Passive Range of Motion: What It Is, Benefits, and How to Perform It

How to perform passive range of motion?

Performing passive range of motion (PROM) involves moving a joint through its available range without any muscular effort from the individual, typically by an external force such as a caregiver or a mechanical device, to maintain joint health and prevent stiffness.

What is Passive Range of Motion (PROM)?

Passive Range of Motion (PROM) refers to the movement of a joint entirely by an external force, without any active muscle contraction by the individual whose joint is being moved. This external force can come from a therapist, caregiver, or even a specialized machine (like a Continuous Passive Motion, CPM, device). Unlike Active Range of Motion (AROM), where the individual moves the joint using their own muscles, or Active-Assistive Range of Motion (AAROM), where they provide some effort with assistance, PROM requires no muscular input from the recipient. Its primary purpose is to maintain joint flexibility and integrity when active movement is impossible or contraindicated.

Benefits of Performing PROM

Regularly performing PROM offers several critical physiological benefits, particularly for individuals with limited mobility:

• Maintains Joint Mobility: Prevents the shortening of connective tissues and muscle fibers, thereby preserving the available range of motion in a joint.
• Prevents Contractures: Reduces the risk of developing joint contractures, which are permanent shortenings of muscles or tendons that cause deformity and limit movement.
• Improves Circulation: Gentle movement can help stimulate blood flow, which is vital for tissue health and waste removal.
• Reduces Pain and Stiffness: By keeping joints moving, PROM can alleviate discomfort associated with immobility and stiffness.
• Enhances Sensory Input: Provides proprioceptive feedback to the brain, helping to maintain body awareness even when voluntary movement is absent.
• Prepares for Active Movement: Can be a foundational step in rehabilitation, preparing joints and tissues for eventual active participation.

Who Can Benefit from PROM?

PROM is a vital intervention for various populations, including:

• Individuals with Neurological Conditions: Patients recovering from stroke, spinal cord injury, or those with conditions like multiple sclerosis or Parkinson's disease who may have paralysis or severe weakness.
• Post-Surgical Patients: Especially after orthopedic surgeries (e.g., total knee or hip replacement, fracture repair) where active movement is temporarily restricted.
• Critically Ill or Comatose Patients: Those in intensive care units who are bedridden or unconscious for extended periods.
• Individuals with Severe Pain: When active movement causes too much pain, PROM can gently maintain mobility.
• Prolonged Immobilization: Patients in casts, traction, or on prolonged bed rest.
• Elderly Individuals: To maintain joint health and prevent stiffness, particularly if they have reduced mobility.

Precautions and Contraindications

While beneficial, PROM must be performed with caution. Certain conditions may contraindicate its use or require modification:

• Acute Injury or Inflammation: Moving an acutely inflamed or injured joint can exacerbate pain and swelling.
• Unstable Fracture: Performing PROM on an unstable fracture site can cause further displacement and damage.
• Deep Vein Thrombosis (DVT): Movement can dislodge a clot, leading to a potentially life-threatening pulmonary embolism.
• Immediate Post-Operative Period: Always follow surgeon's specific post-operative protocols regarding joint movement.
• Extreme Pain: PROM should never be forced beyond the point of pain. If pain occurs, stop immediately.
• Hypermobility: Avoid overstretching joints that are already excessively mobile.

General Principles for Performing PROM

Before initiating PROM, understanding these foundational principles is crucial for safety and effectiveness:

• Communication is Key: Always explain what you are doing to the individual, even if they appear unresponsive. Observe their facial expressions or body language for signs of discomfort.
• Proper Body Mechanics: The person performing PROM should use good posture and body mechanics to protect their own back and joints.
• Support the Limb: Always support the limb being moved, typically by placing one hand proximal (closer to the body) and one hand distal (further from the body) to the joint being mobilized. This provides stability and prevents undue stress on other joints.
• Slow and Controlled Movements: Perform movements smoothly, slowly, and rhythmically. Avoid jerky or sudden motions.
• Move Within Pain-Free Range: Only move the joint through its available, pain-free range of motion. Never force a joint past resistance or into pain.
• Observe for Changes: Pay attention to any changes in muscle tone, resistance, or signs of discomfort.
• Repetitions: Typically, 5-10 repetitions of each movement are performed per joint, 1-3 times per day, but this can vary based on individual needs and medical advice.
• Maintain Neutral Alignment: Ensure the rest of the body is in a comfortable, neutral position to avoid stressing other joints or creating compensatory movements.

