Assessing Range of Motion: Difference between revisions

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== Introduction==
== Introduction==
Range of motion is an fundamental part of human movement essential for your body’s functional mobility and as such forms an integral part of patient assessment in all settings.  Efficient movement with minimal effort relies on adequate range of motion,  which will allow the joints to adapt more readily to stresses imposed on the body.<ref name=":1">Reese NB, Bandy WD. Joint Range of Motion and Muscle Length Testing-E-book. Elsevier Health Sciences; 2016 Mar 31.</ref> Joint range of motion is the arc of motion available at a single joint or series of joints and is the angle through which a joint moves from the anatomical position to the extreme limit of its motion in a particular direction.<ref>Cox R. Oxford Dictionary of Sports Science and Medicine. Reference Reviews. 2007 Sep 25;21(7):50-.</ref> Effectively range of motion is the extent or limit to which a part of the body can be moved around a joint or a fixed point providing you with the totality of movement a joint is capable of.   
Range of motion is an fundamental part of human movement essential for your body’s functional mobility and forms an integral part of patient assessment in all settings. Efficient movement with minimal effort relies on adequate range of motion,  which will allow the joint to adapt more readily to stresses imposed on the body.<ref name=":1">Reese NB, Bandy WD. Joint Range of Motion and Muscle Length Testing-E-book. Elsevier Health Sciences; 2016 Mar 31.</ref> Joint range of motion is the arc of motion available at a single joint or series of joints and is the angle through which a joint moves from the anatomical position to the extreme limit of its motion in a particular direction.<ref>Cox R. Oxford Dictionary of Sports Science and Medicine. Reference Reviews. 2007 Sep 25;21(7):50-.</ref> Effectively range of motion is the extent or limit to which a part of the body can be moved around a joint or a fixed point providing you with the totality of movement a joint is capable of.   


Dysfunction of the [[Neural Circuit|neural]] or [[Musculoskeletal Orthopaedic Assessment|musculoskeletal]] systems may lead to reduced motion (hypomobility) or increased and sometimes excessive motion ([[Hypermobility Syndrome|hypermobility]]). Assessment of range of motion allows us identify any potential limitation to functional ability. Range of motion is typically measured in degrees and can be influenced by the associated bony structure and physiological characteristics of the connective tissues such as [[Ligament|ligaments]] and [[Capsule Constrained Mechanism|joint capsule]] that surround the [[Joint Classification|joint]]. If you have limited range of motion in one or more joints, your body may compensate by placing stress on other joints or [[Muscle|muscles]], which may result in muscle imbalance and improper body alignment. Poor alignment and muscle imbalance may present a greater risk of injury and pain and reduced functional mobility. <ref name=":0">Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. FA Davis; 2016 Nov 18.</ref>  
Dysfunction of the [[Neural Circuit|neural]] or [[Musculoskeletal Orthopaedic Assessment|musculoskeletal]] systems may lead to reduced motion (hypomobility) or increased and sometimes excessive motion ([[Hypermobility Syndrome|hypermobility]]). Assessment of range of motion allows us identify any potential limitation to functional ability. Range of motion is typically measured in degrees and can be influenced by the associated bony structure and physiological characteristics of the connective tissues such as [[Ligament|ligaments]] and [[Capsule Constrained Mechanism|joint capsule]] that surround the [[Joint Classification|joint]]. <ref name=":0">Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. FA Davis; 2016 Nov 18.</ref>  


== Types of Range of Motion ==
== Types of Range of Motion ==
'''Active Range of Motion'''
'''Active Range of Motion'''
Active range of motion (AROM) is the range of movement that can be achieved when opposing muscles contract and relax, resulting in joint movement. It is the arc of motion  produced by a patient during a voluntary, unassisted muscle contraction, which provides us with information about levels of consciousness, willingness to move, ability to follow instructions, attention span, coordination, muscle strength, joint range of motion, movements that cause pain and ability to perform functional activities. <ref name=":0" /><ref name=":3">Clarkson HM. Musculoskeletal assessment: joint motion and muscle testing. 2013.</ref> The end of the active range of motion is sometimes referred to as the physiological barrier.
Active range of motion (AROM) is the range of movement that can be achieved when opposing muscles contract and relax, resulting in joint movement. It is the arc of motion  produced by a patient during a voluntary, unassisted muscle contraction, which provides us with information about levels of consciousness, willingness to move, ability to follow instructions, attention span, coordination, muscle strength, joint range of motion, movements that cause pain and ability to perform functional activities. <ref name=":0" /><ref name=":3">Clarkson HM. Musculoskeletal assessment: joint motion and muscle testing. 2013.</ref> The end of the active range of motion is sometimes referred to as the physiological barrier.
*It should be performed by the patient independently and when the patient is able to voluntarily contract, control, and coordinate a movement.
*Performed by patient independently they are able to voluntarily contract, control, and coordinate a movement.
*For example, the active range of motion to allow the elbow to bend requires the biceps to contract while the tricep muscle relaxes.
*For example, AROM to flex the elbow requires biceps to contract while triceps relax.
*Active range of motion is typically less than passive range of motion as each joint has a small amount of available motion that is not under voluntary control.
*AROM is typically less than PROM as each joint has a small amount of available motion that is not under voluntary control.
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<br>
<blockquote>'''''Observations During Active Range of Motion'''''
<blockquote>'''''Observations During Active Range of Motion'''''
* ''When and where during each of the movements the onset of pain occurs''
* ''Willingness of the patient to move''
* ''Whether the movement increases the intensity and quality of the pain''
* ''When and where onset of pain occurs''
* ''The reaction of the patient to pain''
* ''Whether the movement increases intensity and quality of pain''
* ''The amount of observable restriction and its nature''
* ''Reaction of patient to pain''
* ''The pattern of movement''
* ''Amount of observable restriction and its nature''
* ''The rhythm and quality of movement''
* ''Pattern of movement''
* ''The movement of associated joints''
* ''Rhythm and quality of movement''
* ''The willingness of the patient to move the part'' <ref name=":2">Magee D. Orthopaedic Physical Assessment WB Saunders. pg. 2002;478:483-631.</ref>
* ''Movement of associated joints'' <ref name=":2">Magee D. Orthopaedic Physical Assessment WB Saunders. pg. 2002;478:483-631.</ref>
</blockquote>
</blockquote>
<br>
<br>
'''Active-assisted Range of Motion'''
'''Active-assisted Range of Motion'''
Active-assisted range of motion (AAROM) is the range of movement that can be achieved when the joint receives partial assistance from an outside force. It is the arc of motion produced by a patient during a voluntary muscle contraction to the extent they are able assisted by an external force applied manually, mechanically, or gravity assistance.<ref name=":0" />
 
*Typically performed when the patient needs assistance with a movement from an external force because of weakness, pain, or changes in muscle tone.
Active-assisted range of motion (AAROM) is the range of movement that can be achieved when the joint receives partial assistance from an outside force. It is the arc of motion produced by a patient during a voluntary muscle contraction to the extent they are able, assisted by an external force applied manually, mechanically, or by gravity assistance.<ref name=":0" />
*Typically performed when patient needs assistance with a movement from an external force because of weakness, pain, or changes in muscle tone.
*For example, the patient using their left arm to assist them to lift their right arm to bend the elbow.
*For example, the patient using their left arm to assist them to lift their right arm to bend the elbow.


