Range of motion

Types of ROM Exercises
1. Passive ROM
“Movement of a body segment within the unrestricted ROM that is produced entirely by an external force”.
 There is no/little voluntary muscle contraction
 External force → gravity, machine, another person/body part
2. Active ROM
“Movement of a body segment within the unrestricted ROM that is produced by active contraction of muscles crossing that joint”.
3. Active-Assisted ROM
“Type of A-ROM involving manual/mechanical assistance provided by an outside force because the prime mover muscles need assistance to complete the motion”.
Indication of ROM Exercises
1. Passive ROM
 Acute inflamed tissue → 2-6 days
 Comatose/Paralyzed/Completely bed-ridden patient
2. Active & Active-Assisted ROM
 Active muscle contraction → Active ROM
 Aerobic conditioning program → Active ROM
 Region above & below the immobilized segment → Active ROM
 Weak musculature → Active- Assisted ROM
 Control gained → Manual/Mechanical Resistance Exercise → Improve muscle performance
Goals of ROM Exercises
Passive ROM
Primary Goal
 Decrease complications of immobilization i.e. Cartilage degeneration, Adhesion & Contracture formation, Sluggish circulation
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 of movement
Other uses
 Determine limitations of motion, to determine joint stability, and to determine muscle and other soft tissue elasticity.
 Demonstrate the desired motion for an active exercise program.
 Used preceding the passive stretching techniques.
Active & Active-assisted ROM
Primary Goal
 Similar to PROM in absence of inflammation & contraindication
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
Passive ROM
 Prevent muscle atrophy
 Increase strength or endurance
 Assist circulation to the extent that active, voluntary muscle contraction does
Active ROM
 Maintain or increase strength in a strong muscle
 Develop skill or coordination except in the movement patterns used.
 After acute tears, fractures, surgery
 Disruption to the healing process
 Increased pain & inflammation
 MI, CABAGE, Percutaneous transluminal coronary angioplasty
 Venous stasis & thrombus formation
Principles & Procedures of Application
1. Examination, Evaluation, & Treatment planning
2. Patient Preparation
3. Application of Techniques
Self-assisted ROM → S-AROM
Used to protect healing tissue when more intensive muscle contraction is contraindicated i.e. Post-surgical or Post-trauma
Forms of S-AROM
 Manual
 Equipment
 Wand or T-bar
 Finger ladder,Wall climbing, Ball rolling
 Pulleys
 Skate or Powder board (Hip abd: & adduction, Shoulder Horizontal flexion & extension)
 Reciprocal Exercise devices → Bicycle, Upper/Lower body ergometer etc
Continuous Passive Motion (CPM)
“Passive motion performed by a mechanical device that moves the joint slowly & continuously through a controlled ROM”.
 Beneficial healing effects on diseased/injured structures
↓ Negative effects of immobilization→ Arthritis, Contractures, Intra-articular fractures
↑Recovery rate & ROM―post-surgical
Demonstration by Salter
 Prevents development of adhesions and contractures and thus joint stiffness
 Provides a stimulating effect on the healing of tendons and ligaments
 Enhances healing of incisions over the moving joint
 Increases synovial fluid lubrication of the joint and thus increases the rate of intra-articular cartilage healing and regeneration
 Prevents the degrading effects of immobilization
 Provides a quicker return of ROM
 Decreases postoperative pain
 Decreases postoperative blood drainage & increases analgesia

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