Range of Motion (ROM)
The amount of movement possible at joint.
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| Term | Definition |
|---|---|
Range of Motion (ROM) | The amount of movement possible at joint. |
Flexibility | Ability of muscle to lengthen, allowing one joint (or more than one joint in a series) to move through of a ROM. |
ROM & flexibility | ROM & flexibility are related but not equal. |
Elasticity | Ability to return to normal length. |
Viscosity | Resistance to change from outside force. |
Viscoelasticity | Resistance to change, inability to completely return to its former state after changing shape. |
Plasticity | Allows permanent change. |
Muscle spindles | Sensitive in muscle length. |
Golgi Tendon Organs (GTO) | A protective mechanism, less sensitive to stretch & more sensitive to contraction and tension. |
Fast stretch | If stretch quickly, muscle contracts (muscle spindle). |
Slow stretch | If stretch applied slowly, GTO inhibits muscular contraction. |
Benefits of stretch | Increase ROM and maintain available ROM. |
Benefits of stretch | Improve posture. |
Benefits of stretch | Reduce muscle soreness. |
Benefits of stretch | Prevent musculoskeletal injuries. |
Benefits of stretch | Provide relaxation and relieve neuromuscular tension. |
Benefits of stretch | Control spasticity. |
Factors influencing stretch | Amount of force applied. |
Factors influencing stretch | Amount of time the force is applied. |
Factors influencing stretch | Tissue’s temperature. |
Stretching techniques | Active. |
Stretching techniques | Passive. |
Stretching techniques | Proprioceptive Neuromuscular Facilitation (PNF). |
PNF techniques | Contract-relax (isotonic). |
PNF techniques | Hold-relax (isometric). |
Stretching techniques | Ballistic/Static. |
Stretching techniques | With assistive devices. |
Manual flexibility components | Body positions - Client - Assistant. |
Manual flexibility components | Demonstration. |
Manual flexibility components | Hand Placement - Stabilizing hand - Working hand. |
Manual flexibility components | Communication. |
Manual flexibility components | Eye contact. |
Manual flexibility components | Degree of Motion. |
Stretching cautions | Posture is important. |
Stretching cautions | Stretch slowly. |
Stretching cautions | Do not stretch to the point of the pain. |
Stretching cautions | Do not stretch through the onset of muscle spasm. |
Stretching cautions | Do not hold breath. |
Stretching cautions | Flexibility is joint specific. |
Stretching protocol | Assistant must constantly remind client to inform them if at any time during the stretch they can move further into the ROM. |
Stretching protocol | Assistant starts moving the joint through the ROM to the point of stretch or until the client tells you to hold/stop. |
Stretching protocol | At this point hold your position and start your count 1-1000, 2-1000, 3-1000, etc. |
Stretching protocol | Ask the client if you can go further. |
Stretching protocol | If they say yes, move further into the ROM until the client tells you to stop or hold. At this point, hold your position and start counting where you left off. |
Stretching protocol | If the client says no, hold the same position and continue count. |
Program cards | Recording on program cards (i.e., 3/20, 3 represent the repetitions, 20 presents the amount of time of in seconds). |
Finger Flexors Client Position | seated, elbow bent at 90°, forearm supported by armrest, and palm supinated. |
Finger Flexors Assistant Position | seated close to and facing client. |
Finger Flexors Hand Placement A | stabilizing hand: fingers across palm side, slightly above finger joints; thumb on back side of hand, slightly above finger joints. |
Finger Flexors Hand Placement B | working hand: fingers across palm side of all four fingers. |
Finger Flexors Direction of stretch | moving into finger extensions up to between 30 - 45°. |
Finger Extensors Client Position | seated, elbow bent at 90°, forearm supported by armrest, and palm pronated. |
Finger Extensors Assistant Position | seated close to and facing client. |
Finger Extensors Hand Placement A | stabilizing hand: fingers across back of hand, slightly above finger joints; thumb across palm side, slightly above finger joints. |
Finger Extensors Hand Placement B | working hand: fingers across backside of all four fingers. |
Finger Extensors Direction of stretch | moving into finger flexions up to 90°. |
Wrist Flexors Client Position | seated with stable base posture, elbow bent at 90°, forearm supported by armrest, and palm in supine position. |
Wrist Flexors Assistant Position | seated to the side being stretched. |
Wrist Flexors Hand Placement A | stabilizing hand: grasp forearm slight above wrist joint. |
Wrist Flexors Hand Placement B | working hand: across palm. |
Wrist Flexors Direction of stretch | moving into wrist extensions up to 70°. |
Wrist Extensors Client Position | seated with stable base posture, elbow bent at 90°, forearm supported by armrest, and palm in prone position. |
