NOTE: Range of motion in this series concerns functional limitations in joint motion that is not disease-related. Such limitations are injury, scar tissue build-up, muscle length, stiffness and weakness, fascial adhesion, simple dysfunctional nerve conduction, inflammation, bursitis, osteophytes (bone spur), tendon wear and tear, and sprained or disrupted joints, among others.
Joint & Extremity Range of Motion
All ranges of motion are measured at the joint where two bones are considered to move in relation to one another. Range of motion limitations to any of the major joints of the body form the basis for many movement problems. When we can’t move the way we’re supposed to, we have to find other ways to cope with restrictions and pain they cause. Or worse, we avoid living our lives. In some cases, our coping mechanisms may be fairly harmless. In others, we may develop habits that result in further dysfunction down the line.
The Merck Manual Professional Edition contains a table of normal range of joint motion values for many joints. Orthopedic physicians and manual therapists measure joint movement arcs through full range of motion using a goniometer (a two-arm protractor) for precise measurement, or by eye for approximations.
At Manchester-Bedford Myosekeletal, we concern ourselves with gross, soft tissue movement limitations in the vertebral joints of the spine and gross spinal sections, the Occiput/Atlas (O/A) joint, joints of the shoulder, elbow, wrist, hip, knee, and ankle.
Types of Range of Motion
All movement can take place in four ways. Here is a brief description of each and what they tell us.
Active range of motion is simply the act of a person moving a joint by themselves in gravity. Any movement you make by yourself creates active movement. Active range of motion makes use of the body’s system of levers and pulleys to make functional movement happen. To test active movement is to test the muscles and tendons that are used to move two or more bones in relation to each other.
Passive range of motion is the act of someone or something else moving your joints without your conscious or unconscious assistance. Passive range of motion takes the use of muscles out of the movement equation. Testing passive movement checks ligaments and joint capsular problems and allows assessment of bone-against-bone restrictions to movement.
Active assist range of motion is the act of combining your own active movement with that of some other force, whether it be another person, a piece of equipment, or tool. Active assist range of motion is not usually used for testing, but rather for exercise or other manual therapy. For instance, active assist may be used to stretch a limb, help break up adhesive scar tissue, or release muscle spasm.
Resistive range of motion is the act of either you actively moving against an immovable or resistive object. Testing resistive movement looks at muscle dysfunction caused by nerve communication problems between the motor control center of the brain and a muscle or muscle pattern being tested.
A Word About Neck and Back Pain
We probably see more neck and back problems than any other specific complaints. Oftentimes, these are due to motor vehicle accident injuries, workplace injuries, and trips and falls. However, many patients come in due to pain from overuse, repetitive use, posture, sleeping habits, or some other type of cause. Most of these create range of motion problems and sometimes debilitating pain and joint stiffness.
According to the American Academy and American Association of Orthopaedic Surgeons, half of all Americans experience back pain severe enough to make them aware of it. Furthermore:
…”One in five will experience back pain severe enough to limit the amount or type of work he or she can do, with one in 20 unable to work at all. One in seven persons will spend at least one half day in bed due to back pain.”
To read the full article, please click here.
NOTE: Neck and back pain can have both serious causes and repercussions. At MBM, we take all types of body pain seriously. If we suspect your pain may be complicated for reasons beyond our scope of practice, we may refer you for diagnosis.
Causes of Range of Motion Limitations
Assuming no serious medical condition or disease, the largest cause of range of motion problems is inflammation in a joint. Inflammation may occur from injury or disease, and occurs during a joint’s acute phase of injury. When an injury occurs, the body sends many types of cells to the damaged area to begin repairs and those cells are carried by inflammatory response through the blood and lymph. Soft tissues become swollen and tighten the area surrounding the vertebral joint itself, resulting in visible, palpable, temperature-sensitive, joint swelling.
Inflammation is a newsworthy buzz word at the moment and sometimes gets a bad rap. Listening to all those TV commercials, one might think the pharmaceutical companies are telling us that inflammation is a bad thing to have. They want us to buy and use OTC and prescribed products that reduce all kinds of inflammation. In truth, inflammation should subside naturally on its own in healthy individuals. Unfortunately, not everyone is a healthy individual and inflammation does not always subside on its own.
Needless to say, inflammation has its useful purposes when it comes to injury repair. But it can become problematic if it continues much beyond its needed repair cycle. There are many types and causes of inflammation, and it is not our intent to delve further into the subject here. Suffice to say, inflammation can and does reduce joint movement.
- Muscles & Ligaments
Muscle spasm, length, stiffness, and weakness come next often in range of motion problems. While inflammation may complicate muscle problems, we’ll separate them here for clarity. Muscles in close proximity to bones tend to be called upon to stabilize an otherwise unstable spine. They include the tiny muscles connecting between the bones of the spine (intrisics) and medium-lever muscles (extrinsics) which span many spinal segments or connect to other bones of the skeleton.
When the brain believes the spine or central nervous system is in danger of injury or damage, it calls on local muscles to splint or brace the bones. Depending on the severity, muscles could be held in spasm or contraction for exceptionally long periods of time. The spasm may become habitual, even long after an acute injury phase is past. For instance, following a whiplash injury or such other trauma.
All of our joints have muscle and ligament structures in place to help stabilize them. These structures maintain a stable tension to hold the joint together so that bony parts of the joint can move as freely as they’re supposed to. Two major concerns arise when there is dysfunction in a joint: (1) laxity in the support structures, and; (2) hypertonicity in the support structures.
When joint supporting muscle and ligament tissue is lax, the joint becomes lax. You see this in people who are considered “double-jointed”. While range of motion is significantly increased in these joints, they become vulnerable to damage from strain, arthritis, scarring, and tears much more easily than a tight joint.
When the supporting structures are hypertonic, range of motion becomes limited and we start feel pain in the joint. One of the main reasons joint musculature becomes hypertonic is self-protection. Depending on how the brain perceives danger or damage to the skeleton or central nervous system, several muscles may be called into spasm to brace or splint them. Alternatively, only a group of muscles such as the neck extensor group might be called into action. Muscle guarding may result in limited range of motion.
- Nerve Conduction
Further complicating the patient’s condition, overactive muscles may then neurologically inhibit other muscles in the area. As an example, hyperactive extensors in the back of the neck tend to inhibit the flexors in the front. This is the case for whiplash victims. So the actual injury hyperactivates the extensors and the inhibited flexors result in continuing the hypertonicity of the extensors long after the accident.
Muscles can be relaxed, but the manual therapist must first determine whether they actually should be. In severe cases, such as with a whiplash victim, bones of the cervical spine must be evaluated by a physician before splinting muscles are lengthened and relaxed.
Once the okay is given, the manual therapist may use any number of therapies to bring about change in muscle tension. Massage, a variety of active and passive release techniques, high-velocity or low-impact spinal adjustments, to name a few, may be employed to get muscles to relax and lengthen. Ideally, releases should take place in order from superficial to deep. To make change that lasts, long-lever muscles are first released; the deep intrinsics are released last. And techniques to neurologically reconnect the brain with inhibited muscles and quiet overactive ones must be employed to ensure proper firing order and to help make the release last.
Specific range of motion pages: