RANGE OF MOTION EXERCISE

DEFINITON OF ROM AND OTHER RELATED TERMS Range of motion is the full motion 
    

possible in a joint. PASSIVE ROM ACTIVE ROM ACTIVE ASSISTIVE ROM FUNCTIONAL EXCURSION ACTIVE INSUFFICIENCY PASSIVE INSUFFICIENCY

INDICATIONS FOR ROM EXERCISES

Passive ROM exercise
Indicated in the following patients:  Comatose and completely paralyzed and immobilized patients or body part.  On complete bed rest where any active contraction is contraindicated.  Where there is an acute inflammatory reaction.

INDICATIONS FOR ROM EXERCISES 
Used in evaluating joint and soft tissue

injury.  Used to demonstrate a desired motion or test to a patient.  Used as preparatory to passive stretching.  Used for muscle grade to zero and trace.

INDICATIONS FOR ROM EXERCISES
Active and active assistive ROM 
Used for muscle graded poor to fair minus.  Used to provide enough assistance to

muscles in a carefully controlled manner so that that muscle can function at its maximum level and progressively be strengthened.  Used when there is no contraindication to active movement. 

 Assist circulation and vascular dynamics .  Maintain muscle elasticity and prevent adaptive shortening.EFFECTS OF ROM EXERCISES Passive ROM exercises  Maintain joint and soft tissue integrity.  Prevent contractures.

.  Decrease or inhibit pain.  Assist with the healing process following injury or surgery.EFFECTS OF ROM EXERCISES  Enhance synovial movement for the cartilage nutrition and diffusion of materials in the joint.  Help maintain the patient s awareness of movement.

EFFECTS OF ROM EXERCISES Active and active assisted ROM  Maintain muscle elasticity and contractility.  Provide stimulus for bone integrity.  Provide sensory feedback from contracting muscle. .

EFFECTS OF ROM EXERCISES  Increase circulation and prevent thrombus formation.  Improve cardiovascular and respiratory responses.  Develop coordination and motor skills for functional activities. .

 It will not increase strength and endurance.  It will not prevent atrophy.LIMITATION OF ROM EXERCISES Passive ROM exercises  Difficult to achieve in innervated muscles and conscious patients. .  It will not improve or assist circulation to the extent that active muscle contraction does.

 It will not develop skill or coordination except in the movement pattern used.LIMITATION OF ROM EXERCISES Active ROM  It will not maintain or increase strength.  It may encourage compensatory rather than normal movement patterns .

redness) .  Immediately following acute tears.  Unstable cardiovascular conditions. heat .PRECAUTIONS AND CONTRAINDICATION TO ROM EXERCISES  When motion disrupts the healing process as in acute joint inflammations and immediately after skin graft etc.  Signs of too much or wrong motion include increased pain and increased inflammations(greater swelling. fractures and surgery.

recent fracture site or paralyzed limb. Place the patient in a comfortable position that will allow you to move the segment through the available ROM(patient has proper body alignment) Position yourself so that proper body mechanics can be used. AAROM.PRINCIPLES AND PROCEDURE FOR APPLYING ROM TECHNIQUES  Determine whether PROM. or AROM will meet     the goals based on evaluation of the patient s impairment and level of function. Support areas of poor structural integrity such as hyper mobile joint. Move the segment through its complete pain free range( do not force beyond the available range it becomes stretching technique) .

 Document observable and measurable reactions to the treatment. 4.  Modify or progress the treatment as necessary.PRINCIPLES AND PROCEDURE FOR APPLYING ROM TECHNIQUES Perform the motion smoothly and rhythmically ROM techniques may be performed in the : Anatomical planes of ROM Muscle range of elongation Combined patterns Functional patterns Monitor the patient s general condition during and after the procedure.   1. 3. 2.  .

