1 - Range of Motion

Range of motion (ROM)

The amount of motion a joint has

What is range of motion dependent on?

Dependent on:

• Muscle, joint surfaces, capsules, ligaments, fascia, vessels, and nerves

• Intact CNS

• Frequent movement

What is the purpose of ROM?

• Maintain joint and soft tissue mobility

• Decreases loss of flexibility

• Decreases development of contractures

• Possibly assists with healing of tissue

What are the indications for doing ROM?

• Preserve and maintain ROM

• Minimize contracture formation

• Stimulate bone and joint tissue integrity

• Increase circulation and prevent thrombus formation

• Promotes awareness of joint motion

• Inhibits or reduces pain

• Enhances cartilage nutrition

• Develops coordination and motor skills for functional activities

What are precautions and contraindications for ROM?

• If it inhibits healing

• Acute tears, fractures, and surgery

• After MI, CABG, PTCA

• If it causes sudden or significant increased pain and inflammation

• If it causes sudden pain or inflammation

• Unstable fracture or joint (displacement or dislocation)

Functional excursion (range of muscle)

The distance a muscle is capable of shortening after it has been elongated to its max (does no apply when it crosses 2 joints)

Active insufficiency

The point at which a muscle cannot shorten anymore

Passive insufficiency

The point at which a muscle is completely elongated

Passive range of motion (PROM)

• The patient does not assist at all with the movement

• The therapist or a piece of equipment is moving the limb through the available range

• Used for: acute, inflamed tissue, when a patient cannot move themselves, preparation for stretching, and assessing muscle flexibility, elasticity, and tone

What are the goals for PROM?

• Decrease complications of immobility

• Maintain joint and connective tissue mobility

• Decrease effects of contractures

• Maintain muscle elasticity

• Decrease pain

• Enhances synovial flow to nourish cartilage

• Improve pt’s awareness of movement

• Assists in healing

What are limitations of PROM?

• Does not prevent muscle atrophy

• Does not increase strength or endurance

• Does not increase circulation enough like an active voluntary muscle contraction does

Active- Assistive ROM (AAROM)

The therapist is helping the pt move through their ROM

When would you use AAROM?

Used when:

• A patient is weak and can’t move through the needed range (usually against gravity)

• Assist patient in moving through part or full range when there is a precaution or restriction

Active ROM (AROM)

A patient can move through the range without any help

When would AROM be used?

Used when/to:

• A patient is strong enough to move without assist

• When a joint has to be immobile for a time, AROM can be done to move the parts above and below to maintain ROM

• Used for aerobic conditioning

• Relieve stress or pain from being in the same position for too long

What are goals for AROM and AAROM?

• Same as PROM

• Sensory feedback for contracting muscle

• Provide stimulation for bone and joint tissue integrity

• Increase circulation and prevent thrombus formation

• Develop coordination in the chosen activity

• Develop motor skills for function activities

What are limitations to AROM and AAROM?

• Does not maintain or increase strength to muscles that are already strong

• Does not develop skill or coordination except in the movement pattern used

Self ROM

• The patient moves his/her own weak or non-functioning body part by using his other limb that is strong to move through the ROM

• Used to get patient involvement in treatment and protect the healing tissues

How do you instruct self-assisted ROM?

• Educate on the purpose and value of the motion

• Teach the patient correct body alignment and movement

• Ensure patient safety, observe, and provide feedback

• Give handouts on the motions with # for reps, etc.

Pendulum exercises (Codman’s Exercise)

• The patient’s arm will swing like the pendulum of a clock while leaning on a table with their unaffected arm

• Used to flex/ext, abd/add, circumduction

Continuous Passive Motion (CPM)

The use of a machine to move a joint through a set range of motion in a smooth and continuous fashion

Resistive ROM (RROM)

A resistive force is applied manually by the therapist