Maximizing range of motion in
older adults Expanding range of motion
improves aging clients’
quality of life and ability to
function
by Lisa Jenkins, M.P.T.
It’s no secret that people lose about
20–40% of their muscle mass as they
age. Scientists have discovered that, in
addition to the natural aging process,
the muscle loss is largely due to older
adults no longer participating in
everyday activities that require muscle
power. This lack of use produces a
wasting effect on the muscles,1
decreasing the available range of
motion (ROM). Collectively, these two
areas of decline can lead to pain and
mobility problems for aging adults.
50 The Journal on Active Aging • January February 2005
Optimal range of motion contributes
significantly to older individuals’ ability
to perform daily functional activities.
ROM is also important to this
population’s general quality of life.
Health and wellness professionals can
help aging clients maximize their range
of motion by recognizing early signs
of diminished ROM and the sub-
sequent need for action; creating and
implementing appropriate programs to
treat ROM loss or referring individuals
to professionals qualified to treat
these problems; and encouraging
participation in general wellness
programs.
To start, it is helpful for professionals
who work with older adults to
understand the impact aging has
on ROM.
How aging affects range
of motion
Movement takes place where two
bones meet in the body and muscles
cross over the joints to allow them to
bend. Simply stated, range of motion is
the movement available within a joint,
or the range through which a joint
can move.
Usually ROM refers to a joint’s range of
flexion and extension—movements that
decrease and increase the space between
two areas of the body, respectively.
However, bone shape affects the range
of motion for specific joints. For
example, ball-and-socket joints such as
the hip and shoulder can move in many
directions: flexion, extension, abduction
and adduction (toward and away from
the body’s midline), and rotation. The
aging process affects range of motion in
several ways.
Physiologically, humans experience
actual changes in the muscles as they
age. A general decrease in muscle
strength and mass takes place due to
the altered cellular components and
fibers of muscles, as well as inactivity.
An individual may unconsciously adjust
posture as a result. The cumulative
effect of these changes has an impact on
a person’s balance, coordination and
ability to move and walk.
Nerve conduction, the transmission of
electrical impulses through the nerves,
recruits the muscles used to produce
movement and function in the
body. Proprioception is the ability to
recognize body position in space. Aging
alters nerve impulse conduction,
proprioception and velocity of
movement. Given these alterations, it is
easy to see how it becomes increasingly
difficult to maintain balance during
functional movements such as walking
and changing positions as an individual
ages. Often the fear of falling in itself is
enough to prevent some older adults
from participating in certain activities.
The less individuals move their joints,
the greater their probability of ROM
limitations occurring.
Health and wellness professionals are
wise to investigate the specific causes for
decreased ROM in older clients, apart
from aging-related changes. It is also
important to keep in mind that the
basic cause of decreased ROM is
inactivity, regardless of its origin.
Common causes of reduced
range of motion
What contributes to diminished range
of motion? Anything that prevents
a person from moving. The most
common causes of ROM loss in aging
adults include musculoskeletal and
brain-related disorders.
Lack of mobility may result from an
injury to a joint such as the hip or knee.
For example, doctors often immobilize
fractured bones to promote healing.
This immobility results in decreased
muscle mass, strength and flexibility of
surrounding joints. Collectively, these
effects inhibit range of motion.
The brain also plays a significant role in
range of motion. For example, when a
person stands up, his or her brain sends
impulses to the muscles to move the
bones and change the body’s position. A
brain injury (e.g. stroke), head injury, or
debilitating disease (e.g. arthritis or
Parkinson’s disease) can affect the brain’s
ability to recruit the muscles and limits
the ability to produce movement.2 The
resulting lack of movement may create
joint stiffness, which inhibits ROM.
Regardless of the root of inactivity,
range of motion problems produce a
definite domino effect. Decreased
ROM creates functional problems and
increases pain. The resultant pain often
causes individuals to avoid further
movement, which in turn leads to an
The Journal on Active Aging • January February 2005 51
even greater ROM limitation. For this
reason, interdisciplinary teams (such as
physical therapists, occupational
therapists and fitness specialists) are
necessary to provide well-rounded
programs that help people maximize
ROM and minimize the problems
associated with ROM limitations.
Problems associated with
range of motion loss
Older adults with reduced ROM may
experience any of the problems outlined
in this section.
Joint integrity, stiffness, pain and
immobility. Joints are the places in the
body where the bones meet, and a
joint capsule often surrounds them.
Movement within the joint causes
increased blood flow to the joint
capsule, providing nourishment that
enables the bones to move smoothly
and without pain or discomfort.
When there is little movement and
subsequently less blood flow, the joints
become stiff and painful, leading to
reduced activity and, in turn, ROM
loss. As the cycle continues, joint
integrity is compromised and the risk
for deformity rises.
Muscles are intended to help joints
move through their entire range of
motion. Some clients may have the
ability to move through their full range,
but have less muscle strength at certain
points in the range. For example, an
older man may be strong enough to
move his knee easily through most of its
ROM, but display weakness in the last
20º before his knee fully straightens.
This example demonstrates how loss of
strength may influence a person’s ability
to attain full ROM, thereby limiting
safe functional mobility.
Continued on page 52
Maximizing range of motion in older adults
Continued from page 51
A client’s level of
function will influence
the way ROM
problems are addressed.
Some of the many
variables that need to
be considered when
designing a com-
prehensive plan of care
include available
strength, ROM,
proprioception,
sensation, current
functional level, prior
functional level and
cognitive ability.