Wrist Extensors Assistant Position | seated close to and facing client. |
Wrist Extensors Hand Placement A | stabilizing hand: grasp forearm slight above wrist joint. |
Wrist Extensors Hand Placement B | working hand: on backside of hand. |
Wrist Extensors Direction of stretch | moving into wrist flexion up to 80°. |
Supinators Client Position | seated with stable base posture, elbow bent at 90°, forearm supported by armrest, and palm in neutral position halfway between supination and pronation. |
Supinators Assistant Position | seated close to and facing client. |
Supinators Hand Placement A | stabilizing hand: grasping elbow. |
Supinators Hand Placement B | working hand: interlocking thumbs and palms with fingers reaching to the backside of client’s hand and wrist in what is sometimes referred to as the “cool hand shake” position. |
Supinators Direction of stretch | moving into pronation up to 90°. |
Pronators Client Position | seated with stable base posture, elbow bent at 90°, forearm supported by armrest, and palm in neutral position halfway between supination and pronation. |
Pronators Assistant Position | seated close to and facing client. |
Pronators Hand Placement A | stabilizing hand: grasping elbow. |
Pronators Hand Placement B | working hand: interlocking thumbs and palms with fingers reaching to the backside of client’s hand and wrist in what is sometimes referred to as the “cool hand shake” position. |
Pronators Direction of stretch | moving into supination up to 90°. |
Elbow Flexors Client Position | seated with stable base posture and wheelchair armrest removed. |
Elbow Flexors Assistant Position | seated to the side being stretched. |
Elbow Flexors Hand Placement A | stabilizing hand: grasp backside of upper arm slightly above elbow joint. |
Elbow Flexors Hand Placement B | working hand: grasp forearm slightly above wrist joint. |
Elbow Flexors Direction of stretch | moving into elbow extension up to -5/+5°. |
Elbow Extensors Client Position | seated with stable base posture and wheelchair armrest removed. |
Elbow Extensors Assistant Position | seated to the side being stretched. |
Elbow Extensors Hand Placement A | stabilizing hand: grasp backside of upper arm slightly above elbow joint. |
Elbow Extensors Hand Placement B | working hand: grasp forearm slightly above wrist joint. |
Elbow Extensors Direction of stretch | moving into elbow flexion up to 150°. |
Shoulder Flexors Client Position | seated with stable base posture and involved arm hanging down at side. |
Shoulder Flexors Assistant Position | standing in back and slightly to the side being stretched. |
Shoulder Flexors Hand Placement A | stabilizing hand: fingers on top of shoulder with heel of hand pressing into scapula. |
Shoulder Flexors Hand Placement B | working hand: grasp biceps slightly above elbow joint. |
Shoulder Flexors Direction of stretch | moving into shoulder extension up to 45°. |
Shoulder Extensors Client Position | seated with stable base posture and involved arm hanging down at side. |
Shoulder Extensors Assistant Position | standing in back and slightly to the side being stretched. |
Shoulder Extensors Hand Placement A | stabilizing hand: cupping shoulder joint. |
Shoulder Extensors Hand Placement B | working hand: grasp backside of upper arm slightly above elbow joint. |
Shoulder Extensors Direction of stretch | moving into shoulder flexion up to 180°. |
Shoulder Abductors Client Position | seated with stable base posture and upper arm down at side, and hand in lap. |
Shoulder Abductors Assistant Position | standing in back and to the side being stretched. |
Shoulder Abductors Hand Placement A | stabilizing hand: cupping shoulder joint. |
Shoulder Abductors Hand Placement B | working hand: grasp backside of upper arm slightly above elbow joint. |
Shoulder Abductors Direction of stretch | moving into shoulder adduction up to 45°. |
Shoulder Adductors Client Position | seated with stable base posture and involved arm hanging down at side with palm towards body. |
Shoulder Adductors Assistant Position | standing in back and to the side being stretched. |
Shoulder Adductors Hand Placement A | stabilizing hand: cupping shoulder joint. |
Shoulder Adductors Hand Placement B | working hand: grasp inside of upper arm slightly above elbow joint. |
Shoulder Adductors Direction of stretch | moving into shoulder abduction up to 180°. |
Shoulder Horizontal Flexors Client Position | seated with stable base posture and involved arm parallel to floor with elbow bent at 90°. |
Shoulder Horizontal Flexors Assistant Position | standing behind and slightly to the side being stretched. |
Shoulder Horizontal Flexors Hand Placement A | stabilizing hand: fingers on top of shoulder with heel of hand pressing into scapula. |
Shoulder Horizontal Flexors Hand Placement B | working hand: grasp under upper arm with fingers on biceps slightly above elbow joint. |
Shoulder Horizontal Flexors Direction of stretch | moving into shoulder horizontal extension up to 45°. |