<br>
<br>
'''Passive Range of Motion'''
'''Passive Range of Motion'''
Passive range of motion (PROM) is the range of movement that is achieved when an outside force exclusively causes movement of a joint. It is the arc of motion produced by the therapist without assistance from the patient, which provides us with information about the integrity of the joint surfaces, extensibility of the joint capsule and surrounding ligaments, muscle, fascia and skin. <ref name=":0" />
Passive range of motion (PROM) is the range of movement that is achieved when an outside force exclusively causes movement of a joint. It is the arc of motion produced by the therapist without assistance from the patient, which provides us with information about the integrity of the joint surfaces, extensibility of the joint capsule and surrounding ligaments, muscle, fascia and skin. <ref name=":0" />
* Typically performed when the patient is unable or not permitted to move the body part. It is also performed when the patient needs assistance with movement from an external force because of weakness, pain, or changes in muscle tone and plays no active role in producing the movement. The assistance may be applied mechanically or manually.
* Typically performed when patient is unable or not permitted to move the body part as a result of weakness, pain, or changes in muscle tone.
* For example, continuous passive motion device to performs repetitive passive motion to move the joint to a set of number of degrees and movement speed.<ref>Gil-González S, Barja-Rodríguez RA, López-Pujol A, Berjaoui H, Fernández-Bengoa JE, Erquicia JI, Leal-Blanquet J, Pelfort X. Continuous passive motion not affect the knee motion and the surgical wound aspect after total knee arthroplasty. Journal of Orthopaedic Surgery and Research. 2022 Jan 15;17(1):25.</ref>
* For example, continuous passive motion device to perform repetitive passive motion to move the joint a set of number of degrees and movement speed.<ref>Gil-González S, Barja-Rodríguez RA, López-Pujol A, Berjaoui H, Fernández-Bengoa JE, Erquicia JI, Leal-Blanquet J, Pelfort X. Continuous passive motion not affect the knee motion and the surgical wound aspect after total knee arthroplasty. Journal of Orthopaedic Surgery and Research. 2022 Jan 15;17(1):25.</ref>
* Passive range of motion is typically greater than passive range of motion due to the stretch of the tissues surrounding the joint and the reduced bulk of relaxed muscles compared to contracting muscle, which helps to protect joint structures by absorbing extrinsic forces. It is for this reason that measurement of joint range of motion as a rule uses passive range of motion.<ref name=":0" />
* PROM is typically greater than AROM due to stretch of the tissues surrounding the joint and the reduced bulk of relaxed muscles compared to contracting muscle. It is for this reason that measurement of joint range of motion as a rule uses passive range of motion.<ref name=":0" />
<br>
<br>
<blockquote>'''''Observations During Passive Movement'''''
<blockquote>'''''Observations During Passive Movement'''''
* ''When and where during each of the movements the pain begins''
* ''When and where onset of pain begins''
* ''Whether the movement increases the intensity and quality of pain''
* ''Whether the movement increases the intensity and quality of pain''
* ''The pattern of limitation of movement''
* ''Pattern of Restriction''
* ''The end feel of movement''
* ''End-feel''
* ''The movement of associated joints''
* ''Movement of associated joints''
* ''The range of motion available''
</blockquote>Each joint has a typical or normative range of values for ROM, while each person has a different amount of ability to achieve it. You can find out the generally accepted values for a ROM for individual joints [[Range of Motion Normative Values|here.]]
</blockquote>Each joint has a typical or normative range of values for range of motion, while each person has a different amount of ability to achieve it. You can find out the generally accepted values for a range of motion for each of the individual joints [[Range of Motion Normative Values|here.]]


== Factors Impacting Range of Motion ==
== Factors Impacting Range of Motion ==
Range of motion varies among individuals and can be influenced by a wide range of factors including age, gender, physical constitution such as [[BMI|body mass index]], occupational and recreational activities, and test procedures such as instrument used, test position, number of repeated tests, time of day tests performed or whether the motion is performed actively or passively.<ref name=":1" /><ref name=":0" /><ref name=":3" /><ref name=":4" />
ROM varies among individuals and can be influenced by a wide range of factors including age, gender, physical constitution such as [[BMI|body mass index]], occupational and recreational activities, and test procedures.<ref name=":1" /><ref name=":0" /><ref name=":3" /><ref name=":4" />


=== Age ===
=== Age ===
Significant research has explored the impact of age on range of motion, with gender typically having no impact on range of motion in new borns, infants and toddlers up to about 2 years of age, who tend to have more hip flexion, hip abduction, hip external rotation, ankle dorsiflexion and elbow motion in comparison to adolescents and adults, but show limitations in hip extension, knee extension and plantarflexion, typically linked to the effects of positioning in utero, which are modified only with growth. <ref name=":0" /> On the other hand older age is significantly associated with lower range of motions than younger adults most commonly in shoulder external rotation and horizontal flexion, elbow extension, wrist flexion and extension, although these changes may affect men and women differently. <ref name=":0" /><ref name=":4">Moromizato K, Kimura R, Fukase H, Yamaguchi K, Ishida H. Whole-body patterns of the range of joint motion in young adults: masculine type and feminine type. Journal of physiological anthropology. 2016 Dec;35:1-2.</ref> Increasing loss of active range of motion in the neck, thoracic and lumbar spine occur with every decade passing decade, with the greatest change seen in thoracolumbar mobility with up to research suggesting up to an 8° reduction each decade.<ref name=":0" />
Significant research has explored the impact of age on ROM, with gender typically having no impact in new borns to about 2 years of age, who tend to have more hip flexion, hip abduction, hip external rotation, ankle dorsiflexion and elbow motion in comparison to adolescents and adults, but show limitations in hip extension, knee extension and plantarflexion, typically linked to the effects of positioning in utero, modified only with growth. <ref name=":0" /> Older age is significantly associated with lower ROMs than younger adults in shoulder external rotation and horizontal flexion, elbow extension, wrist flexion and extension, although these changes may affect men and women differently. <ref name=":0" /><ref name=":4">Moromizato K, Kimura R, Fukase H, Yamaguchi K, Ishida H. Whole-body patterns of the range of joint motion in young adults: masculine type and feminine type. Journal of physiological anthropology. 2016 Dec;35:1-2.</ref> Increasing loss of AROM in the neck, thoracic and lumbar spine occur with every passing decade, with the greatest change seen in thoracolumbar mobility with up to an 8° reduction each decade.<ref name=":0" />


