Download passive range of motion exercises

PASSIVE RANGE OF MOTION
EXERCISES
PHTH 201
Definition:

It is exercise in which movement is performed
by an external force in the available pain free
range of motion. The external force may be
from the therapist, family member, or the
patient or equipment.
Passive ROM exercises are characterized
by:
1.
2.
3.
4.
No muscular activation by the patient
Performed within the available ROM
Applied by some external force
No pain
Importance of Passive ROM Exercises
Passive ROM exercises are very important if you have to
stay in bed or in a wheelchair. ROM exercises help keep
joints and muscles as healthy as possible. Without
these exercises, blood flow and flexibility (moving and
bending) of the joints can decrease. Passive ROM
exercises help keep joint areas flexible
Indications



when voluntary movements are impossible as when
the subject is comatose, or when paralysis of the
part.
When Active movement may disrupt the healing
process, as when there is acute inflammation of the
joint or the surrounding tissue.
When active movement is too painful to perform, as
after surgery and injury for 2 to 6 days according to
the condition.
Aims of Passive ROM Exercise
Passive exercises are largely preventive in nature and are
used to:
1.
Maintain range of motion.
2.
Maintain joint and connective tissue mobility.
3.
Minimizes the effects of and the formation of contractures.
4.
Enhances synovial movement.
5.
Maintain mechanical elasticity of muscles.
6.
Assist circulation and vascular dynamics.
7.
Help maintain the patient’s awareness of movement.
Points to remember
Passive ROM exercises will NOT:




Build up muscles or make them stronger.
Prevent muscle atrophy.
Increase strength or endurance.
Assist in circulation to the extent that active,
voluntary muscle contraction will.
Range of motion:
 Range of motion is the term that is used to
describe the amount of movement that occur
at each joint. Every joint in the body has a
"normal" range of motion. Joints maintain their
normal range of motion by being moved. It is
therefore very important to move all your
joints every day.
Causes of decreased Range of Motion







Prolonged immobilization or bed rest.
Trauma to soft tissues, bones or other joint
structures.
Muscle weakness.
Surgeries.
Joint disease.
Neuromuscular disease.
Pain.
Effect of Immobilization and
Decreases Mobility
Immobilization leads to decrease loading and
stress on joints and soft tissues resulting in
 Joint stiffness and adhesion.
 Atrophy and weakness of the skeletal muscle.
 Decrease tensile strength of tendons and
ligaments.
 Degeneration of articular surface.
 Adaptive shortening of the muscle and soft
tissues.
 Osteoporotic changes of the bone
Cycle of immobility
Decreased loading
Adaptive shortening
Weakness
Limitation of
mobility
and function
Decreased ability
to perform A.D.L
Pain from disuse
and adaptive
shortening
Substitution
 All these complications lead to
decrease ability of to perform the
activities of daily living
Application of Passive Exercises
Technical Principles

Before performing passive exercises, some of the
technical principles should be remembered
1.
2.
3.
4.
Place the patient in proper comfortable position with
proper body alignment and stabilization to perform the
exercise.
The therapist should be in a proper position and
effective stance.
Free the region from restrictive closes, linen, splints,
and dressings.
Drape and cover the patient as necessary.
5. Utilize the proper hand holds or grasps by the
therapist.
6. Perform the exercise slowly, smoothly with rhythm
within the available pain free range of motion without
any force behind the range.
7. Do all ROM exercises smoothly and gently. Never
force, jerk, or over-stretch a muscle. This can hurt the
muscle or joint instead of helping.
8. Stop ROM exercises if the person feels pain. The
exercises should never cause pain or go beyond the
normal movement of that joint.
9. Repeat the exercise 5 to 10 repetitions according to the
patient condition and response
Active exercises
Isometric Exercises (cont)
i.e.
– Eccentric cont. = max. tension
– Isometric cont. = intermediate tension.
– Isotonic cont. ( concentric) = minimum
tension.
i.e. to start a stregthening program:
– Start by isotonic (concentric) harden by
isometric then harden by eccentric .
– If no contraction start by static then
follow the same progression.
Rules and Principles of Isometric Exs.
1.
2.
3.
4.
Strength will increase if an isometric contraction is
sustained against resistance for at least 6 seconds.
Isometric resistance exs. will not improve m. endurance as
effectively as dynamic exs.
During isometric training it is suffiscient to use an exercise
load ( resistance) up to 60-80% of th m. force-devloping
capacity in order to gain strength.
Since there is no joint mov. , strength will devlop only at th
position in which the ex. is performed.
To develop strength throughout the ROM, resistance
must be applied when the jt. is in several positions.
Rules and Principles of Isometric
Exs.(cont.)
4.The length of a m. at the time of a contraction directly affects the
amount of tension that can be produced at a specific point in
the ROM.→ the amount of resistance will vary at different
points in the range.
5. Resistance can be applied either manully or mechnically by
having the pt. hold against a heavy load or push against an
immovble object.
Rules and Principles of Isometric
Exs.(cont.)
6. Muscle setting exercises are also a form of isometric exs. but are
not performed against apreciable resistance.
a. Muscle setting exercises will be used to describe gentle static
muscle contractions used to maintain mobility between muscle
fibers and then decrease muscle spasm & pain.
b. Quadriceps settings and gluteal settings are common
examples.
c. They are not performed against resistance and will not
increase appreciably muscle strength.
d. Settings may retard atrophy in the evry early stage of rehab. of
muscle or joint when jt. Immobilization is necessary.
Indications of Isometric contractions
1.
2.
3.
4.
5.
Pain ( sever pain in joints e.g. arthritis);
Effusion of the knee.( static cont. of the knee).
Weakness of the m.( as 1st step in m. reeducation).
Immobilization in plaster cast or back splint.
Inflammation of the joint ( static contraction around the joint)
to avoid weakness during theacute stage.
Practical Points
1.
2.
3.
4.
5.
Position: suitable & comfortable.
Time of contraction equal time of relaxation( not less
than 6 sec.)
Repetition, teach the pt. on the sound limb, then on the
affected limb to be repeated 10 min. every hour.
Manual or mechanical ( Velcro weights or elastised
material as Theraband) could be used gradually ,
beginning with high repetitions and low resistance the
reverse.
Instruct the pt. not to hold his breath.
Contraindications to Isometric Exs.
1.
2.
Hypertension
Haert Disease
Isometric Regimens
 Brief maximal isometric exercise (Hettinger & Muller):
 Single isometric cont. of the muscle to be strengthened
against a fixed resistance.
 Hold for 5 -6 sec. , once a day, 5 – 6 days a week.
 Brief Repetitive Isometric Exs. (BRIME):
 Refinement of the previous study.
 5 – 10 brief but max. isometric contactions are performed
against max. isometric contactins are performed against
resistance 5 days per week.
Isometric Regimens in
Rehabilitation & Conditioning
• Early studies documented that isometric resistance exs.
can be effective means of improving muscle strength.
• Minimal effects in muscle endurance→ dynamic
( isotonic& isokinetic) exs. are more effective.
• Multiple angle isometric exs. are necessary to improve
strength throughout the ROM.
– Resistance should be applied at least every 20°
throughout the range.
– 10 sets of 10 repetitions of 10 sec contraction every
10° in the ROM ( Davies).