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Chapter Four: Range of Motion

Michael Higgins

LEARNING OBJECTIVES

LEARNING OBJECTIVES

Upon completion of this chapter, the learner should be able to demonstrate the following competencies and proficiencies concerning range of motion:

  • Define and understand the difference between active range of motion, passive range of motion, and resistive range of motion

  • Define terms that are associated with joint range of motion

  • Determine what can cause limitations in a patient's range of motion

  • Describe Cyriax's method for classification of tissue injury

  • Describe proper goniometric placement for the upper extremity and lower extremity

  • Describe and understand normal and abnormal end feels for the upper and lower extremity

  • Describe Cyriax's classification for muscular lesions

  • Describe and implement passive, active assistive, and active range of motion exercises for the upper extremity, lower extremity, and spine

  • Describe and implement neural tension/neurodynamic mobilization techniques for the upper and lower extremity

INTRODUCTION

Certain movements such as active, physiologic or voluntary, passive or involuntary, and accessory or inherent occur in the musculoskeletal system.1 When evaluating a patient's range of motion (ROM), it must be assessed in the following order: actively, passively, and against resistance.2,3 ROM should be assessed by the quality of movement, quantity of movement, and pain associated with movement. The quality of movement determines how well the patient moves the joint through the desired range. The quantity of movement determines how far or how much motion is present in the joint being evaluated. Pain must always be evaluated to determine if it limits joint motion and then when and where it occurs within the ROM. When possible, the joint motions that cause pain should be evaluated last so as not to bias or cause pain in otherwise pain-free joint movements. The clinician must be conscious of the cause of the motion restriction in order to apply the most appropriate intervention. Many interventions can be used on the different types of restrictions (Table 4-1).

Table 4-1RANGE OF MOTION RESTRICTION CAN BE CAUSED BY SEVERAL FACTORS
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Table 4-1 RANGE OF MOTION RESTRICTION CAN BE CAUSED BY SEVERAL FACTORS
Type of Restriction Example Type of Exercise Indicated
Soft tissue restriction/muscle tightness Tight hamstrings, which cause a decrease in hip flexion Stretching (active, passive, and/or dynamic)
Muscle imbalances Decrease in shoulder flexion as a result of tight latissimus dorsi Stretching/modification of weight-training exercises
Contracture of soft tissue joint capsule or articular structures Decreased knee extension after ACL surgery Joint mobilization
Neural tension Decreased hip flexion as a result of tension of sciatic nerve Neural tension mobilization
Postural imbalances Anterior pelvic tilt as a result of tight hip flexors Stretching/postural exercises
Joint dysfunction Decreased shoulder ER as a result of anterior capsule damage Stabilization exercises

Clinical Pearl 4-1

Range of motion is best assessed in the following order: active, passive, and resistive.

ROM testing is useful for ...

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