Assessing Arom: Techniques For Measuring Range Of Motion

Assessing a patient's active range of motion (AROM) is a key part of physiotherapy. AROM refers to the range through which a patient can actively move a joint with the help of the muscles acting over it. The goal of testing AROM is to detect possible symptoms like pain and determine their location, quality, and intensity. Physiotherapists will also be able to see how freely their patient can move a specific joint and look out for compensatory movements. For example, when assessing the hip joint, compensations may come from the lumbar spine or the pelvis. AROM can be assessed for different joints, including the shoulder and the hip.

Active vs passive range of motion

Range of motion (ROM) refers to the extent of movement a joint or muscle can make. It is the full movement potential of a joint, or how far it can move. For example, how far you can move your finger back and forth, or how far you can lift your arm up overhead.

There are two types of ROM: active range of motion (AROM) and passive range of motion (PROM).

Active range of motion is the degree of movement in a joint when you move your body independently. This occurs when your brain tells your body to move, and you do so. For example, lifting your arms above your head to stretch the muscles is an active range of motion. Active ROM occurs when you use your muscles to help move your body part, requiring no other person or device to help.

Passive range of motion is the degree of movement in a joint when an outside force moves your body. For example, a massage therapist moving your arm during a massage, or a physical therapist bending and straightening your knee after knee replacement surgery. Passive ROM is usually performed when the patient is unable or not permitted to move the body part.

There is also a middle category of assisted active range of motion (AAROM), which occurs when the joint receives partial assistance from an outside force. This is often performed in physical therapy when the patient needs help moving due to weakness, pain, or changes in muscle tone.

ROM is usually assessed during a physical therapy evaluation or when a joint has been injured. It is important to be aware of your ROM to improve physical well-being and avoid injury.

Assessing shoulder AROM

Assessing shoulder Active Range of Motion (AROM) is a complex process due to the shoulder's unique anatomy and range of motion. Here is a step-by-step guide on how to assess shoulder AROM:

Inspection:

Begin by observing the patient as they remove their shirt. Look for any functional impairments of the shoulder joint, such as muscle abnormalities or associated functional deficits. Pay attention to both the affected and unaffected shoulders to establish a baseline for comparison.

Palpation:

Palpate the shoulder region to gather valuable information. Note the presence of swelling, texture, and temperature of the tissue. Also, observe for asymmetry, sensation differences, and pain reproduction. Key structures to palpate include the acromioclavicular joint, sternoclavicular joint, rotator cuff muscle insertions, and the long head of the biceps tendon.

Range of Motion Testing:

Assess the patient's AROM in different directions. Ask the patient to perform shoulder flexion, abduction, cross-body adduction, external and internal rotation, and elbow flexion. Compare the AROM of the affected shoulder to the unaffected side. Any painful or limited movement in a specific direction may indicate pathology in a specific shoulder structure.

Muscle Strength Assessment:

Evaluate muscle strength by resisting the patient's shoulder movements. For example, to assess the supraspinatus muscle, ask the patient to abduct their arms to 90 degrees and then push upwards against your resistance. To test the infraspinatus and teres minor muscles, apply resistance to the external rotation of the shoulder.

Provocative Testing:

Perform specific tests to evaluate for possible impingement syndrome and glenohumeral instability. Common tests include the Neer's Test, Hawkins-Kennedy Test, Apprehension and Relocation Test, and Speed's Test. These tests help reproduce certain movements or positions that may elicit pain and indicate specific shoulder pathologies.

Neurologic Assessment:

Conduct a comprehensive neurological examination if the patient presents with primary shoulder pain and neurological symptoms such as numbness and tingling. This assessment includes evaluating myotomes, dermatomes, pathological reflexes, and deep tendon reflexes.

It is important to note that the assessment of shoulder AROM should be tailored to the patient's specific condition and symptoms. A thorough history, including information about the patient's age, dominant hand, sport or work activity, and previous injuries, is crucial for an accurate diagnosis.

Assessing hip AROM

Patient Positioning:

Before starting the assessment, ensure your patient is in a comfortable position. Inform them that the assessment might provoke symptoms. It is generally advisable to start with the unaffected leg first.

