Chapter 23: Intervention for Limited Passive Range of Motion

Chapter Objectives

Upon completion of this chapter, the learner should be able to:

1. Summarize the factors that contribute to loss of passive range of motion (PROM) in people with neuromuscular pathology and injury.

2. Utilize range of motion (ROM) examination data and evaluation from a patient case to obtain information that drives clinical intervention decisions.

3. Identify situations in which it is appropriate to provide a ROM intervention to improve function.

4. Describe evidence for implementation of a variety of ROM interventions.

5. Apply principles of ROM intervention to a patient case.

Introduction

Normal movements of the body are fluid and occur with exquisite motor control. Sometimes this normal movement can be restricted by limitations of the bony joint surfaces or of the soft tissue structures at the joint. Range of motion (ROM), the degree to which excursion can take place at a particular joint, is commonly decreased in individuals with neuromuscular impairments. These limitations are of concern because they restrict movement options even when motor control is not impaired and can contribute to pain, loss of function, or altered appearance. For example, the shoulder joint provides us with a wide range of movement options in all planes of motion, but pathological changes that decrease shoulder flexion can cause a multitude of functional impairments, including difficulty reaching overhead to retrieve objects and performing upper body dressing tasks.

Active range of motion (AROM) refers to the ability of a person to use muscle contractions to move a body segment through the motion available at the joint. This ability is primarily an indication of motor strength and motor control and may vary depending on the position of the body segment and the effects of gravity. AROM is an important part of the physical examination, but AROM deficits cannot be reported in isolation. An observed deficit in AROM requires further testing to determine the cause of the restriction, such as limitations of the bony joint surfaces, decreased soft tissue extensibility at the joint, pain, impaired motor control, or muscular weakness.

This chapter focuses on physical interventions for limited passive range of motion (PROM) due to bony joint surface deformities or restrictions in soft tissue extensibility.

PROM refers to movements at a joint caused by an external force when a person is fully relaxed, such as when a physical therapist moves a body segment. This motion can be limited by pain, bony joint surface deformities, or restriction of soft tissue extensibility. PROM at a joint that is limited by tightness of a muscle, joint capsule, or other soft tissue is referred to as a contracture (Halar, 1978). There are two types of contractures: muscle contractures and joint contractures. Muscle contractures are specifically due to shortened muscles, and joint contractures are due to joint capsular tightness. These differences may be difficult to discern in the typical clinical setting. Passive stiffness can ...