Range of motion is a basic technique used for the examination of movement and for initiating movement into a program of therapeutic intervention. Movement that is necessary to accomplish functional activities can be viewed, in its simplest form, as muscles or external forces moving bones in various patterns or ranges of motions. When a person moves, the intricate control of the muscle activity
that causes or controls the motion comes from the central nervous system. Bones move with respect to each other at the connecting joints. The structure of the joints, as well as the integrity and flexibility of the soft tissues that pass over the joints, affects the amount of motion that can occur between any two bones. The full motion possible is called the range of motion (ROM). When moving a segment
through its ROM, all structures in the region are affected: muscles, joint surfaces, capsules, ligaments, fasciae, vessels, and nerves. ROM activities are most easily described in terms of joint range and muscle range. To describe joint range, terms such as flexion, extension, abduction, adduction, and rotation are used. Ranges of available joint motion are usually measured with a goniometer and recorded in degrees.16 Muscle range is related to the functional excursion of muscles.
Functional excursion is the distance a muscle is capable of shortening after it has been elongated to its maximum. In some cases the functional excursion, or range of a muscle, is directly influenced by the joint it crosses. For example, the range for the brachialis muscle is limited by the range available at the elbow joint. This is true of one-joint muscles (muscles with their proximal and distal attachments on the bones on either side of one joint). For two-joint or multi joint muscles (those muscles that cross over two or more joints), their range goes beyond the limits of any one joint they cross. An example of a two[1]joint muscle functioning at the elbow is the biceps brachii muscle. If it contracts and moves the elbow into flexion and the forearm into supination while simultaneously moving the shoulder into flexion, it shortens to a point known as active insufficiency, where it can shorten no more. This is one end of its range. The muscle is lengthened full range by extending the elbow, pronating the forearm, and simultaneously extending the shoulder. When fully elongated it is in a position known as passive insufficiency. Two-joint or multi joint muscles normally function in the mid portion of their functional excursion, where ideal length-tension relations exist.
To maintain normal ROM, the segments must be moved through their available ranges periodically, whether it is the available joint range or muscle range. It is recognized that many factors can lead to decreased ROM, such as systemic, joint, neurological, or muscular diseases; surgical or traumatic insults; or simply inactivity or immobilization for any reason. Therapeutically, ROM activities are administered to maintain joint and soft tissue mobility to minimize loss of tissue flexibility and contracture formation.6 Extensive research by Salter has provided evidence of the benefits of movement on the healing of tissues in various pathological conditions in both the laboratory and clinical settings.
TYPES OF ROM EXERCISES
Passive ROM
Passive ROM (PROM) is movement of a segment within the unrestricted ROM that is produced entirely by an external force; there is little to or no voluntary muscle contraction. The external force may be from gravity, a machine, another individual, or another part of the individual’s own body.8 PROM and passive stretching are not synonymous (see Chapter 4 for definitions and descriptions of passive stretching).
Active ROM
Active ROM (AROM) is movement of a segment within the unrestricted ROM that is produced by active contraction of the muscles crossing that joint.
Active-Assistive ROM
Active-assistive ROM (AAROM) is a type of AROM in which assistance is provided manually or mechanically by an outside force because the prime mover muscles need assistance to complete the motion.
INDICATIONS AND GOALS FOR ROM
Passive ROM
Indications for PROM
In the region where there is acute, inflamed tissue, passive motion is beneficial; active motion would be detrimental to the healing process. Inflammation after injury or surgery usually lasts 2 to 6 days. When a patient is not able to or not supposed to actively move a segment or segments of the body, as when comatose, paralyzed, or on complete bed rest, movement is provided by an external source.
Goals for PROM
The primary goal for PROM is to decrease the complications that would occur with immobilization, such as cartilage degeneration, adhesion and contracture formation, and sluggish circulation. Specifically, the goals are to:
- Maintain joint and connective tissue mobility
- Minimize the effects of the formation of contractures
- Maintain mechanical elasticity of muscle
- Assist circulation and vascular dynamics
- Enhance synovial movement for cartilage nutrition and
- diffusion of materials in the joint
- Decrease or inhibit pain
- Assist with the healing process after injury or surgery
- Help maintain the patient’s awareness of movement
Other Uses for PROM
When a therapist is examining inert structures, PROM is used to determine limitations of motion, to determine joint stability, and to determine muscle and other soft tis[1]sue elasticity. When a therapist is teaching an active exercise program, PROM is used to demonstrate the desired motion. When a therapist is preparing a patient for stretching, PROM is often used preceding the passive stretching techniques.
Active and Active-Assistive ROM
Indications for AROM
Whenever a patient is able to contract the muscles actively and move a segment with or without assistance, AROM is used. When a patient has weak musculature and is unable to move a joint through the desired range (usually against gravity), A-AROM is used to provide enough assistance to the muscles in a carefully controlled manner so the muscle can function at its maximum level and be progressively strengthened. Once patients gain control of their ROM, they are progressed to manual or mechanical resistance exercises to improve muscle performance for a return to functional activities. AROM can be used for aerobic conditioning program hen a segment of the body is immobilized for a period of time, AROM is used on the regions above and below the immobilized segment to maintain the areas in as normal a condition as possible and to prepare for new activities, such as walking with crutches.
Goals for AROM
If there is no inflammation or contraindication to active motion, the same goals of PROM can be met with AROM.
In addition, there are physiological benefits that result from active muscle contraction and motor learning from voluntary muscle control. Specific goals are to:
- Maintain physiological elasticity and contractility of the
- participating muscles
- Provide sensory feedback from the contracting muscles
- Provide a stimulus for bone and joint tissue integrity
- Increase circulation and prevent thrombus formation
