Active vs. passive range of motion

The difference between active and passive range of motion is easy for surgeons and physical therapists to understand, but is often unclear to patients. 

Distinguishing between these two motions is crucial to properly rehabilitate certain surgeries, especially for a rotator cuff repair.  Although I do my best to demonstrate each motion, and patients usually voice understanding, it is common for them to then demonstrate that they do not indeed understand. 

Active range of motion is what we normally do all day every day. Our body normally functions using a coordinated series of active motions. This motion is controlled by muscles. Muscles cross joints, which are where bones meet and move relative to each other. When a muscle contracts, a joint moves. This is active range of motion. 

Passive range of motion much less common in our normal daily activities. It requires a person to relax and allow their joint to be moved by an outside force. This force could be gravity, or another person (like a physical therapist), or a machine (like a stretching brace, or pulley).

 The rotator cuff is a commonly injured tendon. Repairing rotator cuff tears makes up a large part of my practice. I perform this surgery using an arthroscope, and it takes about an hour for me to repair the average rotator cuff tear. Patients usually go home the same day, wearing a special brace to protect the repair. 

This is where the hard work begins for the patient. 

Rehabilitating a repaired rotator cuff takes time, involves discomfort, and is not fun. It is also crucial to do it properly. Improperly rehabilitated rotator cuff repairs could result in problems. Inadequate stretching (passive range of motion) could cause stiffness. Too much active range of motion, too soon, could cause the repair to fail. 

I recommend thinking about rotator cuff rehabilitation as a sequence of 3 main phases:

1. Passive range of motion only- This is for the first 8 weeks after surgery.
2. Active range of motion- This begins about 8 weeks after surgery.
3. Strengthening- This begins 12 weeks after surgery. 

It is very difficult to completely relax while someone, or something else moves your shoulder. Try to imagine your shoulder is paralyzed. Allow your arm to hang relaxed by your side. Then bend forward at your waist allowing your arm to swing away from your body under the influence of gravity . Keep bending at your waist as far as you can. At this point your arm will be hanging straight down, almost like you are trying to touch your toes or the floor in front of you. Now slowly stand up allowing your arm to gradually return to your side. Try to keep the arm completely relaxed throughout the entire motion. When you are standing upright again and your arm is at your side you are done. Congratulations. You just properly performed a basic passive range of motion exercise. 

In an upcoming post I will upload a video demonstrating this basic passive range of motion maneuver and a sequence of increasingly complex passive exercises. After this I will demonstrate active range of motion exercises.