Pain and Passive Movement

Although certain pathologies, age related changes, morphological changes and structural features of a disorder may adversely effect the restoration of functional activity, what appears to commonly frustrate the improvement of such disorders otherwise suited to physical treatment is the presence of pain.

Pain would not seem to adversely influence biological repair, except in cases where the nervous system mechanisms related to nociception are abnormal, such as in neurogenic inflammation.

However the detrimental effect of pain is the inhibitory influence and adverse effect it exerts on functional activity.  The beneficial effects of functional activity and exercise may, therefore not be realised in the presence of a disorder of pain.

If pain can be controlled by any means, particularly with pharmacology, and functional activity can then occur, exercise again should be effective.  However, pharmacology for pain relief does not always fully prevent pain associated with active movement.  Nor does exercise enable function to be restored so that a disorder will improve.

Therefore in certain pain disorders passive movement used to simulate the effects of active movement and exercise on physiology and biology becomes a valuable physical technique of treatment.

The use of passive movement as treatment can be regarded as simulating functional movement.  This may not be ordinarily possible to a variable degree due to the inhibiting effects of a disorder, especially pain, on active function.

Passive treatment technique has to be one which will replicate the actions of functional movement on pathological tissues.  Passive treatment or combinations of treatments must therefore influence musculoskeletal physiology, and therefore the affected tissues, in such a manner that a stimulus for biological repair results.

Therefore, passive treatment seems appropriate only in the absence of specific function or movement, or in the presence of aberrant active movement.

When functional activity is possible and exercise can be prescribed which will specifically influence the pathological area or cause of the disorder, the use of passive technique as treatment may not always be justified.  The beneficial effects of passive treatment when correctly prescribed and performed should always result in improved functional activity

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