Exercise Science Range of Motion

Bell Work What is Range of Motion?

ROM DEFINED The full movement potential of a joint, usually its range of flexion and extension.

Range of Motion (ROM) definition: exercising joints through the available motion to maintain available range and flexibility of joint structures

Purpose of ROM maintain joint movement and integrity prevent deterioration of joint structures, ankylosis and contractures Ankylosis is abnormal stiffening and immobility of a joint due to fusion of the bones.

Indications for ROM patients on prolonged bed rest prevention of contracture: a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints stimulates circulation

Types of ROM active (AROM) performed by patient patient moves the joints through available ROM maintains muscle strength and joint mobility

Types of ROM active assistive (AAROM) performed by patient with assistance from another person or mechanical device patient uses stronger limb to move or support weaker limb practitioner completes movement through full available ROM

Types of ROM passive (PROM) performed for patient by healthcare worker or caregiver moves all muscle groups within each plane over each joint does not maintain muscle strength maintains joint flexibility & integrity

Types of ROM stretching forcing movement beyond the available ROM contraindicated for most healthcare personnel

Principles of ROM Check doctor’s orders Know the patient diagnosis and rationale for ROM Explain the procedure to the patient

Principles of ROM use good body mechanics expose limb being exercised support body part proximal to joint use slow smooth rhythmic motion

Key Factors for ROM start ROM exercises on the unaffected side start each movement in neutral position use a firm comfortable grip while maintaining support of the extremity avoid forcing beyond range avoid overexerting patient avoid skin friction exercise just below point of pain, NOT beyond

Key Factors for ROM if rigidity occurs slightly decrease ROM until it subsides stop if spastic contraction occurs talk to patient to help them relax expect heart rate and respirations to rise exercise 2-3x’s daily, 5-10 movements(see physician’s or Physical Therapist orders) document procedure & patient reaction

Basic Terminology - ROM Flexion to bend a joint Extension to straighten a joint Abduction move away from midline of body Adduction move toward midline of body

Flexion and Extension Flexion and extension are movements that occur in the sagittal plane. They refer to increasing and decreasing the angle between two body parts: Flexion refers to a movement that decreases the angle between two body parts. Flexion at the elbow is decreasing the angle between the ulna and the humerus. When the knee flexes, the ankle moves closer to the buttock, and the angle between the femur and tibia gets smaller. Unit III

Extension Extension refers to a movement that increases the angle between two body parts. Extension at the elbow is increasing the angle between the ulna and the humerus. Extension of the knee straightens the lower limb. Unit III

Dorsiflexion vs. Plantarflexion Dorsiflexion refers to flexion at the ankle, so that the foot points more superiorly. Plantarflexion refers extension at the ankle, so that the foot points inferiorly. Unit III

Joint Movement Terms FLEXION vs. EXTENSION hyperextend flexion flexion dorsiflexion plantar flexion neutral Unit III

Abduction vs Adduction Abduction is any motion of the limbs or other body parts that pulls away from the midline of the body.  Adduction is the movement of a body part toward the body's midline. So, if a person has their arms straight out at the shoulders and brings them down to their sides, it is adduction Unit III

Joint Movement Terms ABDUCT vs. ADDUCT Unit III

Basic Terminology - ROM Horizontal Abduction moving away from body in a transverse plane Horizontal Adduction moving toward body in a transverse plane

Basic Terminology - ROM Rotation internal (medial) pivoting inward along an axis external (lateral) pivoting outward along an axis

Inversion and Eversion Inversion and eversion are movements which occur at the ankle joint, referring to the rotation of the foot around its long axis. Inversion involves the lateral rotation of the foot, such that the sole points medially. Eversion involves the medial rotation of the foot, such that the sole points laterally. Unit III

Lateral and Midline Rotation Movement that brings the anterior surface of the limb toward the midline of the body is called medial (internal) rotation Anterior surface moves away from the midline is lateral (external) rotation Unit III

Joint Movement Terms INVERSION vs. EVERSION turn inward or medially turn outward or laterally Unit III

Rotation Rotation of the neck or body is the twisting movement produced by the summation of the small rotational movements available between adjacent vertebrae Unit III

Circumduction is the movement of a body region in a circular manner, in which one end of the body region being moved stays relatively stationary while the other end describes a circle Unit III

ROTATION vs. CIRCUMDUCTION Joint Movement Terms ROTATION vs. CIRCUMDUCTION pivot circle Unit III

Basic Terminology - ROM Supination rotate forearm, palm up Pronation rotate forearm, palm down Opposition oppose thumb tip to base of little finger (may be done to each individual finger tip)

Example of Opposition Thumb opposition oppose thumb tip base of little finger or to finger tip of each individual finger

PRONE AND SUPINE Prone: Position of lying on the anterior part of the body. Patient lies on stomach with head turned to the side. Supine: Position of lying on the posterior part of the body. Patient lies flat on back. Additional supportive devices may be added for comfort.

PRONATION vs. SUPINATION Joint Movement Terms PRONATION vs. SUPINATION place on front place on back Unit III

Elbow flextion

Knee Flexion

Toe Flexion

Knee Extension

Head or neck extension

Hip abduction

toward midline Toe Adduction

turning part on its axis Left Head and Neck rotation turning part on its axis Right

Example of Rotation Hip internal rotation pivoting inward

toward body in transverse plane Shoulder horizontal adduction toward body in transverse plane

Example of Supination Forearm supination rotate forearm, palm up

rotate forearm, palm down Forearm pronation rotate forearm, palm down

sole of foot turned outward at the ankle Ankle eversion sole of foot turned outward at the ankle

Example of Inversion sole of foot turned inward at the ankle Ankle inversion sole of foot turned inward at the ankle

Example of Dorsiflexion Ankle dorsiflexion an upward or backward motion of the ankle toward the hips

Example of Plantar Flexion Ankle plantar flexion a toe down motion of the foot at the ankle