=== Gender ===
=== Gender ===
As with age, the effects of gender on joint range of motion appear to be joint and motion specific. Typically females are reported to have greater range of motion then males, with these differences more prevalent in adolescents and adults than in younger children.  Females show significantly increased range of motions in the limb joints including shoulder flexion, internal rotation and horizontal flexion, elbow flexion and extension, wrist extension, and hip flexion, adduction, and internal rotation, while males have higher range of motions for hip extension and external rotation, and trunk flexion and rotation. <ref name=":4" />  
The effects of gender on ROM appear to be joint and motion specific. Typically females are reported to have greater ROM then males, with these differences more prevalent in adolescents and adults.  Females show significantly increased ROM in the limb joints including shoulder flexion, internal rotation and horizontal flexion, elbow flexion and extension, wrist extension, and hip flexion, adduction, and internal rotation, while males have higher ROM for hip extension and external rotation, trunk flexion and rotation. <ref name=":4" />  


=== Weight ===
=== Weight ===
Higher lean body mass has been shown to be significantly related to reduced range of motion in shoulder external rotation and horizontal extension, but increase range of motion for wrist flexion and hip adduction. On the other hand increased body fat % has been associated with decreased shoulder external rotation, shoulder horizontal flexion, and elbow flexion and extension, but positively associated with increased trunk flexion and rotation, and hip extension and external rotation. Negative correlations between body fat % and several joint motions may be as a result of physical obstruction by fat tissue caught between the bones constituting the joint such as in shoulder horizontal flexion.<ref name=":4" />
Higher lean body mass has been shown to be significantly related to reduced ROM in shoulder external rotation and horizontal extension, but increase ROM for wrist flexion and hip adduction. While increased body fat % has been associated with decreased shoulder external rotation, shoulder horizontal flexion, and elbow flexion and extension, but positively associated with trunk flexion and rotation, hip extension and external rotation. Negative correlations between body fat % and several joint motions may be as a result of physical obstruction by fat tissue caught between the bones.<ref name=":4" />


=== Dominant versus Non Dominant Side ===
=== Dominant versus Non Dominant Side ===
Range of motion differences between dominant and non-dominant sides were significant with increased range of motion seen in shoulder internal rotation, hip abduction, and ankle plantar flexion on the non-dominant side, while increased shoulder external rotation, wrist flexion, and hip adduction was observed in the dominant side, which suggests that daily activities (occupational or recreational) can lead to  some variation in range of motion. Asymmetry of posture has been associated with side dominance so could account for differences seen between dominant and non-dominant sides, alternatively, these differences  may be attributed to muscle mass, that is a forced and continuous motion on the dominant side that increases its range of motion by stretching the muscles antagonistic to the motion.<ref name=":4" />
ROM differences between dominant and non-dominant sides were significant with increased ROM seen in shoulder internal rotation, hip abduction, and ankle plantarflexion on the non-dominant side, while increased shoulder external rotation, wrist flexion, and hip adduction was observed in the dominant side, which suggests that daily activities can lead to  some variation in ROM. <ref name=":4" />


=== Test Position ===
=== Test Position ===
The testing position of a joint can greatly influence the passive range of motion available as a result of the muscle length of the opposing muscle. One joint muscles cross one joint and thus only influence the motion in that joint. If a one joint muscle is shorter than normal both the passive and active joint range of motion will be influenced Two joint and multi joint muscles cross and influence multiple joints and the length of the muscle is usually not sufficient to allow full passive range of motion simultaneously at all the joints that the muscle crosses. This is called [[Active and Passive Insufficiency|passive insufficiency]], which effectively occurs when the length of a muscle prevents the full range of motion at the joint or joints that the muscle crosses over.<ref>Rogers M, Rogers M. Understanding Active and Passive Insufficiency [Internet]. National Federation of Professional Trainers. 2020 [cited 17 September 2020]. Available from: <nowiki>https://www.nfpt.com/blog/understanding-active-and-passive-insufficiency</nowiki></ref> It is always important to consider passive insufficiency when measuring range of motion.
Resting position of a joint can greatly influence the ROM available as a result of the muscle length of the opposing muscle. One joint muscles cross one joint and thus only influence the motion in that joint. If a one joint muscle is shortened both the PROM and AROM will be influenced.
 
Two joint and multi-joint muscles cross and influence multiple joints and the length of the muscle is usually not sufficient to allow full PROM simultaneously at all the joints that the muscle crosses. This is called [[Active and Passive Insufficiency|passive insufficiency]], which effectively occurs when the length of a muscle prevents the full ROM at the joint or joints that the muscle crosses over.<ref>Rogers M, Rogers M. Understanding Active and Passive Insufficiency [Internet]. National Federation of Professional Trainers. 2020 [cited 17 September 2020]. Available from: <nowiki>https://www.nfpt.com/blog/understanding-active-and-passive-insufficiency</nowiki></ref> It is always important to consider passive insufficiency when measuring ROM.


=== Test Procedures ===
=== Test Procedures ===
Currently there is limited agreement in the research on the number of repetitions to be measured or  warm-up protocols to use prior to during range of motion assessment. Evidence on stretching has shown an increase in mobility, stretch tolerance and reduced passive torque during acute stretch training after only a few repetitions of a stretch<ref>Glück S, Hoffmann U, Schwarz M, Wydra G. Range of motion, traction force and muscle activity in self- and external-regulated stretching. Deutsche ZeitschriftfürSportmedizin. 2002;53:66–71.</ref><ref>Magnusson SP, Simonsen EB, Aagaard P, Kjaer M. Biomechanical responses to repeated stretches in human hamstring muscle in vivo. Am. J. Sports Med. 1996;24:622–628. doi: 10.1177/036354659602400510. </ref><ref>Boyce D, Brosky JA. Determining the minimal number of cyclic passive stretch repetitions recommended for an acute increase in an indirect measure of hamstring length. Physiother. Theory Pract. 2008;24:113–120. doi: </ref><ref>Nakamura M, Ikezoe T, Takeno Y, Ichihashi N. Time course of changes in passive properties of the gastrocnemius muscle–tendon unit during 5 min of static stretching. Manual Therapy. 2013;18:211–215. doi: 10.1016/j.math.2012.09.010. </ref>, and that this acute effect also occurs during range of motion assessment, therefore, differences in the measurement protocol with regard to the measured repetitions and warm-up exercises, can lead to different measurement results of up to 6°. <ref>Holzgreve F, Maurer-Grubinger C, Isaak J, Kokott P, Mörl-Kreitschmann M, Polte L, Solimann A, Wessler L, Filmann N, van Mark A, Maltry L. The acute effect in performing common range of motion tests in healthy young adults: a prospective study. Scientific Reports. 2020 Dec 10;10(1):1-9.</ref> To counteract the impact of testing procedures on range of motion use a consistent protocol around warm up before testing, type of instrument used, the number of repeated measures taken and type of motion.
There is limited agreement in research on number of repetitions or  warm-up protocols to use prior ROM assessment. Evidence on stretching has shown an increase in mobility, stretch tolerance and reduced passive torque during acute stretch training after only a few repetitions of a stretch<ref>Glück S, Hoffmann U, Schwarz M, Wydra G. Range of motion, traction force and muscle activity in self- and external-regulated stretching. Deutsche ZeitschriftfürSportmedizin. 2002;53:66–71.</ref><ref>Magnusson SP, Simonsen EB, Aagaard P, Kjaer M. Biomechanical responses to repeated stretches in human hamstring muscle in vivo. Am. J. Sports Med. 1996;24:622–628. doi: 10.1177/036354659602400510. </ref><ref>Boyce D, Brosky JA. Determining the minimal number of cyclic passive stretch repetitions recommended for an acute increase in an indirect measure of hamstring length. Physiother. Theory Pract. 2008;24:113–120. doi: </ref><ref>Nakamura M, Ikezoe T, Takeno Y, Ichihashi N. Time course of changes in passive properties of the gastrocnemius muscle–tendon unit during 5 min of static stretching. Manual Therapy. 2013;18:211–215. doi: 10.1016/j.math.2012.09.010. </ref>, which also occurs during ROM assessment, therefore, differences in the measurement protocol with regard to the measured repetitions and warm-up exercises, can lead to different measurement results of up to 6°. <ref>Holzgreve F, Maurer-Grubinger C, Isaak J, Kokott P, Mörl-Kreitschmann M, Polte L, Solimann A, Wessler L, Filmann N, van Mark A, Maltry L. The acute effect in performing common range of motion tests in healthy young adults: a prospective study. Scientific Reports. 2020 Dec 10;10(1):1-9.</ref> To counteract the impact of testing procedures on ROM use a consistent protocol for warm up, type of instrument , the number of repeated measures and type of motion measured.


