RANGE OF MOTION

EXCERCISE
 NAMA KELOMPOK
• NI MADE MANIK GITA SANJIWANI
• NI KADEK YESI SUDIARTI
• MUHAMAD YANWAR RAHMATULLOH
• I DEWA GEDE ANGGA PRASTYA
• Teko Mardawa
 DEFINISI
• Range of motion is a basic technique used for
the examination of movement and for
initiating movement into a program of
therapeutic intervention. Movement that is
necessary to accomplish functional activities
can be viewed, in its simplest form, as muscles
or external forces moving bones in various
patterns or ranges of motions.
 Types of ROM Exercises
1. Passive ROM. Passive ROM (PROM) is movement of a segment
within the unrestricted ROM that is produced entirely by an external
force; there is little to no voluntary muscle contraction. The external
force may be from gravity, a machine, another individual, or another
part of the individual’s own body. PROM and passive stretching are
9

not synonymous.
2. Active ROM. Active ROM (AROM) is movement of a segment
within the unrestricted ROM that is produced by active contraction of
the muscles crossing that joint.
3. Active-Assistive ROM. Active-assistive ROM (A-AROM) is a type
of AROM in which assistance is provided manually or mechanically
by an outside force because the prime mover muscles need assistance
to complete the motion.
 Indications, Goals, and
Limitations of ROM
Passive ROM
Indications for PROM :
In the region where there is acute, inflamed tissue, passive motion is beneficial; active
motion would be detrimental to the healing process. Inflammation after injury or surgery
usually lasts 2 to 6 days.
When a patient is not able to or not supposed to actively move a segment(s) of the body,
as when comatose, paralyzed, or on complete bed rest, movement is provided by an
external source.
Goals for PROM: The primary goal for PROM is to decrease the complications that
would occur with immobilization, such as cartilage degeneration, adhesion and contracture
formation, and sluggish circulation. Specifically, the goals are to:
Maintain joint and connective tissue mobility.
Minimize the effects of the formation of contractures.
Maintain mechanical elasticity of muscle.
Assist circulation and vascular dynamics.
Enhance synovial movement for cartilage nutrition and
diffusion of materials in the joint.
Decrease or inhibit pain.
Assist with the healing process after injury or surgery.
Help maintain the patient’s awareness of movement.
Other Uses for PROM :
When a therapist is examining inert structures, PROM is used to determine limitations
of motion, joint stability, muscle flexibility and other soft tissue elasticity.
When a therapist is teaching an active exercise program,
PROM is used to demonstrate the desired motion.
When a therapist is preparing a patient for stretching, PROM is often used preceding
the passive stretching techniques.
Limitations of Passive Motion: True passive, relaxed ROM may be difficult to obtain
when muscle is innervated and the patient is conscious. Passive motion does not :
• Prevent muscle atrophy.
• Increase strength or endurance.
• Assist circulation to the extent that active, voluntary muscle contraction does.
Active and Active-Assistive ROM
Indications for AROM
When a patient is able to contract the muscles actively and move a segment with or
without assistance, AROM is used.
When a patient has weak musculature and is unable to move a joint through the desired
range (usually against gravity), A-AROM is used to provide enough assistance to the
muscles in a carefully controlled manner so the muscle can function at its maximum
level and be progressivel strengthened. Once patients gain control of their ROM, they
are progressed to manual or mechanical resistance exercises to improve muscle
performance for a return to functional activities.
When a segment of the body is immobilized for a period of time, AROM is used on the
regions above and below the immobilized segment to maintain the areas in as normal a
condition as possible and to prepare for new activities, such as walking with crutches.
AROM can be used for aerobic conditioning programs and is used to relieve stress
from sustained postures.
Goals for AROM: If there is no inflammation or contraindication to active motion, the
same goals of PROM can be met with AROM. In addition, there are physiological benefits
that result from active muscle contraction and motor learning from voluntary muscle
control. Specific goals are to:
 Maintain physiological elasticity and contractility of the
participating muscles.
 Provide sensory feedback from the contracting muscles.
 Provide a stimulus for bone and joint tissue integrity.
 Increase circulation and prevent thrombus formation.
 Develop coordination and motor skills for functional
activities.
Limitations of Active ROM
For strong muscles, active ROM does not maintain or increase
strength. It also does not develop skill or coordination except
in the movement patterns used.
 Precautions
and Contraindications to
Range of Motion Exercises
ROM should not be done when motion is disruptive to
the healing process.
 Carefully controlled motion within the limits of pain-free motion during early phases of healing
has been shown to benefit healing and early recovery.
 Signs of too much or the wrong motion include increased pain and inflammation.

