EXS120
Range of Motion Introduction
Definition of Range Of Motion
• The full motion possible at a joint or in a muscle is called the range of
motion (ROM)
• ROM can be passive, active or active assistive (PROM, AROM, AAROM)
• When moving a segment through its ROM, all structures in the region
are affected: Muscles, joint surfaces, capsules, ligaments, fasciae,
vessels, and nerves.
• ROM activities are most easily described in terms of joint range and
muscle range. To describe joint range, terms such as flexion,
extension, abduction, adduction, and rotation are used. To describe
muscle range, terms such as flexibility or excursion are used.
• Ranges of available joint motion are usually measured with a
goniometer and recorded in degrees.
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Definition of ROM
• ROM can be either data collection or intervention
• In physical therapy we call measurements and assessments of
the patient ‘data collection’
• And we call treatments and exercises ‘interventions’
Definition of ROM
• ROM as data collection is the assessment or measurement of
movement: For instance, how far can the joint move?
• So data collection of the Passive ROM or the Active ROM
are two different assessments because they are two
different types of movement
• ROM as an intervention is for initiating movement into a
rehab program: it is a basic level therapeutic exercise
• Again, this could be PROM or AROM or even AAROM
Definition of ROM
• For assessment or measurement of movement – there are
two categories of data collection
• PROM or AROM
• How far can you (as the clinician) move the patient’s joint
or muscle without encountering resistance? (PROM)
• How far can the patient move their own joint or muscle?
(AROM or AAROM)
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Definition of ROM as an exercise
• For initiating movement into a rehab program – there are
three separate types of ROM interventions
• The purposes of PROM or AAROM or AROM in rehab:
• To maintain mobility of tissues - PROM, AAROM, or AROM
can be used
• To maintain muscle activity - AAROM or AROM can be used
• To increase muscle strength - AAROM or AROM can be
used when the strength is very low
Definition of ROM as an exercise
• PROM, AROM, or AAROM can maintain available motion
because the body part is moving
• AROM or AAROM can maintain strength in a weak muscle
• AROM or AAROM can improve strength in a very weak muscle
• PROM can never maintain or gain strength because the
muscles are not activated
• PROM can never increase mobility because it does not stretch
• PROM of a muscle
• PROM as data collection determines how much mobility
or excursion a muscle has before it begins to stretch
• Example – how much flexibility is available in the hamstring
muscle
• PROM as an intervention moves the muscle into a
lengthened position but stops the movement before it
begins to stretch
• Example – you passively move the LE so that the origin and
insertion of the hamstrings move away from each other then
move toward each other with causing a stretch force
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Benefits/Goals of ROM as an intervention
• PROM
• Maintain joint and connective tissue mobility
• Minimize the effects of the formation of contractures
• Maintain elasticity of muscle
• Assist circulation and vascular dynamics
• Move synovial fluid and provide nutrition to hyaline cartilage
• Decrease or inhibit pain
• Assist with healing process after surgery
• Maintain patient’s awareness of movement
Benefits/Goals of ROM as an intervention
• AROM
• Maintain elasticity and contractility of muscle
• Increase circulation and prevent thrombus formation
• Provide a stimulus for bone and joint tissue integrity
• Provide sensory feedback from contracting muscles
• Develop coordination
• Increase strength (in very weak muscles)
Indications of ROM as an intervention
• PROM
• Early in the prehab process, PROM is beneficial to maintain mobility
• When motion is beneficial but the patient is not allowed to contract
the muscle
• When the patient is unable to move the body part themselves
Indications of ROM as an intervention
• AROM
• When the patient is allowed to move and to contract the muscles
• When the patient has weak muscles and unable to move the joint
through the entire range AAROM is used
• When a body part is immobilized but the proximal or distal joints are
allowed to move
Contraindications of ROM as an intervention
