When a client is able to do the range of motion exercises without assistance we refer to these as

What is Musculoskeletal Range of Motion?

Range of motion (ROM) is the measurement of movement around a specific joint or body part. It involves both the distance a joint can move and the direction in which it can move. There are established ranges considered normal for various joints in the body. For a joint to have full ROM, it must have good flexibility. Flexibility is the ROM around a joint. Each joint has its own level of flexibility, expressed in degrees. Flexibility can refer to ligaments, tendons, muscles, bones, and joints. Limited flexibility may lead to pain, limitation, and compensation, all of which can result in increased dysfunction of the joint. If a joint has full ROM, it should be able to move in all planes and directions permitted to that joint. Joint movements include flexion, extension, abduction, and adduction.

Flexion is the movement that decreases the angle of the joint, bringing two bones closer together.

Extension is the opposite of flexion, involving movement that increases the joint angle, or the distance between two bones or parts of the body.

Abduction involves movement of the limb away from the midline of the body.

Adduction is the opposite of abduction, involving movement of the limb towards the body midline.

Limited ROM refers to a joint with decreased ability to move causing limited motion. A problem within the joint, swelling of tissue around the joint, muscle stiffness, or pain can lead to limited ROM. Joint ROM naturally declines as you age, but it can occur due to several conditions. Conditions that can result in these symptoms include arthritis, joint dislocation, joint injury, immobilization, and surgery.

The purpose of ROM exercises is to prevent the development of adaptive muscle shortening, contractures, and shortening of the capsule, ligaments, and tendons. In addition, ROM exercises provide sensory stimulation. ROM exercises are prescribed for a specific joint with limited ROM upon the outcome of a physiotherapy assessment. This assessment looks at the ROM and quality of movement of the joint. These exercises can be assisted by gravity, assisted by yourself, assisted by another person, done within water, and by an external machine. Strengthening exercises may be prescribed alongside or shortly after ROM exercises, as the increased movement at the joint without increasing the strength could cause a further injury.

The 3 types of ROM exercises include passive, active, and active assistive ROM.

Passive ROM is the movement applied to a joint by another person or motion machine. With passive ROM, the joint receiving the exercise is completely relaxed while the outside force moves the body part throughout the available range.

Active ROM is the movement of a joint provided entirely by the individual performing the exercise. Active ROM is done without an outside force aiding in the movement.

Active assisted ROM involves the joint receiving partial assistance from an outside force. Active assisted ROM may result from most of the motion applied by the individual performing the exercise or by the person assisting the individual.

ROM testing is important in determining the cause and severity of issues you may be having with joint movement. Testing ROM provides information as to whether or not joints are moving the full ROM expected of them. An Inclinometer is a device that measures the slopes of your joints, which is helpful in determining your body’s stability in different areas as you perform various movements. At Whole Body Healthcare, we can test your ROM with the use of an inclinometer every two weeks to ensure patient’s ROM is improving appropriately, or whether different or additional ROM exercises are needed.

Here is Arek, a Massage Therapist at Whole Body Healthcare, discussing Range of Motion:

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]

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[2].

Measuring Range of Motion[edit | edit source]

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).[3]

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[4]

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[edit | edit source]

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[edit | edit source]

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

Causes of Limited Range of Motion[edit | edit source]

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.[6]

Medical conditions associated with a limited range of motion in the joints include:

Other causes of restricted range of motion include:

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[edit | edit source]

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[2].

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[8].
• 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.[9]
• Continuous Passive Movement Machine (CPM) is also used to maintain and improve ROM. Physiotherapists may use this machine post operative eg Total knee replacement[10].
• 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[11].

Resources[edit | edit source]

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

References[edit | edit source]

1. ↑ Abu El Kasem ST, Aly SM, Kamel EM, Hussein HM. Normal active range of motion of lower extremity joints of the healthy young adults in Cairo, Egypt. Bulletin of Faculty of Physical Therapy. 2020 Dec;25(1):1-7.
2. ↑ 2.0 2.1 Hudson S. Rehabilitation Methods and Modalities for the Cat. InHandbook of Veterinary Pain Management 2009 Jan 1 (pp. 538-577). Mosby. Available:https://www.sciencedirect.com/science/article/pii/B9780323046794100280 (accessed 25.10.2021)
3. ↑ Gajdosik RL, Bohannon RW. Clinical measurement of range of motion: review of goniometry emphasizing reliability and validity. Physical therapy 1987;67(12):1867-72.
4. ↑ Gandbhir VN, Cunha B. Goniometer. Available: https://www.ncbi.nlm.nih.gov/books/NBK558985/(accessed 25.10.2021)
5. ↑ Wem ROM by joint Available:https://www.wikem.org/wiki/Range_of_motion_by_joint (accessed 25.10.2021)
6. ↑ Magee DJ. Primary care assessment. In: Magee DJ, ed. Orthopedic Physical Assessment. 6th ed. St Louis, MO: Elsevier Saunders; 2014:chap 17 ''Limited range of motion
7. ↑ Healthline What Is Limited Range of Motion? Available:https://www.healthline.com/health/limited-range-of-motion (accessed 25.10.2021)
8. ↑ Physio uk ROM exercises Available: https://www.physio.co.uk/treatments/physiotherapy/range-of-movement-exercises.php(accessed 25.10.2021)
9. ↑ Konrad A, Nakamura M, Bernsteiner D, Tilp M. The accumulated effects of foam rolling combined with stretching on range of motion and physical performance: a systematic review and meta-analysis. Journal of Sports Science & Medicine. 2021 Sep;20(3):535.
10. ↑ Samarpan Physiotherapy Clinic AHMEDABAD ROM Available: https://samarpanphysioclinic.com/ (accessed 25.10.2021)
11. ↑ Nurse Key. ROM exercises Available: https://nursekey.com/range-of-motion-exercises/(accessed 25.10.2021)