Therapeutic Exercise Foundations and Techniques Part II Applied Science of Exercise and Techniques Chapter 3 Range of Motion

Muscle range is related to the functional excursion of muscles Functional excursion is the distance a muscle is capable of shortening after it has been elongated to its maximum The full motion possible is called the range of motion (ROM).

Range of Motion In some cases the functional excursion, or range of a muscle, is directly influenced by the joint it crosses. For example, the range for the brachialis muscle is limited by the range available at the elbow joint.

Range of Motion For two-joint or multi joint muscles,their range goes beyond the limits of any one joint they cross Example of a two joint muscle functioning at the elbow is the biceps brachii muscle This point is known as active insufficiency, where it can shorten no more

Range of Motion The muscle is lengthened full range by extending the elbow, pronating the forearm, and simultaneously extending the shoulder. When fully elongated it is in a position known as passive insufficiency

Leading Factors to decreased ROM Systemic joint Neurological Muscular diseases Surgical or traumatic insults Inactivity or immobilization for any reason.

Range of Motion Therapeutically, ROM activities are administered To maintain joint and soft tissue mobility To minimize loss of tissue flexibility and contracture formation

TYPES OF ROM EXERCISES Passive ROM Active ROM Active-Assistive 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 or no voluntary muscle contraction. Types external forces Gravity A machine Another individual Another part of the individual’s own body.

Passive ROM Indications for PROM In 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 or segments of the body, as when comatose, paralyzed, or on complete bed rest

Passive ROM Goals for PROM Primary Goal is to decrease the complications of immobilization, such as Cartilage Degeneration Adhesion Contracture formation Sluggish circulation

Passive ROM 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

Passive ROM Other Uses for PROM When a therapist is examining inert structures, PROM is used to determine limitations of motion, to determine joint stability, and to determine muscle 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.

Active ROM (AROM) A ROM is movement of a segment within the unrestricted ROM that is produced by active contraction of the muscles crossing that joint

Active-Assistive ROM (AAROM) AAROM 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.

(AROM)& (AAROM)  Indications for AROM& AAROM Whenever 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.

(AAROM) 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 to maintain the areas in as normal a condition as possible and to prepare for new activities, such as walking with crutches

(AROM)  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 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  Limitations of Passive Motion PROM does not: 1.Prevent muscle atrophy 2.Increase strength or endurance 3.Assist circulation to the extent that active, voluntary muscle contraction does  Limitations of Active ROM Active ROM does not maintain or increase strength. It also does not develop skill or coordination

Precautions and contraindications to ROM 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.

PRINCIPLES AND PROCEDURES FOR APPLYING ROM TECHNIQUES  Examination, Evaluation, and Treatment Planning 1.Examine and evaluate the patient’s impairments and level of function 2.Determine the ability of the patient 3.Determine the amount of motion

PRINCIPLES AND PROCEDURES FOR APPLYING ROM TECHNIQUES 4.Decide what patterns can best meet the goals Anatomic planes of motion Muscle range of elongation Combined patterns Functional patterns 5.Monitor the patient’s general condition and responses 6.Document and communicate findings and intervention 7.Re-evaluate and modify the intervention as necessary

PRINCIPLES AND PROCEDURES FOR APPLYING ROM TECHNIQUES  Patient Preparation 1. Communicate with the patient. Describe the plan and method of intervention to meet the goals. 2. Free the region from restrictive clothing, linen, splints, and dressings. Drape the patient as necessary. 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. Position yourself so proper body mechanics can be used.

PRINCIPLES AND PROCEDURES FOR APPLYING ROM TECHNIQUES  Application of PROM 1.During PROM the force for movement is external, being 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.

PRINCIPLES AND PROCEDURES FOR APPLYING ROM TECHNIQUES  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. 3.The motion is performed within the available ROM