Active vs Passive Tightness

This is the basis of a conversation I’ve had with many patients recently.

When examining a patient, it’s important to look at active and passive movements: how they move, and whether they have the potential to move better.

Let’s use the hips as an example. On active examination, we would ask a patient to flex their hip (lift your knee as high as you can), as well as to extend, abduct, adduct and rotate it. We would then lie them down on an examination table and reproduce those movements, but this time we’re doing the moving for them.

  • On active examination, we would ask a patient to flex their hip (lift your knee as high as you can), as well as to extend, abduct, adduct and rotate it. We would then lie them down on an examination table and reproduce those movements, but this time we’re doing the moving for them.
  • We would then lie them down on an examination table and reproduce those movements passively; i.e. this time we’re doing the moving for them.

By this point, we might have watched them moving under their own steam and thought, “Gee, that looks like hard work. Are they stiff? Or weak? Or are they struggling to control themselves?”.

We’d reserve judgement until we’ve examined them passively, and the first thing we look for is CAN they do the movement? By this I mean can the joint move to where we’d expect it to go? If they lack the mobility they are stiff, and this probably needs to be addressed first before thinking about control and strength. You’ve got to have it before you can control it; you’ve got to control it before you can strengthen it.

When we find a stiff joint, we have to consider whether the stiffness we’ve found is active or passive. (Yes, I know, we’ve used those words before, but there’s good reason to keep them around.)

By passive stiffness, we are talking about arthritic joints that have become relatively hypomobile through degenerative changes to the joint surfaces. Not necessarily a nasty thing, but it needs to be noted, and there might not be a lot of potential for improvement.

By active stiffness, we are talking about muscles that are perhaps protecting a joint, and are preventing the bones from moving through their full arc of motion. This might require stretching: tight glutes, for example, will prevent hip flexion. It might also be that the patient is in a state of tension, caused by stress or anxiety, caused by the injury or perhaps

It might also be that the patient is in a generalised state of tension, caused by stress or anxiety. This might be a result of the injury or perhaps not, and this needs to be tackled in order for the muscles to release and allow full motion through the joint. This might mean breathing exercises are useful, and there could be other movements that the patient can practice in order to de-threaten the part of the body that is causing their anxiety.

If this is of interest, there are two further blogs that I think are worth reading:

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