PASSIVE MOVEMENT

Dr. Amal Hassan Mohammed Ibrahim Professor of Physical Therapy

Lecture IV

PASSIVE MOVEMENT

These movements are produced by an external force during muscular inactivity or when muscular activity is voluntary reduced as much as possible to permit movement.

CLASSIFICATION OF PASSIVE MOVEMENT

1- Relaxed Passive Movements, including accessory movements. 2- Passive Manual Techniques: (i)- Mobilization of joints. (ii)- Manipulation of joints. (iii)- Controlled sustained stretching of tightened structures.

RELAXED PASSIVE MOVEMENT

ACCESSORY FUNCTIONAL MOVEMENTS

A- RELAXED PASSIVE MOVEMENT

Definition: These are movements performed accurately, rhythmical and smoothly by the physiotherapist through available range of motion. A knowledge of the anatomy of joints is required. The movements are performed in the same range and direction as active movements. The joint is moved through the existing free range and within the limits of pain.

B- ACCESSORY MOVEMENT
Definition: These occur as part of any normal joint movement but may be limited or absent in abnormal joint conditions. They consist of gliding or rotational movements which cannot be performed in isolation as a voluntary movement but can be isolated by the physiotherapist.

B- ACCESSORY MOVEMENT

Accessory

movements contribute to the normal function of the joint in which they take place or that of adjacent joints.

B- ACCESSORY MOVEMENT
In

abnormal joint conditions there may be limitation of these movements due to loss of full active range caused by stiffness of joints from contracture of soft tissue, adhesion formation or muscular inefficiency. Accessory movements are performed by the physiotherapist to increase 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.

PRINCIPLES OF RELAXED PASSIVE AND ACCESSORY MOVEMENTS

1-Relaxation:

A brief explanation of what is to happen is given to the patient, who is then taught to relax voluntarily, except in cases of flaccid paralysis when this is unnecessary. The selection of a suitable starting position ensures comfort and support, and the bearing of the physiotherapist will do much to inspire confidence and cooperation in maintaining relaxation through the movement.

PRINCIPLES OF GIVING RELAXED PASSIVE MOVEMENTS

2-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.

PRINCIPLES OF GIVING RELAXED PASSIVE MOVEMENTS

3-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 his hand, or it may be supported by axial suspension in slings.

PRINCIPLES OF GIVING RELAXED PASSIVE MOVEMENTS

The latter method is particularly useful for the trunk or heavy limbs, as it frees the physiotherapists hands to assist fixation and to perform the movement. The physiotherapists stance must be firm and comfortable. When standing, his feet are apart and placed in the line of the movement.

PRINCIPLES OF GIVING RELAXED PASSIVE MOVEMENTS

4-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 inter- articular friction.

PASSIVE MANUAL MOBILIZATION TECHNIQUES

5-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 slight over pressure can be given to ensure full range, but in flail joint care is needed to avoid taking the movement beyond the normal anatomical limit.

RANGE

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 extended when the hip joint is extended with the knee flexed.

PASSIVE MANUAL MOBILIZATION TECHNIQUES

6-Speed and Duration:

As it is essential that relaxation is 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.

EFFECTS AND USES OF RELAXED PASSIVE MOVEMENTS AND ACCESSORY MOVEMENTS

1-

Maintain range of motion and prevent formation of adhesions. 2- Maintain the physiological properties of the muscle (extensibility, elasticity, etc.) and prevent adaptive shortening. 3- Help in preserving and maintain the memory of the movement pattern by stimulating the kinaesthetic receptors.

EFFECTS AND USES OF RELAXED PASSIVE MOVEMENTS AND ACCESSORY MOVEMENTS

4-

The mechanical pressure resulted from the stretching of the thin walled vessels which passing across the moved joint will assist the venous and lymphatic return. They are used in conjunction with limb elevation to reduce oedema.

EFFECTS AND USES OF RELAXED PASSIVE MOVEMENTS AND ACCESSORY MOVEMENTS

5-

Can be used in training of relaxation as the rhythmic continuous passive movements can have a soothing effect and induce further relaxation and sleep.

EXAMPLES OF RELAXED PASSIVE

MOVEMENT

EXAMPLES OF RELAXED PASSIVE

MOVEMENT

B- PASSIVE MANUAL MOBILIZATION

TECHNIQUES

1- MOBILIZATION OF JOINTS
Definition:

Mobilization is manual therapy designed to restore joint movement. These are usually small repetitive rhythmical oscillatory, localised accessory, or functional movements performed by the physiotherapist in various amplitudes within the available range, and under the patients 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.

 Grading

based on amplitude of movement & where within available ROM the force is applied. I
Small amplitude rhythmic oscillating movement at the beginning of range of movement Manage pain and spasm

MAITLAND JOINT MOBILIZATION GRADING SCALE

Grade

Grade

II

Large amplitude rhythmic oscillating movement within midrange of movement Manage pain and spasm
Grades

I & II often used before & after treatment with grades III & IV

 Grade

III

Grade

Large amplitude rhythmic oscillating movement up to point of limitation (PL) in range of movement Used to gain motion within the joint Stretches capsule & CT structures

IV

Small amplitude rhythmic oscillating movement at very end range of movement Used to gain motion within the joint

Used when resistance limits movement in absence of pain

Grade

V (thrust technique) - Manipulation

Small amplitude, quick thrust at end of range Accompanied by popping sound (manipulation) Velocity vs. force Requires training

II- MANIPULATION OF JOINTS BY

PHYSIOTHERAPIST Definition These are accurately localised, single, quick decisive movements of small amplitude and high velocity completed before the patient can stop it.

MANIPULATION OF JOINT BY SURGEON /PHYSICIAN

Definition: 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 use of greater force.

MANIPULATION OF JOINT BY SURGEON /PHYSICIAN

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 invertible exudation will form new adhesions.

III- CONTROLLED SUSTAINED

STRETCHING

Passive stretching of muscles and other soft tissues can be given to increase range of movement. Movement can be gained by stretching adhesions in the tendon protective reflex.

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.

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.

QUESTIONS????????????