ROM Principles Flashcards by Michael Obi

DEFINITION: The amount of motion available at a joint

Range of motion (ROM)

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What is the amount of motion available at a joint influenced by?

The joint structure and pain/inflammation

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If the tissues (ligaments or tendons) around a joint become (tight/loose), that can limit the amount of motion at a joint.

tight

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(Inflexibility/Contractures) - Adaptive shortening of the soft tissue surrounding a joint that involves structural changes: change in the composition of connective tissues, decreased collagen and water, formation of cross links and adhesions, and decreased length of the muscle due to loss of sarcomeres

Contractures

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Contractures can occur after surgery, injury, and immobilizations. Contractions (are/aren’t) the same thing as inflexibility

aren’t

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Contractures are named for the position the joint is stuck in. Elbow flexion contracture – the joint is stuck in (flexion/extension) and cannot fully straighten out all the way. Elbow (flexors/extensors) would be the cause of not being able to straighten out all the way and are going to be the things that are tight in an elbow flexion contracture.

flexion; flexors

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(Stretching/ROM) Exercise – done in the available ROM of the joint and the main objective is to try and maintain how much motion is in the joint. For us to physiologically change the length of the tissues that have contractures we have to engage that tissue and put stress on that tissue and put the appropriate type of stress on that tissue to get it to “be” longer. This is not the objective in a ROM exercise, we are just working within our available range.

ROM

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What are the three types of ROM exercises?

Active Range of Motion (AROM), Active Assisted Range of Motion (AAROM), & Passive Range of Motion (PROM).

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(AROM/AAROM) - Patient’s active muscle contraction creates movement

AROM

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(AROM/AAROM) - Patient’s active force + assistance from external force

AAROM

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(AAROM/PROM) - Motion produced by an external force only

PROM

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What are 5 reasons to do AROM/AAROM exercises?

To maintain ROM, strengthen weak muscles, develop motor skills and coordination, decrease swelling and enhance circulation, and decrease pain

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What are 5 reasons to perform PROM?

To maintain ROM, the patient is unable to perform AROM (comatose, paralysis, post op restrictions), and to decrease pain

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Normally for the first _ weeks of a rotator cuff repair, you do not want the patient to do any activation contractions of the cuff so the tissue can heal.

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(ROM/Stretching) - Within available ROM and is done to maintain ROM

ROM

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(ROM/Stretching) - Move past available ROM and is done to improve ROM

Stretching

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(ROM/Stretching) – Trying to put stress on the soft tissue so that it will become longer and the person will get more ROM overall.

Stretching

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(HLBS/LLPS) – Regular everyday stretching that you are most familiar with, whether it is dynamic stretches or a static stretch that you hold for even up to 2 min.

HLBS

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(HLBS/LLPS) - Think of someone put in a splint that is actually putting a stretch on someone (Dynasplint). Example – someone who has limited wrist extension, you get a dynasplint that will hold them at end range for 20 minutes, an hour, all day, etc. Because they are wearing for such long period of times it is low load because that is the only way they can tolerate it but they are wearing it for long periods of time.

LLPS

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As the stress goes up and we put more and more load on the tissue, the tissue should (shorten/lengthen) more and more.

lengthen

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If you are working in the elastic range, you are going to get no permanent length changes in the tissue itself. The plastic range is the desired range, the range we want to work at. In the plastic range we get (temporary/permanent) length changes to the tissue itself. We want to strive to get to the plastic range so ultimately the tissue itself does not return back to the starting point.

permanent

LLPS and HLBS can change ROMs. You can increase the amount of ROM a person has, we can increase the length of tissue using both LLPS and HLBS, it is just going to vary on what population we are going to use each with.

Roger

In contractures there are structural changes that actually happen to the tissue. The composition of connective tissue and the composition of muscle actually change. Individuals who actually have contractures are going to be the ones who are going to need (HLBS/LLPS) to try and create those permanent changes in the length of the tissue.

LLPS

Other people who do not have contractures should be fine with (HLBS/LLPS).

HLBS

__ – the amount of time that you are keeping the tissue at its’ end range. We calculate this over a 24 hour period.

TERT - Total End Range Time

If we are trying to get tissues to go into the plastic region, it will be the TERT, the combination of factors that help us determine whether or not we are getting into that plastic range.

Roger that

The most important factor is how long you hold the tissue at its’ end range. Its’ important that we are keeping that tissue at its end range for a long period of time and that is what dictates whether or not we get into that plastic zone. As far as the variable that is most important, it is a combination of duration, frequency, and intensity.

Roger

If you have tissue that is contracted, the recommended starting point for TERT is __ minutes a day broken up into segments of at least 10 minutes throughout the day.