== Contraindications  ==
== Contraindications  ==
Active and passive range of motion assessment techniques are typically contraindicated where muscle contraction (i.e., in the case of active or active assisted motion) or motion of the part of the body could disrupt the healing process or result in injury or deterioration of the condition. Some examples of conditions where range of motion may be contraindicated are listed below.
ROM assessment techniques are typically contraindicated where muscle contraction or motion of the part of the body could disrupt the healing process or result in injury or deterioration of the condition. Some examples of conditions where ROM may be contraindicated include;


* Suspected or Confirmed
* Suspected or Confirmed
**Joint dislocation or subluxation
**Joint Subluxation / Dislocation
**Unhealed or unstable bone fracture
**Unhealed or Unstable Fracture
**Rupture of tendon or ligament
**Rupture of Tendon / Ligament
**Infectious or acute inflammatory process
**Infectious or Acute Inflammatory Process
**[[Myositis Ossificans]] or Ectopic Ossification  
**[[Myositis Ossificans]] or Ectopic Ossification  
* Post Surgery  
* Post Surgery  
** Range of Motion has potential to disrupt the healing process
** Where potential to disrupt healing process
* [[Osteopenia]], [[Osteoporosis]] or Bone Fragility
* [[Osteoporosis]] or Bone Fragility
** Forced measurements may cause iatrogenic injury  
** Forced measurements may cause iatrogenic injury  


== Precautions ==
== Precautions ==
Conditions where measurement of range of motion may be appropriate with added precautions if movement to the part might aggravate the condition include the following;  
Conditions where measurement of ROM may be appropriate, with added precautions if movement might aggravate the condition include;  


* Presence of [[Pain Assessment|Pain]]
* Presence of [[Pain Assessment|Pain]]
* Infection or inflammation around a Joint
* Infection or Inflammation around a Joint
* [[Hypermobility Syndrome|Hypermobility]] or Instability
* [[Hypermobility Syndrome|Hypermobility]]  
* Instability
* Haemophilia
* Haemophilia
* Bony Ankylosis
* Bony Ankylosis
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== Measuring Range of Motion ==
== Measuring Range of Motion ==
There are different instruments used to measure range of motion. The choice of instrument depends on the purpose of the measurement, the movement to be measured, the size of the limb being measured, the instrument’s accuracy, availability, cost, ease of use, size and its validity and reliability.<ref>Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. FA Davis; 2016 Nov 18.</ref> Reliability of range of motion is influenced by the types of measurement instrument used and procedures, differences among joint actions and body regions, passive versus active measurements, intra-tester versus inter-tester measurements, and different patient types. <ref name=":5">Gajdosik RL, Bohannon RW. Clinical measurement of range of motion: review of goniometry emphasizing reliability and validity. Physical therapy. 1987 Dec 1;67(12):1867-72.</ref>
There are different instruments used to measure ROM. Choice of instrument depends on the movement to be measured, size of the limb, instrument’s accuracy, availability, cost, ease of use, and its validity and reliability.<ref>Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. FA Davis; 2016 Nov 18.</ref> Validity and reliability of ROM is influenced by types of instrument, differences among joint actions and body regions, passive versus active measurements, intra-tester versus inter-tester measurements, and different patient types. <ref name=":5">Gajdosik RL, Bohannon RW. Clinical measurement of range of motion: review of goniometry emphasizing reliability and validity. Physical therapy. 1987 Dec 1;67(12):1867-72.</ref>


=== Visual Estimation ===
=== Visual Estimation ===
Yields only subjective information in contrast to objective goniometric measurements so not recommended. Visual estimates made prior to goniometric measurements may help to reduce errors attributable to incorrect reading of the goniometer, however, knowledge of the estimate has been shown to influence goniometric measurement results.
Visual estimation provide subjective information in contrast to objective goniometric measurements so not recommended. Visual estimates made prior to goniometric measurements may help to reduce errors attributable to incorrect reading of the goniometer, however, knowledge of the estimate has also been shown to influence goniometric measurement results.


=== Goniometry ===
=== Goniometry ===
A [[goniometer]] is the most common instrument used to measure range of motion in the clinical setting. The term 'goniometry' is derived from the greek words '''gonia''<nowiki/>' meaning angle and '<nowiki/>''metron''<nowiki/>' meaning measure, therefore goniometry refers to the measurement of angles, which in rehabilitation settings refers to the measurement of angles in each plane at the joints of the body. There are limited validity studies on goniometry, but they have found high criterion validity in measurements of knee joint angles when compared to x-ray joint angles 29/30. Reliability depends on the joint and motion being assessed but generally the universal goniometer has been shown to have good to excellent reliability, and is more reliable than visual estimation especially with inexperienced examiners. Overall, research shows high intra- and inter-rater reliability of the universal goniometer, with reliability in non-expert examiners improved with clear instructions on goniometric alignment, therefore where possible he same therapist should perform all measures to improve accuracy. Evidence is mixed on on the number of measures to take, or whether taking an average of repeated measures improves assessment. Sources of error when using goniometry can come from our expectations of what the range of motion is, reading the wrong side of the scale on the goniometer, a change in the patient’s motivation to perform, or taking successive measurements at different times of the day.<ref name=":2" />
A [[goniometer]] is the most common instrument used to measure ROM. The term 'goniometry' is derived from the greek words '<nowiki/>''gonia''<nowiki/>' meaning angle and '''metron''<nowiki/>' meaning measure, therefore goniometry refers to the measurement of angles, which in rehabilitation settings refers to the measurement of angles in each plane at the joints of the body. There are limited validity studies on goniometry, but they have found high criterion validity in measurements of knee joint angles when compared to x-ray joint angles 29/30. Reliability depends on the joint and motion being assessed but generally the universal goniometer has been shown to have good to excellent reliability, and is more reliable than visual estimation especially with inexperienced examiners. Overall, research shows high intra- and inter-rater reliability of the universal goniometer, with reliability in non-expert examiners improved with clear instructions on goniometric alignment, therefore where possible he same therapist should perform all measures to improve accuracy. Evidence is mixed on on the number of measures to take, or whether taking an average of repeated measures improves assessment. Sources of error when using goniometry can come from our expectations of what the range of motion is, reading the wrong side of the scale on the goniometer, a change in the patient’s motivation to perform, or taking successive measurements at different times of the day.<ref name=":2" />


