Prom Vs. Arom: What Does The Imbalance Signify?

Physical therapists use PROM and AROM to assess a patient's joint movement and diagnose injuries. AROM (Active Range of Motion) measures how far a patient can voluntarily move a joint without assistance, while PROM (Passive Range of Motion) measures how far a joint can move with assistance. If PROM is less than AROM, it indicates that there is no anatomical limitation to the range of motion, and the limitation is likely neurological or related to strength or stiffness at a specific angle. This topic is important for understanding movement and the human body, as well as for designing effective rehabilitation and fitness programs.

The patient has muscle dysfunction or strength deficiency

If a patient's passive range of motion (PROM) is greater than their active range of motion (AROM), it indicates that the patient has a muscle dysfunction or strength deficiency. This could be due to neurological issues or a lack of strength and stiffness in the muscles at a particular angle.

Passive range of motion refers to the amount of movement possible at a joint when it is moved by an external force or load, such as a therapist or equipment. On the other hand, active range of motion is the amount of movement a patient can voluntarily produce through muscle contraction and relaxation.

When PROM is greater than AROM, it means that the patient's ability to actively move their joints is limited. This could be due to several factors:

• Lack of Control: The patient may not have ideal control over the joint and needs assistance to move it through its full range.
• Tissue Stiffness: The patient's tissues, such as muscles, tendons, and ligaments, may be too stiff, requiring an external force to push through and achieve a greater range of motion.
• Involuntary Guarding: The patient may experience involuntary muscle contractions or spasms that relax when an external force is applied, allowing for a greater range of motion.

In the case of muscle dysfunction or strength deficiency, there are several interventions that can be implemented to improve the patient's condition:

• Physical Therapy: A physical therapist can guide the patient through specific exercises and stretches to improve joint mobility and muscle strength.
• Rehabilitation: If the patient is recovering from an injury, surgery, or a condition like a stroke, rehabilitation can help improve their AROM by strengthening the tendons and muscles and improving joint mobility.
• Yoga and Stretching: Engaging in activities like yoga that combine stretching and strengthening can help increase the patient's AROM and overall flexibility.
• Medical Diagnosis: If the patient notices a reduction in their AROM, seeking medical advice is crucial to determine the underlying cause and develop an appropriate treatment plan.

The patient has poor joint control

If PROM is greater than AROM, it could mean that the patient has poor joint control. This could be due to a lack of knowledge about how to move the joint properly, or it could be a result of tissue stiffness or joint stiffness that requires an external load to push through. It could also be due to involuntary guarding or increased muscle tone that relaxes when an external load is applied.

Poor joint control can have several negative consequences for the patient. Firstly, it can limit their range of motion, making it difficult to perform everyday activities. For example, they may have difficulty reaching for objects or performing basic movements such as sitting or standing. Poor joint control can also lead to pain and discomfort. This is because when a joint is not moving properly, it can place stress on other parts of the body, causing strain and pain.

Additionally, poor joint control can increase the risk of injury. If a joint is not moving correctly, it can become unstable and more prone to sprains or dislocations. This is especially common in joints that bear weight, such as the knee or ankle. Poor joint control can also lead to long-term joint damage. If a joint is not moving through its full range of motion, it can become stiff and less flexible over time. This can result in conditions such as arthritis or bursitis, which can cause chronic pain and further limit mobility.

To improve joint control, patients can work with a physical therapist or movement specialist. They may be given exercises to strengthen the muscles around the joint and improve their range of motion. Techniques such as stretching, foam rolling, or massage can help to reduce muscle tension and improve joint mobility. In some cases, external assistance devices such as braces or supports may be recommended to help guide the joint through its proper range of motion. Improving joint control can help patients regain function, reduce pain, and lower their risk of injury.

The patient has tissue stiffness or joint stiffness

If a patient's PROM is greater than their AROM, it indicates that they have some form of tissue stiffness or joint stiffness. This means that the patient is experiencing a limitation in their range of motion that is not due to anatomical factors.

AROM, or Active Range of Motion, is a measure of how far a patient can actively move a joint without external assistance. It is assessed visually or with a goniometer and is used to determine the extent of injuries, guide rehabilitation, and improve fitness and health. AROM is controlled by muscle contraction and flexion, as well as joint flexibility and other factors.

On the other hand, PROM, or Passive Range of Motion, is a measure of how far a joint can move with assistance, such as when a therapist or equipment moves the joint without any effort from the patient. PROM is not limited by the strength of the patient's muscles.

When PROM is greater than AROM, it suggests that the patient's limitation in range of motion is not due to anatomical factors but rather due to muscle dysfunction, tissue stiffness, or joint stiffness. This could be a result of neurological issues or a strength-to-stiffness problem at a specific angle.

In the case of tissue stiffness or joint stiffness, the patient may require external load or assistance to push through the stiffness and achieve a greater range of motion. This could involve physical therapy, exercises, or treatments to improve joint mobility and flexibility.

It is important to note that a reduction in AROM can impact a patient's health, fitness, and mobility levels. Therefore, seeking medical diagnosis and treatment for tissue stiffness or joint stiffness is crucial to improving range of motion and overall well-being.

The patient has involuntary guarding or increased muscle tone

If the passive range of motion (PROM) is greater than the active range of motion (AROM), it indicates that the patient has involuntary guarding or increased muscle tone. This means that the patient's body is protecting the injured area by tightening the muscles around it, restricting mobility in the joints. This protective mechanism is triggered by the same nerves that signal pain. While this response can be beneficial in the short term, if it continues for too long, it can lead to decreased function and emotional and mental stress.

In the case of involuntary guarding or increased muscle tone, treatment should focus on reducing or minimising the source of pain. Chiropractic adjustments and specific active exercise therapies have been found to be effective in breaking the pain cycle and improving mobility. These treatments can help interrupt the continuous loop of negative issues that occur when an injury activates the pain cycle.

To assess involuntary guarding or increased muscle tone, healthcare professionals can perform a range of motion (ROM) test. This involves measuring the patient's ability to actively and passively move a joint in different directions. The difference between AROM and PROM can provide valuable information about the patient's condition and help determine the best treatment approach.

It is important to note that the terms "muscle tone" and "resistance to passive stretch" have some ambiguities and can be subject to interpretation. Additionally, it is challenging to assess muscle tone when an individual is asked to completely relax, as muscle tone may reflect a state of preparedness for movement.

The patient has a neurological issue or a strength-to-stiffness problem

If the PROM (passive range of motion) is greater than the AROM (active range of motion), it indicates that the patient's limitation is either neurological or related to a strength-to-stiffness issue at a specific angle. This means that there is no anatomical limitation to the range of motion, and the issue lies in the patient's ability to actively move the joint.

Neurological issues can refer to a variety of conditions that affect the nervous system, such as cervical spondylosis, Guillain-Barré syndrome, Lambert-Eaton myasthenic syndrome, or multiple sclerosis (MS). These conditions can cause muscle weakness and affect how nerves transmit messages to the muscles. For example, in cervical spondylosis, age-related changes to the spinal disks in the neck put extra pressure on nerves, resulting in reduced nerve transmission and muscle weakness.

Strength-to-stiffness issues, on the other hand, may be due to tissue stiffness or joint stiffness that requires an external load to push through. This could be a result of involuntary guarding or increased muscle tone that relaxes when an external force is applied.

In either case, further assessment and diagnosis by a medical professional are necessary to determine the specific cause of the patient's limitation.

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