CHAPTER 3
* Range of Motion
1
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HIP AND KNEE FLEXION ACTIVE ASSISTIVE OR
FIGURE 3-1 MOTION.
PASSIVE RANGE
Positioning: Patient lying supine with one knee flexed and foot flat on stable
surface. Physical therapist assistant (PTA) standing next to leg that is flexed.
Procedure: PTA performs unilateral flexion of hip and knee by grasping
patient's limb at knee and under heel and pushing knee toward patient's
shoulder on same side.
Note: Same positioning can be used for active range of motion hip flexion.
Patient actively flexes knee and hip on one side and brings knee toward
shoulder. Motion can be performed with self-assistance by having patient grasp
top of knee and pull hip and knee into flexion by pulling knee toward shoulder on
same side.
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2^
86
96
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25
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2
PART II •
Mobility
HIP ABDUCTION AND ADDUCTION ACTIVE-ASSISTIVE OR PASSIVE
FIGURE 3 2
MOTION.
RANGE
Positioning: Patient lying supine on stable surface with both limbs extended
and one limb positioned in slight hip abduction. Physical therapist assistant
(PTA) standing adjacent to patient's leg.
Procedure: PTA performs unilateral abduction and adduction by grasping
patient's leg under knee and ankle and moving extended, neutrally rotated limb
into abduction and adduction.
Note: Same position can be used for active range of motion hip abduction and
adduction. Patient moves hip by sliding extended, neutrally rotated limb back
and forth across surface.
5785
Positioning: Patient lying supine with one knee flexed and foot flat on stable
surface. Physical therapist assistant (PTA) standing at side of flexed limb and
adjacent to patient's bent leg.
Procedure: PTA performs unilateral medial (A) and lateral (B) rotation of hip by
first grasping patient's limb at knee and heel and positioning patient's limb in
90 degrees of flexion at hip and knee. In this position, PTA stabilizes patient's
distal thigh, knee, and leg while rotating hip by performing a swinging motion
of leg in a horizontal plane.
4
PART II • Mobility
FIGURE 3-4 ! HIP ROTATION ACTIVE
RANGE OF MOTION.
400
087
Positioning: Patient lying prone on stable surface with one knee flexed to
141
90 degrees. Procedure: Patient performs unilateral active medial and
lateral rotation of hip by moving leg toward floor, keeping thigh and
pelvis flat and knee neutral regarding flexion and extension.
FIGURE 3-5 « KNEE FLEXION AND
EXTENSION ACTIVE RANGE OF MOTION
Positioning: Patient lying prone on stable surface with both legs
extended. Procedure: Patient performs unilateral active flexion and
extension of knee by moving leg toward and away from hip in sagittal
piane, keeping thigh and pelvis flat.
44049
FIGURE 3-6 ft
KNEE AND HIP
FLEXION
AND
EXTENSION ACTIVE RANGE OF MOTION (HEEL SLIDES).
Positioning: Patient in long-sitting position on stable
surface with back supported or with patient leaning back
FIGURE 3-7
Procedure; Patient performs active unilateral flexion and
extension of knee by moving heel of leg toward and away
COMBINED THORACH
Positioning: Patient kneeling on hands and knees (quadruped).
hands forward, and lowering chest to surface. Pelvis tilts posteriorly, with
Procedure: Patient performs combined thoracic, lumbar, hip, and knee
cervical spine maintained in neutral regarding flexion and extension.
flexion by sitting back on heels, keeping
on extended arms (tripod sitting).
from hip in sagittal plane, keeping pelvis in neutral position.
FIGURE 3-8 ANKLE PLANTARFLEXION AND DORSIFLEXION ACTIVE-ASSISTIVE OF PASSIVE
RANGE OF MOTION.
Positioning: Patient sitting or lying supine on stable surface with limbs
Dorsiflexion should be performed both with patient's knee extended and with it
extended. Physical therapist assistant (PTA) standing to side of leg and adjacent
slightly flexed. Plantarflexion motion should be performed by pushing on
to ankle and foot. Procedure: PTA performs unilateral plantarflexion and
dorsal surface of midfoot and forefoot.
dorsiflexion of ankle by stabilizing leg at proximal tibia and pulling foot up and
Note: Same position can be used for active range of motion of ankle. Patient
down in sagittal plane. Dorsiflexion motion should be performed by grasping
actively performs dorsiflexion and plantarflexion of the ankle, both with the
heel while pushing plantar surface of forefoot with PTA's forearm.
knee extended and with it slightly flexed.
