Passive Range of Movement Exercises

Passive Range of Movement Exercises

Patient and Carer Information

Community Neuro and Stroke Team

• Author ID:           JH
• Leaflet Ref:         CM 317
• Version:              1
• Leaflet title:         Passive Range of Movement Exercises
• Date Produced:   April 2024
• Expiry Date:        April 2026

Passive exercises are exercises where assistance is used to perform a series of movements aimed at moving specific joints or muscles.  Passive exercises may be recommended by your therapist as part of your treatment program if you require support in exercising as a result of your health condition.

Why are passive range of movement exercises important?

• To maintain and/or reduce muscle tightness and joint stiffness
• To help manage joint and muscular pain aiding comfort and positioning.
• To prevent muscles and joints from becoming permanently contracted.
• To help maintain access to key bodily regions for personal hygiene.
• To help prevent skin breakdown/sores.

How often should I complete my exercises?

Exercise frequency and duration is INDIVIDUAL for each person.  Therefore, guidance will be provided by your treating therapist as to how often you should complete these exercises, how many times you should complete them, and how long for. Each day may be different depending on your individual symptoms (e.g. pain, tiredness, activity levels).

This document is meant as a guide.

Things to consider. 

Due to the physical demands of supporting others with passive exercises, helpers should make the treating therapist aware of any health problems they may have that need to be considered when providing this support. 

It is important that you don’t overstretch the muscles as this may cause injury.  Exercises should be performed in a slow and controlled manner.  The helper should stop performing any exercise which causes excessive pain.  It is important to note that when completing these exercises, it is normal to feel a little discomfort or a pulling sensation. However, this should not be excessive – if this is the case please consult your therapist for further guidance.

Prior to beginning your exercises, it is important to ensure both the individual and person supporting with the exercises are in a good position and comfortable throughout.  Your therapist will direct you as to what the optimum positions are to complete these exercises in, given your individual environment.

Passive Exercises for the Lower Body

Foot and Ankle Mobilisation:

Position: Stretches to the foot and ankle may be completed either in lying or sitting. 

Instructions:

1. Firmly hold the foot as shown in the picture with your thumbs placed under the ball of the foot and your fingers resting over the top of the foot.
2. Slowly apply pressure into the ball of the foot using your thumbs.  Maintaining this pressure draw the thumbs apart towards the big and little toes.
3. Go back to starting position and repeat as directed by your therapist.

Instructions:

1. Alternate your hand position so your thumbs are now placed on top of the foot.
2. Slowly apply pressure into the top of the foot using your thumbs.  Maintaining this pressure draw the thumbs apart towards the ankle and back down towards the toes. 
3. Go back to starting position and repeat as directed by your therapist.
    

Ankle Stretches:

Position: to be completed in lying

Instructions:

1. Place a pillow under the knee so the knee is slightly bent
2. Take hold of the heel of the foot being stretched and rest the forefoot on your forearm.
3. Place your other hand above the knee to keep it stable
4. Gently pull the forefoot towards the face, achieving a stretch in the lower calf.
5. Repeat as instructed by your therapist.

Calf Stretch:

(Same position as the photograph above) 
 

Instructions:

1. Remove the pillow from under the knee so that the knee is straight.
2. Complete as per previous stretch without the pillow in situ.
3. Repeat as instructed by your therapist.
    

Thigh Stretches:

Position: Complete in lying. 

Instructions:

1. Place a pillow under the knee
2. Support the top of the thigh above the knee with one hand
3. Place the other hand under the back of the calf or heel
4. Gently straighten the knee, finding a gentle stretch behind the knee joint.
5. Repeat as instructed by your therapist.

Instructions:

If you wish to take the above stretch slightly deeper:

1. Maintaining a straight leg position as above, gently lift the foot up towards the ceiling finding a slightly deeper stretch at the back of the thigh.
2. You may need to support the back of the knee to prevent overstretching during this exercise.
3. Repeat as instructed by your therapist.

Hip Stretches:

Position: Start in lying with legs out straight and arms relaxed by their sides. 

Instructions:

1. Support under the heel of the foot with one hand and the back of the knee with the other hand.
2. Slowly bring knee towards the chest, allowing the knee and hip joint to bend. 
3. Slowly lower back down again 
4. Repeat as instructed by your therapist.

Instructions:

1. Bend one knee placing the foot flat on the bed.  You may need to support the foot to ensure the leg doesn’t slide back down again. The other leg may remain straight.
2. Gently allow the knee to fall to the side finding a stretch to the inside of the thigh that is moving.
3. Slowly bring the leg back in again.
4. Repeat as instructed by your therapist. 