So overall greater reliability is obtained when measures are taken by the same therapist, using a standardised method with the same measurement tool assessed at the same time of day.<ref name=":0" /><ref name=":5" /><ref>Blonna, D., Zarkadas, P. C., Fitzsimmons, J. S., & O'Driscoll, S.W. (2012). Accuracy and inter-observer reliability of visual estimation compared to clinical goniometry of the elbow. Knee Surgery, Sports Traumatology, Arthroscopy, 20(7), 1378-85. </ref> <ref>Boone, D. C., Azen, S. P., Lin, C., Spence, C., Baron, C., & Lee, L. (1978). Reliability of goniometric measurements. Physical Therapy, 58(11), 1355-1360. </ref>
So overall greater reliability is obtained when measures are taken by the same therapist, using a standardised method with the same measurement tool assessed at the same time of day.<ref name=":0" /><ref name=":5" /><ref>Blonna, D., Zarkadas, P. C., Fitzsimmons, J. S., & O'Driscoll, S.W. (2012). Accuracy and inter-observer reliability of visual estimation compared to clinical goniometry of the elbow. Knee Surgery, Sports Traumatology, Arthroscopy, 20(7), 1378-85. </ref> <ref>Boone, D. C., Azen, S. P., Lin, C., Spence, C., Baron, C., & Lee, L. (1978). Reliability of goniometric measurements. Physical Therapy, 58(11), 1355-1360. </ref>

Revision as of 22:16, 13 June 2023

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Introduction[edit | edit source]

Range of motion is an fundamental part of human movement essential for your body’s functional mobility and forms an integral part of patient assessment in all settings. Efficient movement with minimal effort relies on adequate range of motion, which will allow the joint to adapt more readily to stresses imposed on the body.[1] Joint range of motion is the arc of motion available at a single joint or series of joints and is the angle through which a joint moves from the anatomical position to the extreme limit of its motion in a particular direction.[2] Effectively range of motion is the extent or limit to which a part of the body can be moved around a joint or a fixed point providing you with the totality of movement a joint is capable of.

Dysfunction of the neural or musculoskeletal systems may lead to reduced motion (hypomobility) or increased and sometimes excessive motion (hypermobility). Assessment of range of motion allows us identify any potential limitation to functional ability. Range of motion is typically measured in degrees and can be influenced by the associated bony structure and physiological characteristics of the connective tissues such as ligaments and joint capsule that surround the joint. [3]

Types of Range of Motion[edit | edit source]

Active Range of Motion

Active range of motion (AROM) is the range of movement that can be achieved when opposing muscles contract and relax, resulting in joint movement. It is the arc of motion produced by a patient during a voluntary, unassisted muscle contraction, which provides us with information about levels of consciousness, willingness to move, ability to follow instructions, attention span, coordination, muscle strength, joint range of motion, movements that cause pain and ability to perform functional activities. [3][4] The end of the active range of motion is sometimes referred to as the physiological barrier.

  • Performed by patient independently they are able to voluntarily contract, control, and coordinate a movement.
  • For example, AROM to flex the elbow requires biceps to contract while triceps relax.
  • AROM is typically less than PROM as each joint has a small amount of available motion that is not under voluntary control.


Observations During Active Range of Motion

  • Willingness of the patient to move
  • When and where onset of pain occurs
  • Whether the movement increases intensity and quality of pain
  • Reaction of patient to pain
  • Amount of observable restriction and its nature
  • Pattern of movement
  • Rhythm and quality of movement
  • Movement of associated joints [5]


Active-assisted Range of Motion

Active-assisted range of motion (AAROM) is the range of movement that can be achieved when the joint receives partial assistance from an outside force. It is the arc of motion produced by a patient during a voluntary muscle contraction to the extent they are able, assisted by an external force applied manually, mechanically, or by gravity assistance.[3]

  • Typically performed when patient needs assistance with a movement from an external force because of weakness, pain, or changes in muscle tone.
  • For example, the patient using their left arm to assist them to lift their right arm to bend the elbow.


Passive Range of Motion

Passive range of motion (PROM) is the range of movement that is achieved when an outside force exclusively causes movement of a joint. It is the arc of motion produced by the therapist without assistance from the patient, which provides us with information about the integrity of the joint surfaces, extensibility of the joint capsule and surrounding ligaments, muscle, fascia and skin. [3]

  • Typically performed when patient is unable or not permitted to move the body part as a result of weakness, pain, or changes in muscle tone.
  • For example, continuous passive motion device to perform repetitive passive motion to move the joint a set of number of degrees and movement speed.[6]
  • PROM is typically greater than AROM due to stretch of the tissues surrounding the joint and the reduced bulk of relaxed muscles compared to contracting muscle. It is for this reason that measurement of joint range of motion as a rule uses passive range of motion.[3]


Observations During Passive Movement

  • When and where onset of pain begins
  • Whether the movement increases the intensity and quality of pain
  • Pattern of Restriction
  • End-feel
  • Movement of associated joints
Each joint has a typical or normative range of values for ROM, while each person has a different amount of ability to achieve it. You can find out the generally accepted values for a ROM for individual joints here.

