Chapter 2: Range of Motion and Goniometry (PDF)

**In class lecture** **Definitions:** 1. **Active Range of Motion (AROM):** - The individual moves voluntarily through the range of motion. - You do not manipulate or assist their movement. - Influenced by muscle strength, coordination, and willingness to move. -...

**In class lecture** **Definitions:** 1. **Active Range of Motion (AROM):** - The individual moves voluntarily through the range of motion. - You do not manipulate or assist their movement. - Influenced by muscle strength, coordination, and willingness to move. - Provides information about the person\'s functional ability. 2. **Passive Range of Motion (PROM):** - The examiner moves the individual through the range of motion without their active effort. - Often results in higher ROM readings compared to AROM. - Limited by soft tissues (muscles, fascia, skin), joint articulations, or other restrictions (e.g., scar tissue, bone-on-bone contact). **Key Points:** - PROM typically gives **greater ROM** readings than AROM due to the lack of active muscle engagement. - Endpoints for PROM can be subjective and vary: - **Soft tissue stretch**: E.g., hamstring flexibility. - **Soft tissue opposition**: E.g., scar tissue or bulk stopping movement. - **Bone-on-bone contact**: E.g., elbow/knee extension where joint articulations stop motion. - **AROM and PROM provide different insights:** - AROM indicates **functional capacity** and **muscle control**. - PROM highlights **joint integrity** and **soft tissue flexibility**. - Challenges: - PROM requires manual assistance and can be labor-intensive. - Measurements can vary based on the subjective feel of the endpoint. **Using a Goniometer:** 1. **Parts of a Goniometer:** - **Axis:** Rotates at the joint. - **Moving arm:** Aligned with the moving body segment. - **Stationary arm:** Aligned with the stationary body segment. 2. **Reading the Goniometer:** - Goniometers have **multiple scales** (red and black numbers). - The **starting position** determines which scale to read: - **Elbow flexion:** Start fully extended; read the scale overlapping \"0\". - Ensure the moving arm aligns with the moving segment and the stationary arm aligns with the stationary segment. 3. **Common Mistakes:** - Misreading scales based on starting position. - Confusing range of motion with the angle between arms. - Always check which end overlaps \"0\" at the starting position to ensure correct readings. **Classroom Activity:** - Break into groups and use goniometers to measure AROM at various joints. - Focus on understanding: - Proper alignment of goniometer arms. - Reading the correct scale based on the starting position. - Differences in readings between joint types (e.g., elbow vs. hip flexion). **Example:** - Measure elbow flexion: - Fully extend the arm (starting at 0). - Flex the elbow. - Use the scale corresponding to the \"0\" overlap to record the range of motion (e.g., 0--150°). **Takeaway:**\ AROM and PROM measurements require precision and consistency to gather meaningful data. Understanding the mechanics of the goniometer and interpreting the correct scale is crucial for accurate assessments. **Notes on Joint and Muscle Structure from videos** **Overview of Joints** - Joints allow movement by connecting bones. - Movement range and freedom depend on bone configuration and articulation (bone interaction). - **Articulation/Arthrosis:** Connection between bones at a joint, allowing movement; facilitated by articular cartilage. **Joint Classifications** 1. **Synarthrodial Joints (Immovable):** - Examples: Sutures in the skull, tooth sockets (gomphosis). 2. **Amphiarthrodial Joints (Slightly Movable):** - Examples: - **Pubic symphysis:** Allows minor expansion and twisting. - **Intervertebral discs:** Enable limited spinal movement. - **Rib-sternum joints:** Allow ribcage expansion for breathing. 3. **Diarthrodial Joints (Freely Movable):** - Synonymous with **synovial joints.** - Key features: - **Joint capsule:** Contains synovial membrane and fluid. - **Bursa sacs:** Reduce friction, prevent joint pain, and swelling (e.g., bursitis). - Stabilized by ligaments (e.g., ACL in the knee). - Require healthy cartilage for smooth, pain-free motion. **Types of Diarthrodial Joints** 1. **Ball-and-Socket Joints:** - Examples: Shoulder (glenohumeral joint), hip. - Movement in multiple planes (e.g., swinging arm in all directions). 