Range of Motion PDF

RANGE OF MOTION Is the amount of motion that can occur between any two bones. To describe joint range, terms such as flexion, extension, abduction, adduction, and rotation are used. Ranges of available joint motion are usually measured with a goniometer and recorded in degrees. ❖ Types of Movemen...

RANGE OF MOTION Is the amount of motion that can occur between any two bones. To describe joint range, terms such as flexion, extension, abduction, adduction, and rotation are used. Ranges of available joint motion are usually measured with a goniometer and recorded in degrees. ❖ Types of Movement A. Physiological Movements Physiological movements are movements the patient can do voluntarily (e.g., the classic or traditional movements, such as flexion, abduction, and rotation). The term osteokinematics is used when these motions of the bones are described. shoulder flex/ext and shoulder abd/add shoulder internal and external rotation elbow flexion and extension  wrist flex/ext and ulnar/radial deviation hip flex/ext and abd/add knee flexion and extension ankle movements B. Accessory Movements (ARTHROKINEMATICS) Accessory movements are movements in the joint and surrounding tissues that are necessary for normal ROM but that cannot be actively performed by the patient. 1- Rolling: Characteristics of one bone rolling on another are as follows: 1. The surfaces are incongruent. 2. New points on one surface meet new points on the opposing surface. 3. Rolling results in angular motion of the bone (swing). 4. Rolling is always in the same direction as the swinging bone motion whether the surface is convex or concave. 5. In normally functioning joints, pure rolling does not occur alone but in combination with joint sliding and spinning Representation of one surface rolling on another. New points on one surface meet new points on the opposing surface. 2- Sliding/Translation (gliding): Characteristics of one bone sliding (translating) across another include the following. 1. For a pure slide, the surfaces must be congruent, either flat or curved. 2. The same point on one surface comes into contact with the new points on the opposing surface 3. Pure sliding does not occur in joints because the surfaces are not completely congruent. 4. The direction in which sliding occurs depends on whether the moving surface is concave or convex. Sliding is in the opposite direction of the angular movement of the bone if the moving joint surface is convex. Sliding is in the same direction as the angular movement of the bone if the moving surface is concave. Representation of one surface sliding on another, whether (A) flat or (B) curved. The same point on one surface comes into contact with new points on the opposing surface Representation of the concave-convex rule. (A) If the surface of the moving bone is convex, sliding is in the direction opposite to that of the angular movement of the bone. (B) If the surface of the moving bone is concave, sliding is in the same direction as the angular movement of the bone. N.B: The more congruent the joint surfaces are, the more sliding there is of one bony partner on the other with movement. The more incongruent the joint surfaces are, the more rolling there is of one bony partner on the other with movement. 3- Spinning: Characteristics of one bone spinning on another include the following: 1. There is rotation of a segment about a stationary mechanical axis 2. The same point on the moving surface creates an arc of a circle as the bone spins. 3. Spinning rarely occurs alone in joints but in combination with rolling and sliding Representation of spinning. There is rotation of a segment about a stationary mechanical axis.  ❖ Planes of Movement and Axes of Rotation Human movements are described in three dimensions based on a series of planes and axis. Planes of movement All body movements occur in different planes and around different axes. A plane is an imaginary flat surface running through the body. There are three planes of movement: 1. Sagittal plane A vertical plane that divides the body into left and right sides. Flexion and extension types of movement occur in this plane, e.g. Kicking a football, chest pass in netball, walking, jumping, squatting. 2. Frontal plane Passes from side to side and divides the body into the front and back. Abduction and adduction movements occur in this plane, e.g. Jumping jack exercises, raising and lowering arms and legs sideways, cartwheel. 3. Transverse plane Passes through the middle of the body and divides the body horizontally in an upper and lower half. Rotation types of movement occur in this plane, eg hip rotation in a golf swing, twisting in a discus throw, pivoting in netball, spinning in skating. Planes of Movement  ❖ Axes of Movement An axis is an imaginary line at right angles to the plane, about which the body rotates or spins. There are three axes of movement around which the body or body parts rotate: 1. Medio-lateral axis this line runs from left to right through the centre of the body. For example, when a person performs shoulder flexion and extension. This axis is perpendicular to the sagittal plane. 