Passive Range of Motion: Understanding, Benefits, Principles, and How to Perform

How to Do Passive Range of Motion?

Passive Range of Motion (PROM) involves moving a joint through its available range exclusively by an external force, such as a therapist, caregiver, or even another part of one's own body, without any active muscle contraction from the individual whose joint is being moved.

What is Passive Range of Motion (PROM)?

Passive Range of Motion (PROM) refers to the movement of a joint through its full available arc, where the movement is generated entirely by an external force, and the muscles surrounding the joint remain relaxed or inactive. This distinguishes it from Active Range of Motion (AROM), where the individual actively contracts their own muscles to move the joint, and Active-Assisted Range of Motion (AAROM), which involves a combination of the individual's muscle effort and external assistance.

The primary goals of PROM are to:

• Prevent contractures and maintain joint flexibility: By regularly moving the joint through its full range, it helps prevent shortening of muscles and connective tissues.
• Improve circulation: Movement can aid in blood flow to the joint and surrounding tissues.
• Decrease pain: Gentle movement can sometimes alleviate stiffness-related pain.
• Enhance sensory awareness: Providing proprioceptive input to the brain.
• Prepare for active movement: In rehabilitation, PROM often precedes AAROM and AROM.
• Assess joint integrity: Allowing a clinician to feel for capsular patterns, end-feels, or restrictions.

Who Benefits from PROM?

PROM is a crucial intervention for individuals who are unable to actively move a joint themselves due to various reasons. This includes:

• Individuals with paralysis or severe muscle weakness: Such as those recovering from a stroke, spinal cord injury, or severe neurological conditions.
• Post-surgical patients: In the early stages of recovery when active movement might be contraindicated or painful.
• Comatose or unresponsive patients: To prevent complications associated with immobility.
• Patients experiencing significant pain: Where active movement would exacerbate discomfort.
• Bedridden individuals: To maintain joint health and prevent stiffness.
• Individuals with severe spasticity: PROM can help temporarily reduce muscle tone.

Key Principles and Precautions for Performing PROM

Performing PROM requires careful attention to technique to ensure safety and effectiveness. Adhere to these critical principles:

• Consult a Professional: Always seek guidance from a physical therapist, occupational therapist, or medical doctor before initiating PROM, especially if dealing with an injury, surgery, or chronic condition. They can provide a tailored program and identify contraindications.
• Proper Positioning: Ensure the individual is in a comfortable, stable position (e.g., lying supine on a firm surface) that allows for the full range of motion without obstruction.
• Support the Limb: Always support the limb above and below the joint being moved. This stabilizes the limb and prevents undue stress on the joint or surrounding tissues.
• Slow and Controlled Movements: Perform all movements slowly, smoothly, and rhythmically. Avoid jerky, sudden, or forceful motions, which can cause injury or pain.
• Move to End Range, Not Beyond: Move the joint only to the point of resistance or the onset of pain. Never force the joint beyond its natural anatomical limit or into a painful range. The goal is to maintain, not increase, range of motion.
• Communicate: If performing PROM on another person, maintain clear communication. Ask about pain levels, discomfort, or any unusual sensations. Observe facial expressions or body language for signs of distress.
• Repetitions and Frequency: Typically, 5-10 repetitions per joint are performed, 2-3 times a day, or as prescribed by a healthcare professional.
• Body Mechanics: If assisting another person, use proper body mechanics to protect your own back and joints.
• Contraindications: PROM should be avoided or performed with extreme caution in cases of:
  • Acute inflammation or infection in the joint.
  • Recent unhealed fracture.
  • Joint dislocation or instability.
  • Severe sharp pain during movement.
  • New or unhealed surgical sites (unless specifically cleared by the surgeon).
  • Presence of a DVT (deep vein thrombosis).

Step-by-Step Guide: General Principles for Performing PROM

While specific movements vary by joint, the general process remains consistent:

1. Preparation:

   • Explain the procedure to the individual (even if unresponsive, as a matter of respect and routine).
   • Ensure the environment is safe, comfortable, and free of obstacles.
   • Position the individual appropriately (e.g., lying down) to allow for full joint movement.
   • Expose the joint area to be moved for clear visibility and access.

2. Stabilize the Proximal Segment:

   • Place one hand firmly above the joint being moved (on the bone closer to the body's core). This stabilizes the segment that is not moving, ensuring the movement occurs only at the target joint.