• When motion is disruptive to the healing process
• When the patient has been told not to move the body part
• After acute tears or active bleeding
• After fractures
• When motion causes significant pain
• With acute inflammation
Physiological Adaptations to ROM - intervention
• Prevention of the negative effects of immobility
• PROM can maintain mobility
• PROM does not stretch
• PROM does not strengthen
• AROM can strengthen a very weak muscle but will not strengthen a
strong muscle
Determinants of ROM – intervention
• Alignment
• Stabilization
• Volume – reps and sets – generally 5-10 reps and 1-3 sets
• Frequency – how many times a day – anywhere from 2 times to 12
times a day
• Rest interval – no significant rest is needed for PROM, 1-2 minutes is
needed if AROM fatigues the muscle
• Speed of exercise – slow and controlled
Separate Domains of ROM
• PROM as Data Collection • PROM as Intervention
• Distance moved • Maintenance of motion or
• End feel mobility
• Pain? Where in the motion does • Does not increase ROM
it occur? • Does not go into end feel
Continuum of Active Motion to restore
strength
• AAROM gravity eliminated
• AAROM against Gravity
• AROM gravity eliminated
• AROM against Gravity
• Resistive Exercises
• Specific Training
PROM as an intervention
• Movement within the unrestricted ROM for a segment that is
produced entirely by an external force
• Must be stopped before End Feel if it is an intervention
• Therefore the exercise of PROM stops before TR1 (Tissue Resistance
One)
• PROM is not stretching – it usually does not gain motion
AAROM as an intervention
• Type of AROM in which assistance is provided by an outside
force to complete the motion
• Typically is used when there is a weakness in the muscle
AROM an intervention
• Movement within the unrestricted ROM for a segment that
is produced by active contraction of the muscles that cross
that joint
Testing Techniques
• PROM as Data Collection – what data is collected?
• Distance moved (the number of degrees)
• End feel
• Pain? Where in the motion does it occur?
Testing Techniques
• PROM data collection assesses the mobility of all tissues that
cross a joint
• When elongated the tissues will provide a resistance that can
be felt by the clinician
• Each tissue that crosses a joint has a different feel when
stretched – this is called End Feel
Testing Techniques
• In PTA we will cover three general types of normal End Feels
• Bony end feel – when a two bones limit the motion
• Firm (Tissue stretch) end feel – when either a
ligament/capsule or a muscle limits the motion
• Can be further defined as Firm Muscular end feel or
Firm Capsular end feel
• Soft tissue approximation end feel – when a soft tissue is
being squeezed together and limits the motion
Testing Techniques
• AROM data collection is typically assessed against gravity
• AROM should be the same as what was measured passively
• Assesses mobility, but also provides information on strength
and coordination
• No end feel assessment with AROM
Application of PROM
• Usually have one hand proximal and one hand distal to the joint that
is being moved
• Typically the proximal segment should be stabile and the moving
segment should be kept in the proper plane
• Move the segment through complete PROM to point of tissue
resistance (TR1). Do not force beyond available range (do not push
past TR1). If you force motion, it becomes a stretching technique.
• The patient must be relaxed and must not try to help the movement
• Perform the motions smoothly, slowly, and rhythmically, 5 to 10
repetitions for 1-3 sets. The number of repetitions and sets depends
on the objectives of the program and the patient’s condition and
response to the treatment.
What can limit PROM?
What can limit AROM?
If AROM is limited what Therapeutic
Exercise should be prescribed?
Data Collection or Intervention?
AROM or PROM?
Joint and anatomical motion?
Data Collection or Intervention?
AROM or PROM?
Joint and anatomical motion?
Data Collection or Intervention?
AROM or PROM?
Joint and anatomical motion?
CONTINUOUS PASSIVE MOTION - CPM
• CPM: Passive motions performed by a
mechanical device which moves a joint
slowly and continuously through a range of
motion.
Proposed benefits of CPM:
Lessening of effect of immobilization in conditions such
as arthritis and intraarticular fractures; improved
recovery rate and ROM after surgeries including those
involving cartilage and ligament