2. Antero-posterior axis this line runs from front to back through the centre of the body. For example, when a person performs shoulder abduction and adduction. This axis is perpendicular to the frontal plane. 3. Vertical axis this line runs from top to bottom through the centre of the body. For example, when a person performs horizontal abduction and adduction. This axis is perpendicular to the transverse plane. ❖ RANGE OF MOTION EXERCISES Definition: Passive movements are the movements produced by an external force during muscular inactivity (no voluntary muscle contraction). These external forces may be done by the therapist, another individual (relatives of the patient), another part of the individual own body, by gravity or by a machine. Purpose: Range of motion (ROM) exercises are done to preserve flexibility and mobility of the joints on which they are performed. These exercises reduce stiffness and will prevent or at least slow down the freezing of the joints as the disease progresses and the patient moves less often. Every joint in the body has a "normal" range of motion. ❖ Types Of Rom Exercises 1. Passive ROM: Passive ROM (PROM) is movement of a segment within the unrestricted ROM that is produced entirely by an external force; there is little to or no voluntary muscle contraction. The external force may be from gravity, a machine, another individual, or another part of the individual's own body. 2. Active ROM: Active ROM (AROM) is movement of a segment within the unrestricted ROM that is produced by active contraction of the muscles crossing that joint. 3. Active-Assistive ROM: Active-assistive ROM (AAROM) is a type of AROM in which assistance is provided manually or mechanically by an outside force because the prime mover muscles need assistance to complete the motion. Factors That Can Affect Joint Range of Motion 1. Joint Articulation Joint articulation refers to how the bones, tendons, ligaments and muscles are oriented in a joint to permit certain range of motions. Some articulations provide only one range of motion, such as the elbow joint, where it allows only the arm to flex or extend. Others allow a wide variety of movements, such as the ball-and-socket joint of the shoulder, where it can flex, abduct, adduct and rotate. 2. Muscle or Fat Mass Extra fat or muscle mass may inhibit a joint's normal range of motion by physically blocking its path of movement. For example, a protruding abdomen can limit how high you can flex your hip and pull your knee to your ribs. 3. Injury and Disease Pain from an injury or disease causes the muscles in the injured site to contract reflexively to avoid further damage, thus limiting the joint's range of motion. Such conditions include arthritis, bursitis, bruises, dislocation and sprains. Regular range of motion can be achieved over time with proper rehabilitation and treatments, such as corrective exercises, massage, heat therapy and acupuncture. 4. Tissue Extensibility Tissue extensibility refers to the elasticity and flexibility of the muscles and their surrounding connective tissues. If they are not stretched or moved regularly, they can become stiff and lack extensibility, which affects how much you can move.  In practical application, before exercise, you should perform warm-up exercises that move your joints in its full range of motion. For example, before you run, you can do hip swings in the sagittal plane (front to back), frontal plane (side to side) and transverse plane (rotation). This exercise not only elevates your body temperature to improve tissue extensibility, but also moves the hip joint in all plane to motion to minimize stiffness and increase neural stimulation. Classification of passive movement 1. Relaxed Passive Movements. 2. Forced Passive movement. 3. Continuous Passive movement. ❖ Relaxed passive movement Definition: These are movements performed accurately, rhythmical and smoothly by the physiotherapist through available range of motion. The passive movements are performed in the same range and direction as active movements. The joint is moved through the free range and within the limits of pain. Relaxed passive movement are characterized by: 1. No muscular activation by the patient. 2. Performed within the available ROM. 3. Applied by some external forces. 4. No pain. Indications of relaxed passive movement: 1. In cases of paralysis, patient who is confined in bed for a long time or complete rest on bed. 2. When the patient in coma. 3. when active movement is too painful to perform. 