Factors Impacting Range of Motion[edit | edit source]

ROM varies among individuals and can be influenced by a wide range of factors including age, gender, physical constitution such as body mass index, occupational and recreational activities, and test procedures.[1][3][4][7]

Age[edit | edit source]

Significant research has explored the impact of age on ROM, with gender typically having no impact in new borns to about 2 years of age, who tend to have more hip flexion, hip abduction, hip external rotation, ankle dorsiflexion and elbow motion in comparison to adolescents and adults, but show limitations in hip extension, knee extension and plantarflexion, typically linked to the effects of positioning in utero, modified only with growth. [3] Older age is significantly associated with lower ROMs than younger adults in shoulder external rotation and horizontal flexion, elbow extension, wrist flexion and extension, although these changes may affect men and women differently. [3][7] Increasing loss of AROM in the neck, thoracic and lumbar spine occur with every passing decade, with the greatest change seen in thoracolumbar mobility with up to an 8° reduction each decade.[3]

Gender[edit | edit source]

The effects of gender on ROM appear to be joint and motion specific. Typically females are reported to have greater ROM then males, with these differences more prevalent in adolescents and adults. Females show significantly increased ROM in the limb joints including shoulder flexion, internal rotation and horizontal flexion, elbow flexion and extension, wrist extension, and hip flexion, adduction, and internal rotation, while males have higher ROM for hip extension and external rotation, trunk flexion and rotation. [7]

Weight[edit | edit source]

Higher lean body mass has been shown to be significantly related to reduced ROM in shoulder external rotation and horizontal extension, but increase ROM for wrist flexion and hip adduction. While increased body fat % has been associated with decreased shoulder external rotation, shoulder horizontal flexion, and elbow flexion and extension, but positively associated with trunk flexion and rotation, hip extension and external rotation. Negative correlations between body fat % and several joint motions may be as a result of physical obstruction by fat tissue caught between the bones.[7]

Dominant versus Non Dominant Side[edit | edit source]

ROM differences between dominant and non-dominant sides were significant with increased ROM seen in shoulder internal rotation, hip abduction, and ankle plantarflexion on the non-dominant side, while increased shoulder external rotation, wrist flexion, and hip adduction was observed in the dominant side, which suggests that daily activities can lead to some variation in ROM. [7]

Test Position[edit | edit source]

Resting position of a joint can greatly influence the ROM available as a result of the muscle length of the opposing muscle. One joint muscles cross one joint and thus only influence the motion in that joint. If a one joint muscle is shortened both the PROM and AROM will be influenced.

Two joint and multi-joint muscles cross and influence multiple joints and the length of the muscle is usually not sufficient to allow full PROM simultaneously at all the joints that the muscle crosses. This is called passive insufficiency, which effectively occurs when the length of a muscle prevents the full ROM at the joint or joints that the muscle crosses over.[8] It is always important to consider passive insufficiency when measuring ROM.

Test Procedures[edit | edit source]

There is limited agreement in research on number of repetitions or warm-up protocols to use prior ROM assessment. Evidence on stretching has shown an increase in mobility, stretch tolerance and reduced passive torque during acute stretch training after only a few repetitions of a stretch[9][10][11][12], which also occurs during ROM assessment, therefore, differences in the measurement protocol with regard to the measured repetitions and warm-up exercises, can lead to different measurement results of up to 6°. [13] To counteract the impact of testing procedures on ROM use a consistent protocol for warm up, type of instrument , the number of repeated measures and type of motion measured.

Contraindications[edit | edit source]

ROM assessment techniques are typically contraindicated where muscle contraction or motion of the part of the body could disrupt the healing process or result in injury or deterioration of the condition. Some examples of conditions where ROM may be contraindicated include;

  • Suspected or Confirmed
    • Joint Subluxation / Dislocation
    • Unhealed or Unstable Fracture
    • Rupture of Tendon / Ligament
    • Infectious or Acute Inflammatory Process
    • Myositis Ossificans or Ectopic Ossification
  • Post Surgery
    • Where potential to disrupt healing process
  • Osteoporosis or Bone Fragility
    • Forced measurements may cause iatrogenic injury  

Precautions[edit | edit source]

Conditions where measurement of ROM may be appropriate, with added precautions if movement might aggravate the condition include;

  • Presence of Pain
  • Infection or Inflammation around a Joint
  • Hypermobility
  • Instability
  • Haemophilia
  • Bony Ankylosis
  • After Prolonged Immobilisation

Measuring Range of Motion[edit | edit source]

There are different instruments used to measure ROM. Choice of instrument depends on the movement to be measured, size of the limb, instrument’s accuracy, availability, cost, ease of use, and its validity and reliability.[14] Validity and reliability of ROM is influenced by types of instrument, differences among joint actions and body regions, passive versus active measurements, intra-tester versus inter-tester measurements, and different patient types. [15]

Visual Estimation[edit | edit source]

Visual estimation provide subjective information in contrast to objective goniometric measurements so not recommended. Visual estimates made prior to goniometric measurements may help to reduce errors attributable to incorrect reading of the goniometer, however, knowledge of the estimate has also been shown to influence goniometric measurement results.

Goniometry[edit | edit source]

A goniometer is the most common instrument used to measure ROM. The term 'goniometry' is derived from the greek words 'gonia' meaning angle and 'metron' meaning measure, therefore goniometry refers to the measurement of angles, which in rehabilitation settings refers to the measurement of angles in each plane at the joints of the body. There are limited validity studies on goniometry, but they have found high criterion validity in measurements of knee joint angles when compared to x-ray joint angles 29/30. Reliability depends on the joint and motion being assessed but generally the universal goniometer has been shown to have good to excellent reliability, and is more reliable than visual estimation especially with inexperienced examiners. Overall, research shows high intra- and inter-rater reliability of the universal goniometer, with reliability in non-expert examiners improved with clear instructions on goniometric alignment, therefore where possible he same therapist should perform all measures to improve accuracy. Evidence is mixed on on the number of measures to take, or whether taking an average of repeated measures improves assessment. Sources of error when using goniometry can come from our expectations of what the range of motion is, reading the wrong side of the scale on the goniometer, a change in the patient’s motivation to perform, or taking successive measurements at different times of the day.[5]

So overall greater reliability is obtained when measures are taken by the same therapist, using a standardised method with the same measurement tool assessed at the same time of day.[3][15][16] [17]

  • Versatile: Measures joint position and range of motion at almost all joints of the body
  • Construction: Typically plastic or metal, contains a body (similar to protractor) and two lever arms (stationary and movable)
  • Alignment: Arms align with proximal and distal segments of the individual’s joints
  • Cost: Varies from $5 to $100

You can read more about other types of goniometry tools including inclinometers and smart phone apps now available for use here

End-Feel[edit | edit source]

End-feel is the quality of the tissue resistance to motion at the end of passive range of motion. Each joint has a unique structure and this determines the amount of passive range of motion available to that specific joint. In some joints the joint capsule limits the amount of movement in certain directions, while in other joints the ligaments or the bones limit the movement because of the joint structure. [1] A normal end feel exists when there is full passive range of motion at the joint, which is stopped by the normal anatomy of the joint, an abnormal end feel exists when there is either a decreased or an increased passive range of motion or when there is a normal passive range of motion, but structures other than the normal anatomy stop joint movement.[4]

When the therapist performs the passive range of motion the end feel is the barrier the therapist feels when slight over pressure is applied at the end of the joint motion that prevents further movement, which takes practice and sensitivity to develop the ability to determine the character of the end-feel.