 Lift the arm through the available range and return.ROM TECHNIQUES  UPPER EXTREMITY 1. the scapula should free to rotate upward as the shoulder flexes. the scapula is stabilized. If the motion of only the glenohumeral joint is desired. Note: for normal motion. cross over and grasp the wrist and palm of the patient s hand.  with the top hand.Shoulder : flexion and extension Hand Placement and Motion  grasp the patient s arm under the elbow with your lower hand. .

lying or prone. . Shoulder : extension(hyperextension) Alternate Position  Extension is possible if the patient s shoulder is at the edge of the bed when supine or if the patient positioned side.

The elbow may be flexed. . there must be external rotation of the humerus and upward rotation of the scapula. but move the arm out to the side. Shoulder :abduction and adduction Hand Placement and Motion  use the same hand placement as with flexion.  Note: to reach the full range of abduction.

Rotation may also be performed with the patient s arm at the side of thorax. . Shoulder: internal (medial) and external(lateral) rotation Initial Position of the Arm  If possible the arm is abducted 90 . but full internal rotation will not be possible. the elbow is flexed to 90 and forearm is held in neutral position.

thus stabilizing the wrist.  With the other hand. .  Place your thumb and the rest of your fingers on either side of the patient s wrist. stabilize the elbow.Hand Placement and Motion  Grasp the hand and the wrist with your index finger between the patient s thumb and index finger. Rotate the humerus by moving the forearm like a spoke in a wheel.

the shoulder must be at the edge of the table.  Shoulder: horizontal abduction(extension) and . but the therapist turn his or her body and faces the patient s head as the patient arm is moved out to the side then across the body. Begin with the arm either flexed or abducted 90 . Hand Placement and Motion  -same as with flexion.adduction(flexion) Position of the Arm  to reach the full horizontal abduction.

.  For elevation. with the patient facing the therapist and the patient s arm draped over the therapist bottom arm.Scapula: elevation/depression. or side lying. direct the scapular motions at the inferior angle.  For rotation. the clavicle also moves as the scapular motions are directed at the acromion process. and upward/downward rotation Alternate Position  prone . Hand Placement and Motion  cup the top hand over the acromion process and place the other hand around the inferior angle of the scapula. protraction. protraction/retraction. retraction. with the patient s arm at the side. depression.

Note: control forearm supination and pronation with your fingers around the wrist. The shoulder should not protract when the elbow extends: this disguises the true range. . Perform elbow flexion and extension with forearm pronated as well as supinated. Elbow: flexion and extension Hand Placement and Motion  same as with shoulder flexion except the motion occurs at the elbow as it is flexed and extended.

 -The shoulder is then extended (hyperextended) until the patient experiences discomfort in the anterior arm region. and extend the elbow by supporting under the elbow. full available lengthening of the two joint muscles is reached. Elongation of two joint muscle crossing the shoulder and elbow Biceps brachii muscle Position of the Patient  supine with the shoulder at the edge of the treatment table so that shoulder can be extended past the neutral position. At this point. . Hand Placement and Motion  -first pronate the patient s forearm by grasping around the wrist.

Hand Placement and Motion  First. flex the patient s elbow full range with one hand on the distal forearm  Then flex the shoulder by lifting up on the humerus with the other hand under the elbow. With marked limitation in muscle range. the patient must be sitting or standing to reach the full ROM. . Long head of the triceps brachii muscle Alternate Position  when near normal range of this muscle is available. ROM can be performed in supine position.  Full available range is reached when discomfort is experienced in the posterior arm region.

Alternate Hand Placement  sandwich the patient s distal forearm between the palms of both hand. Note: pronation and supination should be performed with the elbow both flexed and extended.  The motion is a rolling of the radius around the ulna at the distal radius. supporting the hand with the index finger and placing the thumb and the rest of the finger on either side of the distal forearm. control the pronation and supination motion by moving the radius around the ulna. Caution: do not stress the wrist by twisting the hand. .  Stabilize the elbow with the other hand. Forearm: pronation and supination Hand Placement and Motion  grasp the patient s wrist.

