Physical Therapy Technician Protocol:

Passive Range of Motion

Level 1

Technical Skill

Prerequisites

Physical Therapy Technician Knowledge Protocols

AnatomyCanine Biomechanics & Gait

Benefits of Passive Range of Motion (PROM)

RelaxationDecreases painPrevents joint contracturePrevents adaptive muscle shorteningEnhances blood and lymphatic flowImproves synovial fluid production and diffusionImproves rate of recoveryMaintains mobility of the soft tissue layers

Joint Contracture

Permanent shortening of a muscle, resulting in decreased range of motion of a joint, due to spasticity, ischemia, or prolonged immobility.

Adaptive Muscle Shortening

When a muscle is shortened for a prolonged period of time, it loses sarcomeres and loses length permanently, resulting in joint contracture.

Passive Range of Motion

•PROM occurs when a joint is moved through its range of motion WITHOUT the patient's muscular contraction or effort.•The motion occurs due to external force applied with the hands of the therapist, technician, or owner.•PROM occurs at the joint, while stretching is performed to the muscle. (Stretching will be discussed in detail in a subsequent protocol.)

Indications for PROM

Immediately post-operatively.Within the range of

motion and in the directions that are “safe” based on the surgical procedure.

Immobile patients, especially those prescribed crate rest.

Paretic or paralyzed patients.

Contraindications for PROM

Unstable or unstabilized fractures.

Unstable ligament or tendon injuries.

Pain due to PROM.

Method for PROM•The patient should be relaxed.•Be gentle.

– Your hands relay your level of stress, anxiety, or relaxation to the patient.

•Support the bones proximal and distal to the joint.– One hand is above and one hand is below the

joint that is passively moved.– Consider the length of “lever arms” and keep

your hands comfortably close to the joint.•Avoid handling painful areas such as wounds or incisions.•The motion should be slow, smooth, and steady.•Watch the patient for signs of discomfort.

Patient Positioning for PROM

•Sidelying or laterally recumbent– This is the optimal position for both you and the

patient.– Position yourself behind the patient, if possible,

for most efficient body mechanics.•Standing– For fractious, nervous, or dominant dog, this

may be the only option.– Be sure to support your patient's body when

performing standing PROM as he/she will be balancing on three legs.

PROM of the Carpus

Allow the elbow and shoulder to be flexed and relaxed.

Hold above the carpus and below on the paw.

Flex and extend gently for 10 repetitions.

PROM of the Elbow

Allow the carpus and shoulder to be flexed and relaxed.

Hold above the elbow on the brachium and below on the antebrachium.

Flex and extend gently for 10 repetitions.

PROM of the Shoulder

Allow the elbow and carpus to be flexed and relaxed.

Hold at the shoulder blade/scapula or body and below at the elbow.

Flex and extend gently for 10 repetitions.

PROM of the Tarsus

Allow the hip and stifle to be flexed and relaxed.

Hold above the tarsus and below on the paw.

Flex and extend gently for 10 repetitions.

PROM of the Stifle

Allow the hip and tarsus to be flexed and relaxed.Hold above the stifle on the femur and below on the tarsus.Flex and extend gently for 10 repetitions.You might notice that the hip and stifle move at the same time.

PROM of the Hip

Allow the stifle and tarsus to be flexed and relaxed.

Hold at the back or pelvis and at the stifle.

Flex and extend gently for 10 repetitions.

PROM Procedure

Invite the patient to lie down and relax.Give positive feedback and prepare, relax, or distract the patient through:

Petting or massage.Treats.Toys for distraction.

Position your body and your hands.Perform PROM to the prescribed joint(s) for at least 10 slow repetitions to each joint.