Active exercises require exertion to move the muscles.

This includes stretching to improve

range of motion, resistance training to build muscle mass, and aerobic exercises in which the
muscles move the body to increase the heart rate. Active exercises are also useful in
rehabilitation to develop nerve pathways and make it easier to control action. Active exercises
provide more benefits than passive exercises and are preferred in the rehabilitation process
when not contraindicated by health conditions or ability.

Passive exercises require no effort on the part of the person exercising. A helper or machine
moves the body to work the muscle. In rehabilitation programs, the goal of passive exercises
is increasing range of motion and joint function while preventing muscle stiffness and loss of
tissue . Regular passive exercise also reduces muscle spasms in some patients with
neurological damage. Passive exercises are part of the rehabilitation process for many
patients following joint replacement surgery or while recovering from stroke or paralysis.

What Are Passive Exercises?

Passive exercises are also known as passive range of motion (ROM) exercises; and your
range of motion includes how far you can move your joints in different directions. These
exercises are considered passive because you dont exert any effort. Instead, someone helps
you move your muscles and joints through their full range of motion for you.

Who Can Benefit from Passive Exercises?

Passive ROM exercises are great for stroke survivors who are left with mild to severe
paralyzation, or paresis. These exercises can help prevent muscle stiffness and spasticity a
common post-stroke side effect that results in limited coordination and muscle movement.
Along with prevention, passive ROM exercises can also be used to treat spasticity.

Stroke survivors who dont suffer from paresis can still benefit from range of motion
exercises, but its better to do them yourself through active ROM exercises.

What Are Active Exercises?

Active exercises involve your physical effort exerted into muscular activity. Active exercises
can include active range of motion, like self-stretching, or general exercises where you get
your muscles moving, like leg exercises. As long as youre doing the movements yourself,
its active exercise.
During stroke recovery, active rehab exercises help strengthen the neural pathways in your
brain that enable you to perform the movement. So the more you practice, the better youll
get.

Who Can Benefit from Active Exercises?

Stroke survivors who are looking to recover impaired movement after stroke can benefit from
active exercise. In fact, rehab exercises are the only way to regain lost movement after stroke
because you need to retrain your brain how to communicate with your muscles.

Now that you know the difference between active and passive exercises, do you feel like
your rehab regimen is properly geared to fit your capabilities? If yes, then great! If not,
then talk with your therapist to see how you can adjust your rehab exercise program.

Passive Exercises

What are passive range of motion exercises?

Passive range of motion exercises help keep a person's joints flexible, even if he cannot move
by himself. Range of motion is how far the person's joints can be moved in different
directions. The exercises help you move all the person's joints through their full range of
motion.

What do I need to know about passive range of motion exercises?

Do the exercises every day, or as often as directed by the person's healthcare

provider. Regular movement helps prevent contractures. Contractures are severely
tightened joints and muscles.

You may do the exercises in any order. You may spread the exercises out over the
course of the day. All the exercises may be done while the person lies in bed.

Move the person slowly, gently, and smoothly. Avoid fast or jerky motions.

Support the area near the joint as shown by the person's healthcare provider.
Move the person's body part with your other hand.

Each joint should be moved as far it will go. Move each joint to the point where
you feel some resistance. The person may feel discomfort, but do not push to where it
 hurts. Hold the position a few seconds, and then return the person to a resting
position.

Do the exercises on both sides. Do each group of exercises on one side, and then do
the same exercises on the other side.

Neck exercises:

Support the person's head with your hands. Gently return the person's head to the middle,
facing forward, after each exercise.

Head turns: Turn the person's head to the side. Then turn his head to the other side.

Head tilts: Tilt the person's head, bringing his ear toward his shoulder. Then tilt his
head toward the other shoulder.

Chin-to-chest: Gently bow the person's head toward his chest.

Shoulder and elbow exercises:

Support the person's elbow with one hand. Hold his wrist with your other hand.

Shoulder movement, up and down: Raise the person's arm forward and then up over
his head. Bring his arm back down to his side.

Shoulder movement, side to side: Raise the person's arm to the side as far as it will
go. Bring his arm back down to his side.

Elbow bends: Place the person's arm at his side with his palm facing up. Bend and
straighten his arm.

Arm and wrist exercises:

Support the person's wrist with one hand. Hold his fingers with your other hand.

