Therapeutic Exercise: Range of Motion

what are examples of contractile tissue?

muscle and to some extent tissue

what are inert tissues?

non-contractile tissues (bone, ligament, capsule, cartilage, nerve)

what will active ROM assess?

the integrity of contractile and inert tissues (both tissues)

what will passive ROM assess?

only inert tissues

what are restrictors of joint motion?

internal derangement (loose body), arthrosis (Arthogenic), ankylosis, myofascial length (myostatic contracture), effusion, hemarthrosis, capsular (+ligament), neurodynamic lesion

what are abnormal end feels?

• springy, boggy, spasm, empty

what is the capsular pattern for the hip?

greatest loss of IR, then flexion, then equal losses of abduction and extension

what is the capsular pattern for the knee?

flexion greater than extension

what is the capsular pattern for the talocrural joint?

greater loss of plantarflexion than dorsiflexion

what is the capsular pattern for subtalar joint?

greater loss of inversion than eversion

what is the capsular pattern for the 1str MTP?

greater loss of extension than flexion

what is the capsular pattern for MTPs 2-5 and IPs?

flexion greater or equal to extension

what is the capsular pattern of the GHJ?

greater loss of external rotation, followed by abduction, then internal rotation

what is the capsular pattern for humeroulnar joint?

flexion greater than extension

what is the capsular pattern for the wrist joint?>

equal losses of flexion and extension

what is the capsular pattern of the 1st CMC joint?

greatest loss of reposition

what is the capsular pattern of the MCPs 2-5 and the PIPs?

loss of flexion greater than extension

how does stage affect ROM?

will impact how early pain occurs in the range, for example, pain occurs earlier in ROM for acute as compared to late subacute and chronic

how can ROM be used as an intervention?

to maintain joint mobility, maintain soft tissue mobility and tissue flexibiliy, avoid contracture formation, reduce pain, spasm, and effusion

when should PROM be used?

with acute inflammation, when active movement would hinder healing, and when a pt is unable to actively move.

what is the goal of PROM?

maintain mobility to prevent degredation and maintain integrity of soft tissue, joint, and muscle healing. promote healing, movement of synovial fluid, and assist in circualtion/vascular dynamics. decrese or inhibit pain, sensory input, maintain awareness of movement.

what are limitations of PROM techniques?

does not prevents muscle atrophy, increase strength or endurance. will not assist in circulation to extent of active muscle contraction

when should active ROM and AAROM be used?

when it is safe for muscle to be contracted, after immobilization, on segments above and below the immobilized segment, progress from PROM to AAROM to APROM when a strength deficit is present

what are the goals of AROM and AAROM?

maintain muscle elasticity and contractility, provide sensory feedback from muscle contraction, provide stimulus for bone and cartilage integrity, increase circulation, prevent thrombus formation, develop coordination and motor skills for functional activities.

what are the limitations of A/AAROM

will not maintain or increase strength of strong muscles, will not develop skill or coordination except in the movement patterns used (specificity of training)

what are the precautions and contraindications for ROM?

contraindications: when movement is disruptive to healing, knowledge of condition-specific resistrictions needed (post surgical)

precautions: early controlled motion beneficial in specific cases with close monitoring, adverse signs include increased pain, inflammation

what is the general procedure for ROM techniques?

• determine type of ROM

• patient set up (with position in respect to gravity, remove barriers and restrictions, gather equipment)

• therapist positioned for optimal mechanics for assistance as needed

• firm/broad grasp, supporting structures

• perform thorugh a PAIN FREE range, smooth rhythmic motion

• monitor the patient’s condition

what are the patterns of ROM?

can be in anatomical planes, through the muscle range of elongation, combined patterns, PNF patterns, functional patterns

what is continuous passive motion?

an “old school” mechanical device that moves a joint slowly and continuously through a controlled ROM- generally used post-op, with a set rom that is progressed dailu and slow rate of motion. the duration depends on the protocol and discharge is when range goal is achieved- short term benefits and bulky- better to just get up and move

What are some AAROM techniques used?

self assist or therapist assist- assistance from uninvolved side, stick/canes, ropes, straps, pulleys, surfaces, balls, skates

how can skates and powder board be utilized in AROM?

can be used to aid with the force of gravity- minimize its impact on movements

how much volume should be used for ROM?

depends, no universal standard! should work in a pain free range- though may need to modify reps, increased rest

what should documentation include for ROM?

the joint/segment, active/passive. position, equipmemt used, reps/sets