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Perhaps you have heard the term range of motion during your rehab journey and wondered what it was and why it is even part of your treatment. This blog is a great starting place to discover what range of motion is, why it’s important, how it can be impacted, and what you can do in conjunction with physical therapy to address range of motion concerns.
What is range of motion (ROM)?
Range of motion in a joint is the ability for that joint to move over a given distance (measured in degrees) and in a particular direction (ex: flexion or extension). You actually practice ROM all day long without even thinking about it! Lifting a fork to your mouth while eating, bending to put on socks, sitting down in your recliner - these all require your joints to move over a certain range. Each joint has a reference value for what is considered typical ROM. For example, your elbow should be able to fully extend, or straighten, to 0° and fully flex, or bend, to 140°.
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Physical therapists typically measure ROM with a tool we call a goniometer. This tool is used to measure the exact degree of joint mobility, allowing therapists to determine if there is a loss of movement. ROM limitations can also be observed by performing functional tasks such as climbing stairs, squatting, raising your arms to reach overhead, and reaching behind your back. With OneStep you can measure ROM on your own using only your smartphone, by performing a few quick exercises.
The importance of ROM in daily life.
In order to perform your day to day activities with ease, your joints need to be free to move without restriction. Simply being able to go for a walk or climbing stairs requires you to have adequate ROM at your ankles, knees, and hips. When one joint becomes stiff and loses mobility, this makes it more difficult to not only do the things you love, but to perform regular activities with ease and comfort.
Factors that play a role in ROM:
1. Muscle Flexibility
Have you ever noticed your neck feels stiff and doesn’t move as much when you look over one side or the other? One common cause of neck stiffness is decreased muscle flexibility! How tight or flexible a muscle is directly impacts how much a given joint is able to move. When a muscle is tight and stiff, it is typically in a shortened position and limits mobility. On the contrary, when a muscle is flexible, it is able to achieve the lengths needed for maximal range of motion. Muscle tightness doesn’t just impact the neck and back, but every part of the body. Say your latissimus dorsi muscles (back muscles commonly referred to as “the lats”) are too tight, this can limit how much you can raise your arms in front of you into shoulder flexion. Muscles work within a carefully balanced system between being strong and flexible. A physical therapist is trained to perform ROM testing to determine if tight muscles are limiting your range in any given area.
2. Body Structure and Composition
Body structure and composition refers to the components of your body such as bones, muscles, ligaments, adipose tissue, among others. Humans are unique individuals, so each of us has a different body structure and composition - which is totally expected and also pretty cool. However, these differences can impact available ROM for each person. Someone with laxity in their ligaments might have increased ROM or joint hypermobility. A joint may not be able to move through as much range if there is increased muscle bulk or adipose tissue causing tissue approximation (that’s when the joint can’t move any more because the surrounding tissue stops it). Bone structure variations impact the ability of a joint to roll, glide, and slide as it was designed to, which can also impact available range. Variations in ROM due to body structure and composition are not necessarily a bad thing at all. Just something to keep in mind during everyday exercise and the rehab process.
3. Medical Conditions
While there is a general way that our bodies are structured from an anatomical perspective, genetics and medical conditions create variations. Scoliosis, a condition in which the spine curves away from midline, alters the other joint positions since the spine and pelvis are the foundation of the body.
Neurological conditions such as cerebral palsy, cerebral vascular accidents (commonly called a stroke), brain injuries, and multiple sclerosis can alter muscle tone, strength, and spasticity. These changes can result in an inability to move parts of the body in various directions.
Osteoarthritis is characterized by age related changes of joint surfaces and decreased lubrication causing the bones of a joint to rub against each other and break down, often forming other bony structures called osteophytes. Osteoarthritis can cause limited range of motion due to both painful movement and structural changes (such as osteophytes) that create bony blocks within a joint's typical plane of movement.
4. Injuries
Sustaining a musculoskeletal injury can result in decreased or even increased range of motion depending on the type of injury. Oftentimes when a ligament is sprained or torn, this compromises the stability of the joint because ligaments act as reinforcement structures. In the event of overstretched or torn ligaments, this may increase joint movement and subsequently increase ROM. However, depending on the severity of the injury and the damage to surrounding tissues, you might experience inflammation, swelling, and pain that will limit your overall ability to move that area.
Muscle strains or tears also result in inflammation, swelling, and pain. Additionally when a muscle is injured, this impacts the strength and function of that muscle. Since a muscle's main job is to move your body, you can see how this will directly impact the range of motion at the joints the injured muscle acts upon.
5. Post-Operation
After surgery – particularly any joint replacement surgery – there is bound to be a limited range of motion. The type and purpose of surgery will impact your immediate and long term range of motion goals, which your physical therapist will discuss with you in detail. In addition, swelling, inflammation, pain, and scar tissue formation are all factors that your physical therapist takes into consideration when creating a personalized post-op program for you to increase your range of motion and get you back to living the life you love ASAP.
How Can I Improve or Maintain My Range of Motion?
• ROM exercises
There are plenty of exercises for each joint that work on increasing your range simply by practicing the movement. Even if you only have a small degree of movement, your physical therapist will work with you in that range and safely progress the exercise as you gain movement.
• Stretches
Stretching tight muscles is key for optimal range of motion. Performing daily stretches keeps your muscles flexible and comfortable to prevent stiffness and limited mobility.
• Staying Active
Taking daily walks, participating in an online yoga class, or riding your bike are all great low impact activities that you can add into your weekly schedule without much hassle. The key is to form small habits that keep your joints mobile and your body healthy!
• Consult a PT
A physical therapist is an excellent resource even if you are not injured at the moment. They can perform postural and functional mobility assessments to create an exercise and flexibility program for you meant to optimize your specific joint range of motion and prevent future injuries before they happen with exercise and stretching.
You can download our OneStep Digital Physical Therapy app to consult with a licensed physical therapist regarding any and all ROM, rehabilitation, and exercise related questions you may have from the comfort of your own home!
References
Giangregorio LM. Exercise and physical activity in individuals at risk of fracture. Best Pract & Res Clin Endocrinal Metab. 2022. https://doi.org/10.1016/j.beem.2021.101613.
Cho KH, Park SJ. Effects of joint mobilization and stretching on the range of motion for ankle joint and spatiotemporal gait variables in stroke patients. J Stroke Cerebrovasc Dis. 2020;29(8): 104933. https://doi.org/10.1016/j.jstrokecerebrovasdis.