Wrist bends: Bend the person's hand back toward his shoulder so his fingers point
toward the ceiling. Then bend his hand down so his fingers point toward the floor.

Wrist rotation: Rock the person's hand back and forth sideways. Gently roll his hand
in circles in one direction. Then roll his hand in circles the other direction.
 Palm up, palm down: Tuck the person's elbow against his side. Turn his hand so the
palm faces up toward the ceiling. Then turn his palm so it faces down.

Hand and finger exercises:

Hold the person's hand with both of your hands. Hold his hand out toward yourself, with his
fingers long.

Finger bends: Curl the fingers into a fist. Straighten the fingers again. Curl and
straighten each finger one at a time. Curl and straighten the thumb.

Finger spreads: Spread the thumb and first finger apart, then bring them back
together. Spread the first finger and middle finger apart, then bring them back
together. Do the same with the rest of the fingers.

Finger-to-thumb touches: Touch the person's fingertips to the pad of his thumb, one
finger at time.

Finger rotations: Roll each finger in a circle in one direction. Roll each finger in the
other direction. Roll the thumb in each direction.

Hip and knee exercises:

Start with the person's legs straight. Put one hand under his knee. Hold his ankle with your
other hand.

Hip and knee bends: Slowly bend the person's knee up as close to his chest as
possible. Then gently straighten the leg.

Leg movement, side to side: Move one leg out to the side, away from the other leg.
Bring the leg back to the middle and cross it over the other leg.

Leg rotation, in and out: Roll one of the person's legs toward the other leg so his
toes point in. Then roll his leg out toward the side so his toes point out.

Ankle and foot exercises:

Put a rolled towel under the person's thigh. For the ankle exercises, support the person's ankle
with one hand, and his toes with the other hand. For the toe exercises, allow his foot to relax
on the bed, and hold only his toes.
 Ankle bends: Bend the person's foot so his toes point toward the ceiling. Then bend
his foot the other direction so his toes are pointed.

Ankle rotation: Raise the person's foot slightly off the bed. Roll his foot in circles.
Then roll his foot in circles in the other direction.

Ankle movement, side to side: Tilt the person's ankle in so the sole of his foot points
toward the opposite leg. Then tilt his ankle out so the sole of his foot points away
from the opposite leg.

Toe bends: Curl the person's toes down toward the sole of his foot. Straighten them.
Curl the toes up toward the ceiling. Then straighten them again.

Toe spreads: Spread the big toe and the second toe apart, then bring them back
together. Do the same with the rest of the toes.

When should I contact the person's healthcare provider?

The person feels pain with any movement.

You cannot move the person's body, because the joints and muscles have tightened.

You have questions or concerns about the person's condition, care, or exercise
program.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may
be treated. Discuss treatment options with your caregivers to decide what care you want to
receive. You always have the right to refuse treatment. The above information is an
educational aid only. It is not intended as medical advice for individual conditions or
treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to
see if it is safe and effective for you.

Active Exercises

What are active range of motion exercises?

Active range of motion exercises help improve joint function. Range of motion is how far
you can move your joints in different directions. These exercises help you move each joint
through its full range of motion. Movement can help keep your joints flexible, reduce pain,
and improve balance and strength.

What do I need to know about active range of motion exercises?

Do the exercises your healthcare provider teaches you. Practice the exercises with
your healthcare provider before you try them by yourself. Exercise every day, or as
often as directed by your healthcare provider.

Do the exercises in the same order every time. Go from head to toe, to help you
remember the series of moves. Start with neck stretches. Then exercise other body
parts in order, moving toward your feet. Do each group of exercises on one side, and
then do the same exercises on the other side.

Move slowly, gently, and smoothly. Avoid fast or jerky motions.

Stop if you feel pain. It is normal to feel some discomfort at first. Regular exercise
will help decrease the discomfort over time.

Neck exercises:

Starting position: You may sit or stand. Face forward. Your shoulders should be straight and
relaxed.

Head tilts, forward and back: Gently bow your head and try to touch your chin to your
chest. Raise your chin back to the starting position. Tilt your head back as far as
possible so you are looking up at the ceiling. Return your head to the starting position.

Head tilts, side to side: Tilt your head to the side, bringing your ear toward your
shoulder. Return your head to the starting position.