3. Grasp the Distal Segment:

   • With your other hand, gently but firmly grasp the limb below the joint being moved (on the bone further from the body's core). Ensure your grip is secure but not painful, providing adequate support.

4. Perform the Movement:

   • Slowly and smoothly move the joint through its available range of motion.
   • Guide the joint through all its physiological movements (e.g., flexion, extension, abduction, adduction, rotation).
   • Move until you feel a gentle resistance or the individual reports discomfort. Do not push past this point.

5. Observe and Listen:

   • Pay close attention to the individual's reactions, looking for grimacing, guarding, or verbal cues of pain.
   • Listen for any clicks, pops, or crepitus (grinding sounds), which may indicate joint issues.

6. Return to Starting Position:

   • Gently and slowly return the joint to its neutral starting position.

7. Repeat:

   • Perform the prescribed number of repetitions (e.g., 5-10 times) for each movement of the joint.
   • Move to the next joint or limb as needed.

Specific Joint Examples

Here are illustrative examples of PROM for common joints, highlighting key support points and movements. Always remember the general principles above.

Shoulder PROM

The shoulder is a highly mobile ball-and-socket joint.

• Flexion: Support the elbow with one hand, and the wrist with the other. Gently raise the arm forward and upward, keeping the elbow straight or slightly bent, until the arm is overhead or resistance is met.
• Extension: From the neutral position, gently move the arm backward.
• Abduction: Support the elbow and wrist. Gently move the arm out to the side, away from the body, keeping the palm facing inward, until the arm is overhead or resistance is met.
• Adduction: From abduction, bring the arm back towards the body.
• Internal Rotation: With the elbow bent to 90 degrees and supported, gently rotate the forearm inward towards the body.
• External Rotation: With the elbow bent to 90 degrees and supported, gently rotate the forearm outward away from the body.

Elbow PROM

The elbow is a hinge joint.

• Flexion: Support the upper arm with one hand and the wrist with the other. Gently bend the elbow, bringing the hand towards the shoulder.
• Extension: From the flexed position, gently straighten the elbow.

Wrist PROM

The wrist allows for multiple movements.

• Flexion: Support the forearm with one hand. With the other hand, gently bend the wrist downward, bringing the palm closer to the forearm.
• Extension: From the flexed position, gently bend the wrist upward, bringing the back of the hand closer to the forearm.
• Radial Deviation: Gently move the hand towards the thumb side.
• Ulnar Deviation: Gently move the hand towards the little finger side.

Hip PROM

The hip is a large ball-and-socket joint.

• Flexion: Support the knee with one hand and the heel with the other. Gently bend the hip and knee, bringing the knee towards the chest.
• Extension: From the flexed position, gently straighten the hip, bringing the leg back towards the bed.
• Abduction: Support the knee and ankle. Gently move the leg out to the side, away from the body, keeping the knee straight.
• Adduction: From abduction, gently bring the leg back towards the midline.
• Internal Rotation: With the hip and knee bent to 90 degrees, support the knee and ankle. Gently rotate the foot outward, causing internal rotation of the hip.
• External Rotation: With the hip and knee bent to 90 degrees, support the knee and ankle. Gently rotate the foot inward, causing external rotation of the hip.

Knee PROM

The knee is primarily a hinge joint.

• Flexion: Support the thigh above the knee with one hand and the ankle with the other. Gently bend the knee, bringing the heel towards the buttocks.
• Extension: From the flexed position, gently straighten the knee.

Ankle PROM

The ankle is crucial for mobility.

• Dorsiflexion: Support the lower leg. Gently pull the foot upward, bringing the toes towards the shin.
• Plantarflexion: Support the lower leg. Gently push the foot downward, pointing the toes away from the shin.
• Inversion: Gently turn the sole of the foot inward.
• Eversion: Gently turn the sole of the foot outward.

When to Seek Professional Guidance

While this guide provides a foundation for understanding and performing PROM, it is paramount to emphasize that professional guidance is often necessary and highly recommended. A qualified physical therapist or occupational therapist can:

• Accurately assess the individual's specific needs, joint limitations, and potential contraindications.
• Teach correct techniques tailored to the individual's condition, ensuring safety and effectiveness.
• Progress the program from PROM to AAROM and AROM as appropriate.
• Identify early signs of complications or areas requiring further medical attention.

For complex cases, post-surgical recovery, or conditions involving neurological impairment, always consult with a healthcare professional before initiating any passive range of motion exercises.