Range of Motion(ROM) Flashcards
What is Range of Motion?
The angle through which a joint moves from the anatomicposition to the ends of its motion in a particular direction
It is measured in degrees
Each joint has a normal range of motion
Factors affecting ROM
Age, Sex/Gender
Injury
Anatomical variations – genetic and developmental differences in joint shape, bone size, muscle, ligament and fascia or nerve supply can drastically affect ROM
Lifestyle- sedentary vs Yogi
The shape of the bones that form the joint
The tautness or laxity of the ligament and capsule structure of the joint
The length of the soft tissue structure that supports and moves the joint
Whether the joint moves independently of other joints(open chain – distal body part moves) or is linked to other joints in a combined movement (closed chain – proximal body part moves around a planted limb
Barriers/Limits to ROM
Anatomical- the farthest the joint can move structurally. This barrier is never reached because of risk of injury to the joint
Physiological– normal barriers/Soft and Pliable END FEELS to ROM
Pathological- An adaptation in a physiologic barrier that causes the protective function to limit ROM. Often are manifested as stiffness, pain or a “catch”
Active ROM
The amount of joint motion attained during unassisted voluntary joint movement
Client moves body part themselves
AROM is important to get a baseline of function and reassess throughout treatment
AROM can be limited by pain of CONTRACTILE tissues (muscles & fascia) or INERT/NON-CONTRACTILE tissue (ligaments, joint capsules, bursa)
Inert tissue in not contractile or neurological
If AROM is easy and painless, further testing is probably not needed
If AROM is limited, painful or awkward, additional testing is needed
Capsular Patterns
Patterns of limitation or restriction are expected but can be present during pathologies
If the capsule of the joint is affected, there will be an expectedpattern of limitation
This pattern is the result of a total joint reaction
Only joints that are controlled by muscles have a capsular pattern, joints such as the sacroiliac and distal tibiofibular joints do not exhibit a capsularpattern
Passive ROM
Movement done by practitioner without client assistance – involuntary joint movement - slight overpressure is added to obtain end feel
PROM is normally greater than AROM
PROM provides info about joint capsules, ligaments, fascia, nerve tension, muscles and articular surfaces
PROM is primarily performed to determine the available anatomical ROM and end feel
The passive movements may be within normal limits, hypermobile or hypomobile
The therapist puts the joint through its ROM while the patient is relaxed
These movements may also be referred to as anatomical movements
The end of passive movement is sometimes referred to as the anatomicalbarrier
END FEEL
(The sensation the therapist “feels” in the joint as it reaches the end of the ROM)
Normal End Feel/ Physiological – PAIN FREE
1. TISSUE STRETCH – hard/firm quality with a slight give, movement limited by tension in musclefascia (cervical lateral flexion)
2. LIGAMENTOUS – hard/firm, limited by tension in ligaments (kneeextension)
3. SOFT TISSUE APPROXIMATION – squeezing quality,soft tissue compressionprevents further motion (elbow flexion)
4. BONE TO BONE – hard, non-giving (elbow extension)
Pathological /Abnormal End Feels
BONE TO BONE – painful, hard (osteophytes, ankylosis).
MUSCLE SPASM – abrupt, painful, guarded or splinting feel caused by movement (apprehension, instability or trauma).
CAPSULAR – firm, leathery, decreased ROM with pain but not spasm (adhesions, capsulitis, scar tissue)Seen in more chronic conditions. The limitation comes on rather abruptly after a smooth, friction-free movement.
BOGGY – spongy end feel from diffuse swelling edema.More often seen in acute conditions with stiffnessoccurring early in the range and increasing until the end of range is reached.
SPRINGY BLOCK – bounce and spring in joints with menisci (knee internal derangement/meniscal tears) Rebound effect that occurs earlier than expected.
EMPTY - did not complete,client stops the test before the end range is felt.
ROM to remember
Cervical Spine ROMQ
Flexion: 80-90
Extension: 70
Side Flexion: 20-45
Rotation: 70-90
GH ROMQ
Flexion: 160-180
Extension: 50-60
Abduction: 170-180
Adduction: 50-75
External Rotation: 80-90
Internal Rotation: 60-100
Horizontal Abd/Adduction: 130
Elbow ROM
Flexion: 140-150
Extension: 0-10
Supination: 90
Pronation: 80-90
Wrist ROM
Flexion: 80-90
Extension: 70-90
Radial Deviation: 15
Ulnar Deviation: 30-40
Thoracic Spine ROM
Flexion: 20-45
Extension: 25-45
Side Flexion: 20-40
Rotation: 35-50
Hip ROMQ
Flexion: 110-120
Extension: 10-15
Abduction: 30-50
Adduction: 30
Lateral Rotation: 40-60
Medial Rotation: 30-40
Knee ROM
Flexion: 0-135
Extension: 0-15
Lateral Rotation: 30-40
Medial Rotation: 20-30
Ankle ROM
Plantar Flexion: 50
Dorsiflexion: 20
Supination: 45-60
Pronation: 15-3
Lumbar Spine ROM
Flexion: 40-60
Extension: 20-35
Side Flexion: 15-20
Rotation: 3-18
Basic ROM Findings
Pain in multiple directions suggests joint/capsular damage
Pain in a single direction indicates muscle, tendon or ligament damage
FULL ROM without pain = Normal Finding
FULL ROM with pain = minor sprain/strain
HYPOMOBILITY without pain = tissue contracture, adhesions or joint dysfunction
HYPOMOBILTY with pain = acute sprain with possible muscle guarding or joint dysfunction
HYPERMOBILITY without pain = complete ligament rupture
HYPERMOBILITY with pain = partial ligament tear or sprain
ROM findings summary chart
Cervical Spine
Actions – Flexion, extension, rotation, lateral flexion
Resting position – slight extension
Capsular pattern - lateral flexion, lateral rotation and extension
Normal end feel is tissue stretch
Abnormal end feel
Spasm – muscle/ligament tear, instability
Empty - ligament rupture
Bone to bone - osteophytes
Shoulder / GH joint
Actions – flexion, extension, abduction, adduction, lateral rotation, medial rotation, horizontal abduction, horizontal adduction
Resting position – 55° to 70° abduction, 30°, horizontal abduction.
Capsular pattern of restriction – external rotation, abduction, internal rotation
Normal end feel
Flexion = elastic, firm, boney contact
Abduction = elastic
Extension = firm
Internal and external rotation = elastic/firm
Horizontal adduction = soft tissue
Horizontal abduction = firm/elastic
Abnormal end feel
Empty = subacromial bursitis
Hard, capsular = frozen shoulder
Spasm = instability
Elbow
Actions- flexion, extension, supination, pronation
Resting position
Humeroulnar - 70% flexion
Humeroradial - full extension and supination,
proximal Radioulnar - 70° flexion, 35° supination
Capsular pattern of restriction
Flexion, extension, supination, pronation
Normal end feel
Flexion = soft tissue, or boney approximation
Extension = boney approximation
Pronation = bony, approximation, or ligamentous
Supination = ligamentous
Abnormal end feel
Boggy = joint effusion
Spasm = acute injury, instability
Springy block = loose body
Wrist
Actions – flexion, extension, ulnar flexion, Radial flexion
Normal end feel
flexion = firm, ligamentous
Adduction/abduction = boney
