Range of Motion

Original Editor - SULEIMAN USMAN

Top Contributors - Angeliki Chorti, Lucinda hampton, SULEIMAN USMAN, Kapil Narale, Naomi O'Reilly, Shaimaa Eldib, Vidya Acharya, Mariam Hashem, Kim Jackson, Leana Louw and Shreya Pavaskar  

Introduction

Measuring ROM

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 of a joint is gauged during passive ROM (assisted) PROM or active ROM (independent) AROM.

1. ROM is usually assessed during a physical therapy assessment or treatment. Normal values depend on the body part, and individual variations.
2. The purpose of ROM exercises are prevention the development of adaptive muscle shortening, contractures, and shortening of the capsule, ligaments, and tendons. ROM exercises also provide sensory stimulation.

Types of ROM

1. Passive range of motion (PROM) is the ROM that is achieved when an outside force (such as a therapist or a CPM machine) exclusively causes movement of a joint and is usually the maximum range of motion that a joint can move. Usually performed when the patient is unable or not permitted to move the body part.
2. Active-assisted range of motion (AAROM) is when the joint receives partial assistance from an outside force. Usually performed when the patient needs assistance with movement from an external force because of weakness, pain, or changes in muscle tone
3. Active range of motion (AROM) is the ROM 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. Usually performed by the patient independently and when the patient is able to voluntarily contract, control, and coordinate a movement.

Measuring Range of Motion

Goniometer

ROM measurements are an integral part of the physiotherapy assessment since monitoring patient status and documenting patient progress are standard requirements of physiotherapy practice. The tool used may depend on the body part, ease of use and physiotherapist's experience.

Schober Test

A Goniometer is the most common tool for measuring range of motion of the joints of the body. It uses a stationary arm, fulcrum, and movement arm to measure joint angles from the axis of the joint. Making a ROM measurement by using a goniometer requires training for reliable results. See the goniometry collection of pages for instructions on how to correctly (reliably and accurately) place the goniometer when measuring range of motion.

Other types of ROM measurement: Tape measures can also be used to measure range of motion in some specific parts of the body. For example lumbar spine flexion can be assessed with a tape measure in the Schober Test.

For more information on this topic, check the Assessing Range of Motion page.

Movement Planes

Cardinal planes

Three basic reference planes are used in anatomy. When considering the range of motion of a joint, or the movement direction, the three universal planes need to be taken into account. Each of the movements lie in one of the respective planes.

Causes of Limited Range of Motion

Limited ROM refers to a joint that has a reduction in its ability to move. Motion may be limited because of a problem within the joint, swelling of tissue around the joint, stiffness of the muscles, or pain.

Medical conditions associated with a limited range of motion in the joints include:

• Ankylosing Spondylitis
• Osteoarthritis (OA)
• Rheumatoid Arthritis (RA)
• Juvenile RA, which is an autoimmune form of arthritis that occurs in children under the age of 16 years
• Cerebral Palsy (CP)
• Legg-Calve-Perthes disease.
• Sepsis of the hip and other joints, which is a bacterial infection of the joints
• Congenital Torticollis
• Syphilis, which is a sexually transmitted infection (STI)

Other causes of restricted range of motion include:

• Inflammation of the soft tissues surrounding the joint, or joint swelling
• Muscle Stiffness
• Pain
• Joint Dislocation
• Fractures

Other than pathological causes for restriction of movement, there could be non-pathological causes such as

• Tight Clothing
• Hypertrophy of muscles due to strength training (e.g biceps brachii hypertrophy limits the range of elbow flexion)
• Fat

Increasing Range of Motion

Range of motion can be maintained and gradually increased through the following range of motion & stretching exercises. Check out the page on Stretching for an in-depth explanation of the concept and topic.

Range of Motion Exercises & Stretching

Range of motion exercise refers to activity aimed at improving movement of a specific joint. This motion is influenced by several structures: configuration of bone surfaces within the joint, joint capsule, ligaments, tendons, and muscles acting on the joint.

There are three types of range of motion stretching exercises:

1. Active Range of Motion (AROM): Movement of a joint provided entirely by the individual performing the exercise. In this case, there is no outside force aiding in the movement.
2. Passive Range of Motion (PROM): Movement applied to a joint solely by another person or persons or a passive motion machine. When passive range of motion is applied, the joint of an individual receiving exercise is completely relaxed while the outside force moves the body part, such as a leg or arm, throughout the available range.
3. Active Assisted Range of Motion (AAROM): Joint receives partial assistance from an outside force. This range of motion may result from the majority of motion applied by an exerciser or by the person or persons assisting the individual. It also may be a half-and-half effort on the joint from each source.

Physiotherapy

There are many reasons for seeing a Physiotherapist to aid with limited range of motion at a join. Range of motion therapy benefits include:

• Healing and recovery from soft tissue and joint lesions
• Maintaining existing joint and soft tissue mobility
• Minimizing the effects of contracture formation
• Preventing adhesions between myo-fascia.
• Assisting neuromuscular reeducation
• Enhancing synovial movement .

Range of movement exercises can:

• Increase movement at a joint
• Increase the function of a joint, and the entire limb
• Improve movement efficiency
• Increase independence
• Decrease pain
• Improve and maintain joint integrity
• Improve Balance

Regaining range of motion in a joint is one of the first phases of injury rehabilitation. A physiotherapy assessment will be performed prior to prescribing a range of movement exercises. The assessment looks at the present range and the quality of the movement.

• Joints maintain a balanced range of motion by regular use and stretching of the surrounding soft tissues. Just 10 minutes of stretching three times a week can help improve range of motion.
• Quite often strengthening exercises are prescribed alongside or shortly after range of movement exercises as the increased movement at a joint without increasing the strength could cause a further injury .
• If the goal is to increase performance, the combination of foam rolling followed by stretching (but not vice versa) should be favored compared to stretching alone.
  
• Continuous Passive Movement Machine (CPM) is also used to maintain and improve ROM. Physiotherapists may use this machine on post-operative patients (eg Total knee replacement patients).
• In pediatrics, ROM exercises are used when all or some of the normal physical activities are not able to be completed due to the physical condition of the child. Attention is given to the joint not being used through provision of active or passive ROM exercises. Passive ROM exercises can be performed by a family member or the healthcare provider. Active ROM exercises are performed by the child .