Passive Movement Lower Lomb

Question 1

What is passive movement

Answer 1

movements carried out through the normal anatomical range and direction of movement, whilst the muscles are inactive or voluntarily relaxed.

Question 2

Why would you use Passive Movement

Answer 2

assessment or a treatment depending on context

Used when active movement is impossible or difficult for a patient (e.g. muscle paralysis after a stroke, patients who are heavily sedated on ITU)

when active movements are contraindicated.

Question 3

Principles of application of relaxed passive movements

Answer 3

• Relaxation of body part – requires appropriate starting position to promote relaxation and sometimes voluntary relaxation by patient. An explanation of technique should be given.
• Fixation – if movement is to be localized to a specific joint, the bone lying proximal to the joint is fixed by the therapist as close to the joint line as possible. Compensatory movement of adjacent joint must be avoided.
• Support – should be maximal to minimize muscle activity, usually given by the therapist’s hands.
• Range – should be as full as possible without causing pain and within normal range. Limiting factors to joint range should be considered, for example, bony block or apposition of soft tissues. There are certain examples when joints may potentially have an excess range of movement, but normal range should not be exceeded.
• Speed and duration – movement should be smooth and rhythmical and maintained at a uniform speed.
• Sequence – the sequence of motion should be decided, either distal to proximal or proximal to distal.
• Traction – slight distraction of the joint may facilitate movement by reducing inter-articular friction.
• Compression – this can also be exerted at the end of range to stimulate joint proprioceptors

Question 4

Uses of relaxed passive movements

Answer 4

1. Assessment of a joint
2. Maintain or increase joint range
3. Maintain extensibility of muscle, tendon and ligaments
4. Provide proprioceptive stimulation
5. Prevent soft tissue shortening
6. Increase venous and lymphatic flow – influencing oedema

Question 5

Frequency of application

Answer 5

This is dependent on purpose and patient presentation.

For example, passive movements may only be done once or twice to assess a joint’s range of motion in some situations however, a patient who is unconscious may need passive movements to be applied as a treatment, repeatedly to each joint a few times a day.

In other specific examples (e.g. post joint replacement) there are machines which produce continuous passive movement (CPM) and these can be used for hours a day depending on the rehab protocols.

Question 6

Precautions

Answer 6

• Careful handling is required in the instance of patients having skin damage, for example burns or in the instance of a flail limb, for example a paralysed upper limb following a stroke
• Passive movements should be pain free
• Take care around intra-venous infusion sites

Question 7

Contraindications

Answer 7

• Recent fractures
• Severe soft tissue damage preventing the safe use of passive movements
• Compromised circulation- blood clot