Chapter 13. Improving Range of Motion and Flexibility

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 ...