Head turns: Turn your head to look over your shoulder. Tilt your chin down and try to
touch it to your shoulder. Do not raise your shoulder to your chin. Face forward again.
Shoulder and elbow exercises:

Starting position: Stand or sit. Hold your arm straight down at your side. Face palms in
toward your body. It is best to use a chair without arms if you are in a sitting position.

Shoulder movement, up and down: Raise your arm forward and then up over your
head. Try to raise it so that your inner arm touches your ear. Bring your arm back
down to your side. Bring it back as far as possible behind your body. Return your arm
to the starting position.

Shoulder movement, side to side: Raise your arm to the side and then up over your
head as far as possible. Return your arm to your side. Bring your arm across the front
of your body and reach for the opposite shoulder. Return your arm to the starting
position.

Shoulder rotation: Raise both shoulders up toward your ears, as if you were trying to
shrug. Lower them to the starting position, and relax your shoulders. Pull your
 shoulders back. Then relax them again. Roll your shoulders in a smooth circle. Then
roll your shoulders in a smooth circle in the other direction.

Elbow bends: With your palm facing forward, bend your elbow. Try to touch your
shoulder with your fingertips. Return your arm to the starting position.

Arm and wrist exercises:

Starting position: Sit down. Bend your elbow and rest your forearm on a flat surface, such as
a table or your lap. Make sure your wrist hangs loosely over the side.

Wrist bends: Bend your hand back toward your wrist so that your fingers point toward
the ceiling. Then bend your hand down so that your fingers point toward the floor.
 Wrist rotation: Move your hand from side to side. Then roll your hand in circles in
one direction. Roll your hand in circles in the other direction.

Palm up, palm down: Stay in the same position, but tuck your bent elbow against your
side. Face your palm down. Turn your palm so that it faces up toward the ceiling.
Then turn your palm so it faces down.

Hand and finger exercises:

Starting position: Sit or stand. Place your hand out in front of you.

Finger bends: Make a tight fist. Then open and relax your hand.
 Finger spreads: Open your hand and stretch the fingers as far apart as possible. Bring
your fingers together again.

Finger-to-thumb touches: One at a time, touch each fingertip to the pad of your
thumb.

Thumb-to-palm stretches: Move your thumb and rest it across your palm. Move it out
to the side again.
Hip and knee exercises:

Starting position: If you have had a hip injury or surgery, only do the hip exercises directed
by your healthcare provider. Lie flat on the bed with your legs flat and straight.

Hip and knee bends: Point your toes. Slowly bend your knee up as close to your chest
as possible. Straighten your leg and return it to a flat position on the bed.

Leg lifts: Raise your leg so that your foot is 6 to 12 inches (15 to 31 centimeters) off
the bed. Hold it in the air. Return your leg to the bed.
 Leg movement, side to side: Flex your foot so your toes point up toward the ceiling.
Move your leg out to the side as far as possible. Bring your leg back to the middle.

Leg rotation, in and out: Put your leg flat on the bed. Roll your leg toward the middle
so your big toe touches the bed. Then roll your leg out and try to make your smallest
toe touch the bed.

Knee rotation, in and out: Lie on your back on the bed. Bend your knee so the bottom
of your foot is flat on the bed. Slide your heel towards your buttocks. Return your foot
to the starting position.

Ankle and foot exercises:

Starting position: Sit in a chair with both feet flat on the floor.

Ankle bends: Keep your toes on the floor and raise your heel as high as you can.
Lower your heel. Then keep your heel on the floor and raise your toes as high as you
can.

Ankle rotation: Raise your foot slightly off the floor. Roll your ankle in circles. Then
roll your ankle in circles in the other direction.
 Toe bends: Curl your toes down toward the sole (bottom) of your foot. Straighten
them. Curl them up toward the ceiling. Then straighten them again.

Toe spreads: Spread your toes apart. Bring them together again.

When should I contact my healthcare provider?

You feel pain when you do active range of motion exercises.

You have questions or concerns about your condition, care, or exercise program.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may
be treated. Discuss treatment options with your caregivers to decide what care you want to
receive. You always have the right to refuse treatment. The above information is an
educational aid only. It is not intended as medical advice for individual conditions or
treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to
see if it is safe and effective for you.
Active vs Passive

Your active and passive range of motion may be very different, not only from each other, but
also at the joints themselves. Active range of motion means you move a joint through its
range of motion, or ROM. Passive range of motion involves someone else moving a joint for
you. Anytime you are moving your body, you are using active ROM. An example of passive
ROM is if a doctor is testing a joint, such as the shoulder, and is moving it for you without
your assistance.