Shoulder Horizontal Extensors Client Position | seated with stable base posture and involved arm parallel to floor with elbow bent at 90°. |
Shoulder Horizontal Extensors Assistant Position | standing behind and slightly to the side being stretched. |
Shoulder Horizontal Extensors Hand Placement A | stabilizing hand: cupping shoulder joint. |
Shoulder Horizontal Extensors Hand Placement B | working hand: grasp under upper arm with heel of hand on triceps. |
Shoulder Horizontal Extensors Direction of stretch | moving into shoulder horizontal flexion up to 150°. |
Shoulder Internal Rotators Client Position | seated with stable base posture, elbow bent at 90° pressing against body, and palm in neutral position halfway between supination and pronation. |
Shoulder Internal Rotators Assistant Position | seated to the side being stretched. |
Shoulder Internal Rotators Hand Placement A | stabilizing hand: grasp upper arm slightly above elbow and press into body. |
Shoulder Internal Rotators Hand Placement B | working hand: grasp forearm slightly above wrist joint. |
Shoulder Internal Rotators Direction of stretch | moving into shoulder external rotation up to 45°. |
Shoulder External Rotators Client Position | seated with stable base posture, elbow bent at 90° pressing against body, and palm in neutral position halfway between supination and pronation. |
Shoulder External Rotators Assistant Position | seated to the side being stretched. |
Shoulder External Rotators Hand Placement A | stabilizing hand: grasp upper arm slightly above elbow and press into body. |
Shoulder External Rotators Hand Placement B | working hand: grasp forearm slightly above wrist joint. |
Shoulder External Rotators Direction of stretch | moving into shoulder internal rotation up to 55°. |
Cervical Flexors Client Position | seated with stable base posture. |
Cervical Flexors Assistant Position | standing directly in back of client. |
Cervical Flexors Hand Placement A | stabilizing hand: cup neck at the base of the skull. |
Cervical Flexors Hand Placement B | working hand: across forehead. |
Cervical Flexors Direction of stretch | moving into cervical extension up to 55°. |
Cervical Extensors Client Position | seated with stable base posture. |
Cervical Extensors Assistant Position | standing directly in back of client. |
Cervical Extensors Hand Placement A | stabilizing hand: cup neck at the base of the skull. |
Cervical Extensors Hand Placement B | working hand: on the back of the head. |
Cervical Extensors Direction of stretch | moving into cervical flexion up to 45°. |
Cervical Lateral Flexors Client Position | seated with stable base posture. |
Cervical Lateral Flexors Assistant Position | standing in back and slightly to the side being stretched. |
Cervical Lateral Flexors Hand Placement A | stabilizing hand: grasp top of shoulder. |
Cervical Lateral Flexors Hand Placement B | working hand: on side of head slightly above ear. |
Cervical Lateral Flexors Notes | Be aware of sensitive spots where you are applying pressure. |
Cervical Lateral Flexors Direction of stretch | moving into cervical lateral flexion up to 45°. |
Cervical Rotators Client Position | seated with stable base posture. |
Cervical Rotators Assistant Position | standing directly in back of client. |
Cervical Rotators Hand Placement A | stabilizing hand: on right side of head slight above ear. |
Cervical Rotators Hand Placement B | working hand: on left side of head slight above ear. |
Cervical Rotators Notes | Be aware of sensitive spots where you are applying pressure. |
Cervical Rotators Direction of stretch | moving into cervical rotation up to 90°. |
Spinal Flexors Client Position | seated with stable base posture with a rolled up towel placed vertically between back and backrest at scapular level. |
Spinal Flexors Assistant Position | standing directly in back of client. |
Spinal Flexors Hand Placement A | working hand: on upper right chest. |
Spinal Flexors Hand Placement B | working hand: on upper left chest. |
Spinal Flexors Notes | Both hands are considered working hands when doing this exercise. |
Spinal Flexors Direction of stretch | moving into spinal extension up to 30°. |
Spinal Extensors Client Position | seated with feet slightly wider than shoulder width apart and hands together hanging between legs. |
Spinal Extensors Assistant Position | standing directly in back of client. |
Spinal Extensors Hand Placement A | working hand: fingers cupping top of left shoulder and heel of hand on scapula. |
Spinal Extensors Hand Placement B | working hand: fingers cupping top of right shoulder and heel of hand on scapula. |
Spinal Extensors Notes | Both hands are considered working hands when doing this exercise. |
Spinal Extensors Direction of stretch | moving into spinal flexion up to 85°. |
Spinal Lateral Flexors Client Position | seated with stable base posture and arms hanging down at sides. |