Recommended intensity for LLPS – the patient should be able to tolerate the stretch for the period of time they do it. If you put an initial stretch on the person and after 3 or 4 or 5 minutes they are like OMG I gotta take this off it is killing me then the intensity is too (low/high).

high

What are the 4 things that need to have happened in order to know to use LLPS?

Trauma + immobilization, restricted motion > 3 weeks, loss of PROM in a capsular pattern, and a capsular/firm end feel

LLPS VS HLBS: Trauma + Immobilization: Think of a person who got in a car crash or an athlete who had an injury and had to be put in a cast or a brace for a period of time. This can even happen with someone who gets hit in the shoulder or gets hit in the knee and experiences some level of trauma and then for weeks afterwards the person sort of protects their arm, keeps it at their side or not moving it through its’ full ROM. That is referred to as self imposed immobilization.

Got it

LLPS VS HLBS: A capsular pattern is a specific loss of ROM in a joint that would indicate that is actually a capsule that is causing those restrictions as opposed to some other soft tissue around the joint. If the capsule was tight around those joints, which motion would be the most restricted? There are specific patterns to every single joint and if the joint exhibits that pattern of loss of motion, for example.. The glenohumeral joint is most restricted in external rotation followed by abduction and internal rotation. So if you are measuring someone’s ROM at the shoulder joint and this person has the greatest loss in external rotation, followed by abduction, and then internal rotation, it would be referred to as capsular pattern, IE it is the capsule that is causing the restrictions in the joint. Therefore the treatment needs to be directed to the capsule, you have to stretch out the capsule and that is how you get back your range of motion. If you measured someone else’s shoulder joint and saw their greatest loss of ROM was flexion, followed by internal rotation, and then external rotation , that is not capsular pattern. There are tight tissues around their shoulder but it is not the capsule so you have to direct their treatment to other tight tissues.

Got it

These people that will normally respond to LLPS have loss of motion in a capsular pattern and the LLPS will be applied to the capsule.

Got it

A firm end feel (also known as capsular end feel) is referring to a joint that’s’ motion is really stopped by the (bone/soft tissue) around the joint itself.

soft tissue

The elbow has a (firm/hard+bony) end feel because due to the anatomy of the joint, you have two bones that are approximating each other and that is what stops the motion.

hard+bony

Firm end feels can be stretched because it is soft tissue, bony end feels cannot be stretched. We feel for end feels because if it is a firm end feel we (can/can't) influence that, but if it is a bony end feel we cannot influence that.

can

A (soft/firm) end feel is simply where you are getting two soft tissue masses that are approximating on one another and that is stopping motion.

soft

Elbow flexion (approximation of the biceps and forearms), knee flexion (mass on the back of your calf and your posterior thigh will approximate). Soft or firm end feel?

Soft

What is another name for a firm end feel?

Capsular end feel

(Soft/Firm) end feel - the muscle or capsule is being stretched and there is some give to the tissue at end range.

Firm

Dorsiflexion. Soft or firm end feel?

Firm

(Firm/Hard) end feel - Abrupt, hard stop. Occurs when bone contacts bone.

Hard

Elbow extension. Capsular end feel or hard end feel?

Hard

What is another name for a hard end feel?

Bony end feel

We can identify abnormal end feels because we are short of what we consider to be full range of motion. With abnormal amounts of motion there is a (soft/hard) end feel that they refer to that is due to swelling in the joint and that is restricting the amount of motion. Think of someone that has a lot of swelling in their knee. If we go to bend their knee, because they have all of that fluid in there that is occupying space you will feel sort of a soft end feel that is restricting motion because of the fluid in the tissue.

soft

Firm end feels can also be abnormal. This firm end feel can feel like there is tissue tightness, that there is give that is there, it just happens to happen before what we consider to be normal amounts of range of motion.

Got it

(Firm/Hard) abnormal end feel – think of punching the wall, having a bone chip, and then you can’t get to your full range of motion because of that bone or whatever is obstructed in the bone that limits motion.

Hard

(Bony/Empty) – When the patient themselves stops you from moving the joint because there is so much pain. You might not feel any restriction at the joint but the patient says it hurts or I notice that the patient is in so much pain that you do not want to move the joint any further.

Empty

Treatment for an empty end feel is to do something to decrease their pain through rest, medication, etc and that should help improve their range of motion.

Got it

If you have an abnormal (hard/firm) end feel, you might want to stretch that or loosen that tissue to help improve them.

firm

Identifying the type of end feel the patient has will help us from a treatment perspective so we can know what to do with the patient.

Got it

(ROM/Stretching) - Performed at end range with the goal to change the length of the tissue.

Stretching