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

Range of motion is the capability of a joint to go through its complete spectrum of movements. Range of motion of a joint can be passive or active.

Definition - The definition of ROM varies among published sources; Kapandji and colleagues described ROM as “the extent of osteo-kinematic motion available for movement activities, functional or otherwise, with or without assistance”

1. Passive range of motion can be defined as the range of motion that is achieved when an outside force (such as a therapist) causes movement of a joint and is usually the maximum range of motion that a joint can move.
2. Active range of motion is the range of motion 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.

Range of motion therapy is beneficial in healing and in recovery from soft tissue and joint lesions, maintaining existing joint and soft tissue mobility, minimizing the effects of contracture formation, assisting neuromuscular reeducation, and enhancing synovial movement.

Measuring Range of Motion

Devices to measure range of motion in the joints of the body include the Goniometer (image 2) and Inclinometer (image 3). Both use a stationary arm, protractor, fulcrum, and movement arm to measure angle from axis of the joint).

Of all the types, a universal goniometer is most widely used and comes in two forms: short arm and long arm.

• The short arm goniometer is used for smaller joints like the wrist, elbow, or ankle,
• The long arm goniometers are more accurate for joints with long levers like the knee and hip joints

Tape measures can also be used to measure range of motion in some specific parts of the body (lumbar range of motion).

Range of Motion Exercises

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 exercises

1. Passive Range of Motion: 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.
2. Active Assisted Range of Motion: 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.
3. Active Range of Motion: Movement of a joint provided entirely by the individual performing the exercise. In this case, there is no outside force aiding in the movement.

Range of Motion Chart

Each joint has a normal ROM, while each person has a different amount of ability to achieve it. Below are generally accepted values for a normal ROM for some individual joints as measured in degrees

Table 1. Typical Joint Ranges

Joint / Segment	Movement	Degrees
Wrist	Flexion	60
	Extension	60
	Radial Deviation	20
	Ulnar Deviation	20
Forearm	Pronation	80
	Supination	80
Elbow	Flexion	140
	Extension	0
Shoulder	Flexion	180
	Hyperextension	50
	Abduction	180
	Adduction	50
Shoulder with Abducted Arm	Internal Rotation	90
	External Rotation	90
	Horizontal Adduction	-
	Horizontal Adduction	-
Cervical Spine	Flexion	60
	Hyperextension	75
	Lateral Flexion	45
	Rotation	80
Thorac0-Lumbar Spine	Flexion	45-50
	Hyperextension	25
	Lateral Flexion	25
	Rotation	30
Hip	Flexion	100
	Hyperextension	30
	Abduction	40
	Adduction	20
	Internal Rotation	40
	External Rotation	50
Knee	Flexion	150
	Extension	0
Ankle	Plantarflexion	40
	Dorsiflexion	30

Causes of Limited Range of Motion

Limited range of motion 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)

Physiotherapy

There are many reasons for seeing a physiotherapists if movement is reduced at a join. Range of motion therapy benefits

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

Range of movement exercises can:

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

Regaining range of motion in a joint is one of the first phases of injury rehabilitation and a physiotherapy assessment will be performed prior to prescribing a range of movement exercises. The assessment looks at the 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 post operative eg Total knee replacement.
• In paediatrics, 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 the family member or the healthcare provider. Active ROM exercises are be performed by the child.

Resources

• Verywell Health
• Movement for Life Blog
• Human kinetics Blog