To get full range of the wrist joint.  Wrist: flexion(palmar flexion) and extension Note: the range of the extrinsics muscle to the finger will affect the range at the wrist if tension is placed on them.(dorsiflexion). radial and ulnar deviation Hand Placement and Motion  for all wrist motions. grasp the patient s hand just distal to the joint with one hand. allow the fingers to move freely as you move the wrist. . and stabilize the forearm with the other hand.

 Hand : cupping and flattening the arch of the hand at carpometacarpal and intermetacarpal joints Hand Placement and Motion  face the patient s hand.  Roll the metacarpal to increase the arch. then flattened it. place the fingers in the palms of the patient s hand and the thumbs on the posterior aspect. Note: extension and abduction of the thumb at the carpometacarpal joint are important in maintaining the web space for functional movement of the hand. Alternate Hand Placement  one hand is placed on the posterior aspect of the patient s hand with the fingers and thumb cupping around the metacarpals. .

stabilize the metacarpals with one hand and move all the proximal phalanges with the other hand.  Joints of the Thumb and Fingers: flexion and extension and . Example: to move all the metacarpophalangeal joints of digits 2 through 5. Alternate Method  several joints can be moved simultaneously if proper stabilization is provided. do not place tension on the extrinsic muscle going to the fingers. Tension on the muscle can be relieved by altering the wrist position as the fingers are moved. the forearm and hand can be stabilized on the bed or table or against therapist body.  Note: to accomplish full joint range of motion.abduction and adduction(of the metacarpophalangeal joints of the fingers) Hand Placement and Motion  each joint of the patient s hand can be moved individually by stabilizing the proximal bone with the index finger and thumb with one hand and moving the distal bone with the index finger and thumb of the other hand depending on the position of the patient.

then move the metacarpophalangeal joint to the end of the available range. begin the motion with the distal most joint. . Elongation of the extrinsic muscles of the wrist and hand General Technique  to minimize compression of the small joints of the fingers. then elongate the muscle over one joint at a time. Hand Placement and Motion  First move the distal IP joint  hold both these joint at the end of their range. stabilize that joint then elongate the muscle over the next joint until the multijoint muscles are at maximum length. the muscles are fully elongated. When patient feels discomfort in the forearm.  stabilize all the finger joints and begin to extend the wrist.

LOWER EXTREMITY  Combined Hip and Knee: flexion and Extension Hand Placement and Motion  support and lift the patient s leg with the palm and fingers of the top hand under the patient s knee and the lower hand under the heel. the hip must be flexed to release tension on the rectus femoris muscle. swing the fingers to the side of the thigh. the knee must also be flexed to release tension on the hamstring muscle group. .  as the knee flexes full range. To reach the full range of knee flexion. Note: to reach full range of hip flexion.

lift the thigh with the bottom hand under the patient s knee. bring the bottom hand under the thigh and place the hand on the anterior surface.  if the patient is side-lying. . Hand Placement and Motion  if the patient is prone. do not flex the knee full range. as the two-joint rectus femoris would then restrict the range. stabilize the pelvis with the top hand. Hip: extension ( hyperxtension) Alternate Position  prone or side lying must be used if the patient has a near normal or normal motion. For full range of hip extension. stabilize the pelvis with the top hand or arm.

. Elongation of two-joint Hamstring Muscle Group Hand Placement and Motion  place the lower hand under the patient s heel and the upper hand across the anterior aspect of the patient s knee.  if the knee requires support. The hand provides support or stabilization where needed. cradle the patient s leg in your elbow flexed under the calf and your hand across the anterior aspect of the patient s knee.  keep the knee in extension as the hip is flexed.

stabilize the pelvis with the top hand. with knee flexed over the edge of the treatment table. which means full available range is reached. Elongation of the two-joint Rectus Femoris Muscle Alternate Position  supine. . Hand Placement and Motion  when supine. stabilize lumbar spine by flexing the hip and knee of the opposite lower extremity and placing the foot on the treatment table(hook lying)  when prone.  flex the patient s knee until tissue resistance is felt in the anterior thigh. or prone.

