4- Passive Movement

7/28/2019 4- Passive Movement

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PASSIVE

MOVEMENT

Dr. Amal Hassan Mohammed Ibrahim

Professor of Physical Therapy

Lecture IV


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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.


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CLASSIFICATIONOF 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

tightenedstructures.


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RELAXEDPASSIVEMOVEMENT

ACCESSORYFUNCTIONALMOVEMENTS


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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. Thejoint is moved through the existing

free range and within the limits of

pain.


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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.


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Accessory movements contribute

to the normal function of thejoint in which they take place or

that of adjacent joints.


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In abnormal joint conditions there may belimitation of these movements due to loss offull active range caused by stiffness of jointsfrom contracture of soft tissue, adhesionformation or muscular inefficiency.

Accessory movements are performed by thephysiotherapist to increase lost range of

movement and to maintain joint mobility.Hence they form an important part of thetreatment of a patient who is unable toperform normal active movement.


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PRINCIPLES OF RELAXED PASSIVE

ANDACCESSORYMOVEMENTS

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 flaccidparalysis when this is unnecessary. The

selection of a suitable starting position

ensures comfort and support, and the

bearing of the physiotherapist will domuch to inspire confidence and

cooperation in maintaining relaxation

through the movement.


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PRINCIPLES OF GIVING RELAXED

PASSIVE MOVEMENTS

2-Fixation:

Where movement is to belimited to a specific joint, thebone which lies proximal to it

is fixed by the physiotherapistas close to the joint line aspossible to ensure that themovement is localized to that

joint; otherwise any decrease

in the normal range is readilymasked by compensatorymovements occurring at other

joints in the vicinity.


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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 besupported by axial

suspension in slings.


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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. Whenstanding, his feet are apart and placed in the line

of the movement.


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PASSIVE MOVEMENTS

4-Traction:

Many joints allow thearticular surfaces to bedrawn apart by traction,

which is always given inthe long axis of a joint, thefixation of the boneproximal to the jointproviding an opposing

force to a sustained pull onthe distal bone. Traction isthought to facilitate themovement by reducinginter- articular friction.


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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 thenormal anatomical limit.


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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 passover two or more joints, these

muscles must be progressively

extended over each joint until they

are finally extended to their normallength over all the joints

simultaneously e.g. the Quadriceps

are fully extended when the hip joint

is extended with the knee flexed.


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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 slowand rhythmical. The number of times

the movement is performed depends on

the purpose for which it is used.


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EFFECTS AND USES OF RELAXED

PASSIVE MOVEMENTS AND ACCESSORY

MOVEMENTS

1- Maintain range of motion and

prevent formation of adhesions.

2- Maintain the physiologicalproperties 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.


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EFFECTSAND USESOF RELAXED PASSIVE

MOVEMENTSANDACCESSORYMOVEMENTS

4- The mechanical pressure resulted

from the stretching of the thin

walled vessels which passing acrossthe moved joint will assist the

venous and lymphatic return. They

are used in conjunction with limbelevation to reduce oedema.


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EFFECTSAND USESOF RELAXED PASSIVE

MOVEMENTSANDACCESSORYMOVEMENTS

5- Can be used in training of

relaxation as the rhythmic

continuous passive movements canhave a soothing effect and induce

further relaxation and sleep.


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EXAMPLESOFRELAXEDPASSIVE

MOVEMENT


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EXAMPLESOFRELAXEDPASSIVE

MOVEMENT


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B- PASSIVEMANUALMOBILIZATION

TECHNIQUES


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1- MOBILIZATIONOFJOINTS

Definition:

Mobilization is manual therapy designed to

restore joint movement. These are usually smallrepetitive 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 quitestrongly, and are graded according to the part of

the available range in which they are performed.

M J M


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MAITLAND JOINT MOBILIZATION

GRADING SCALEGrading based on amplitude of movement &

where within available ROM the force is applied.

Grade I Small amplitude rhythmic oscillating movement at

the beginning of range of movement Manage pain and spasm

Grade II Large amplitude rhythmic oscillating movement

within midrange of movement Manage pain and spasm

Grades I & IIoften used before & aftertreatment with grades III & IV


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Grade III 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

Grade IV Small amplitude rhythmic oscillating movement at

very end range of movement

Used to gain motion within the jointUsed 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


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II- MANIPULATIONOFJOINTSBY

PHYSIOTHERAPIST

Definition

These are accurately localised, single, quick

decisive movements of small amplitude and high

velocity completed before the patient can stop it.


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MANIPULATIONOFJOINTBYSURGEON

/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.


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MANIPULATIONOFJOINTBYSURGEON

/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 ofthe 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 exudationwill form new adhesions.


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III- CONTROLLEDSUSTAINED

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


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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 thephysiotherapist and moved in such a

way that a sustained stretch can be

applied to the contracted structures for a

period of time within a functionalpattern of movement.
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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.


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

4- Passive Movement

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