INTRODUCTION
• ROM is a basic technique used for the
examination of movement and for initiating
movement into a program of therapeutic
intervention.
• The structure of the joints, as well as the
integrity and flexibility of the soft tissues that
pass over the joints, affects the amount of
motion that can occur between any two bones.
• all structures are affected by ROM
INTRODUCTION
• To describe joint range  flex. Ext. …
– measured with a goniometer and recorded in degrees.
• Muscle range  functional excursion of muscles.
– the distance a muscle is capable of shortening after it
has been elongated to its maximum.
– directly influenced by the joint it crosses
• one-joint muscles v.s. two-joint muscles
• two-joint muscles shortens to a point known as active
insufficiency, where it can not shorten any more.
• when fully elongated it is in a position known as passive
insufficiency.
INTRODUCTION
• To maintain normal ROM, the segments must be
moved through their available ranges periodically
• Factors can lead to decreased ROM
– systemic, neurological, or muscular diseases
– surgical or traumatic insults
– inactivity or immobilization for any reason.
• 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 (PROM).
– movement of a segment within the unrestricted ROM
that is produced entirely by an external force
• Active-Assistive ROM (A-AROM).
– assistance is provided manually or mechanically by an outside
force because the prime mover muscles need assistance to
complete the motion.
• Active ROM (AROM).
– movement of a segment within the unrestricted ROM
that is produced by active contraction of the muscles
crossing that joint.
Indications for PROM
• Regions of acute, inflamed tissue
• Patient unable to or not supposed to
actively move a body segments
– comatose, paralyzed, or on complete bed rest
Goals for PROM
• 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
• Decrease or inhibit pain
• Assist with the healing process after injury or surgery
• Help maintain the patient's awareness of movement
Other Uses for PROM
• When a 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 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.
Indications for AROM, AAROM
• patient able to contract the muscles actively and move a
segment with or without assistance. AROM
• patient has weak musculature and is unable to move a joint
through the desired range (usually against gravity) A-AROM
• aerobic conditioning programs. AROM + A-AROM
• on the regions above and below the immobilized segment
Goals for AROM
• same goals of PROM can be met with AROM
– 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
PROM:
• Passive motion does not:
– Prevent muscle atrophy
– Increase strength or endurance
– Assist circulation to the extent that active,
voluntary muscle contraction does
Limitations of ROM exercises
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 to
ROM exercises
• when motion to a part is disruptive to the healing
process
• Historically, ROM has been contraindicated immediately
after acute tears, fractures, and surgery; but ...
• stays within the range, speed, and tolerance of the
patient during the acute recovery stage
• Signs of too much or the wrong motion include
increased pain and increased inflammation
Precautions and contraindications to
ROM exercises
• ROM should not be done when patient
response or the condition is life-threatening.
• PROM may be carefully initiated to major joints
and AROM to ankles and feet to minimize
venous stasis and thrombus formation.
• After myocardial infarction, coronary artery
bypass surgery 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
– Examine and evaluate the patient's impairments and
level of function, determine any precautions and
prognosis, and plan the intervention.
– Determine the ability of the patient to participate in
the ROM activity and whether PROM, AAROM, or
AROM can meet the immediate goals.
– Determine the amount of motion that can be safely
applied for the condition of the tissues and health of
the individual.
Principles and procedures for applying
ROM techniques
• Decide what patterns can best meet the goals
– Anatomic planes of motion: frontal, sagittal, transverse
– Muscle range of elongation: antagonistic to the line of
pull of the muscle
– Combined patterns: diagonal motions or movements that
incorporate several planes of motion
– Functional patterns: motions used in activities of daily
living (ADL)
• Monitor the patient's general condition and responses
during and after the examination and intervention
• Document and communicate
• Re-evaluate and modify the intervention as necessary.
Patient Preparation
• Communicate with the patient.
• Free the region from restrictive clothing, linen,
splints, and dressings
• Position the patient in a comfortable position
with proper body alignment and stabilization
• 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
• Move the segment through its complete pain-free
range to the point of tissue resistance only .
• Perform the motions smoothly and rhythmically,
with 5 to 10 repetitions.
Application of PROM
• During PROM the force for movement is
external, being provided by a therapist or
mechanical device.
• No active resistance or assistance is given by
the patient's muscles that cross the joint.
• The motion is carried out within the free ROM
Application of AROM
• Demonstrate the motion desired using PROM; then
ask the patient to perform the motion.
• Provide assistance only as needed for smooth
motion. When there is weakness, assistance may be
required only at the beginning or the end of the
ROM, or when the effect of gravity has the greatest
moment arm
• The motion is performed within the available ROM.