 Hip: Abduction and Adduction Hand Placement and Motion  support the patient s leg with the upper hand under the knee and lower hand under the ankle. . the opposite leg needs to be in a partially abducted position.  for full range of adduction.  keep the patient s hip and knee in extension and neutral to rotation as abduction and adduction are performed.

cradle the thigh and support the proximal calf and knee with the bottom hand. Hand Placement and Motion with the Hip and Knee Extended  flex the patient s hip and knee to 90 . . support the knee with the top hand. Hip: Internal (medial) and External( lateral) Rotation Hand Placement and Motion with the Hip and Knee Extended  grasp just proximal to the patient s knee with the top hand and just proximal to the ankle with the bottom hand.  rotate the femur by moving the leg like a pendulum.  If the knee is unstable.  roll thigh inward and outward.

 pull the calcaneus distal ward with the thumb and fingers while pushing upward with the forearm. Note: if knee is flexed. .  cup the patient s heel with the bottom hand and place the forearm along the bottom of the foot. full range of the ankle joint can be obtained. If the knee is extended. Ankle: Dorsiflexion Hand Placement and Motion  stabilize around the malleoli with the top hand.apply dorsiflexion in both positions of the knee to provide range to both the joint and the muscle. the lengthened range of the two-joint gastrocnemius muscle limits full range of dorsiflexion.

the ankle tends to assume a plantarflexed position from the weight of the blankets and the pull of the gravity. Note: in bed-bound patient s. so this motion may not need to performed. .  place the top hand on the dorsum of the foot and push it into plantarflexion. Ankle: Plantarflexion Hand Placement and Motion  support the heel with the bottom hand.

. place the thumb medial and the fingers lateral to the joint on either side of the heel. Subtalar(lower ankle) Joint: Inversion and Eversion Hand Placement and Motion  using the bottom hand.  turn the heel inward and outward. and pronation may be combined with eversion. Note: supination of the foot may be combined with inversion.

. grasp around the navicular and cuboid. Transverse Tarsal Joint Hand Placement and Motion  stabilize the patient s talus and calcaneus with one hand  with the other hand.  gently rotate the midfoot by lifting and lowering the arch.

 the technique is the same as for ROM of the fingers. . and move the distal bone with the other hand. Joints of the Toes: Flexion and Extension and Abduction and Adduction (Metatarsophalangeal and Interphalangeal Joint) Hand Placement and Motion  stabilize the bone proximal to the joint that is to be moved aith the other hand. Alternate Procedure  several joints of the toes can be moved simultaneously if care is taken not to stress any structure.

CERVICAL SPINE Position of the therapist and Hand Placement  standing at the end of the treatment table.  once full nodding is complete. Flexion (Forward Bending)  lift the head as though it were nodding(chin towards larynx) to flex the head on the neck. securely grasp the patient s head by placing hands under the occiput. . continue to flex the cervical spine and lift the head toward the sternum.

 once full nodding is complete. . continue to flex the cervical spine and lift the head toward the sternum.Flexion (Forward Bending)  lift the head as though it were nodding(chin towards larynx) to flex the head on the neck.

The patient may also be prone or sitting. the head must clear the end of the table to extend the entire cervical spine.Extension (Backward Bending or Hyperextension)  tip the head backward. Note: if the patient is supine. only the head and the upper cervical spine can be extended. .

Lateral Flexion(Side Bending)  Maintain the cervical spine neutral to flexion and extension as you direct the head and neck into side bending(approximate the ear toward the shoulder) and rotation(rotate from side to side) .

LUMBAR SPINE Flexion  bring both the patient s knees to the chest by lifting under the knees(hip and knee flexion)  flexion of the spine occurs as the hips are flexed full range and the pelvis starts to rotate posteriorly.  greater range of flexion can be obtained by lifting under the patient s sacrum with the lower hand. .

.Extension  the patient is prone  with hands under the thigh. lift the thighs upward until the pelvis rotates anteriorly and the lumbar spine extends.