Flexion:

Ask your patient to bring their knee as far as possible to their chest. The expected range of motion for flexion is 110-120 degrees.

Adduction:

For this movement, lift one leg and ask the patient to cross the other leg underneath it. The norm-value for adduction is 30 degrees.

Abduction:

Instruct the patient to move their leg as far as possible off the bench. The standard range for abduction is 30-50 degrees.

Internal and External Rotation:

Ask your patient to flex the hip to about 90 degrees. To assess internal rotation, ask them to bring the heel outwards as far as possible. For external rotation, they should bring the heel inwards. The standard values for internal rotation are 30-40 degrees, and for external rotation, 40-60 degrees.

Extension:

Instruct the patient to lift the leg off the table. The norm-value for extension is 10-15 degrees.

Additional Considerations:

When assessing hip AROM, it is important to look out for compensatory movements from other body parts, such as the lumbar spine or pelvis. Try to assess as many movements as possible in one position before moving on to the next. Additionally, using a goniometer can help measure the joint angles during hip AROM assessment, but it may not capture the full range of motion during dynamic activities like walking.

Tools for measuring AROM

Goniometry is the standard method for measuring active range of motion (AROM). A goniometer is a tool with two arms (one stationary and one moveable) and a fulcrum surrounded by a body containing a measuring scale. The scale is usually similar to a protractor and calibrated in degrees, and the arms range in length from 1 inch to 14 inches. Long-armed goniometers are used for long bone joints like the knee, while short-arm goniometers are used for smaller joints like the toe and finger. The correct technique for goniometer alignment involves placing the stationary arm along the longitudinal axis of the stabilized joint segment and the moveable arm parallel to the longitudinal axis of the moving joint segment. The goniometer's axis should be aligned with the joint's axis of motion.

There are various types of goniometers available, including gravity-dependent goniometers (inclinometers) that are often used to measure spinal motion, and electric goniometers typically reserved for research. The universal goniometer and parallelogram goniometer have both demonstrated high intra- and inter-tester reliability for measuring maximum active knee flexion and extension.

In addition to goniometry, markerless motion capture systems like EuMotus can be used to measure AROM. This system allows clinicians to assess their patients' muscular patterning and movement instabilities, as well as track rehabilitation progress.

Benefits of AROM exercises

Active Range of Motion (AROM) exercises are therapeutic exercises that can be performed for any joint in the body, including the neck, shoulders, elbows, wrists, fingers, hips, knees, ankles, toes, and spine. They are commonly used in physical therapy to aid in recovery from injuries, illnesses, or surgeries, as well as to improve athletic performance and prevent future injuries.

AROM exercises offer numerous benefits, including:

• Improved Joint Function: AROM exercises help enhance the function of the joints by increasing their range of motion. This can assist in performing daily activities and improve overall quality of life.
• Increased Muscle Strength and Endurance: By working the muscles around the joints, these exercises help build strength and endurance, contributing to better physical performance and a reduced risk of injuries.
• Improved Flexibility: Regularly performing AROM exercises can help improve flexibility in the joints and surrounding muscles and tendons. This, in turn, can enhance physical performance and reduce the risk of injury.
• Enhanced Blood Circulation: AROM exercises promote blood flow to the joints and surrounding areas, which can aid in reducing stiffness, improving recovery, and enhancing overall joint health.
• Reduced Joint Pain and Discomfort: By improving joint mobility and flexibility, AROM exercises can help reduce pain, discomfort, swelling, and inflammation associated with joint conditions or injuries.
• Improved Balance and Coordination: These exercises contribute to better balance and coordination, which can be beneficial for overall physical health and fall prevention.
• Preventative Benefits: AROM exercises can help prevent future injuries and ailments, especially for individuals with joint mobility issues due to accidents, surgeries, or other disorders.

Overall, AROM exercises are a safe and effective way to improve joint health, flexibility, strength, and overall physical fitness. They are customizable to each individual's needs and can be easily incorporated into a regular exercise routine.

Frequently asked questions