CHAPTER 13: Improving Mobility

CHAPTER OBJECTIVES

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

1. Describe the three components of mobility and their differences.

2. Describe the two different types of flexibility.

3. Perform a goniometric assessment of each joint.

4. Describe strategies to increase range of motion (ROM) using different techniques.

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

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

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

8. Define flexibility and describe its importance in rehabilitation.

9. Explain the differences between the various stretching techniques.

10. Describe strategies to increase flexibility using different techniques.

OVERVIEW

Normal mobility is necessary for efficient movement. The terms range of motion (ROM), flexibility, and accessory joint motion are often listed as components of mobility.

• ROM refers to the distance and direction a joint can move. The direction in which a joint moves is described using terms like flexion, extension, abduction, adduction, internal rotation, and external rotation. 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, adaptive shortening of the muscles, and capsular and ligamentous structures surrounding that joint. Under normal circumstances, it is the muscles that move the joints. The full range of extensibility of a muscle is called its functional excursion. The amount of excursion depends on the arrangement of the muscle fibers and whether the muscle is a one-joint or a multi-joint muscle (see later).

• Flexibility refers to the passive extensibility of connective tissue that provides the ability for a joint or series of joints to move through a full, nonrestricted, injury-free, and pain-free ROM. Flexibility is also dependent upon pain levels and neuromuscular control. Magnusson¹ identified three factors that might contribute to improving flexibility: passive tissue properties, segmental reflex excitability, and tolerance of discomfort. When an 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.²

• Accessory joint motion. Accessory joint motion is the amount of the arthrokinematic glide that occurs at the joint surfaces, termed joint play (see Chapter 1). A number of anatomic factors can limit the ability of a joint to move through a full, unrestricted ROM, including the integrity of the joint surfaces, increasing age, and the mobility and pliability of the soft tissues that surround a joint. Before attempting to improve the arthrokinematic glide at a particular joint, the clinician must always consider the status of the neighboring joints in terms of their hypermobility or hypomobility (see ...