Regaining Your Range of Motion After Injury

We all depend on our muscles and joints working together properly to get around safely. The ability of our joints to move is called range of motion and is measured in degrees. All human movement is dependent on the amount of range of motion (ROM) available in synovial joints. In general, ROM may be limited by two anatomical entities: joints and muscles. When we are healthy, our knees, elbows, wrists, etc. all can bend and flex to their maximum amount. After an injury or surgery their ability to move may be diminished. Through therapy and exercise we can regain most if not all our range of motion. These exercise target the joints and surrounding muscles to increase flexibility and strength.

Regaining and Maintaining Our Range of Motion After Injury

What Can Cause My Range of Motion to Deteriorate?

When we are young, healthy, and active all of our joints and muscles, that control movement, have a full range of motion. This means that we can easily flex at our knees, hips, elbows, etc. to their full capacity. However, sometimes an injury or a surgery (such as a knee replacement) causes the joints and the muscles surrounding them to lose their flexibility. The effect of this loss of range can be a diminishment of stability and/or coordination as well as pain and stiffness. Also, as we age we can naturally lose some of our flexibility and range of motion. Disease can also be a contributing factor to joint stiffness. Osteoarthritis, rheumatoid arthritis, and other types of arthritis can cause joint stiffness and swelling.

What Is Normal Range of Motion?

Our joint’s range of motion is measured in degrees. Your physical therapist measures your range of motion with a goniometer. These work much like a protractor, measuring angles. Fabrication Enterprises makes a Baseline 360° clear plastic goniometer that can be placed on the joint to measure its range. They even offer a wall-mounted version which makes measurement of hip movement easier. An Arthrodial protractor is ideal for measuring all major articulations, utilizing a bubble level to identify the horizontal plane. There is even a small goniometer to measure small finger joints. Other manufacturers are Chattanooga Group and Lenjoy Medical . These can be made of clear plastic or metal and even incorporate soft comfortable materials. Measurement varies depending upon which joint we are talking about and the different movements that joint can make. The extension and flexion, abduction and adduction, lateral and medial rotation all have normal values depending on the joint. In an article for About.com, Carol Eustice gives some examples of normal range of motion. They are:

  • Hip flexion (bending) 0°-125°
  • Hip extension (straightening) 115° – 0°
  • Hip hyperextension (straightening beyond normal range) 0° – 15°
  • Hip abduction (move away from central axis of body) 0° – 45°
  • Hip adduction (move towards central axis of body) 45° – 0°
  • Hip lateral rotation (rotation away from center of body) 0° – 45°
  • Hip medial rotation (rotation towards center of body) 0° – 45°
  • Shoulder flexion 0° – 90°
  • Shoulder extension 0° – 50°
  • Shoulder abduction 0° – 90°
  • Shoulder adduction 90° – 0°
  • Shoulder lateral rotation 0° – 90°
  • Shoulder medial rotation 0° – 90°
  • Knee flexion 0° – 130°
  • Knee extension 120° – 0°
  • Elbow flexion 0° – 160°
  • Elbow extension 145° – 0°
  • Elbow pronation (rotation inward) 0° – 90°
  • Elbow supination (rotation outward) 0° – 90°

 

Types of Range of Motion Therapy

  • Passive Range of Motion (PROM): this is when you do not use your muscles to move your joint. Your doctor or physical therapist manually moves your body while you relax or even in bed. These exercises should be done daily and can be spread out throughout the day. They should be done slowly and gently, taking care to avoid jerky movements. Each joint should be moved as far as they go, stopping when resistance is felt. Often after knee replacement surgery, a machine called continuous passive motion (CPM) will provide passive range of motion.
     
  • Active Assist Range of Motion (AAROM): active assist therapy is when you can move your injured limb, but require assistance from another person or machine to help in order not to cause further injury or pain. This would be the next step of rehabilitation after passive range of motion. This can help with the strengthening of the muscles surrounding the joint without over stressing the injured area. You should stop immediately if you feel pain.
     
  • Active Range of Motion (AROM): active ROM is when you are capable of using your own muscles to move your limb or joint without assistance. This means you are moving independently after injury or surgery. Strengthening exercises are a form of active range of motion. At this stage, elastic bands and additional weights can be used to strengthen weakened muscles. The use of additional resistance should be used in conjunction with continued targeted stretching of the area affected.

 

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