Passive Movements: Principles & Practice MCQa

Passive Movements: Principles & Practice

💡 Core Concept: Passive Movement is movement produced entirely by an external force (Therapist, Gravity, Machine) without any voluntary muscle contraction by the patient. It is used when the patient is unable or not supposed to move the segment actively.

1. Classification of Passive Movements

Type	Key Feature	Indication
1. Relaxed Passive Movements	Smooth, rhythmical motion performed within the available range.	Maintain ROM, improve circulation, proprioception.
2. Forced Passive Movements (Mobilization)	Movement beyond the limited range (into restriction).	Stiff joints, adhesions, contractures.
3. Continuous Passive Motion (CPM)	Uninterrupted motion by a mechanical device for hours.	Post-TKR, ACL reconstruction, Burn rehabilitation.
4. Manipulation	High Velocity, Low Amplitude thrust (Grade V).	To snap adhesions, reposition joint surfaces.

2. Physiological Effects & Uses

A. Effects on Joints & Soft Tissue

• Prevents Adhesions: Keeps collagen fibers organized during healing.
• Maintains ROM: Prevents contractures and stiffness.
• Cartilage Nutrition: Movement circulates synovial fluid (imbibition), feeding the avascular articular cartilage.

B. Effects on Muscles

• Maintains mechanical elasticity (prevents shortening).
• Exam Note: Passive movement does NOT increase muscle strength or prevent atrophy completely (because there is no electrical activity/contraction).

C. Effects on Circulation

• Provides a mechanical pumping action (though less effective than active muscle pump) to assist venous return and reduce edema.

D. Effects on Nervous System

• Maintains Proprioception (joint position sense).
• Reduces pain via the Gate Control Mechanism (rhythmic movement stimulates mechanoreceptors).

3. Indications

• Paralysis: (MMT Grade 0 or 1) e.g., Hemiplegia (flaccid stage), Coma, Spinal Cord Injury.
• Acute Inflammation: When active movement is painful or contraindicated.
• Post-Surgery: To maintain range while protecting surgical repair (e.g., Tendon repair).
• Assessment: To determine end-feel, joint play, and ligament stability.

⚠️ Contraindications

• Unstable Fracture: Movement may disrupt the healing bone.
• Deep Vein Thrombosis (DVT): Risk of dislodging the clot (Embolism).
• Immediately after certain surgeries: If the protocol demands strict immobilization (e.g., skin graft, unstable spine).
• Malignancy: Around the joint (Osteosarcoma).

🏆 Golden Points

• CPM Machine: Proven to increase ROM faster post-TKR but does not significantly differ in long-term outcomes compared to manual therapy.
• Fixation: The proximal bone must be fixed/stabilized by the therapist so movement occurs only at the target joint.
• End-Feel: Passive movement is the only way to assess the "End-Feel" (Bone-to-bone, Soft tissue approximation, Empty, etc.).

📝 20 High-Yield MCQs

Test your knowledge for AIIMS/JIPMER.

Q1. Passive movements are primarily indicated for muscles with MMT Grade:

A. 0 to 1 B. 2 to 3 C. 4 D. 5

Rationale: Grade 0 (Zero) and 1 (Flicker) imply the patient cannot move the limb actively against gravity or even gravity-eliminated. Passive movement is required to maintain joint health.

Q2. Which of the following is NOT an effect of relaxed passive movement?

A. Maintain Joint ROM B. Increase Muscle Strength C. Maintain Proprioception D. Assist Circulation

Rationale: Strength increases only when a muscle contracts against resistance (Active Resisted). Passive movement involves no voluntary contraction.

Q3. Continuous Passive Motion (CPM) is most commonly used after:

A. Total Knee Replacement (TKR) B. Hip Fracture C. Stroke D. Amputation

Rationale: CPM provides prolonged, slow passive motion to prevent stiffness, improve cartilage nutrition, and reduce edema following extensive knee surgeries like TKR or ACL repair.

Q4. Forced Passive Movement is synonymous with:

A. Active Assisted Exercise B. Stretching / Mobilization C. Isometric Exercise D. Proprioceptive Neuromuscular Facilitation

Rationale: Forced passive movement involves applying an external force to take the joint beyond its current limited range, effectively stretching shortened tissues.

Q5. An absolute contraindication for passive movement is:

A. Coma B. Paralysis C. Unstable Fracture site D. Post-operative tendon repair

Rationale: Movement shear forces can disrupt the callus formation or displace fracture fragments in an unstable fracture.

Q6. Synovial fluid nutrition to articular cartilage is enhanced by:

A. Rest B. Movement (Passive or Active) C. Heat D. Cold

Rationale: Cartilage is avascular. It relies on the "Imbibition" mechanism—movement compresses and releases the cartilage, pumping nutrient-rich synovial fluid in and waste out.