2. **Hinge Joints:** - Examples: Elbow, knee. - Movement limited to one plane (flexion and extension). - Provides stability and control; prevents excessive rotation. **Functional Design of Joints** - **Hinge Joint Stability:** Prevents excessive motion, ensuring efficient movement and structural stability (e.g., necessary for running or lateral movements). - **Ball-and-Socket Flexibility:** Enables wide ranges of motion critical for multidirectional tasks. **Summary:** Joints vary in structure and function based on their classification. Synarthrodial and amphiarthrodial joints have limited motion, while diarthrodial joints are highly movable. These differences ensure stability, range, and control across various bodily movements. **Notes on Muscle Structure and Function** **Muscle Function** - Muscles enable movement by shortening and pulling on bones at joints. - Shortening occurs along the **angle of pull**, determined by the orientation of muscle fibers. **Connective Tissues Involved in Movement** 1. **Tendons:** - Connect muscles to bones and are crucial for force transmission. - Tough, flexible, fibrous tissue. - Tendons can be shared by multiple muscles (e.g., quadriceps tendon). - **Insertion Point:** Determines the direction of movement caused by muscle contraction. - **Example:** Biceps insert anteriorly on the forearm to enable flexion, while triceps insert posteriorly for extension. 2. **Aponeurosis:** - Expansion of tendons; a broad, flat sheet of dense fibrous connective tissue. 3. **Fascia:** - A fibrous sheet that envelops, separates, and binds muscles, organs, and other soft tissues. - Plays a role in movement patterns and may cause friction or restrictions if remodeled improperly. - Techniques like **myofascial release** (foam rolling, massage) are used to restore tissue length and normalize movement. **Muscle Attachments** 1. **Origin:** - Proximal attachment (closer to the midline of the body). - The least movable part. 2. **Insertion:** - Distal attachment (farther from the midline). - The most movable part. - **Example (Biceps Brachii):** - Origin: Scapula (less movable). - Insertion: Radius (more movable). **Key Insights on Movement** - The relationship between origin, insertion, and tendon attachment dictates the type and direction of movement. - Knowing these relationships helps identify movement problems and design effective exercises. **Summary:**\ Muscles work with tendons, aponeurosis, and fascia to enable movement. Their origins, insertions, and fiber orientation dictate how they move bones at joints. Understanding these structures is crucial for analyzing movement and designing training or rehabilitation programs. **Notes on Muscle Fiber Arrangements and Contraction Types** **Muscle Fiber Arrangements** 1. **Parallel Fiber Arrangement:** - Fibers run parallel to the long axis of the muscle. - Allows for **greater shortening velocity** and **range of motion**. - Examples: Biceps (fusiform), flat, strap, radiate, and sphincter arrangements. 2. **Pennate Fiber Arrangement:** - Fibers align at an **oblique angle** to the muscle\'s long axis. - Advantages: **Greater force production** and more fibers per cross-sectional area. - Trade-off: Reduced range of motion and velocity. - Examples: Triceps (unipennate, bipennate, multipennate variations). **Muscle Contractions** 1. **Isometric Contraction:** - Tension develops without joint movement (e.g., holding a weight in a fixed position). - Good for stabilization and preventing motion. 2. **Isotonic Contraction:** - Tension develops with joint movement. - **Types:** - **Concentric:** Muscle shortens while generating tension (e.g., lifting a weight). - **Eccentric:** Muscle lengthens while controlling tension (e.g., lowering a weight). **Roles of Muscles in Movement** 1. **Agonist (Prime Mover):** - Main muscle causing movement (e.g., biceps during elbow flexion). 2. **Antagonist:** - Opposes the agonist\'s action (e.g., triceps during elbow flexion). - Relaxes to allow smooth movement or engages to control motion. 3. **Stabilizers:** - Fixate or stabilize a joint to allow movement in another segment. - Example: Hamstrings stabilize the hip during knee flexion. **Key Insights** - **Tension Development:** \"Contraction\" refers to generating tension, not necessarily shortening. Muscles can develop tension while shortening (concentric), lengthening (eccentric), or staying the same length (isometric). - **Practical Example:** - During a biceps curl: - **Concentric Phase:** Biceps shorten as the weight is lifted. - **Eccentric Phase:** Biceps lengthen as the weight is lowered. - **Stabilization:** Auxiliary muscles fixate other joints to isolate movement. **Summary:**\ Muscle fiber arrangement influences the force, velocity, and range of motion. Different contraction types serve specific roles in movement, while muscle groups (agonists, antagonists, and stabilizers) coordinate to produce and control motion.