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INTRODUCTION

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Loss of range of motion (ROM) can occur from a variety of causes, including but not limited to pain, immobilization, edema, spasticity, and decreased muscle strength. Although many treatment strategies may be used to restore or improve ROM, therapeutic modalities represent one such strategy. The use of biophysical agents, such as cold, heat, and ultrasound, is appropriate in many cases for addressing limited ROM. Likewise, electrical stimulation in the form of transcutaneous electrical nerve stimulation (TENS) for pain relief or neuromuscular electrical stimulation (NMES) for decreasing spasticity and activating skeletal muscle may be useful for improving ROM. While the physiological mechanisms and clinical administration of each of the biophysical agents have been presented in greater detail in earlier chapters of this text, this chapter presents the use of modalities as part of the active treatment plan for increasing ROM due to limited joint mobility. Therefore, the intent of this chapter is to show the clinician how to effectively use therapeutic modalities to increase ROM.

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CLINICAL REASONING

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Limited ROM can affect the efficiency of many tasks, including gait and activities of daily living. For example, lack of full knee extension can decrease step length in gait, making ambulation less efficient. Lack of elbow extension may make reaching difficult. Limited wrist mobility can affect upper extremity activities. This limited motion can be a result of injury, immobilization, or arthritis. A thorough assessment of motion will enhance the development of an appropriate plan of care, which will include the judicious and careful use of modalities. Which modality to use is based on the examination findings as well as an understanding of the course of injury recovery.

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SOURCES OF LOSS OF MOBILITY AND RANGE OF MOTION

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Many musculoskeletal and neuromuscular disorders result in limited active and passive ROM. The main contributors to limited ROM include pain, edema, arthritic joint stiffness, and joint contracture. Neurologically, spasticity can also be an impairment that may lead to limited ROM. These will be examined in detail, and the appropriate interventions for each will be discussed.

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Joint Pain as a Limiter of ROM

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Pain has been discussed extensively in this text. Pain with joint movement can cause the patient to avoid movements that cause pain, thus not taking the joint through its entire ROM, either actively or passively. This will lead to limited ROM, typically within a few days. Pain can also trigger muscle spasm, which serves to further minimize joint movement. An example of this is adhesive capsulitis of the shoulder, which may have started due to tissue injury and the pain-spasm-limited-ROM cycle. Any modality—such as TENS, cryotherapy, and deep or superficial heat—that decreases pain can be useful for these situations (Fig. 12-1). It is optimal to perform these modalities before or concurrent with active interventions to gain the most ROM. Greater details regarding physiological mechanisms and ...

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