FIGURE 3 9
TOE FLEXION AND
EXTENSION ACTIVE-ASSISTIVE OR
PASSIVE RANGE OF MOTION.
Positioning: Patient sitting or lying supine on stable surface with
legs extended. Physical therapist assistant (PTA) standing to side
of leg and adjacent to ankle and foot.
Procedure: PTA performs unilateral flexion and extension of one or more
toes at metatarsophalangeal joints by grasping entire digit and moving it in
sagittal plane while stabilizing metatarsal bones of forefoot.
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CHAPTER 3
• Range of Morion 7
FIGURE 3-10 « SHOULDER ABDUCTION AND ADDUCTION ACT1VE-ASSISTIVE OR PASSIVE RANGE
OF MOTION.
Positioning; Patient lying supine on stable surface with one arm at side and
shoulder in lateral rotation. Physical therapist assistant (PTA) standing at
patient's side and adjacent to shoulder.
Procedure: PTA performs unilateral abduction and adduction of shoulder by
grasping patient's limb under elbow and at wrist and hand and moving arm
toward head and then back to patient's side in frontal plane. Elbow can be
positioned in flexion or extension. Patient's scapula should be allowed t o
move, and shoulder must be positioned in lateral rotation when moving arm
overhead to minimize subacromial impingement.
8
PART II •
Mobility
54
Positioning: Patient lying/supine on stable surface with
and moving upper arm toward opposite shoulder (tiori-
one arm in 90 degrees of flexion. Physical therapist assist
zontai adduction) (A) and then back to starting position
tant (PTA) positioned at patient's side adjacent to shoulder.
(horizontal abduction) (S) in horizontal plane (relative to
Procedure: PTA performs horizontal adduction and ab-
patient). Patient's scapula should be allowed to move, and
duction of shouider by grasping patient's wrist and elbow
elbow can be positioned in flexion or extension.
8
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9
7
5
3
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4
7
FIGUR
Positioning: Patient lying supine on stable surface with one arm at side and
shoulder positioned in neutral relative to rotation. Physical therapist assistant
patient's wrist and hand, and moving arm toward head and then back to
patient's side in sagittal plane. Elbow can be positioned in extension, and
patient's scapula should be allowed to move..
FIGURE 3-13 : SHOULDER
ABDUCTION AND
ADDUCTION ACTIVE RANG
OF MOTION (AROM).
(PTA) standing at patient's side and adjacent to shoulder. Procedure: PTA
performs unilateral flexion of shoulder by grasping patient's arm at eibow,
crossing over to gras
Positioning: Patient standing or sitting with upper
extremities in anatomic position.
Procedure: Patient performs active shoulder
abduction and adduction (unilateral or bilateral).
Note: Same position can be used for performing
AR.OM for shouider flexion, extension; horizontal
abduction, and horizontal adduction.
10
PART II ■
Mobility
FIGURE 3 14 ft SI
OF MOTION.
Positioning: Patient lying supine
on stable surface with one arm in 90 degrees of shoulder abduction (neutral
rotation) and 90 degrees of elbow flexion. Physical therapist assistant (PTA)
standing at patient's side and adjacent to elbow. Procedure: PTA performs
unilateral medial and lateral rotation of shoulder by grasping patient's distal
forearm,
stabilizing elbow, and moving forearm in swinging motion toward floor in
sagittal plane (relative to patient). Note: Rotation motion can also be performed
with patient's shoulder in less than 90 degrees of abduction if necessary.
FIGURE 3-
ER ROTATION ACTIVE RANGE OF MOTION
Positioning: Patient standing or sitting with elbows flexed at 90
degrees.
Procedure: Patient performs active medial (A) and lateral (B) rotation of
shoulder (unilateral or bilateral)
by swinging forearms toward and away from abdomen in horizontal plane
while keeping upper arms against trunk.
12
PART II • Mobility
FIGURE 3-16 -, COMBINED SHOU
FLEXION AND LATERAL ROTATION
ACTIVE RANGE OF MOTION.
Positioning: Patient standing or sitting with arms side.