Importance of Each

Active ROM is what you work with everyday and tends to be the type of ROM that concerns
most people. If you have limited active ROM, you may have trouble lifting your arms
overhead for exercising or putting away groceries, for example. It could also limit
performance during sporting activities and thus increase the chance of injury. Passive ROM is
not a concern for everyone, however. It is significant if you have a long-term or permanent
change to your body, such as being in a wheelchair. You may not be able to move your joints,
but having a nurse or therapist do it for you helps maintain ROM and can reduce pain or
dysfunction. It is also used a lot for physical therapy if you have an injury.

How to Improve ROM

Active and passive ROM can be improved through stretching and even strengthening
exercises. Dynamic stretches, such as arm circles, or pulling one knee at a time to your chest
in a standing position, take strength and flexibility. It is good for warming up before a sport
performance or exercise. Static stretches where you hold a stretch can improve both active
and passive ROM. These are the stretches you do after a workout when your muscles are
warmed up. Holding a stretch 15 seconds or longer can show greater improvements to your
active ROM than shorter stretches, according to researchers from School of Health Sciences,
University of Sunderland, United Kingdom, who published a study in the "British Journal of
Sports Medicine."

Factors Affecting ROM

There are many factors that can affect both active and passive ROM. Your lifestyle is a major
contributing factor. If you are sedentary, or perform repetitive tasks throughout the day, you
may have limited ROM. Injury or a chronic condition, such as arthritis, could also affect both
active and passive ROM. Your body size can also limit ROM. If you are overweight, excess
skin and fat could impede your movement. As you lose weight, however, you will notice that
both active and passive ROM improve.

Main Difference Active vs Passive Range of Motion

The range of motion (ROM) in physics is defined as the linear or angular distance traveled by
a moving object while being properly attached to another object. But when it comes medical
terms, the definition involves the distance and direction a joint can move between the flexed
and extended positions (movement around a joint).This basically depends on the muscle
strength and flexibility.

Reduction of this range of motion is referred to as limited range of motion and is

particularly seen as a result of a mechanical problem with a specific joint or conditions like
osteoarthritis, rheumatoid arthritis, etc. Inflammatory signs of these diseases can lead to pain,
swelling, and stiffness associated with a limited range of movements.

Active and passive range of motions are two types of exercises which supports to increase the
range of motion to a healthy level while reducing associated inflammatory signs. The main
difference between active and passive range of motion is the fact that active range of
motion is carried out by the patient himself whereas passive range of motion is carried
out by a physiotherapist.
What is Active Range of Motion

This is a type of exercise where the patient himself carries out all the necessary activities, and
movements without any assistance and the physiotherapist will provide guidance through
verbal clues.

Furthermore, the physiotherapist will observe how the movements are being done in order to
identify any possible dysfunctions or weaknesses in the joints. He will also document the
improvement of the individual and his condition.

As far as the advantage of this method is considered, the patient himself will be able to
increase the strength of his muscles and flexibility of joints, thereby identifying his
improvement and overall capacity.
What is Passive Range of Motion

This particular type of exercise is practiced on a joint which is found to be inactive; the
patient does not try to do any movement, and therapist himself stretches the soft tissues in
patients body, kept in a relaxed position.

Physiotherapists are the health care professionals who engage in this therapy, and passive
ROM is usually used to help paralyzed patients individuals who are unable to mobilize a
specific joint following a road traffic accident, etc.

This entire performance will be helpful to identify the degree of the limited range of
movements, dysfunctional areas of the body, improvement of the condition and possible
complications such as immobility and muscle atrophy.

Passive ROM will prevent the occurrence of stiffness and further limitation of movements.
Difference Between Active and Passive Range of Motion

The main difference between active and passive range of motion is the fact that Active ROM
is carried out by the patient himself whereas Passive ROM is carried out by a
physiotherapist.

The selection of Active ROM and Passive ROM on a patient is usually decided by factors
such as patients overall mobility and medical requirements.

For example, a patient who is trying to identify the extent of their injury and course of
recovery will be captivated by Active ROM whereas a patient who is partially or completely
paralyzed or has a permanently disable limb will proceed with passive ROM.

However, it is important to carry out one of these in order to ensure an adequate blood supply
and to increase the muscular strength.