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Passive movements – lower limb

Information for patients

Spinal cord injuries building pictured from the front.

Spinal Cord Injuries

Passive movements or stretches for people with spinal cord injury

Why do we do them?

Passive movements or stretches are done with spinal cord injured patients for the following reasons:

  • Maintain joint range of movement

  • Maintain length in muscles

  • Improve circulation

While doing someone’s passive movements it is also a chance to check for any changes in the limbs such as an increase in muscle tone, changes in muscle activity and also to detect for any problems developing such as stiffening of joints or pressure areas.

There is not a lot of research supporting the use of passive stretches but based on feedback it has been found to be beneficial to patients in almost all cases.

There can also be a psychological benefit and a decrease in nerve pain for some patients when they have had passive stretches done.

How to do passive stretches

  • If a person has not had stretches for a long time it is best to check with a doctor that it is safe to start doing them. They may need to have x-rays for any osteoporotic changes and if they do have osteoporosis more care will need to be taken when performing the stretches.
  • Take care when handling the patient and do not expect to achieve full range of movement the first time you start to do their stretches.
  • Begin with smaller movements and build up to the large movements.
  • Always start with the bigger joints first, for example; hip or shoulder and work down the limb to the smaller joints such as the hands and feet.
  • Ensure the bed is at the correct height for you.
  • Ensure the patient feels safe and supported in the bed.
  • Support the joint you are moving using as small a lever as possible so you can’t cause any damage to the joint by over stretching it or use too much force during the movements.
We have included photographs of handholds for different movements at each joint. Please use these to remind yourself of the hand positions shown to you during your training with staff from the spinal unit.

Hand hold for hip and knee flexion and extension

Leg raised, hand placed under knee joint and the other hand under the heel
Leg raised, hand placed under knee joint and the other hand under the heel pushing the leg into a 90 degree angle

Hand hold for internal rotation of the hip

Leg is at 90 degrees with the hand on the knee joint and the other hand placed on the heel, and pulling outwards to rotate the hip

Hand hold for external rotation of the hip

Knee bent, one hand holding the knee joint the other hand holding the heel and rotating the hip inwards
Knee bent, one hand holding the knee joint the other hand holding the heel and rotating the hip outward

Hand hold for mobilising the knee cap.

Both hands either side of the knee joint

Hand hold for hamstring stretch

Leg raised and out straight, hand placed just above the top of the knee, the other hand under the ankle joint

Hand hold for hip abduction

Leg raised and out straight, hand placed over the top of the knee supporting under the joint, the other hand under the heel

Hand hold for plantarflexion of the foot and ankle

The foot is being gently pressed downward

Hand hold for dorsiflexion of the foot and ankle

Hand hold for inversion of the foot and ankle

Foot gently pressed to turn inwards

Hand hold for eversion of the foot and ankle

Foot is gently pressed to turn outwards

Hand hold for toe movements

The big toe is being pressed downwards

Hand hold for mobilisation of the metatarsal joints

pressure is being applied to the joints above each toe

Hand hold for toe movements

Big toe is being pressed backwards
Each toes is being pressed downwards
Each toe is being pressed inwards
Each toes is being pressed upwards

Patient experience

South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.

This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.

To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.

T: 01642 835964
E: [email protected]

The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW.
Telephone: 01642 850850
ST2055