Hello friends, in this lesson we’ll talk about passive movement. This is the third lesson of Movement and Its Classification, part of our full Exercise Therapy Video Lessons course for BPT 1st year. In the previous lessons, we covered active exercises and resistance exercise.
Broadly, there are two classifications of passive movement.
- Relaxed passive movement.
- Passive manual mobilisation.
Manual mobilisation is very important. We physiotherapists use mobilisation extensively for low back pain or joint stiffness, and sometimes we also have to use manipulation. But today we’ll talk about relaxed passive movement. So, let’s get started.
What is passive movement?
First, let’s try to understand what passive movement is.
Passive movements are the movements produced by an external force during muscular inactivity. How can muscular inactivity occur? It occurs if there is muscle weakness or paralysis, as in a condition called hemiplegia. Weakness could be due to inactivity after the fracture, or we could be unable to contract the muscle due to pain.
Passive movement is a movement in which movement is generated using external force. For example, you can see in the image where a therapist is passively flexing the elbow of the subject.
In this movement, no muscle contraction occurs. The flexion and extension of the elbow are performed using external force of the therapist. This is called passive movement.
Classification of passive movement
Now let’s try to understand the classification of passive movement. Broadly, passive movement can be classified into two types:
- Relaxed passive movement,
- Passive manual mobilisation.
Now, we can divide manual mobilisation into three broad categories.
- Mobilisation of the joint,
- Manipulation of the joint,
- Controlled sustained stretching.
In physiotherapy, we use these the most in our treatment.
Relaxed passive movement
These are movements performed accurately and smoothly by the physiotherapist. Like the example I just gave you of elbow flexion. In this, a physiotherapist is passively flexing and extending my elbow accurately and smoothly. This is what we call passive movement.
Principles of Relaxed Passive Movement
Now, what are the principles for performing passive movement? Let’s try to understand them one by one.
- Relaxation
Whenever we try to perform a passive movement, we first have to relax that body part. Or we can instruct our patient, “I’m going to perform a movement now. Don’t apply any resistance or movement at all. Relax completely, and I’ll flex and extend your elbow.” You can give instructions this way.
Or, if there’s a paralysis condition, or, for example, hemiplegia, where the muscles are already weak and paralysed, you don’t need to give instructions. - Fixation
Whenever we try a passive movement, we need to properly fix the body part proximal to the joint so that the movement is localised to the joint. I’ll give you an example of elbow flexion.
In this, I’ll fix my arm properly. A physiotherapist will hold it securely and fix it as close as possible to the joint. This will localise my elbow movement.
There should be no movement anywhere else, neither in the shoulder nor in the same joint. And where will the fixation take place? As close to the joint as possible. - Support
Now, the proximal body part should be well supported. Often, we physiotherapists give examples of this: elbow flexion and extension. We often support the arm in our thighs or on the edge of the bed, and after fixing it well, we then perform elbow flexion and extension. This means that you need to support that part properly. - Traction
Now, the next thing is traction. By applying traction to the joint, we separate the inter-articular surface. Due to this, the friction there reduces, and our movement in it becomes easier.
I will give you a practical example of this. In knee joint osteoarthritis is that the gap in our knee joint reduces, and the articular surfaces start touching each other. That is why, when osteoarthritis patients walk, they feel a lot of pain because during movement, the intra-articular surfaces, which have become rough due to osteoarthritis, rub against each other, and there is pain there.
So, when we mobilise the knee joint by grasping the upper end of the tibia, we apply slight traction to the knee joint to reduce intra-articular friction and achieve proper mobilisation. - Range
Whenever we perform a relaxed passive movement, we must move the joint throughout its range of motion. For example, if I take the elbow joint, we must move it throughout its entire range of motion.
For example, suppose my elbow joint is stiff and extension motion is restricted at 30 degrees short of full extension. This is the only range of motion available from full flexion to 30 degrees short of full extension. After this, full extension is impossible.
So, what we do is we move the elbow joint within this range. We will do full movement, and at the end of the range, we can apply a little overpressure.
So gradually, the stiffness starts to release. - Speed and duration
Whenever we perform a relaxed passive movement, the speed should be uniform and rhythmic. This means that if you move slowly once and then move at speed, that’s not a uniform motion.
You have to move at the same speed. And it should be rhythmic. Rhythmic means that you flex to this point, then extend. Then the next time you flex to this point, then extend. This shouldn’t happen. It should be rhythmic.
Now let’s move on to its effects and uses of relaxed passive movement.
Effects and uses of relaxed passive movement
Prevents adhesion formation
Adhesion means sticking together. Let me explain this with an example. Suppose I have a fracture in my elbow and it’s plastered. After the 30-day cast is removed, we should engage in relaxed, passive movement. This will free up the muscle fibers that tend to adhere to each other.
Let me explain another condition.
Let’s say there were stitches in the skin during surgery. The stitches have been removed, but now the chances of the stitches adhering to the subcutaneous tissue below increase. So, if we initiate passive movement there, the skin will move, reducing the chances of adhesion to the subcutaneous tissue. This is a very important effect.
Helps preserve the memory of movement patterns
This is especially useful for paralysis patients. As a paralysis patient gradually recovers, we should encourage passive movement so that the brain can remember and retain the movements.
If we don’t engage in passive movement, the brain will forget it.1 It won’t store it in memory, and we’ll have trouble recovering.
Maintains muscle extensibility and prevents adaptive shortening
For us physiotherapists, relaxed passive movement is very important to prevent adaptive shortening. What is adaptive shortening?
In short, adaptive shortening causes joint stiffness. In the short video clip above, you can see that I am performing relaxed passive movement on the knee joint.
It is a case of a post-surgical tibia fracture stabilised with an Ilizarov external fixator. If I don’t move the knee, the soft tissues around the knee will become stiff in its shortened position over time, which is adaptive shortening. So, when we engage in passive movement, we can prevent adaptive shortening.
This is also seen in paralysis patients.
Relieves edema by improving venous and lymphatic drainage
Oedema means swelling.
Let me explain this with an example. When a fracture occurs in the elbow, oedema develops around the palm of the hand. Or sometimes oedema develops in the entire forearm. So, to prevent that oedema, we should practice passive movement. Passive movement of the elbow and the wrist. Rather, you should practice passive movement of all the small joints, including the small joints of our fingers.
What happens with passive movement is that venous flow and lymphatic drainage. Oedema also occurs due to the collection of lymphatic fluid in the lymph. So, when we practice passive movement, lymphatic drainage increases there, and any fluid that has pooled there is dispersed, providing relief from oedema.
Promotes relaxation
So, whenever we perform passive movement, the muscles there relax. So, let me explain this with an example. Let’s say I need to stretch my elbow flexors, and my elbow flexors are tight. It won’t extend after that because my elbow flexors are tight. So, if I do a little passive movement before stretching, my elbow flexor muscles will relax a little.
If I stretch after that, the effect increases. So, this was a relaxed passive movement. We hope this topic is completely clear to you.
The author is a physiotherapist who has been practising for the last 17 years. He holds a Bachelor's in Physiotherapy (BPT) from SVNIRTAR (Swami Vivekananda National Institute of Rehabilitation and Research), one of the prestigious physiotherapy schools in India.
Whatever he learns dealing with his patient, he shares it with the world through blogs and e-books. He also owns a YouTube channel, "Sunit Physiotherapist" with over 8 lakh active subscribers. Here, he shares everything he gets to learn serving the patient.