Table.1 Normal End-feel [3][5]
End-feel Description Example
Soft Soft Tissue Approximation
  • Occurs when two soft tissue masses meet one another, limiting further movement.
  • The quality of the resistance is soft, with a gradual increase in resistance as soft tissue is compressed between body parts
 Knee Flexion;

Contact between soft tissue of posterior leg and posterior thigh

Firm Muscular End Feel
  • Occurs when muscular tension limits the range of motion at a joint.
  • The quality of the resistance felt is firm, although not as firm as with the capsular end-feel, and somewhat springy.
  • Feels like stretching a bicycle tyre inner tube
 Hip Flexion with Knee Straight (SLR);

Passive elastic tension of the Hamstring Muscles

Ligamentous End Feel
  • Occurs when tension in the ligaments surrounding the joint limits the range of motion at a joint.
  • The quality of the resistance felt is firm, although not as firm as with the capsular end-feel, and somewhat springy.
  • Feels like stretching a leather belt.
 Forearm Supination;

Tension in the Palmar Radioulnar Ligament of the Inferior Radioulnar Joint, Interosseous Membrane, Oblique Cord

Capsular End Feel
  • Occurs when the joint capsule and the surrounding non-contractile tissues limit the range of motion at a joint.
  • The quality of the resistance felt is firm but not hard. There is a slight "give" to the movement.
  • Feels like stretching a leather belt, more resistance than ligament.
 Extension of Metacarpophalangeal Joints Tension in the Anterior Capsule
Hard Bone on Bone
  • Occurs when the approximation of two bones stops the range of motion at a joint.
  • The quality of the resistance felt is very hard and abrupt, and further motion is impossible.
 Elbow Extension;

Contact between Olecranon Process of the Ulna and the Olecranon Fossa of the Humerus

Table.2 Abnormal End-feels [3][4][5]
End-feel Description Example
Empty
  • No real end-feel with no mechanical limitation to the end of the range
  • Pain typically prevents the body part from moving through available range of motion
  • No resistance is felt
  • Fracture
  • Abscess
  • Bursitis
  • Acute Joint Inflammation
  • Psychogenic Disorder
Soft
  • Occurs sooner or later in the Range of Motion than is usual or in a joint that normally has a firm or hard end-feel.
  • Feels Boggy
  • Soft Tissue Oedema
  • Synovitis
Firm
  • Occurs sooner or later in the range of motion than is usual or in a joint that normally has a soft or hard end feel.
  • Increased Muscle Tone
  • Connective Tissue Shortening e.g. capsular, muscle, ligament and fascia
Hard
  • Occurs sooner or later in the range of motion than is usual or in a joint that normally has a soft or firm end feel.
  • A bony grating or bony block is felt.
  • Fracture
  • Osteoarthritis
  • Chrondromalacia
  • Myositis Ossificans
  • Loose Bodies in Joint
Springy
  • A rebound is seen or felt during the movement
  • Internal Derangement
  • Torn Meniscus
Spasm
  • Involuntary muscle contraction that prevents normal range of motion
  • Often accompanied by pain more indicative of an acute or sever lesion
  • Where no pain is present it may be an increase in muscle tone secondary to Central Nervous System involvement
  • Acute Protective Spasm
  • Acute Arthritis
  • Fracture
  • Lesion of Central Nervous System
Loose
  • Movement beyond expected anatomical limits
  • Extreme Hypermobility
  • Ankle Instability
  • Shoulder Instability

Determination of the end-feel must be carried out slowly to enable detection of the end of the range of motion and distinguish among the various normal (physiological) and abnormal (pathological) end-feels, and requires repeated practice. [3][5]

Pattern of Limitation or Restriction[edit | edit source]

In addition to evaluating the end feel, the examiner must look at the pattern of limitation or restriction. Where there is a limitation or restriction in passive range of motion, it will be important to assess the pattern of restriction, to determine whether there is a capsular or non-capsular pattern of loss.[4]

  1. Capsular Pattern
    • If there is a lesion of the joint capsule or a total joint reaction is present, a characteristic pattern of restriction in the passive range of motion will occur: Restriction is a limitation of pain and movement in a joint specific ratio, which is usually present with arthritis, or following prolonged immobilisation.
    • The capsular pattern manifests as a proportional limitation of joint motions that are characteristic to each joint; for example, the capsular pattern of the elbow joint differs from the pattern of restriction at the ankle joint.
    • Only joints that are controlled by muscles exhibit capsular patterns, while joints that rely primarily on ligaments for their stability do not exhibit capsular patterns.
    • Some research suggests that capsular patterns may not be relied upon as much as previously thought. [18][19]
  2. Non-capsular Pattern
    • Restriction is a limitation in a joint in any pattern other than a capsular one, and may indicate the presence of either a derangement, a restriction of one part of the joint capsule, or an extra-articular lesion, that obstructs joint motion. Non-capsular pattern typically indicates the absence of a total joint reaction.

You can read more about Capsular versus Non-capsular Patterns here.

Principles of Measurement[edit | edit source]

There are some overall guiding principles when assessing range of motion. Typically with range of motion assessment we are always comparing to the unaffected side. The unaffected limb active range of motion is assessed first where possible, which allows the examiner to establish the patients willingness to move and get a baseline for normal movement for the joint being tested. This also shows the patient what to expect, resulting in increased patient confidence and reduced apprehension when the affected side is tested. Any movements that are painful should be completed last, which will also minimise the risk of overflow of painful symptoms to the next movement. [1][5]

Preparation: Determine whether there are contraindications or precautions and what joints and motions need to be tested. Organise the testing sequence by body position to minimise changes in positioning.

Communication: Briefly explain the range of motion assessment and measurement procedure to the patient. Explain and demonstrate how the goniometer works and allow the individual to inspect the instrument. Explain and demonstrate the movement to be performed. Explain and demonstrate the examiner’s and  individual’s roles and confirm the individual’s understanding and willingness to participate.

Expose the Area: Explain and demonstrate anatomical landmarks and why they need to be exposed. Adequately expose the area and drape the patient as required.

Positioning: Ensure the patient is comfortable and well supported with the joint to be assessed in the anatomical position allowing for complete and unobstructed joint movement during the assessment. If movement being assessed will lengthen or stretch a two- or multi-joint muscle, ensure to move the non-test joint crossed by the muscle into position so that the two-joint or multi-joint muscle is placed on slack. This prevents the muscle from becoming passively insufficient and restricting the range of motion. If there is any variance to the patients position from standard assessment position outlined in our technique videos, ensure to make a note of this in your documentation; for example if the elbow is unable to achieve full extension record the starting angle before measuring the range of motion of flexion.[15]

Stabilisation: Isolate the motion to one joint to ensure that a true measurement of the motion is obtained. Ensure the proximal joint is stabilised to minimise any substitute movements (usually the proximal bony segment of the joint being moved) and passively move the other end to lengthen the muscle.[15] Substitute movements at other joints may occur without adequate stabilisation, which can affect results.[7] To increase accuracy therapists should know and recognise the possible substitute movements at each joint they are assessing.

Assess End Feel and Pattern of Restriction: Move the distal joint segment to the end of the passive range of motion and apply gentle overpressure at the end of the range. If active range of motion is reduced, overpressure should only be applied only with extreme care to prevent the exacerbation of symptoms. If active range of motion is full, overpressure may be carefully applied to determine the end feel of the joint. Visually estimate the passive range of motion, note the end feel, presence of pain and return the limb to the start position. Determine the presence of a capsular or non-capsular pattern of movement.

