Passive Movements
Movements produced by an external force when muscles are not able to perform movement voluntarily. The external force can be mechanical or manual.
Classification of Passive Movements

• Relaxed Passive Movements
  These are the movements performed accurately & smoothly by the physiotherapist. The joint is moved through a free range with limits of pain.
• Mobilizations
  There are small, repetitive oscillatory movements performed by the physiotherapist within the available range and under the patient’s control. This can be done very gently or quite strongly.

Effects of Joint Mobilization

• Moves the synovial fluid which brings the nutrients to the avascular articular cartilage of the joint surfaces.
• Maintain the tensile strength of articular & periarticular tissues. With immobilization, there are biochemical changes in tendons, ligaments & joint capsule tissue which causes joint contractures, and muscle weakness.

Indications of Mobilization

• Painful Joints.
• Muscle Spasm. Contra Indication.
• Non–functional joint.

Contra Indications

• Hyper mobile joints.
• Inflammation in the joints.
• Neurosis of the ligaments.
• Joint effusion.
• Bleeding in the joints e.g., hemophilia.

3) Stretching
It is a therapeutic maneuver designed to lengthen pathologically shortened soft tissue structures to increase the range of motion.
Effects of Stretching

• To regain normal range of motion of joints & mobility of soft tissues that surrounds a joint.
• To prevent contractures.Stretching.
• To increase the flexibility of the part of body.
• To prevent or minimize the risk of musculotendinous injuries.

Indications of Stretching

• When range of motion is limited as a result of contractures, adhesions, and scar tissue formation leading to shortening of muscles.
• When limitations may lead to structural deformities.

Contraindications

• After a recent fracture.
• Acute inflammation in tight tissues.
• Acute pain with joint movement.
• Haematoma.

Types of Stretching

1. Passive Stretching
   The therapist applies the external force & controls the direction, speed, intensity & duration of the stretch to the soft tissues that have caused the contractures of the joint. Passive stretching takes the structures beyond the free range of motion. The stretch force is applied for 6–8 seconds & repeated several times in an exercise session. The intensity & duration of the stretch are dependent on the patient’s tolerance & the therapist’s strength & endurance.
2. Active Inhibition
   In this structure, the patient relaxes the muscle to be elongated prior to or during the stretching maneuver. When a muscle is relaxed (inhibited), there is minimal resistance to elongation of the muscle. Active Inhibition techniques relax only the contractile structures within muscle, not connective tissues. This type of stretching is possible only if the muscle.
3. Self Stretching
   The patients carry out this technique themselves. Patients may passively stretch out their own control be elongated is normally innervated & under voluntary control. It cannot be used in patients with severe muscle weakness, spasticity or paralysis by using their body weight as the stretch force. This technique is carried out as an important aspect of home exercise program. Educating the patient to safely carry out the self–stretching procedures at home is important for prevention of re–injury.

Active Movements
The movements performed or controlled by voluntary action of muscles, working in opposition to an external force.