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

Indications

• 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

Limitations

• CANNOT CHANGE DISEASE PROCESS
• WILL NOT prevent muscle atrophy
• WILL NOT increase strength or endurance

Contractions

• 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