Rotation  the patient is hook lying. .  push both of the patient s thorax with the top hand  repeat in the opposite direction.

SELF.ASSISTED ROM Arm and Forearm  instruct the patient to reach across the body with the uninvolved(or assisting)extremity and grasp the involved extremity around the wrist. . the patient pulls the extremity across the chest and returns it out to the side. Shoulder Horizontal Abduction and Adduction  beginning with the ram abducted to 90 . supporting the wrist and hand. Shoulder Flexion and Extension  patient lifts the involved extremity over the head and returns it to the side.

 Shoulder Rotation  beginning with the arm at the patient s side in slight abduction or abducted 90 and elbow flexed 90 . the patient rotates the forearm with the uninvolved extremity.  it is important to emphasized rotating the humerus. not merely flexing and extending the elbow. Elbow flexion and Extension  patient bends the elbow until the hand is near the shoulder and then moves the hand down toward the side of the leg. .

Pronation and Supination of the Forearm  with the forearm resting across the body. . the patient rotates the radius around the ulna. emphasized to the patient not to twist the hand at the wrist joint.

. Finger Flexion and Extension  patient uses the uninvolved thumb to extend the involved fingers and cups the normal fingers over the dorsum of the involved fingers to flex them. applying no pressure against the fingers.Wrist and Hand Wrist flexion and Extension and Radial and Ulnar deviation  patient moves the wrist in all directions.

 to flex and oppose the thumb. the patient cups the normal hand around the dorsal surface of the involved hand and pushes the first metacarpal toward the little finger.Thumb Flexion with Opposition and extension with reposition  patient cups the uninvolved fingers around the radial border of the thenar eminence of the involved thumb and places uninvolved thumb to extend it. .

Hip abduction and Adduction  instruct the patient to slide the normal foot from the knee down to the ankle and then move the involved extremity from side to side.Hip and Knee Hip and knee flexion  with the patient supine. instruct the patient to initiate the motion by lifting up the involved knee with strap or belt under the knee. The patient can then grasp the knee with one or both hands to bring the knee up toward the chest to complete the range. .

 the knee is moved outward and back inward with assistance from the upper extremity.Combined Hip abduction with external rotation  patient is sitting on the floor or on abed with the back supported and the involved hip and knee flexed and foot resting on the surface. .

 The uninvolved hand moves the involved ankle into dorsiflexion. inversion and eversion and toe flexion and extension.Ankle and Toes  patient sits with the involved extremity crossed over the uninvolved one so the distal leg rests on the normal knee. plantarflexion. .

TECHNIQUES OF ROM USING MECHANICAL ASSISTANCE SUSPENSION SYSTEM  Vertical fixation  Axial fixation .

Patient can work independently. rhythmic motion Little work is required for stabilization Modifications can be made to the system to provide grades of exercise resistance.Benefits of suspension for ROM exercises  Active participation is required. thus the     patient learns to use the appropriate muscles for the desired movement. It promotes relaxation through secure support and smooth. .

CONTINOUS PASSIVE MOTION(CPM) Indication and procedure of CPM  Patient s response. time.  A low arc of 20 to 30 degrees may be used immediately after surgery and ma progress the patient s range as tolerated.  May be used for one hour 3x a day or for 24 hours .  CPM may be used or applied to the involved extremity immediately after surgery while patient is still under anesthesia or within 3 days if bulky dressings limit movement. surgical procedure or disease entity may necessitate modifying the range. and duration of CPM application.

Benefits of CPM  Lessens negative effects of joint immobilization in arthritis. contractures and intra-articular fractures  Decrease the frequency of postoperative complication  Prevent development of adhesions and decrease contracture formation  Decrease post operative pain  Improve circulation to enhance nutritional status of extremity  Increase synovial fluid lubrication of the joint  Decrease joint effusion and wound edema thus improving wound healing  Increase the rate of intra-articular cartilage healing regeneration  provide a quicker return of ROM .

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