Voluntary movement by the patient is in itself better than passive movement, because it not only prevents matting, but is also a potent means of preventing muscle waste, which is not greatly affected by passive movement, except when used in conjunction with methodical massage. Voluntary movement to any great extent cannot, however, be employed with safety until the fracture has become to some degree consolidated, in consequence of the strain thrown upon the fractured part; hence in the immediate and early use of movements these should be of the passive kind. The most useful movement of all is the combined passive and voluntary motion, gentle voluntary movements by the patient being aided by passive movement given by the manipulator at the same time.

The main objection to the use of voluntary movement is its liability to cause harmful movements between the ends of the fragments. This, however, is not so important a matter as at first sight may appear, excepting when the fracture involves the shaft of a long bone, and even in such circumstances careful support of the fracture area by the hand of the surgeon, or by means of a well-moulded splint during the voluntary movements of the parts below the break, is generally sufficient to prevent any harmful result. In fractures in immediate proximity to joints, and especially in intra-capsular fracture of the neck of the thigh-bone, voluntary movements are, in my experience, always beneficial, unless by chance the pain resulting from them is too acute to allow of their adoption - an exceptional occurrence.