Document Sample

       PHTH 201

   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

 1.   No muscular activation by the patient
 2.   Performed within the available ROM
 3.   Applied by some external force
 4.   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

   when voluntary movements are impossible as when
    the subject is comatose, or when paralysis of the
   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
       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
 Degeneration of articular surface.
 Adaptive shortening of the muscle and soft
 Osteoporotic changes of the bone
Cycle of immobility

 Decreased loading

                       Limitation of
                                         Decreased ability
Adaptive shortening       mobility
                                         to perform A.D.L
                        and function

                      Pain from disuse
     Weakness           and adaptive       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.   Place the patient in proper comfortable position with
     proper body alignment and stabilization to perform the
2.   The therapist should be in a proper position and
     effective stance.
3.   Free the region from restrictive closes, linen, splints,
     and dressings.
4.   Drape and cover the patient as necessary.
5. Utilize the proper hand holds or grasps by the
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)

       – Eccentric cont. = max. tension
       – Isometric cont. = intermediate tension.
       – Isotonic cont. ( concentric) = minimum
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.    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.
2.    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.
3.    Since there is no joint mov. , strength will devlop only at th
      position in which the ex. is performed.
4.       To develop strength throughout the ROM, resistance
      must be applied when the jt. is in several positions.
Rules and Principles of Isometric

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

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
    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.   Pain ( sever pain in joints e.g. arthritis);
2.   Effusion of the knee.( static cont. of the knee).
3.   Weakness of the m.( as 1st step in m. reeducation).
4.   Immobilization in plaster cast or back splint.
5.   Inflammation of the joint ( static contraction around the joint)
     to avoid weakness during theacute stage.
                   Practical Points

1.   Position: suitable & comfortable.
2.   Time of contraction equal time of relaxation( not less
     than 6 sec.)
3.   Repetition, teach the pt. on the sound limb, then on the
     affected limb to be repeated 10 min. every hour.
4.   Manual or mechanical ( Velcro weights or elastised
     material as Theraband) could be used gradually ,
     beginning with high repetitions and low resistance the
5.   Instruct the pt. not to hold his breath.
Contraindications to Isometric Exs.

1.   Hypertension
2.   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).