Aligning Measurement Tool: Bony landmarks are usually used to align our measurement tools when assessing range of motion. This is because bony landmarks are more stable and less likely to experience a change in position from factors like oedema. You will usually need to find three landmarks to align a goniometer:

  1. One landmark is used to align the fulcrum or axis of the goniometer - the fulcrum is positioned over a point near the joint's axis of rotation.
  2. One landmark is used to align the stationary arm - this arm is usually aligned with the midline of the stationary segment of the joint.
  3. One landmark is used to align the moving arm - this arm is usually aligned with the midline of the moving segment of the joint.[4]

The goniometer is first aligned to measure the defined zero position for the range of motion at a joint. If it is not possible to attain the zero or anatomical position, the joint is positioned as close as possible to the zero position, and the starting angle measured.

Documentation: Record the results of your range of motion and the testing position in the patient's notes. For range of motion numerical or pictorial charts are often used to record the range of motion available, and typically record the starting position and the final position; for example Elbow Flexion 0° - 150°. When it is not possible to begin the movement from the 0° start position, the range of motion is recorded by writing the number of degrees the joint is away from the 0° at the beginning of the range of motion; For example Elbow Flexion 10° - 150°.

Clinical Significance[edit | edit source]

Proficiency in assessing and measuring joint range of motion is gained through practice. It is important to practice the techniques on as many persons as possible to become familiar with the variation between individuals. On completion of the evaluation of ROM and muscle strength, the therapist must consider the impact of deficit on the patient’s daily life. Knowledge of functional anatomy of the musculoskeletal system is required to integrate the assessment findings into meaningful and practical information.

Assessing active and passive range of motion help us to determine what structures or tissues may be impacting on joint range of motion and help to quantify baseline limitations of motion, support clinical decision making regarding the management and selection of specific therapeutic interventions, outcome analysis after a particular intervention has been applied, and compare the efficacies of different interventions.

Summary[edit | edit source]

Having adequate joint range of motion enables optimal movement.  Thus, assessing range of motion is an important piece in the clinical puzzle. When performing your assessment, please remember the following:

  • The testing position of a joint can greatly influence the passive range of motion available as a result of the muscle length of the opposing muscle.
  • If movement being assessed will lengthen or stretch a two- or multi-joint muscle, ensure to move the non-test joint crossed by the muscle into position so that the two-joint or multi-joint muscle is placed on slack.
  • When we observe changes in range of motion, we must always consider our findings in the context of the rest of our assessment, including our movement analysis, as well as posture, muscle length, muscle strength, tone, neural tests and more, and apply our clinical reasoning skills to what we find.

References  [edit | edit source]

  1. ↑ 1.0 1.1 1.2 1.3 Reese NB, Bandy WD. Joint Range of Motion and Muscle Length Testing-E-book. Elsevier Health Sciences; 2016 Mar 31.
  2. ↑ Cox R. Oxford Dictionary of Sports Science and Medicine. Reference Reviews. 2007 Sep 25;21(7):50-.
  3. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. FA Davis; 2016 Nov 18.
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Clarkson HM. Musculoskeletal assessment: joint motion and muscle testing. 2013.
  5. ↑ 5.0 5.1 5.2 5.3 5.4 5.5 Magee D. Orthopaedic Physical Assessment WB Saunders. pg. 2002;478:483-631.
  6. ↑ Gil-González S, Barja-Rodríguez RA, López-Pujol A, Berjaoui H, Fernández-Bengoa JE, Erquicia JI, Leal-Blanquet J, Pelfort X. Continuous passive motion not affect the knee motion and the surgical wound aspect after total knee arthroplasty. Journal of Orthopaedic Surgery and Research. 2022 Jan 15;17(1):25.
  7. ↑ 7.0 7.1 7.2 7.3 7.4 7.5 Moromizato K, Kimura R, Fukase H, Yamaguchi K, Ishida H. Whole-body patterns of the range of joint motion in young adults: masculine type and feminine type. Journal of physiological anthropology. 2016 Dec;35:1-2.
  8. ↑ Rogers M, Rogers M. Understanding Active and Passive Insufficiency [Internet]. National Federation of Professional Trainers. 2020 [cited 17 September 2020]. Available from: https://www.nfpt.com/blog/understanding-active-and-passive-insufficiency
  9. ↑ Glück S, Hoffmann U, Schwarz M, Wydra G. Range of motion, traction force and muscle activity in self- and external-regulated stretching. Deutsche ZeitschriftfürSportmedizin. 2002;53:66–71.
  10. ↑ Magnusson SP, Simonsen EB, Aagaard P, Kjaer M. Biomechanical responses to repeated stretches in human hamstring muscle in vivo. Am. J. Sports Med. 1996;24:622–628. doi: 10.1177/036354659602400510.
  11. ↑ Boyce D, Brosky JA. Determining the minimal number of cyclic passive stretch repetitions recommended for an acute increase in an indirect measure of hamstring length. Physiother. Theory Pract. 2008;24:113–120. doi:
  12. ↑ Nakamura M, Ikezoe T, Takeno Y, Ichihashi N. Time course of changes in passive properties of the gastrocnemius muscle–tendon unit during 5 min of static stretching. Manual Therapy. 2013;18:211–215. doi: 10.1016/j.math.2012.09.010.
  13. ↑ Holzgreve F, Maurer-Grubinger C, Isaak J, Kokott P, Mörl-Kreitschmann M, Polte L, Solimann A, Wessler L, Filmann N, van Mark A, Maltry L. The acute effect in performing common range of motion tests in healthy young adults: a prospective study. Scientific Reports. 2020 Dec 10;10(1):1-9.
  14. ↑ Norkin CC, White DJ. Measurement of joint motion: a guide to goniometry. FA Davis; 2016 Nov 18.
  15. ↑ 15.0 15.1 15.2 15.3 Gajdosik RL, Bohannon RW. Clinical measurement of range of motion: review of goniometry emphasizing reliability and validity. Physical therapy. 1987 Dec 1;67(12):1867-72.
  16. ↑ Blonna, D., Zarkadas, P. C., Fitzsimmons, J. S., & O'Driscoll, S.W. (2012). Accuracy and inter-observer reliability of visual estimation compared to clinical goniometry of the elbow. Knee Surgery, Sports Traumatology, Arthroscopy, 20(7), 1378-85.
  17. ↑ Boone, D. C., Azen, S. P., Lin, C., Spence, C., Baron, C., & Lee, L. (1978). Reliability of goniometric measurements. Physical Therapy, 58(11), 1355-1360.
  18. ↑ Thurnwald PA. The effect of age and gender on normal tem- poromandibular joint movement. Physiotherapy Theory Practice. 1991;7:209–221.
  19. ↑ Venes D, ed. Taber’s Cyclopedic Medical Dictionary. 19th ed. Philadelphia, PA: FA Davis; 2001.
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