Skip to Main Content


At the completion of this chapter, the reader will be able to:


  1. Define the different types of range of motion (ROM).

  2. Describe strategies to increase ROM.

  3. Describe the indications and contraindications for the various types of ROM exercises.

  4. Define active insufficiency and passive insufficiency of a muscle.

  5. Outline the indications and contraindications for continuous passive motion (CPM).

  6. Define flexibility and describe its importance in rehabilitation.

  7. List and describe two types of flexibility.

  8. Describe strategies to increase flexibility using different techniques.


The terms range of motion and flexibility are often used synonymously by clinicians, yet they are not the same.


  • Range of motion (ROM) refers to the distance and direction a joint can move. Each specific joint has a normal ROM that is expressed in degrees. Within the field of physical therapy, goniometry is commonly used to measure the total amount of available motion at a specific joint. ROM of a joint may be limited by the shape of the articulating surfaces and by capsular and ligamentous structures surrounding that joint.
  • Flexibility refers to the ability to move a joint or series of joints through a full, nonrestricted, injury, and pain-free ROM. Flexibility is dependent on a combination of joint ROM, muscle flexibility, and neuromuscular control. When injury occurs, there is almost always some associated loss of the ability to move normally due to the pain, swelling, muscle guarding, or spasm. The subsequent inactivity results in a shortening of connective tissue and muscle, loss of neuromuscular control, or a combination of these factors.1


A decrease in ROM and/or in the flexibility of one joint can affect the entire kinetic chain. For example, a decreased ROM or flexibility in the shoulder can impact the function of the entire arm. In order to provide a treatment for a loss of movement, the clinician must make the determination as to the specific cause i.e., loss of ROM or decreased flexibility. For example, is the specific cause due to joint effusion, adaptive shortening of connective tissue structures, changes in bony architecture, or alignment of the articular surfaces?


Normal flexibility and ROM are necessary for efficient movement. Joint movement may be viewed as the amount of joint ROM, the arthrokinematic glide that occurs at the joint surfaces, termed joint play, whereas flexibility is determined by the degree of extensibility of the periarticular and connective tissues that cross the joint. A number of anatomic factors can limit the ability of a joint to move through a full, unrestricted ROM. These include


  • muscles and their tendons
  • connective tissue
  • bone
  • adipose tissue
  • skin
  • neural tissue


When referring to ROM, three major movements are recognized:1


  • Active range of motion (AROM). AROM, also called dynamic flexibility, refers to the degree to which a joint can be moved by a single muscle contraction, usually through the mid range of movement. Active ROM ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.


About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessPhysiotherapy Full Site: One-Year Subscription

Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.

$595 USD
Buy Now

Pay Per View: Timed Access to all of AccessPhysiotherapy

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.