Spinal Lateral Flexors Assistant Position | standing in back and slightly to the side being stretched. |
Spinal Lateral Flexors Hand Placement A | stabilizing hand: on top of thigh near hip joint holding pelvis down. |
Spinal Lateral Flexors Hand Placement B | working hand: grasp upper arm slightly below shoulder joint. |
Spinal Lateral Flexors Direction of stretch | moving into spinal lateral flexion up to 20°. |
Spinal Rotators Client Position | seated with stable base posture and arms crossed over chest, and hands tucked under arms. |
Spinal Rotators Assistant Position | standing directly in back of client. |
Spinal Rotators Hand Placement A | working hand: on scapula of side being stretched. |
Spinal Rotators Hand Placement B | working hand: on upper chest of opposite side. |
Spinal Rotators Notes | Both hands are considered working hands when doing this exercise. |
Spinal Rotators Direction of stretch | moving into spinal rotation up to 80°. |
Hip Flexors Client Position | supine lying with uninvolved hip and knee flexed at 90°. |
Hip Flexors Assistant Position | standing opposite of the side being stretched. |
Hip Flexors Hand Placement A | stabilizing hand: grasp back of thigh slightly above knee and push leg up towards chest until involved leg rises of table up to 90°. |
Hip Flexors Hand Placement B | working hand: grasp top of thigh slightly above knee only after involved leg has risen off table up to 30°. |
Hip Flexors Direction of stretch | pressing leg down into hip extension up to 30° while making sure uninvolved leg stays in fixed position. |
Hip Extensors Client Position | supine lying with involved hip and knee flexed 90°. |
Hip Extensors Assistant Position | standing to the side being stretched. |
Hip Extensors Hand Placement A | stabilizing hand: grasp top of uninvolved leg slightly above knee keeping leg flat on table. |
Hip Extensors Hand Placement B | working hand: grasp back of thigh slightly above knee. |
Hip Extensors Direction of stretch | moving into hip flexion up to 135° while making sure uninvolved leg is held flat on table. |
Hip Adductors Client Position | supine lying. |
Hip Adductors Assistant Position | standing to the side being stretched. |
Hip Adductors Hand Placement A | stabilizing hand: grasp under lower leg slightly above ankle to support leg. |
Hip Adductors Hand Placement B | working hand: grasp inside of thigh slightly above knee. |
Hip Adductors Direction of stretch | moving into hip abduction up to 45-50° (make sure to pull only with working hand to avoid stressing knee joint). |
Hip Abductors Client Position | supine lying. |
Hip Abductors Assistant Position | standing opposite of the side being stretched. |
Hip Abductors Hand Placement A | stabilizing hand: grasp under lower leg slightly above ankle to support leg. |
Hip Abductors Hand Placement B | working hand: grasp outside of thigh slightly above knee. |
Hip Abductors Direction of stretch | moving into hip abduction up to 20-30° (make sure to pull only with working hand to avoid stressing knee joint). |
Knee Flexors Client Position | supine lying with involved leg on assistant’s shoulder. |
Knee Flexors Assistant Position | kneeling between client’s legs. |
Knee Flexors Hand Placement A | stabilizing hand: grasp thighs of both legs slightly above knees keeping uninvolved leg flat on table and involved leg straight on shoulder. |
Knee Flexors Hand Placement B | working shoulder: under lower leg slightly above ankle of involved side. |
Knee Flexors Direction of stretch | moving into hip flexion up to 90°. |
Knee Extensors Client Position | supine lying with involved hip and knee flexed. |
Knee Extensors Assistant Position | kneeling between client’s legs. |
Knee Extensors Hand Placement A | stabilizing hand: on backside of knee joint of involved leg. |
Knee Extensors Hand Placement B | working shoulder: grasp top of lower leg slightly above ankle of involved side. |
Knee Extensors Direction of stretch | pressing leg into knee flexion up to 135°. |
Plantar Flexors Client Position | supine lying with involved leg on top of assistant’s thigh. |
Plantar Flexors Assistant Position | standing to side being stretched with knee closest to head of client underneath knee of involved leg. |
Plantar Flexors Hand Placement A | stabilizing hand: grasp top of thigh slightly above knee keeping leg straight. |
Plantar Flexors Hand Placement B | working hand: cup heel with hand and place forearm along the bottom of the foot. |
Plantar Flexors Notes | Knee under leg provides better leverages while preventing hyperextension of the knee. |
Plantar Flexors Direction of stretch | moving into dorsiflexion up to 20°. |
Dorsiflexors Client Position | supine lying. |
Dorsiflexors Assistant Position | standing at the feet of the client slightly to the side being stretched. |
Dorsiflexors Hand Placement A | stabilizing hand: cupping heel. |
Dorsiflexors Hand Placement B | working hand: grasp top of foot slightly above toes. |
Dorsiflexors Direction of stretch | moving into plantar flexion up to 50°. |