Range of motion

Range of motion

Types of ROM Exercises

1. Passive ROM

“Movement of a body segment within the unrestricted ROM that is produced entirely by an external force”.

 There is no/little voluntary muscle contraction

 External force → gravity, machine, another person/body part

2. Active ROM

“Movement of a body segment within the unrestricted ROM that is produced by active contraction of muscles crossing that joint”.

3. Active-Assisted ROM

“Type of A-ROM involving manual/mechanical assistance provided by an outside force because the prime mover muscles need assistance to complete the motion”.

Indication of ROM Exercises

1. Passive ROM

 Acute inflamed tissue → 2-6 days

 Comatose/Paralyzed/Completely bed-ridden patient

2. Active & Active-Assisted ROM

 Active muscle contraction → Active ROM

 Aerobic conditioning program → Active ROM

 Region above & below the immobilized segment → Active ROM

 Weak musculature → Active- Assisted ROM

 Control gained → Manual/Mechanical Resistance Exercise → Improve muscle performance

Goals of ROM Exercises

Passive ROM

Primary Goal

 Decrease complications of immobilization i.e. Cartilage degeneration, Adhesion & Contracture formation, Sluggish circulation

Specific Goals

 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

 Determine limitations of motion, to determine joint stability, and to determine muscle and other soft tissue elasticity.

 Demonstrate the desired motion for an active exercise program.

 Used preceding the passive stretching techniques.

Active & Active-assisted ROM

Primary Goal

 Similar to PROM in absence of inflammation & contraindication

Specific Goals

 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 ROM Exercises

Passive ROM

 Prevent muscle atrophy

 Increase strength or endurance

 Assist circulation to the extent that active, voluntary muscle contraction does

Active ROM

 Maintain or increase strength in a strong muscle

 Develop skill or coordination except in the movement patterns used.

Contraindications

 After acute tears, fractures, surgery

 Disruption to the healing process

 Increased pain & inflammation

Precautions

 MI, CABAGE, Percutaneous transluminal coronary angioplasty

 Venous stasis & thrombus formation

Principles & Procedures of Application

1. Examination, Evaluation, & Treatment planning

2. Patient Preparation

3. Application of Techniques

Self-assisted ROM → S-AROM

Used to protect healing tissue when more intensive muscle contraction is contraindicated i.e. Post-surgical or Post-trauma

Forms of S-AROM

 Manual

 Equipment

 Wand or T-bar

 Finger ladder,Wall climbing, Ball rolling

 Pulleys

 Skate or Powder board (Hip abd: & adduction, Shoulder Horizontal flexion & extension)

 Reciprocal Exercise devices → Bicycle, Upper/Lower body ergometer etc

Continuous Passive Motion (CPM)

“Passive motion performed by a mechanical device that moves the joint slowly & continuously through a controlled ROM”.

 Beneficial healing effects on diseased/injured structures

Benefits

↓ Negative effects of immobilization→ Arthritis, Contractures, Intra-articular fractures

↑Recovery rate & ROM―post-surgical

Demonstration by Salter

 Prevents development of adhesions and contractures and thus joint stiffness

 Provides a stimulating effect on the healing of tendons and ligaments

 Enhances healing of incisions over the moving joint

 Increases synovial fluid lubrication of the joint and thus increases the rate of intra-articular cartilage healing and regeneration

 Prevents the degrading effects of immobilization

 Provides a quicker return of ROM

 Decreases postoperative pain

 Decreases postoperative blood drainage & increases analgesia

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