Range of motion (ROM) loss is a common impairment that can affect function and participation. Loss of, or impaired ROM, can occur from a number of causes including pain, immobilization, edema, spasticity, and decreased muscle strength. As a result, the interventions used to address this impairment vary according to the source or cause. It is, therefore, important to determine the cause of the impairment when selecting the appropriate therapeutic interventions. For example, if ROM is thought to be limited by pain, therapeutic modalities and interventions aimed at controlling pain such as transcutaneous electrical nerve stimulation (TENS) would be helpful. Likewise, if the cause of the ROM impairment is edema, therapeutic modalities aimed at reducing that edema such as cryotherapy may be helpful in restoring ROM. The mechanisms, parameters, and application of these therapeutic modalities have been presented in detail in other chapters of this text. The purpose of this chapter is to demonstrate how these physical agents can be used as a complement to improve ROM impairment as part of the treatment plan.
The importance of ROM for functional and efficient movement is noted throughout the body. The loss of this ROM may have immediate consequences to completing functional tasks. For example, a lack of full ankle dorsiflexion ROM can make descending steps difficult. This may lead to compensations or altered movement patterns to complete a functional task such as external rotation of the leg or early heel rise. Over time, additional consequences may be apparent as the movement compensations may place excessive stresses on other structures. Understanding the root cause of a ROM restriction is important in determining how to address the ROM impairment. A detailed examination and assessment of ROM will help determine the causes of a ROM impairment and therefore help develop a course of treatment to improve it, complemented by therapeutic modalities.
SOURCES OF LOSS OF MOBILITY AND RANGE OF MOTION
Determining the cause of limited or impaired ROM is crucial to the development of a plan to address it. Many musculoskeletal and neuromuscular conditions result in limited active and passive ROM. Common sources of limited ROM include pain, edema, muscle weakness, arthritic joint stiffness, and joint contracture. In addition, muscle length/flexibility and muscle tone can limit ROM, as is the case with spasticity due to a neurological lesion or injury. These sources of ROM loss are discussed in detail along with recommended interventions to address them. However, it is important to recall that therapeutic modalities represent complementary interventions to be used as cotherapies with other skilled interventions.
Joint Pain as a Limiter of ROM
Pain is commonly seen as a source of impaired ROM. The causes and expressions of pain are discussed throughout this text. While pain perception is a unique and individual experience, it can sometimes lead to common ...