4. In relaxation as a factor helping to reduce spasm in group of muscles. Contraindications of relaxed passive movement: 1. Unhealed fracture, recent fracture, at the site of fracture. 2. Deep Venus thrombosis. 3. Immediately following surgical procedure to tendon, ligaments, joint capsule. 4. Immediately after recent tear to ligament, tendon. 5. When a bony block limits joint motion. 6. Recent injuries. 7. Fever. 8. Acute inflammation or infection. Effects of relaxed passive movements: 1. Maintain range of motion and prevent formation of adhesions. 2. Maintain the physiological properties of the muscle (extensibility, elasticity, etc.) and prevent shortening and contracture. 3. Help in preserving and maintain the memory of the movement pattern. 4. Improving circulation by the mechanical pressure resulted from the stretching of the thin-walled vessels which passing across the moved joint, which will assist the venous and lymphatic return. 5. Can be used in training of relaxation as the rhythmic continuous passive movements can have a soothing effect and induce further relaxation and sleep. 6. Teaching the patient the desired movement. Principles of relaxed passive movement: 1. Relaxation: The selection of a suitable starting position ensures comfort and support, for both patient and physiotherapist through the movement. 2. Fixation: Good fixation for the proximal and distal joint by the physiotherapist to ensure that the movement is localized to the movable joint. 3. Support: Full and comfortable support is given to the part to be moved, so that the patient has confidence and will remain relaxed. 4. Traction: The fixation of the bone proximal to the joint providing an opposing force to a sustained pull on the distal bone. Traction is thought to facilitate the movement by reducing inter- articular friction especially for distal joints e.g: (ankle and wrist joints). 5. Range of movement: The range of movement is done in painless range. 6. Speed of movement: The speed of the movement must be slow and rhythmical. Limitations Of Relaxed Passive Movement: Passive movement does not: 1. Increase the strength or endurance of the muscle. 2. Prevent muscle atrophy. 3. Assist circulation to the extent that active, voluntary muscle contraction does. ❖Forced passive movement; Movement performed by an external force, within the tolerance of pain to increase the limited range of motion. ❖ Continuous passive motion (CPM); Definition: Continuous passive motion (CPM) is a therapy in which a machine is used to move a joint without the patient having to exert any effort. A motorized device gently bends the joint back and forth to a set number of degrees, and the amount of movement and speed can be adjusted by the physical therapist. The concept was created by Robert B. Salter M.D in 1970 and, along with help from engineer John Saringer, a device was created in 1978. Benefits: CPM is typically used in the first phases of rehabilitation following a surgical procedure as an aid to joint recovery by allowing for better diffusion of nutrients into the damaged and healing areas of the joint. Goals of CPM: 1. To control post-operative pain. 2. To improve circulation through pumping action. 3. To Prevent development of adhesions, contracture and joint stiffness. 4. To improve recovery rate and maintain range of motion (ROM) of a joint, usually following surgery. 5. To Reduce postsurgical swelling. 6. Reduce inflammation. Indications of (CPM): CPM may be used to maintain or improve ROM following: 1-After Joint reconstructive surgery or arthroplasty; Knee arthroplasty Anterior cruciate ligament (ACL) reconstruction. Meniscectomy Osteochondral repair. Rotator cuff repair. 2- Stroke rehabilitation. Contraindication: Continuous passive motion is contraindicated in cases for which the device can cause unwanted translation of opposing bones, overstressing the healing process. Precautions: 1. The use of CPM in conjunction with anticoagulation therapy may produce an intra-compartmental hematoma. 2. Skin irritation from the straps or carriage cover may develop. Clinical Application of Continuous Passive Motion General Principles 1. The CPM unit is often applied in the recovery room immediately after surgery even when the patient is wearing brace or surgical bandages. 2. The arc of motion for the joint is determined. Often a low arc of 20 to 30 degrees is used initially and progressed to 10 to 15 degrees per day. 3. The rate of motion is usually 1 cycle per 45 seconds or per 2 minutes. 4. The amount of time on the CPM machine ranges from 1 hour, three time a day to continuous for 24 hours. After surgery use is for 6 to 8 hours a day. 5. Physical therapy treatment is provided during the time the patient is not on the CPM machine. 6. Duration minimum for CPM is usually less than one week when a satisfactory range of motion is reached.