Examine the joints carefully and ask appropriate questions. If any of the following conditions are present then the treatment should not be carried out.
Bone fractures: avoid working on the affected limb until healing is complete; the other unaffected limbs can be treated.
Swelling of the joint: swelling may indicate some damage to the joint and passive movements are contra-indicated. However, if there is no damage, swelling around the ankles may be due to an accumulation of tissue fluid: passive movements combined with massage can then be carried out to improve this condition.
Hot or painful joints: these signs indicate that pathological changes are occurring in the joint.
Recent or active arthritic conditions: the joint will usually be hot, stiff and swollen.
Open wounds, cuts and abrasions near the joint: risk of increasing the bleeding; risk of infection and blood contamination.
Bruising around the joint: risk of further bleeding; healing must be complete before commencing treatment.
Recent sprains of the joint: healing must be complete before commencing treatment.
Recent strains of any muscle around the joint: healing must be complete before commencing treatment.
Recent scar tissue: there is a danger of breaking down scar tissue. However, when the scar is completely healed (after about six months) passive movements may help to stretch it.
Spasticity in the muscles, i.e. muscles with increased tone: pulling against spastic muscles may increase the spasticity.
Metal pins or plates within a joint or within the bones forming the joint: these will have been inserted to stabilise the joint or bone following trauma. There is the risk of displacing or loosening these pins.
Thrombosis or phlebitis: these conditions are explained in Chapter 3. Although the muscles are not actively contracting during passive movements, the alternate stretch and release of the muscles acting on the joint may be sufficient to dislodge a blood clot from the vein wall, releasing it into the blood stream. The clot may then be carried to a vital organ such as the lungs where it may cause a blockage of the blood supply with potentially fatal consequences.
Skin infections and very fragile skin: there is a risk of spreading an infection and also of cross-infection. If the skin is very thin and fragile, great care must be taken to avoid splitting or causing open sores.
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