RANGE OF MOTION

EXERCISE
THERAPEUTIC EXERCISE 1
OBJECTIVES
Define range of motion (ROM) exercise.
Describe the types of ROM exercises
Differentiate among the types of ROM
exercises as to:
Indications
Goals
Limitations
Contraindications
OBJECTIVES
Explain the guidelines and
procedures when carrying out
range of motion exercises
Identify the benefits and
procedures for using CPM
equipment.
RANGE OF MOTION
Is a basic technique used for
examination of movement and
for initiating movement into a
program of therapeutic
intervention
RANGE OF MOTION
When moving a segment
through its ROM, all structures in
the region are affected:
muscles, joint surfaces, capsules,
ligaments, fasciae, vessels,
and nerves.

RANGE OF MOTION

Joint range
Muscle range

FUNCTIONAL EXCURSION
Is the distance that a muscle is
capable of shortening after it has
been elongated to its maximum

REMEMBER!
To maintain normal ROM, the
segments must be moved
through their available ranges
periodically.
TYPES OF ROM EXERCISES
Passive ROM (PROM)
Active-Assistive ROM (A-AROM)
Active ROM (AROM)
TYPES OF ROM EXERCISES
TYPES PRO
M
AARO
M
ARO
M
DESCRIPTION
INDICATIONS
GOALS
LIMITATIONS
CONTRAINDICATIO
NS
DESCRIPTION
DESCRIPTION
Passive ROM (PROM)
is movement of a segment within
the unrestricted ROM that is
produced entirely by an external
force
little to or no voluntary muscle
contraction

DESCRIPTION
Passive ROM (PROM)
The external force may be
from gravity, a machine,
another individual, or another
part of the individuals own
body.
DESCRIPTION
Active ROM (AROM)
movement of a segment within
the unrestricted ROM that is
produced by active contraction of
the muscles crossing that joint
DESCRIPTION
Active-Assistive ROM (AAROM)
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
INDICATIONS
PROM
In the region where there is acute,
inflamed tissue
When a patient is not able to or not
supposed to actively move a segment
of the body (when comatose,
paralyzed, or on complete bed rest)
INDICATIONS (OTHER USES)
PROM
When examining inert structures
(to determine LOM, joint stability,
and soft tissue elasticity)
When teaching an active exercise
program (to demonstrate the
desired motion)
INDICATIONS (OTHER USES)
PROM
When preparing a patient for
stretching (preceding the passive
stretching techniques)
INDICATIONS
AROM and AAROM
Whenever a patient is able to
contract the muscles actively and
move a segment with (AAROM) or
without assistance (AROM)
INDICATIONS
AROM
AROM can be used for aerobic
conditioning programs.
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.

GOALS
GOALS
PROM
Primary goal: to decrease the
complications that would occur
with immobilization

GOALS
PROM
Maintain joint and connective
tissue mobility
Minimize the effects of the
formation of contractures
Maintain mechanical elasticity of
muscle
GOALS
PROM
Assist circulation and vascular
dynamics
Enhance synovial movement for
cartilage nutrition and diffusion of
materials in the joint
Decrease or inhibit pain

GOALS
PROM
Assist with the healing process
after injury or surgery
Help maintain the patients
awareness of movement

GOALS
AROM
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
GOALS
AROM
Maintain physiological elasticity
and contractility of the
participating muscles
Provide sensory feedback from
the contracting muscles
GOALS
AROM
Provide a stimulus for bone and
joint tissue integrity
Increase circulation and prevent
thrombus formation
Develop coordination and motor
skills for functional activities
LIMITATIONS
LIMITATIONS
PROM
True passive, relaxed ROM may be
difficult to obtain when muscle is
innervated and the patient is
conscious.
LIMITATIONS
PROM
Passive motion does not:
Prevent muscle atrophy
Increase strength or endurance
Assist circulation to the extent
that active, voluntary muscle
contraction does
LIMITATIONS
AROM
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
ROM should not be done when
motion is disruptive to the healing
process.
PRECAUTIONS AND
CONTRAINDICATIONS
Carefully controlled motion within
the limits of pain-free motion
during early phases of healing has
been shown to benefit healing
and early recovery.
PRECAUTIONS AND
CONTRAINDICATIONS
Signs of too much or the wrong
motion include increased pain and
inflammation.
PRECAUTIONS AND
CONTRAINDICATIONS
ROM should not be done when
patient response or the condition
is life-threatening.
PRECAUTIONS AND
CONTRAINDICATIONS
PROM may be carefully initiated
to major joints and AROM to
ankles and feet to minimize
venous stasis and thrombus
formation.
PRECAUTIONS AND
CONTRAINDICATIONS
After MI, CABG, or percutaneous
transluminal coronary angioplasty,
AROM of upper extremities and
limited walking are usually
tolerated under careful
monitoring of symptoms.
Principles and Procedures
for Applying ROM
Techniques
Examination, Evaluation, and
Treatment Planning

Determine:
Pts impairments & level of
function
Pts ability to participate
Safe amount of motion
Examination, Evaluation, and
Treatment Planning

Patterns
Anatomic planes of motion
Muscle range of elongation
Combined patterns
Functional patterns

Examination, Evaluation, and
Treatment Planning

Monitor the patients general
condition and responses during and
after the examination and
intervention.
Document and communicate findings
and intervention.
Re-evaluate and modify the
intervention as necessary.
Patient Preparation
1. Communicate with the patient. (plan
and method of intervention)
2. Free the region from restrictive
clothing. Drape the patient as
necessary.
3. Position the patient in a comfortable
position.
4. Position yourself so proper body
mechanics can be used.
Application of Techniques
To control movement, grasp the
extremity around the joints.
Support areas of poor structural
integrity.
Perform the motions amoothly and
rhythmically, with 5 to 10
repetitions.
Application of Techniques
Move the segment through its
complete pain-free range to the
point of tissue resistance. Do not
force beyond the available range!
Self-Assisted ROM (S-AROM)
Is used to protect the healing
tissues when more intensive
muscle contraction is
contraindicated
Self-Assisted ROM (S-AROM)
Forms of Self-Assisted ROM
Manual
Equipment
Wand or T-bar
Finger ladder, wall climbing, ball rolling
Pulleys
Skate board/powder board
Reciprocal exercise devices

Manual Self - AROM
Self-AROM with wand
Self-AROM
Wall-climbing Overhead pulley
Range of Motion through
Functional Patterns
Can be beneficial in initiating the
teaching of ADLs and IADLs.
Helps the patient recognize the
purpose and value of ROM
exercises
Develops motor patterns that can
be used in daily activities
Continuous Passive Motion (CPM)
Refers to passive motion that is
performed by a mechanical
device that moves a joint slowly
and continuously through a
controlled ROM.
Benefits of CPM
Effective in lessening the negative
effects of joint immobilization
Effective in improving the
recovery rate and ROM after
surgical procedures

General Guidelines for CPM
May be applied immediately after
surgery
ARC OF MOTION:
Low arc of 20-30 initially;
progressed 10-15 per day as
tolerated
RATE: 1 cycle/45 sec or per 2 min
General Guidelines for CPM
AMOUNT OF TIME:
Varies for different protocols;
anywhere from continuous 24
hours to continuous for 1 hour, 3x
a day.

General Guidelines for CPM
PT treatments are usually
initiated during periods when the
patient is not on CPM.
DURATION MINIMUM: Less than
1 week

REFERENCE:
Kisner, C. & Colby,
L.A. (2007).
Therapeutic
Exercise
Foundations and
Techniques, 5th ed.
Chapter 3.