Procedure: Patient performs.active motion of con bined shoulder
flexion and lateral rotation at one shoulder by performing shoulder
flexion with elbo flexed and reaching toward posterior portion of sf
822
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der and scapula on same side.
FIGURE 3 17
COMBINED SHOULL _
EXTENSION AND INTERNAL ROTATION ACTIVE
RANGE OF MOTION.
Positioning: Patient standing or sitting with arms at
Procedure: Patient performs active motion of combined shoulder extension
and medial rotation at one. shoulder by performing shoulder extension with
elbow flexed while reaching toward inferior angle of scapula -; on same side.
.^^rttfHfilllHIIll
CHAPTER 3
FIGURE 3 18
OF MOTION.
• Range of Motion 13
ELBOW FLEXION AND EXTENSION ACTIVE ASSISTIVE OR PASSIVE RANGE
Positioning: Patient lying supine on stable surface, with arms at side.
moving forearm toward and away from upper arm in sagittal piane. Movement
Physical therapist assistant (PTA) standing or sitting at side of patient and
should be performed with patient's forearm pronated and
adjacent to elbow .an.c forearm.
Procedure: PTA performs unilateral elbow flexion and extension by
Note: Sams position can be used for active range of motion of elbow flexion
grasping patient's distal forearm, stabilizing elbow and upper arm, and
and extension.
FIGURE 3-19 # FOREARf
PRONATION AND SUPINATION
ACTIVE-ASSISTIVE OR PASSIVE
RANGE OF MOTION.
Positioning: Patient lying supine on stable surface with one
arm in 90 degrees of elbow flexion. Physical therapist
assistant (PTA) standing or sitting at patient's side and
adj cent to elbow.
Procedure: PTA performs unilateral forearm pronation
and supination by grasping patient's distal forearm,
stabilizing elbow an upper arm, and rotating forearm
toward and away from patient in horizontal plane. Note:
Same position can be used for active range of motion of
forearm pronation and supination. Patient actively rotates
forearm
FIGURE 3-20 WRIST FLEXION, EXTENSION, AND DEVIATION ACTIVE-ASSISTIVE OR PASSIVE RANGE
OF MOTION.
Positioning: Patient lying supine on stable surface with one arm in 90 degrees,
Procedure: PTA performs unilateral flexion, extension, and deviation of wrist by
of elbow flexion. Physical therapist assistant (PTA) standing or sitting at
grasping patient's hand; stabilizing distal forearm in neutral rotation; and
patient's side and adjacent to forearm.
moving wrist into flexion, extension, radial deviation, and ulnar deviation.
Note: Same position can be used for active range of motion at wrist. Patient
actively flexes, extends, and deviates wrist.
Positioning: Patient lying supine on stable surface or sit ting in chair with one
arm in 90 degrees of elbow flexion. Physical therapist assistant (PTA) standing
or sitting at patient's side and adjacent to hand. Procedure: PTA performs
unilateral flexion and extension of one or more digits at metacarpophalangeal
and
interphalangeal joints by grasping segment distal to joint arid moving it in
sagittal plane while stabilizing segment proximal to joint.
Note:
Same position can be used for active range of motion at fingers.
Patient actively flexes and extends fingers.
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CHAPTER 3
• Range of Motion 15
FIGURE 3-22 SHOULDER HORIZONTAL ADDUCTION AND ABDUCTION ACTIVE ASSISTIVE
RANGE OF MOTION WITH CANE.
Positioning: Patient lying supine on stable surface or standing with arms in
Procedure: Patient performs unilateral or bilateral horizontal abduction and
90 degrees of shoulder flexion, elbows fairly extended, and wand held in
adduction of shoulder by moving wand and arms back and forth across
hands.
chest, keeping trunk stable.
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9
3
1
FIGURE 3-24 * CERVICAL ROTATION ACTIVE-ASS I STIVE OR
PASSIVE RANGE OF MOTION (PROM).
)TION (AAROM)
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28
Positioning: Patient lying supine with head off stable surface. Physical
support applied to patients occipital region. Extension and lateral flexion
therapist assistant (PTA) sitting or standing at end of stable surface,
motions are avoided. Note: Similar positioning can be used for AAROM and
supporting patient's head with his/her elbows at about 90 degrees.
PROM for cervical flexion, lateral flexion, and extension.
