Assessing Range of Motion

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Original Editors - Naomi O'Reilly and Tarina Van Der Stockt

Top Contributors - Naomi O'Reilly, Jess Bell, Ewa Jaraczewska and Tarina van der Stockt      

Introduction

Range of motion (ROM) means the extent or limit to which a part of the body can be moved around a joint or a fixed point; the totality of movement a joint is capable of doing. Range of motion is essential to your body’s functional mobility. Bones, ligaments, muscles, and tendons support each joint in your body, enabling it to move within a specific range.

If you have limited range of motion in one or more joints, your body may compensate by placing stress on other joints or muscles, resulting in muscle imbalance and improper body alignment. Poor alignment and muscle imbalance present a greater risk of injury and pain and reduce functional mobility.

Types of 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. For example, the active range of motion to allow the elbow to bend requires the biceps to contract while the triceps muscle relaxes. Active range of motion is usually less than passive range of motion. Performed by the patient independently and when the patient is able to voluntarily contract, control, and coordinate a movement. AROM exercises are used when the patient is able to voluntarily contract, control, and coordinate a movement when such a movement is not contraindicated.

Active-assisted Range of Motion

• Active-assisted range of motion (AAROM) is the range of movement when the joint receives partial assistance from an outside force. Typically performed when the patient needs assistance with movement from an external force because of weakness, pain, or changes in muscle tone. The assistance may be applied mechanically, manually, or by gravity while the patient performs a voluntary muscle contraction to the extent they are able.

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. Usually 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. The assistance may be applied mechanically or manually.

Factors Impacting Range of Motion

Age

Gender

Body Mass Index

Test Position

Instrument Used

Contraindications

Conditions where active range of motion may be contraindicated include the following;

• Suspected or Confirmed
  • Joint dislocation or subluxation
  • Unhealed or unstable bone fracture
  • Rupture of tendon or ligament
  • Infectious or acute inflammatory process
• Post-surgery if movement disrupts the healing process
• Regions of osteoporosis or bone fragility, as forced measurements may cause iatrogenic injury  

Precautions

Conditions where measurement of range of motion is appropriate with added precautions include the following;

1. Infection or inflammation around a joint
2. Severe pain aggravated by movement
3. Hypermobility or instability
4. Presence of pain or muscle spasms

Measuring Range of Motion

There are different instruments used to measure ROM. The choice of instrument depends on the purpose of the measurement, the movement to be measured, the instrument’s accuracy, availability, cost, ease of use, size and its validity and reliability.

Goniometer

Most common instrument used to measure range of motion in the clinical setting. Reliability & validity of hand-held goniometry has been shown to be good to excellent but has limited use in movement analysis as it gives you a static end range measurement only, but is helpful as an outcome measure to assess effect of treatment in conjunction with functional testing.

• Versatile: Measures joint position and range of motion at almost all joints of the body
• Construction: Typically plastic, contains a body (similar to a 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

Smart Phones

Can be loaded with appropriate software applications

• Allows smartphones to function as inclinometers by using built-in tilt-sensitive systems
• Data on reliability and validity are currently insufficient to support use in the clinical setting

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.

Principles of Measurement

Positioning

• Testing Position
  • Body positions recommended for obtaining goniometric and muscle length measurements
  • Places the joints in a zero starting position when measuring range of motion (ROM)
  • Helps to stabilise the proximal joint segment
  • Important for the comfort of the examiner and individual being measured
  • Stabilises the body and proximal joint segment
  • Isolates the motion to one joint to ensure that a true measurement of the motion is obtained

End Feel

End feel is the quality of the tissue resistance to motion at the end of the passive range of motion. Each joint has a normal end feel at a normal point in the range of motion (ROM). Abnormal end feel, or correct end feel but at the incorrect point in the range indicate pathology.

Table.1 Normal End Feel

End Feel	Description	Example
Soft	Soft Tissue Approximation End Feel 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	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
	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 Inferior Radioulnar Joint, Interosseous Membrane, Oblique Cord
	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 the knee straight Passive elastic tension of the Hamstring Muscles
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 Feel

End Feel	Description	Example
Empty	No real end feel Movement definitely beyond the anatomical limit or Pain prevents the body part from moving through available ROM	Fracture Ligament Rupture Psychogenic Disorder
Soft	Occurs sooner or later in the Range of Motion than is usual or in a joint that normally has a hard end feel.	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 firm end feel.	Increased Muscle Tone Soft Tissue Shortening
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 Myositis Ossificans
Spasm	Involuntary muscle contraction that prevents normal ROM due to pain (guarding; eg, muscle spasm)	Acute Protective Spasm
Loose	Extreme Hypermobility	Ankle Instability Shoulder Instability

Clinical Significance

Resources

References