COLLEGE OF PHYSICAL THERAPY
Subject: Therapeutic Exercises 101
DMM-IHS
RANGE OF MOTION (ROM) Exercise
Definition of terms
ROM: Basic technique used for the examination of movement.
Range of Motion Exercise (ROMEx): Initiating movement into
a program of therapeutic intervention
Functional excursion: The distance a muscle is
capable of shortening after it has been elongated to its
maximum.
o Active Insufficiency Vs. Passive Insufficiency
Immobility
o Physical restriction or limitation of body members and
of the body in turning, sitting and ambulation.
o Can be a result of certain disease or treatment
procedures
o This results in different adverse effects on the different
system of the body, including Tightness and
contractures.
o Leads to Limitation of Motion.
Purpose of ROM
o To Maintain the available Range of Motion and delay
the onset of Limitation of Motion
Passive Range of Motion ex. (PROM.)
o Passive ROM (PROM) is movement of a segment
within the unrestricted ROM that is produced entirely
by an external force: there is little to or no voluntary
muscle contraction.
o The external force may be from gravity, a machine,
another individual, or another part of the individual’s
own body.
o PROM and passive stretching are not synonymous.
Indications of PROM
o In the region where there is acute, inflamed tissue,
passive motion is beneficial : inflammation after
injury or surgery usually lasts 2 to 6 days.
o When a patient is not able to or not supposed to
actively move a segment or segments of the body,
as when comatose, paralyzed, or on complete bed rest,
movement is provided by an external source.
Goals for PROM
The primary goal for PROM
• Decrease the complications that would occur with
immobilization, such as cartilage degeneration,
adhesion and contracture formation, and sluggish
circulation.
Specific Goals of PROM
o Maintain joint and connective tissue mobility
o Minimize the effects of the formation of contractures
o Maintain mechanical elasticity of muscle
o Assist circulation and vascular dynamics
o Enhance synovial movement for cartilage nutrition and
diffusion of materials in the joint
o Decrease or inhibit pain
o Assist with the healing process after injury or surgery
o Help maintain the patient’s awareness of movement
CPT
Notes on: ROM Exercise
Other Uses for PROM
o When a therapist is examining inert structures, PROM
is used to determine limitations of motion, to
determine joint stability, and to determine muscle and
other soft tissue elasticity.
o When a therapist is teaching an active exercise
program, PROM is used to demonstrate the desired
motion.
o When a therapist is preparing a patient for stretching.
 PROM is often used preceding the passive stretching
techniques.
Active Assistive Range of Motion (AAROM)
o Assistance is provided manually or mechanically by an
outside force because the prime mover muscles need
assistance to complete the motion.
Active ROM (AROM)
o Active ROM (AROM) is movement of a segment within
the unrestricted ROM that is produced active
contraction of the muscles crossing that joint.
Indications for AROM
o Whenever a patient is able to contract the muscles
actively and move a segment with or without
assistance, AROM is used.
o Move a joint through the desired range (usually
against gravity), A-AROM is used to provide enough
assistance to the muscles in a carefully controlled
manner so the muscle can function at its maximum
level and be progressively strengthened.
o AROM can be used for aerobic conditioning
programs.
o When a segment of the body is immobilized for a
period of time, AROM is used on the regions above
and below the immobilized segment to maintain the
areas in as normal a condition as possible and to
prepare for new activities, such as walking with
crutches.
Goals for AROM
o If there is no inflammation or contraindication to
active motion, the same goals of PROM can be met
with AROM.
Specific goals are to:
o Maintain physiological elasticity and contractility of
the participating muscles
o Provide sensory feedback from the contracting muscles
o Provide a stimulus for bone and joint tissue integrity
o Increase circulation and prevent thrombus formation
o Develop coordination and motor skills for functional
activities
Summary of Precautions and Contraindications to Range of
Motion Exercises
o ROM should not be done when motion is disruptive to
the healing process.:
o Carefully controlled motion within the limits of pain-
free motion during early phases of healing has been
shown to benefit healing and early recovery.
o Signs of too much or the wrong motion include
increased pain and inflammation.
o ROM should not be done when patient response or the
condition is life-threatening
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Limitations of ROM
PROM Limitations:
o True passive, relaxed ROM may be difficult to obtain
when muscle is innervated and the patient is
conscious. Passive motion does not:
1. Prevent muscle atrophy
2. Increase strength or endurance
3. Assist circulation to the extent that active, voluntary
muscle contraction does
AROM Limitations:
o For strong muscles, active ROM does not maintain or
increase strength. It also does not develop skill or
coordination except in the movement patterns used
CONTINUOUS PASSIVE MOTION
o Refers to passive motion performed by a mechanical
device that moves a joint slowly and continuously
through a controlled ROM.
o The mechanical devices that exist for nearly every joint
in the body were developed as a result of the research
by Robert Salter, who demonstrated that continual
passive motion has beneficial healing effects on
diseased or injured joint structures and soft tissues in
animal and clinical studies
BENEFITS of CPM
PATIENT PREPARATION
1. Communicate with the patient. Describe the plan and
method of intervention to meet the goals.
2. Free the region from restrictive clothing, linen, splints, and
dressings. Drape the patient as necessary.
3. Position the patient in a comfortable position with proper
body alignment and stabilization but that also allows you to
move the segment through the available ROM.
4. Position yourself so proper body mechanics can be used.
APPLICATION TECHNIQUES
1. To control movement, grasp the extremity around the joints.
If the joints are painful, modify the grip, still providing support
necessary for control.
2. Support areas of poor structural integrity, such as a
hypermobile joint, recent fracture site, or paralyzed limb
segment.
3. Move the segment through its complete pain-free range to the
point of tissue resistance. Do not force beyond the available
range. If you force motion, it becomes a stretching technique.
4. Perform the motions smoothly and rhythmically, with 5 to 10
repetitions. The number of repetitions depends on the objectives
of the program and the patient’s condition and response to the
treatment.

o Prevents development of adhesions and contractures

and thus joint stiffness END
o Provides a stimulating effect on the healing of tendons
and ligaments Suggestion:
o Enhances healing of incisions over the moving joint
o Increases synovial fluid lubrication of the joint and Read the Therapeutic Exercise 6th edition by Kisner and Colby
for a more detailed discussions
thus increases the rate of intra-articular cartilage
healing and regeneration
o Prevents the degrading effects of immobilization
o Provides a quicker return of ROM
o Decreases postoperative pain

PRINCIPLES AND PROCEDURES FOR APPLYING ROM

TECHNIQUES

Examination, Evaluation and Treatment Planning

1. Examine and evaluate the patient’s impairments and level

of function, determine any precautions and prognosis, and plan
the intervention.
2. Determine the ability of the patient to participate in the
ROM activity and whether PROM, A-AROM, or AROM can meet
the immediate goals.
3. Determine the amount of motion that can be safely
applied for the condition of the tissues and health of the
individual.
4. Decide what patterns can best meet the goals. ROM
techniques may be performed in the:
a. Anatomic planes of motion: frontal, sagittal, transverse
b. Muscle range of elongation: antagonistic to the line of pull of
the muscle
c. Combined patterns: diagonal motions or movements that
incorporate several planes of motion
d. Functional patterns: motions used in activities of daily living
(ADL)
5. Monitor the patient’s general condition and responses
during and after the examination and intervention; note any
change in vital signs, any change in the warmth and color of the
segment, and any change in the ROM, pain, or quality of
movement.
6. Document and communicate findings and intervention.
7. Re-evaluate and modify the intervention as necessary.

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CPT