Contractures and skin breakdown.
Many changes occur when a joint
remains immobile for an extended
period of time. Most obvious is that the
joint itself becomes stiff and painful to
move. The muscles that surround the
joint become tight and do not slide as
easily upon one another to produce
movement. Eventually, changes occur at
52 The Journal on Active Aging • January February 2005
the cellular level. The musculoskeletal
components of the joint can actually
lose their ability to stretch and become
permanently shortened. This new
alignment of the joint surface is called a
contracture.
Cellular changes also take place in the
skin overlying the contracted joint. As
the skin remains folded upon itself for
an extended period of time, it becomes
moist and malodorous. Eventually,
the skin breaks down and, as healing
occurs, reestablishes to mimic the new
musculoskeletal formation of the
contracture.
Typically, splints, positioning and
routine ROM are used to prevent
contractures and subsequent skin
breakdown.
Functional problems. Limited range of
motion can substantially hinder daily
function such as bathing, dressing or
walking. An example of functional
difficulties as they relate to ROM
limitations is a change in posture. An
older female client often has forward,
rounded shoulders. The forward
position of the shoulders creates a need
for her to raise her head in order to see
properly. This alignment of the shoulder
joint anatomically prevents her from
completely raising her arm overhead. A
ROM limitation such as this can create
difficulty in retrieving clothes from a
closet, reaching items on a high shelf, or
even putting on an overhead sweater or
shirt. The alignment of the client’s
head to enable vision, now creates
compression on the joints and nerves in
the back of the neck. This compression
can lead to a variety of symptoms,
including headaches, and pose
challenges with nerves and muscles
in the arms.
Many functional limitations result from
arthritis. Painful, swollen joints limit
movement, eventually leading to
changes in available ROM. If the many
joints of the hands are affected by
arthritis, tasks such as buttoning a shirt,
opening a jar, writing a letter or holding
a fork challenge the individual. Likewise,
if the knee joints are affected, movement
in and out of a car, on and off a chair or
toilet, or up and down a staircase or
sidewalk curb becomes difficult.
Clearly, any person who maintains
a sedentary lifestyle risks ROM
limitations. Health and wellness
professionals can help these
individuals to maximize movement,
thereby improving function and quality
of life.
Programs to address
diminished range of motion
Once decreased ROM is identified, the
health or wellness professional should
conduct a comprehensive client
evaluation to determine the root
cause(s), in order to design a program
that addresses limitations. Is the root
cause for ROM decline due to an
individual sitting in a recliner chair all
day and seldom moving? Has a broken
hip prevented a person’s leg from
bearing weight, and now the joints are
painful, swollen and stiff? Or is an
independent older adult experiencing
ROM loss from a long-term lack of
physical activity? Once professionals
know the cause of ROM loss, they can
create a plan or program to tackle the
problem.
A client’s level of function will influence
the way ROM problems are addressed.
Some of the many variables that need
to be considered when designing a
comprehensive plan of care include
available strength, proprioception,
ROM, sensation, current functional
level, prior functional level and
cognitive ability.
Regardless of the client’s functional
level, professionals such as therapists
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their highest level of function. occur throughout the body. The Biodex
resulting ripple effect can debilitate
Preventing range of aging adults. Page 15
motion loss The Core
Health and wellness professionals No matter the setting, programs
Page 19
should aim to prevent ROM limitations established to prevent or address ROM
First Step to Active Health
in older clients. In individuals with low problems can greatly improve the
function, professionals might focus on quality of life for older adults. By Page 21
positioning to ensure proper body helping individuals maximize ROM, HOGGAN Sprint
alignment and joint integrity, and/or health and wellness professionals can
splinting and contracture management help their clients enjoy a full, active life Page 25
to prevent further range of motion loss. at any age. Fit Express
Programs for aging clients with higher
function might focus on improving Lisa Jenkins, M.P.T., is a clinical specialist Page 29
performance in activity-specific tasks. for the Eastern Division of RehabWorks, Miracles
Individualized fitness or wellness the largest contract therapy providers
Page 32
programs help avert ROM problems, in the United States’ long-term care Cooper Ventures
in addition to providing many other industry. She is also a certified clinical
health benefits. instructor. Jenkins has 10 years experience Page 37
in both the physical therapy field and Jazzercise
Fitness or wellness programs that management. She can be reached via
incorporate fun activities using mobility www.rehabworks.com. Page 43
to improve strength, stamina, balance ICAA
and flexibility are typically most References
successful at helping older individuals Page 49
become active. Programs that encourage 1. National Institute on Aging, U.S. Department Med-Fit Systems
adults to get moving include general of Health and Human Services, National
Institutes of Health, 2002. Available at Page 62
fitness, walking, yoga, water aerobics, tai www.nia.nih.gov AARP
chi, golf, line dancing and bowling, 2. National Institute of Neurological Disorders
among others. In fact, health and and Stroke. “NINDS Thoracic Outlet
Page 69
wellness professionals are wise to Syndrome Information Page.” Available at
www.ninds.nih.gov/disorders/thoracic/ Walk 500
incorporate a variety of activities that thoracic.htm
focus on safely improving their older Page 71
clients’ strength, endurance, fitness, Keiser
flexibility and balance. Aging adults
Page 72
Life Fitness
Continued on page 54

The Journal on Active Aging • January February 2005 53