Classification & Therapeutic Application
ACTIVE EXERCISES
(there is voluntary muscle contraction)
1) Active Free Exercise (AROM)
What: Patient moves the joint through available range without external assistance or
resistance (other than gravity).
Goals: Maintain/improve joint ROM, neuromuscular control, circulation; prevent stiffness;
begin motor relearning.
Indications: Post-immobilization stiffness (pain controlled), early rehab when MMT
≥ 3/5 (can move against gravity), deconditioning.
Examples: Shoulder flexion in sitting; heel slides; ankle pumps; wall slides with just limb
weight.
Dosage (guide): 1–3 sets × 10–15 reps, smooth tempo, pain-free range, 1–2×/day early.
Precautions: Pain, inflammation—reduce range; avoid substitution/cheating.
2) Active Assisted Exercise (AAROM)
What: Patient initiates and contributes to movement, but gets help from therapist, other
limb, strap/stick, pulley, or gravity to complete the range.
Goals: Bridge from PROM to full AROM; re-educate movement pattern; reduce effort
when strength < 3/5 or when pain/fatigue limits range.
Indications: Early post-op rotator cuff, post-stroke with partial voluntary control, severe
weakness (MMT ≈ 2–3−/5).
Examples:
Pulleys for shoulder elevation; wand (stick) exercises.
Therapist-assisted knee flexion after TKA.
Gravity-eliminated planes (e.g., hip abduction in supine with sheet support).
Dosage (guide): 1–3 sets × 8–12 reps, slow, emphasize patient effort and correct
pattern; rest as needed.
Precautions: Do not “over-assist”; cue patient to work as much as possible.
3) Resisted Exercise (ARROM/Strength training)
What: Patient moves against added resistance (manual, elastic bands, weights, machines,
isokinetic).
Goals: Hypertrophy, strength, endurance, power; tendon/ligament capacity; bone density;
function.
Indications: When MMT ≥ 3/5 (can control against gravity) and tissue healing allows load.
Types:
Manual resistance (therapist).
Mechanical: dumbbells, cables, bands.
Modes: Isometric, isotonic (concentric/eccentric), isokinetic.
Chains: Open vs closed kinetic chain.
Dosage (typical):
Strength: 60–80% 1RM, 6–12 reps, 2–4 sets, 48 h between sessions.
Endurance: ≤50% 1RM, 15–25+ reps, short rests.
Early tendon: slow tempo, emphasize eccentrics as tolerated.
Contra/Precautions: Acute inflammation, uncontrolled pain, post-repair early
phases, unstable angina/HTN—monitor vitals.
PASSIVE EXERCISES
(there is no voluntary contraction in the target muscles)
1) Relaxed Passive Exercise (PROM)
What: External force (therapist, other limb, strap, gravity, CPM) moves the joint
through available pain-free range; patient stays relaxed.
Goals: Maintain joint mobility & capsule glide; prevent contracture/adhesions; pain
modulation; assist circulation (without increasing strength).
Indications: Coma/ICU, flaccid paralysis, immediately post-op when active motion is
restricted, acute pain where AROM is not tolerated.
Examples: Therapist-performed shoulder PROM; CPM after knee surgery; ankle PROM in
bed-bound patients.
Dosage (guide): 1–3 sets × 10–15 slow repetitions per joint or 30–60 s gentle oscillations at
end-range (Grades I–II for pain).
Contra/Precautions: Unstable fractures, DVT in the limb, acute infections, recent grafts
with motion restrictions—follow protocol.
2) Forced Passive Exercise (End-range Overpressure / Passive Stretching)
What: External force takes the joint to end-range and gently beyond the current passive
limit to lengthen soft tissues (capsule, muscle-tendon, fascia). Patient remains relaxed.
Goals: Increase ROM; remodel shortened tissues; correct contracture; improve
arthrokinematics.
Indications: Capsular tightness (adhesive capsulitis), post-immobilization stiffness, chronic
muscle shortening.
Techniques:
Prolonged static stretch (30–60 s × 3–5 reps; or low-load long-duration 5–15 min with
splints/weights).
Joint mobilization Grades III–IV (sustained/large-amplitude end-range).
Contra/Precautions (important): Recent repair (tendon/ligament/capsule), acute
inflammation, bony block, hypermobility/instability, severe osteoporosis, severe pain
—do not use. Progress slowly; watch for post-stretch soreness >24 h.
How to Choose (simple pathway)
PROM (relaxed passive) → when no active control or active motion is contraindicated.
AAROM (assisted) → when some voluntary contraction exists but insufficient to complete
the range or against gravity.
AROM (free) → when patient can move through range against gravity without help.
Resisted → when quality AROM is present and tissue can tolerate load to build capacity.
Forced passive → when primary goal is to increase ROM after stiffness/contracture and it’s
safe to stretch.