ROM should not be done when patient response or the

condition is life-threatening.
 PROM may be carefully initiated to major joints and AROM to ankles and feet to minimize
venous stasis and thrombus formation.
 After myocardial infarction, coronary artery bypass surgery, or percutaneous transluminal
coronary angioplasty, AROM of upper extremities and limited walking are usually tolerated under
careful monitoring of symptoms.
Note: ROM is not synonymous with stretching. For precautions and
contraindications to passive and active stretching technique.
 Principles and Procedures
for Applying ROM
Techniques
Examination, Evaluation, and Treatment Planning

1. Examine and evaluate the patient’s impairments and level of function, determine any precautions and their
prognosis, and plan the intervention.
2. Determine the ability of the patient to participate in the ROM activity and whether PROM, A-ROM, or
AROM can meet the immediate goals.
3. Determine the amount of motion that can be applied safely for the condition of the tissues and health of the
individual.
4. Decide what patterns can best meet the goals. ROM techniques may be performed in the:
a. Anatomic planes of motion: frontal, sagittal, transverse
b. Muscle range of elongation: antagonistic to the line of pull of the muscle
c. Combined patterns: diagonal motions or movements that incorporate several planes of motion
d. Functional patterns: motions used in activities of daily living (ADL)
5. Monitor the patient’s general condition and responses
6. during and after the examination and intervention; note any change in vital signs, in the warmth and color of
the segment, and in the ROM, pain, or quality of movement. Document and communicate findings and
intervention.
7. Re-evaluate and modify the intervention as necessary.
 MEKANISME
Patient Preparation
1. Communicate with the patient. Describe the plan and
method of intervention to meet the goals.
2. 2. Free the region from restrictive clothing, linen, splints,
and dressings. Drape the patient as necessary.
3. 3. Position the patient in a comfortable position with proper
body alignment and stabilization but that also allows you to
move the segment through the available ROM.
4. 4. Position yourself so proper body mechanics can be used.
Application of Techniques
1. To control movement, grasp the extremity around the joints. If the
joints are painful, modify the grip, still providing support necessary
for control.
2. Support areas of poor structural integrity, such as a hypermobile
joint, recent fracture site, or paralyzed limb segment.
3. Move the segment through its complete pain-free range to the point
of tissue resistance. Do not force beyond the available range. If you
force motion, it becomes a stretching technique.
4. Perform the motions smoothly and rhythmically, with 5 to 10
repetitions. The number of repetitions depends on the objectives of
the program and the patient’s condition and response to the treatment.
Application of PROM
1. During PROM the force for movement is external; it is
provided by a therapist or mechanical device. When
appropriate, a patient may provide the force and be taught to
move the part with a normal extremity.
2. No active resistance or assistance is given by the patient’s
muscles that cross the joint. If the muscles contract, it
becomes an active exercise.
3. The motion is carried out within the free ROM—that is, the
range that is available without forced motion or pain
Application of AROM
1. Demonstrate the motion desired using PROM; then ask the
patient to perform the motion. Have your hands in position to
assist or guide the patient if needed.
2. Provide assistance only as needed for smooth motion. When
there is weakness, assistance may be required only at the
beginning or the end of the ROM, or when the effect of
gravity has the greatest moment arm (torque).
3. The motion is performed within the available ROM.
 Movement
ROM
Upper Extremity
FIGURE 3.1 Hand placement and positions for (A)
initiating and (B) completing shoulder flexion.
FIGURE 3.2
Hyperextension of
the shoulder (A)
with the patient at
the edge of the bed
and (B) with the
patient side-lying.
FIGURE 3.3 Abduction of the shoulder with
the elbow flexed.

FIGURE k3.4 The 90/90 position for initiating

(A) internal and
(B) external rotation of the shoulder.
FIGURE 3.5 Horizontal (A)
abduction and (B) adduction
of the
shoulder.
FIGURE 3.6 ROM of
the scapula with the
patient (A) prone and
with the patient (B) side-
lying.
FIGURE 3.7 Elbow (A) flexion
and (B) extension with the
forearm
supinated.

FIGURE 3.8 End ROM for the long head of the

triceps brachii muscle.
FIGURE 3.9 Pronation of the forearm.

FIGURE 3.10 ROM at the wrist. Shown is wrist

flexion; note that
the fingers are free to move in response to passive
tension in the
extrinsic tendons.
FIGURE 3.11 ROM to the arch of the hand.

FIGURE 3.12 ROM to the

metacarpophalangeal joint of the thumb.
FIGURE 3.13 End of range for the extrinsic finger (A) FIGURE 3.13 (B) extensors.
flexors and
Lower Extremity
 FIGURE 3.14 (A) Initiating and

FIGURE 3.14—cont’d (B)

completing combined hip and
knee
flexion.
 FIGURE 3.16 ROM to the
hamstring muscle group.
FIGURE 3.15 Hip extension with the patient
side-lying.
FIGURE 3.17 Abduction of the hip, maintaining the
hip in extension and neutral to rotation.

FIGURE 3.19
Dorsiflexion of the
ankle.
 FIGURE 3.20 Inversion
of the subtalar joint.

FIGURE 3.21 Extension of

the metatarsophalangeal joint
of the
large toe.
Cervical Spine
FIGURE 3.22 Cervical (A) flexion
and

FIGURE 3.22 (B) rotation.

Lumbar Spine
 FIGURE 3.24 Rotation of the lumbar spine results
when the thorax is stabilized and the pelvis lifts off
the table as far as allowed.

FIGURE 3.23 Lumbar flexion is achieved by

bringing the patient’s hips into flexion until the
pelvis rotates posteriorly.