Sunday, 17 January 2010

Passive Movements

"Movements produced on a person by an external force (i.e. no voluntary muscle contractions by patient) provided either by a person or a machine (CPM)"
Sub-divided into:
  • Physiological passive movements (mobilisations)
  • Accessory movements (mobilisations) - Glides,Rolls,Distractions,Compressions,Rotations (cannot be performed actively)
  • Passive stretching (mobilisations)
  • Adverse Neural Tensioning (ANT)
  • Manipulations

Structures Involved:

  • INTRA-ARTICULAR: subchondral bone; articular cartilage, synovial fluid, synovial membrane, menisci and fat pads
  • PERI-ARTICULAR: joint capsule, supporting ligaments, tendons, muscles, fascia, skin, blood & lymphatic vessels, nerves

Normal Restrictions to Joint ROM:

  • Joint capsule
  • Ligaments
  • Muscles & their tendonous attachements (active/passive insufficiency)
  • Bone/cartilage approximation i.e. shape and joint surface (loose packed,closed packed)

Abnormal Restrictions to Joint ROM:

  • Increased synovial fluid volume/pressure
  • Muscle imbalance
  • Mal-tracking
  • Trauma
  • Abnormal physiological changes in connective tissue due to immobilisation
  • Decrease in water in tissue matrix = abnormal points of collagen cross-linking - 'adhesions'
  • Atrophy of ligaments
  • Tendons degrade
  • Muscle contractures
  • Nerve tensioning
  • Synovial tissue atrophy
  • Pain/guarding mechanism (muscle spasm)

Beneficial Physiological Effects:

  • Maintains ROM/Increases ROM
  • Cartiliage healing/nutrition (hydrokinetic transport)
  • Smearing of synovial fluid reducing friction
  • Appropriate alignment
  • Increases lymphatic drainage/helps reduce oedema


  • Assessment of passive ROM
  • Diagnostic testing
  • Maintaining joint ROM in a paralysed or unconscious patient
  • Reducing joint pain
  • Reducing muscle spasm / guarding
  • Restoration of range (correction of 'mal-tracking and/or passive stretching)
  • Facilitates healing process


  • WILL NOT prevent muscle atrophy
  • WILL NOT increase strength or endurance


  • Excessive pain
  • Joints adjacent to unstable fractures
  • DVT in area
  • Infection
  • Active inflammatory (R.A)

Range of Motion

  • Direction of movement will depend on the desired efffect
  • Amplitude of the passive movement can be graded to indicate where in the available range the technique is being performed
  • Helpful in matching the induced range of P.M. to the desired mobilising effect depending on the irritiability of the lesioned structure

Maitland Grading Scale

  • 1 - SMALL amplitude movement performed at the beginning of range (within resistance free zone)
  • 2 - LARGE amplitude movement performed within a resistance free part of the range
  • 3 - LARGE amplitude movement performed into resistance or up to the limit of resistance
  • 4 - SMALL amplitude movement performed into resistance or up to the limit of resistance
  • 5 - High velocity, short amplitude thrust often near or at the limit of abnormal movement, at speed outside of patient's control

1 comment:

  1. Another benefit is that passive movements act as a 'TRANS-SYNOVIAL PUMP' - increasing fluid movement in and out of a joint (clearance rate)