OVERVIEW.

PROM is motion produced by an external force, without voluntary contraction, and within an unrestricted portion of a joint.¹ One of its chief purposes is to maintain (not increase) joint mobility.

SUMMARY: CONTRAINDICATIONS AND PRECAUTIONS.

Four sources list a common contraindication.^1–4 PROM is contraindicated if it disrupts healing (i.e., condition intensifies). Complications from PROM are reported below and include (1) fractures/dislocations—in often fragile bone, (2) autonomic dysreflexia—in spinal cord patients, and (3) heterotopic ossification. In addition, overly vigorous techniques may have led to fractures in cases where family members or lay people administer PROM to infants.

Note: It is not always clear in the harm literature whether the injurious technique in question (often referred to as “passive”) was truly that or perhaps a more forceful technique (i.e., stretching) (also see Mobility testing; Devices; AROM section; Stretching).

OVERVIEW.

Passive stretching is a therapeutic maneuver that involves applying an external manual or mechanical force to a passive patient.¹ The purpose is to lengthen shortened soft tissue in order to increase range of motion.

SUMMARY.

Eight sources contributed to a total of 28 concerns for stretching. The largest percentage of concerns was procedural and musculoskeletal. Three sources (two PTs and one MD/PT) were concerned about stretching recent fractures, osteoporotic bone tissue, or contractures, which would result in loss of function or stabilization. Stretching-related fractures (osteoporotic bone), soft tissue ruptures, graft ruptures, and autonomic dysreflexic responses (in persons with spinal cord injuries) have been reported in the literature (see below).

Note: Adverse events attributed to passive ranging in the literature may (possibly) reflect a more aggressively performed stretching technique (also see Passive Range of Motion).