Relaxed Passive
Movement
Shoulder joint
• DEFINITION
• This is the smooth, rhythmical and accurate anatomical movement performed by
the therapist within the pain-limited range.
• PRINCIPLES
• Relaxation Patient has to be positioned in relaxed manner before starting the
treatment procedure.
• During the relaxed state there will not be any muscle work and the total body
part will be fully relaxed and also the patient can cooperate for the treatment.
• If the patient feels inconvenient by the position, he cannot cooperate for the
treatment. So, the position of the patient is strictly noticed before giving the
treatment and also the position should not be changed during a treatment
process.
• The therapist’s position also plays an important role to treat the patient. The
therapist has to adopt the walk standing position while treating the patient
• Fixation
• The proximal joints to the joint to be moved should be fixed.
Otherwise trick movement may occur. To prevent it and localize the
movement the proximal joints have to be fixed or stabilized.
• Traction
• The long axis traction given to increase the space between the
articular surfaces. It reduces the intra-articular friction as well as
breaks the adhesion formation in the joint. Free passive movement
can be performed due to the less friction effect done by the long axis
traction
• Range
• The movement performed within the pain limited range. In that joints care must
be taken to avoid the movement exceeding the anatomical movement in the stiff
joint the movement has to be done bit forcefully to break the adhesions as well as
to maintain the muscle property.
• Speed and Duration
• Speed should be rhythmical, smooth and same speed should be maintained
throughout the movement. There should not be jerky movement, the movements
performed number of times may vary depends on the condition we treat
• Sequence
• The sequence to be decided before treating the patients, while treating the
flaccid conditions the movement should be proximal to distal, in spastic as well as
to increase the venous and lymphatic drainage the movement has to be
performed from distal to proximal.
• INDICATIONS :
• • The patients who cannot perform active movements.
• • The patients who cannot perform full range of movements.
• • For the prolonged bed-ridden patients mainly to prevent DVT, maintain the
muscle property and increase the venous drainage as well as lymphatic drainage.
• • To break adhesion formation through that joint range can be increased.
• • Unconscious patients.
• • For relaxation.
• • Edematous limb
• CONTRAINDICATIONS
• • Recent fractures
• • Recent dislocations
• • DVT
• • Malignant tumor
• • Psoriatic arthritis
• • Recently injuries and inflammation
• • Precaution must be taken for the flial joints
• • Hemarthrosis
• • Early burns
• • Immediately after any joint surgery or repair
• • Hemophilic joints
• • Patients with external appliances
• • Patients with POP plaster cast.
• EFFECTS AND USES
• • Maintains the muscle properties
• • Increases the ROM
• • Increases the venous and lymphatic drainage
• • Breaks the adhesion formations in the joints
• • Prevents the DVT
• • Induces the relaxation.
• PROCEDURE OF RELAXED PASSIVE MOVEMENT
• The therapist has to adopt the walk stand position and should face the
patient’s face. So, that he can observe the patient’s reaction while performing
movement.
• Right side is taken as an example and
explained in detail about to the
passive movements to be performed for
each and every joint and action.
• Upper Limb :
• Shoulder Joint
• Flexion
• Position of the patient: Supine lying.
• Position of the therapist:
• Standing beside the patient and facing the patient’s face.
• Holding:
• • Left hand of the therapist restricts the wrist and carpometacarpal
movement of the patient.
• • Therapist’s right hand should grasp the lower part of the arm of the
patient.
• Procedure:
• Mild long axial traction is given and the movement is performed.
• The traction should be maintained throughout the movement, beginning
stage traction is applied by the right hand and above 90º the traction is
maintained by the left hand of the therapist. Perform the movement up to
the available range
• Extension:
• Position of the patient: Side lying.
• Position of the therapist: Standing back to the patient and facing the shoulder joint.
• Holding:
• • Forearm and elbow is placed over the
right side forearm of the therapist by
flexing the elbow of the patient and wrist
movement is restricted by the therapist’s hand.
• • Left hand of the therapist stabilizes
the shoulder joint of the patient.
• Procedure:
• It is not possible to apply the long axial traction.
• Therapist’s right hand is performing the extension
movement of the shoulder.
• Abduction
• Position of the patient: Supine lying:
• Position of the therapist: Standing beside the patient and facing the
patient’s face.
• Holding: • Patient’s elbow is flexed (90º).
• • Patient’s wrist is grasped by the left hand of the therapist.
• • Dorsal aspect of the elbow and the lower part of the arm is grasped
by the therapist’s right hand.
• Medial and lateral rotation
• Position of the patient: Supine lying.
• Position of the therapist: Standing beside the patient and facing the
patient’s shoulder.
• Holding: • Patient’s shoulder is abducted for 90º and the elbow also flexed
for 90º.
• • Therapist’s left hand grasping the lower end of the humerus of the
patient.
• • Therapist’s right hand grasping the wrist and the hand of the patient.
• Procedure:
• The long axial traction is applied and the medial and lateral rotation
movement of the shoulder is performed by the therapist.
