the forearm towards cephalic side for lateral rotation of shoulder or according to the patient’s condition.
- This movement is performed considering the principles of applying relaxed passive movement. I.e. Relaxation, fixation, support, traction, range, speed and duration.
Relaxation
Fixation
The proximal joint with the scapula is fixed due to the subjects position and distal joint (Elbow Joint), is fixed by therapist inner hand
Support
The Subject is fully supported in the supine lying position and will thus remain relaxed. The physiotherapist grasps the part firmly but comfortably in her or his hand.
Traction
Traction is given in the long axis of humerus to the joint. This traction is maintained throughout the movement. Traction facilities the movement by reducing intra-articular friction.
Range
The Range of movement of shoulder medial and lateral rotation is o-90 degrees. The R.O.M achieve is either full or as the condition of the joints permit without eliciating pain or spasm in the surrounding muscles. In case of the normal joint slight over pressure can be given to ensure full range but in flial joints care is needed to avoid taking the movement beyond the normal anatomical limit.
Speed and Duration
The speed is uniform fairly slow and rhythmical the number of times the movement is performed depends upon the condition of the patient .
Uses of Relaxed Passive Movement
- Adhesion formation is prevented, usually given twice.
- Relaxed passive movement is given when full range active movement is not possible or to maintain the extensibility of the muscle.
- When active movement is absent, passive movement maintain the muscle memory by stimulating the kinesthetic receptors.
- The lymphatic and venous drainage is assisted by giving mechanical pressure in conjunction with elevation, when patient is unable to perform the active movement.
- The rhythm of CPM (Continuous passive movement) has soothing effect and induce relaxation and sleep.
Recommended Exercise Machines
CPM (Continuous Passive Motion) For Knee
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