Q7. When performing passive movement, the therapist should grasp the limb:

A. Close to the joint line (Short lever) B. Far from the joint (Long lever) C. Using fingertips only D. Over the muscle belly

Rationale: A grip close to the joint (proximal and distal to it) provides better control and reduces the torque/stress on the shaft of the bone.

Q8. Manipulation (Grade V) differs from Mobilization because:

A. It is slower B. It is High Velocity, Low Amplitude (Thrust) C. It is performed by the patient D. It creates large movements

Rationale: Manipulation involves a sudden, small amplitude thrust performed at the end of the range, which the patient cannot prevent. Mobilization is slower and oscillatory.

Q9. What is the primary goal of passive movement in a comatose patient?

A. To wake them up B. To prevent contractures and joint stiffness C. To build muscle mass D. To increase heart rate

Rationale: Comatose patients are immobile. Without passive ROM, collagen fibers will shorten, and joints will fuse (contractures).

Q10. In DVT (Deep Vein Thrombosis), passive movement is contraindicated because:

A. It is painful B. It may dislodge the clot causing Pulmonary Embolism C. It causes arterial rupture D. It increases blood pressure

Rationale: Mechanical pumping of the leg muscles (even passively) can break a thrombus loose, sending it to the lungs, which is life-threatening.

Q11. Which "End Feel" is abnormal?

A. Bone to Bone (Elbow extension) B. Soft Tissue Approximation (Knee flexion) C. Empty (Pain limits motion before resistance) D. Tissue Stretch (Shoulder rotation)

Rationale: An "Empty" end feel means the patient stops the movement due to severe pain before the therapist feels any mechanical restriction. This indicates acute pathology (e.g., abscess, fracture).

Q12. "Accessory Movements" (Joint Play) are:

A. Movements that cannot be performed voluntarily but are essential for full ROM B. Active movements done by the patient C. Large swinging movements D. Isometric contractions

Rationale: Examples include gliding, rolling, and spinning of joint surfaces. You cannot voluntarily "glide" your tibia, but it must happen passively for the knee to extend fully.

Q13. Controlled Sustained Stretching is used to treat:

A. Flaccidity B. Shortened tissues / Tightness C. Weakness D. Acute fracture

Rationale: Sustained passive force creates plastic deformation (elongation) in shortened collagen tissues, increasing length.

Q14. The speed of Relaxed Passive Movement should be:

A. Fast and jerky B. Slow, smooth, and rhythmical C. Extremely slow (1 degree per minute) D. Variable

Rationale: Smooth, rhythmical movement induces relaxation and prevents the stretch reflex (which causes resistance) from being triggered.

Q15. While giving passive movement to the shoulder, stabilization should be applied to the:

A. Humerus B. Scapula / Shoulder Girdle C. Elbow D. Wrist

Rationale: Stabilizing the proximal bone (Scapula) ensures that the movement actually occurs at the Glenohumeral joint and is not compensated by scapular movement.

Q16. Which technique is used to break adhesions under anesthesia?

A. Relaxed Passive Movement B. Manipulation C. Active Assisted D. Isometric

Rationale: Manipulation under Anesthesia (MUA) is a medical procedure using forceful passive movement to tear scar tissue/adhesions in a frozen joint (e.g., Frozen Shoulder).

Q17. Does passive movement prevent muscle atrophy in denervated muscle?

A. Yes, completely B. No, not significantly C. Only if done fast D. Only if done with CPM

Rationale: Atrophy prevention requires metabolic activity and protein synthesis triggered by active contraction or electrical stimulation. Passive movement does not trigger this.

Q18. "Maitland Mobilization" grades I and II are primarily used for:

A. Pain relief B. Stretching stiffness C. Strengthening D. Breaking adhesions

Rationale: Low amplitude oscillations (Grades I & II) stimulate mechanoreceptors to inhibit nociceptors (Gate Control), relieving pain. Grades III & IV are for stiffness.

Q19. During passive movement, the therapist uses their body weight and stance to:

A. Look professional B. Prevent fatigue and apply effective force (Ergonomics) C. Scare the patient D. Increase speed

Rationale: Good body mechanics (Walk Standing stance) allow the therapist to use body weight shift rather than just arm strength, preventing therapist injury/fatigue.

Q20. Passive Insufficiency refers to:

A. Weak muscle contraction B. Limitation of ROM because a muscle cannot stretch any further C. Ligament tear D. Joint fusion

Rationale: Passive insufficiency occurs in multi-joint muscles (e.g., Hamstrings). You cannot fully flex the hip while the knee is extended because the muscle is not long enough to cover both joints simultaneously.