How to Perform Passive Range of Motion (Step-by-Step)

The specific movements will vary by joint, but the general methodology remains consistent:

1. Preparation:

   • Explain: Inform the individual what you are about to do.
   • Position: Ensure the individual is lying or sitting comfortably and safely, with the joint accessible. Remove any clothing or blankets that might restrict movement.
   • Your Position: Position yourself close to the individual, using good body mechanics to avoid strain.
   • Support: Gently but firmly grasp the limb, supporting above and below the joint you intend to move. For example, when moving the knee, support the thigh and the calf.

2. Execution:

   • Initiate Movement: Slowly and gently move the joint through its specific plane of motion.
   • Monitor for Resistance/Pain: As you move, feel for any resistance or observe for signs of pain. Stop immediately if either occurs.
   • Full Available Range: Move the joint to the end of its pain-free and available range. Do not push beyond this point.
   • Hold (Optional): You may hold the joint briefly (1-2 seconds) at the end of the range, if comfortable for the individual.
   • Return to Start: Slowly and smoothly return the joint to its starting anatomical position.
   • Repeat: Perform the desired number of repetitions (e.g., 5-10) for that specific movement.
   • Change Movement: Once one movement plane is complete, move to the next (e.g., after knee flexion, move to knee extension).

3. Completion:

   • Comfort: Ensure the individual is comfortable and well-positioned after the exercises.
   • Feedback: If possible, ask for feedback on their comfort level.

Common Joints for PROM and Example Movements:

• Neck:
  • Flexion: Gently bring chin towards chest.
  • Extension: Gently tilt head back, looking towards the ceiling.
  • Lateral Flexion: Gently tilt ear towards shoulder on each side.
  • Rotation: Gently turn head to look over each shoulder.
• Shoulder:
  • Flexion: Lift arm straight forward and up overhead.
  • Extension: Move arm straight back behind the body.
  • Abduction: Move arm straight out to the side and up overhead.
  • Adduction: Bring arm across the body.
  • Internal Rotation: With elbow bent to 90 degrees, rotate forearm towards the body.
  • External Rotation: With elbow bent to 90 degrees, rotate forearm away from the body.
• Elbow:
  • Flexion: Bend the elbow, bringing hand towards the shoulder.
  • Extension: Straighten the arm fully.
  • Pronation: With elbow bent, rotate forearm so palm faces down.
  • Supination: With elbow bent, rotate forearm so palm faces up.
• Hip:
  • Flexion: With knee bent, bring knee towards the chest.
  • Extension: Straighten leg back behind the body (if prone).
  • Abduction: Move leg straight out to the side.
  • Adduction: Bring leg across the midline of the body.
  • Internal Rotation: With hip and knee bent to 90 degrees, rotate foot away from midline.
  • External Rotation: With hip and knee bent to 90 degrees, rotate foot towards midline.
• Knee:
  • Flexion: Bend the knee, bringing heel towards the buttocks.
  • Extension: Straighten the knee fully.
• Ankle:
  • Dorsiflexion: Point toes towards the shin.
  • Plantarflexion: Point toes downwards, away from the shin.
  • Inversion: Turn the sole of the foot inwards.
  • Eversion: Turn the sole of the foot outwards.

Post-PROM Considerations and When to Seek Professional Guidance

After performing PROM, ensure the individual is comfortable and their limb is safely positioned. Monitor for any delayed pain or discomfort.

While these guidelines provide a comprehensive overview, it is crucial to emphasize that passive range of motion should ideally be taught and supervised by a qualified healthcare professional such as a physical therapist, occupational therapist, or a trained nurse, especially in complex cases or when specific medical conditions are present. They can assess the individual's specific needs, identify any contraindications, and teach proper techniques to ensure safety and maximize benefits. Never hesitate to seek professional guidance if you are unsure about performing PROM or if the individual experiences pain or discomfort.

Conclusion

Passive Range of Motion is a fundamental and invaluable technique for maintaining joint health, preventing complications from immobility, and supporting recovery in individuals unable to move independently. By understanding its principles, benefits, and proper execution, caregivers and health enthusiasts can play a proactive role in preserving the physical well-being and quality of life for those who need it most. Always prioritize safety, communication, and moving within a pain-free range to ensure PROM is a positive and beneficial experience.