Range of Motion (ROM) Overview

Range of Motion is the range through which a joint can move or be moved. ROM testing is used to determine if the movement is limited, normal, or excessive.

Goals of ROM Testing

• Determine the end feel of the motion.
• Assess presence of pain, including the location, quality, and intensity.

Principles of Examination: Range of Motion Testing

1. Test the normal/uninjured side first.
2. Inform patients that movement may exacerbate symptoms and ensure informed consent is obtained.
3. Provide clear instructions for each test.
4. Ensure correct and stable positioning for both the therapist and the patient.
5. Perform as many tests as possible with the patient in one position before repositioning.
6. Active tests should be performed before passive tests.
7. Overpressure can be applied to determine the end feel of the joint if no pain or limitation exists in Active Free Range of Motion.
8. Assess painful movements last to prevent overflow of symptoms and ensure compliance.
9. Resisted Isometric movements should be done with the joint in a neutral/resting position.
10. Never stress the structure beyond the point of pain.

Types of Range of Motion Testing

Active Free Range of Motion (AF ROM)

• The patient actively moves the joint and notes when pain occurs.
• Tests both contractile and inert/non-contractile structures.

Active Assisted Range of Motion (AA ROM)

• Used when the patient’s strength is decreased.
• Therapist supports the limb while the patient moves within a pain-free range.

Passive Relaxed Range of Motion (PR ROM)

• Tests inert structures only.
• Therapist moves the joint passively.
• Patient indicates when pain is felt.

Passive Forced/Overpressure

• Tests the end feel of the joint.
• Therapist applies gradual pressure to assess tissue resistance.

Active Resisted Range of Motion (AR ROM)

• Tests strength and contractile tissues.
• Joint is placed in a neutral/resting position.
• Patient contracts muscles against resistance.
• Only submaximal strength is used if there is an injury.

Contraindications for AR ROM Testing

• Acute, severe injuries (1-3 days), tendon or muscle rupture, fracture.
• Do not perform maximal resistance testing on acutely injured individuals.

ROM Testing Outcomes

1. Strong & Pain-Free: No lesion in contractile tissue.
2. Strong & Painful: Possible local lesion (e.g., strain, tendonitis).
3. Weak & Pain-Free: Possible muscle rupture or nerve supply issue.
4. Weak & Painful: Possible severe lesion (e.g., dislocation, fracture).

Notes

• Review available ROM for all joints.
• Review normal and abnormal end feels for all joints.
• Be aware of contraindications such as acute injuries, dislocations, fractures, etc.

Videos for Further Learning

• Cervical Spine Range of Motion Testing
• Thoracic Spine Range of Motion Testing
• Hip Range of Motion Testing