When someone presents at the clinic in pain or with difficulties in moving, the first thing we assess is their Range of Motion. Range of motion is the movement of a joint within a 3-dimensional space, and for each joint we expect to see a certain degree of movement, with comfort and no pain. If pain or limitations are present, then we can start investigating more about why those restrictions are present, and if there is anything that can be done to improve them. Different types of Range of Motion When talking about ROM, we have to be specific about the different types. Active Range of Motion If we get the client to do their own movement, with no assistance, we are looking at Active Range of Motion (AROM). In this type of movement, we are assessing the client’s capacity of delivering a movement, and here is a list of things that we look for: Pain – 0 to 10 Quality of movement – Good or Poor Distance reached – More or less than expected That information, put together, starts giving us an idea of why the client may be in pain, or why the client may not be able to reach a complete movement. Passive Range of Motion (PROM) PROM are ROM that we, as therapists, deliver ourselves by moving the client’s joints, without their assistance. This type of movement can be delivered only when the patient is not opposing any resistance to our force. It is not always easy to deliver, as someone in pain may find it difficult to relax enough to be guided in a ROM that may be painful. What we are looking at with PROM is to differentiate between muscle pain and joint pain. Indeed, if the pain occurs only when the client is delivering AROM and not PROM, we are most likely looking at tendon or muscle pain, as when the joint is isolated in its movement, no pain occurs. Resisted Range of Motion (RROM) RROM are ROM delivered under a practitioner’s resistance. The resistance is placed in 2 or 3 different phases, such as a light, medium and strong resistance. This type of testing is delivered with the intention of reproducing the client’s symptoms of pain, but not only. Indeed, a form of RROM is the Myotome. Myotomes are specific RROMs for the upper and lower body that we apply to assess nerve impingement or motor deficits caused by nerve damage. Specific movements are going to give us an idea of which nerve root may be involved at the spine level. Clinical reasoning has to be a summary of the results we obtained not only from the ROM in all its forms, but also by including the mechanism of injury, clinical history, previous injury and much more information. So ROM in all their forms are just a starting point for our understanding of the client’s reason for being in pain. When to use a range of motion evaluation. Before performing a Myotherapy, Remedial Massage, or a Thai massage session, we check for a Range of Motion, also known as ROM. Checking for ROM is to establish the functionality of the joint and the muscles that surround it. For example, when a client walks in complaining of cervical pain, the first thing we look at too after the postural assessment is the ROM. A postural assessment is an evaluation of the skeletal structure. After that, we ask the client to do specific movements with their head. Like Rotation side to side, flexion, extension, and lateral flexion. Indeed, these are the basic range of motion for the cervical area. What can this range of motion tell us? Well, depending on the essential mobility of the person, we expect a minimum and maximum range. Let’s say that the client has average mobility; we expect the range of motion of their cervical to be: Flexion (able to flex the head forward and leave a gap of 3cm between the chin and the sternum) Extension: we look in too 70° of movement Lateral rotation: we look in too 80° of rotation (the chin is nearly in line with the shoulder) Lateral Flexion we look in too 45°. If this post talks to you, book your next massage session by clicking here. Is the range of motion the same for everyone? A person with a hypermobile joint range may have about 10° less ROM than this. Indeed, a person who has a hypermobile joint range can reach 10° more. That’s why every person needs his evaluation. Moving forward, if the range of motion is limited, it could be muscle tightness or a joint mobility issue. The best approach for improving joint mobilisation is the Myotherapy treatment or Thai Massage. Both techniques relieve muscle tension and improve muscle tone and joint mobility. The release of tension from the muscle would improve the ROM. On the other hand, when we ask a client to do a ROM, we don’t look only for the length of movement. Quality of movement. For the quality of movement, we refer to how smooth the movement is. Is the client trying to compensate for the cervical rotation by flexing the head? Is the client compensating for the flexion by shrugging the shoulder? Indeed, the movement of a joint is the key to understanding what muscle is responsible for the pain, discomfort or limited ROM. Once we individualise the key muscle/s, we can address the issue. Different types of ROM. In conclusion, the ROM can be active, passive and resisted. The client itself does active ROM. Passive are ROM done by the therapist with no assistance in controlling the movement by the client. Reisted is ROM active done by the client, with a resistance force applied by the therapist again the client’s movement. Each of this ROM can tell us something different about the joint. Active is about muscle lengthening. Passive is about joint mobility (ligament and tendon) Resisted is about the strength of the […]
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