75
Procedure: PTA performs cervical rotation motion bilaterally with grasp and
FIGURE 3-25 ft CERVICAL ROTATIOr
ACTIVE RANGE OF MOTION (AROM).
Positioning: Patient sitting, standing, or lying supine Procedure:
Patient performs active cervical rotation motion bilateraMy; flexion,
extension, and lateral flexion motion are avoided.
Note: Rotation motion can be self-assisted by patient using one hand
to support the mandible and assist wit the motion. Similar positioning
can be used for AROM for cervical flexion, lateral flexion, and
extension.
08
18
PART II •
Mobility
standing to one side of patient and adjacent to lumbopelvic region.
Procedure: PTA performs lumbar rotation motion bilaterally by moving knees
laterally with one hand and stabilizing thorax with other. Peivis should rise off
stable surface on opposite side during movement.
Positioning: Patient lying supine with knees flexed, feet flat on stabie surface,
and arms relaxed at side (hook-lying). Physical therapist assistant (PTA)
MBAR ROTATION ACTIVE ASSISTIVE OR PASSIVE RANGE OF MOTIO
FIGURE 3-27
LUMBAR ROTATION ACTIVE RANGE OF MOTION.
Positioning: Patient tying supine with knees flexed, feet flat on stable surface,
shouider girdles and upper back Hat on stable surface. One side of pelvis should
and arms relaxed at side (hook-lying). Procedure: Patient performs active
rise up off stable surface durinc movement.
lumbar rotation motion bilaterally by moving knees laterally while keeping
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CHAPTER 3
FIGURE 3-28 LUMBAR FLEXION ACTIVE
RANGE OF MOTION.
Positioning: Patient sitting upright in sturdy chair with feet flat
on floor, pelvis in neutral, and hands in midline.
Procedure: Patient performs active lumbar flexion by slowly lowering
head, upper extremities, and trunk toward floor while allowing pelvis
to tilt posteriorly and then returns to upright position. Cervical spine
should be kept in neutral position relative to flexion and extension.
FIGURE 3-29 # THORACIC AND
LUMBAR EXTENSION ACTIVE RANG OF
MOTION.
Positioning: Patient standing on stable, level surfac with hands placed
on iliac crests; pelvis in neutral. Procedure: Patient performs active
thoracic and lumbar extension by slowly leaning trunk backward and
allowing pelvis to tilt anteriorly and then returns to upright position.
• Range of Mo don
19
20
PART II •
Mobility
FIGURE 3-30 LUMBAR AND HIP FLEXION ACTIVE-ASSISTIVE RANGE OF MOTION
(SELF-ASSISTED).
Positioning: Patient lying supine with knees flexed, feet flat on stable surface,
and arms relaxed at side (hoojf^p
Procedure: Patient performs self-assisted lumbar and bilateral hip flexion by
grasping behind one knee and pulling knee toward chest. A. For slightly more
difficult exercise, patient grasps both knees and pulls knees toward chest (B).
Note: Allowing pelvis to tilt posteriorSy during motion will result in greater
range of lumbar flexion; stabilizing pelvis in neutral will result in greater range
of hip flexion.
CHAPTER
3 • Range of Motion 21
FIGURE 3-3
(SELF-ASSISTED)
Positioning: Patient lying prone on stable surface with
elbows flexed so that forearms and hands are under
shoulder and upper arm.
is provided by elbow extensors straightening elbows,
Fumbar extensor muscles should remain relaxed during
iBWBljHfc. motion.
Procedure: Patient performs self-assisted lumbar extension by raising head and
upper back off of surface. Force
FIGURE 3-32
SHOULDER ABDUCTION AAROM (WITH PULLEY).
Positioning: Patient sitting and holding one handle of pulley system in each
be kept stable, elbow extended on arm being lifted, and shoulder being lifted
hand (A).
must be positioned in lateral rotation when moving arm overhead to minimize
Procedure: Patient performs unilateral or bilateral abduction of shoulders by
subacromial impingement.
pulling rope down on one side, causing other arm to be lifted into abduction
(B). Trunk should
Positioning: Patient lying supine in bed with involved lower extremity
Procedure; Range, rate, and duration of motion are programmed. Unilateral
stabilized in CPM device (with straps, padding, and an underlying rigid frame).
flexion and extension of knee are performed continuously by device for hours
Movement hinge is aligned with knee joint.
at a time.