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 (ROM) is the capability of a joint to go through its complete spectrum of movements. Range of motion of a joint can be passive, active-assisted 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 or a CPM machine) exclusively causes movement of a joint and is usually the maximum range of motion that a joint can move.
2. Active-assisted range of motion happens when the joint receives partial assistance from an outside force.
3. 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.

ICF Category

b - Body functions > b7 - Neuromusculoskeletal and movement- related functions >

b710 - Mobility of joint functions: functions of the range and ease of movement of a joint.

- Inclusions: functions of mobility of single or several joints, vertebral, shoulder, elbow, wrist, hip, knee, ankle, small joints of hands and feet; mobility of joints generalized; impairments such as in hypermobility of joints, frozen joints, frozen shoulder, arthritis

- Exclusions: stability of joint functions (b715); control of voluntary movement functions (b760)

- Subcategories:

b7100 - Mobility of a single joint: Functions of the range and ease of movement of one joint.

b7101 - Mobility of several joints: Functions of the range and ease of movement of more than one joint.

b7102 - Mobility of joints generalized: Functions of the range and ease of movement of joints throughout the body.

b7108 - Mobility of joint functions, other specified

b7109 - Mobility of joint functions, unspecified

Measuring Range of Motion

- A Goniometer is commonly used to measure 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.

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

See the goniometry collection of pages for instructions on how to correctly (reliably and accurately) place the goniometer when measuring range of motion.

- An Inclinometer can also be used, which has different purpose. It is not as versatile as a goniometer.
- Tape measures can also be used to measure range of motion in some specific parts of the body (lumbar spine range of motion).

- Digital applications: measurements by using mobile phones are the most recent proposal for the range of motion of various joints.

Movement Planes

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

Plane	Division of plane and axis	Axis of Rotation	Movements
Frontal (coronal)	Divides body or segment into anterior or posterior sections	Sagittal	Abduction and adduction
Sagittal	Divides body or segment into left and right sections, which is referred to as medial and lateral sections	Frontal (transverse)	Flexion and Extension
Transverse	Divides body or segment into to and bottom, or upper and lower sections, which is also referred to as superior and inferior	Longitudinal (vertical)	Internal Rotation and External Rotation

Range of Motion Normal Values

Each joint has a normal ROM range of values, 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)
  

Increasing Range of Motion

As mentioned in the next section, 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: 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: 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: 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 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 entire 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. 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 .

Resources

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