Instructions:

1. Slowly bring the leg out to the side away from the body.
2. Bring the leg out until resistance is felt and hold for 30 seconds. 
3. Slowly bring the leg back in towards the body. 
4. Repeat as instructed by your therapist. 

Trunk Stretches:

Position: Start in lying with both knees bent and arms relaxed by the side.

Instructions:

1. Place your hand on one knee and your other hand on their stomach to steady them.
2. Gently bring their knees towards you allowing a stretch on their opposite side.
3. Make sure their back stays still on the bed and it is just their legs coming towards you.
4. Slowly bring their knees back to the middle
5. Stand on the other side and repeat as instructed by your therapist.

Passive Exercises for the Upper Body

Shoulder:

Care should be taken with shoulder exercises to avoid injury.

Position: Start in lying. Place one hand on the upper arm and your other hand holding their wrist/hand (palm to palm support) as shown below:

Instructions: 

1. Keeping the arm straight gently move the arm up towards the ceiling.
2. Continue to move their arm slowly until you meet resistance.  Do not try and push past the resistance. 
3. Hold the stretch for 30 seconds.
4. Slowly lower the arm back towards the bed.
5. Repeat as instructed by your therapist. 

Position: Start in lying with their arm rested by their side, palm facing the ceiling.  Support the upper arm with one hand underneath. Support the wrist and hand with your other hand.

Instructions:

1. Keeping the arm straight slowly bring the patient’s arm out to the side away from the body with palm facing upwards. 
2. Hold the stretch for 30 seconds.
3. Slowly bring the arm back towards the body. 
4. Repeat as instructed by your therapist. 

Position: Start in lying with arms down by their side. Bend the elbow and place the hand on the stomach around navel height. Support the hand and wrist with one hand, and place your other hand on their upper arm to keep it tucked in alongside the body. 

Instructions:

1. Keeping the elbow bent, gently move the hand towards you until you feel resistance.
2. Make sure the top part of their arm remains tucked into their side.
3. Slowly bring the hand back to the stomach again.
4. Repeat as instructed by your therapist

Elbow:

Position: Start in lying with their arm rested on a pillow. Support the upper arm with one hand placed underneath the elbow. Support the wrist and hand with your other hand. 

Instructions:

1. Slowly bend the elbow, bringing the hand towards the shoulder.
2. Lower back down again, ensuring the elbow is straight
3. Repeat as directed by your therapist 

Forearm:

Position: Start in lying with the arm supported by a pillow, elbow straight and palm facing down. Using one hand, support the arm behind the elbow.  Using your other hand take a palm-to-palm grip (as if you are shaking hands):

Instructions:

1. Turn the forearm so that palm is face up. Hold the stretch for a few seconds.
2. Then turn the forearm so palm is face down.
3. Repeat as instructed by therapist 

Wrist:

Position: In lying with the arm supported by a pillow. Position the forearm so the thumb is pointing up towards the ceiling.  Place one hand over the top of the forearm.  Hold the other hand in a palm-to-palm grip:

Instructions:

1. Bend the wrist so the fingers move towards you.  Keep the forearm still and in contact with the pillow throughout.
2. Bring it back to the starting position.
3. Then bend the wrist so the fingers move away from you. Again keep the forearm still and stable.
4. Repeat as instructed by your therapist. 

Fingers:

Position: In lying or sitting, support the hand on a pillow. Take one hand and support around the thumb and the other hand gripping the fingertips as demonstrated in the photograph: 

Instructions:

1. Support the thumb and wrist to keep this part of the hand still.
2. With your other hand gently bend their fingers and knuckles in towards their palm in a slow movement. 
3. Slowly straighten back out again.
4. Repeat as instructed by your therapist. 

Instructions:

1. Continue to support the thumb and wrist with one hand.  Move the other hand so you hook the ends of your fingers over the top of the persons fingers as demonstrated in the picture.
2. Keeping the persons fingers straight with the heel of your hand, bend the fingers at the wrist.
3. Straighten back out again.
4. Repeat as instructed by your therapist. 

Patient Diary/ Activity Log

You may find it helpful to keep a log of how often you are completing your exercises.  Your therapist will direct you as to how often is advised.  Please use the table below as needed record this.

Contact Community Neuro and Stroke Team

If you have any concerns or questions, please do not hesitate to contact us on 0300 707 4255 or 0300 707 8507.