Physical, occupational and speech therapists all use range of motion therapy as a cornerstone of their treatment approach. Because adequate range of motion is integral to normal functioning, therapists strive to restore or at least increase impaired range of motion to facilitate increased functional independence. However, range of motion therapy can be completed by the patient or non-medical friends or family members who have been trained by therapists.
Significance
Range of motion, or ROM, is inextricably intertwined with functional independence. Without the ability to adequately move your arms, legs, trunk or face you will experience difficulties with self-care, ambulation, speaking and a myriad of other activities of daily living. For example, a patient with decreased shoulder range of motion will experience difficulty with reaching the top of her head when shampooing her hair. Decreased ROM in the ankle can offset your balance and contribute to an increased risk of falls.
Primary Approach
When providing range of motion therapy, therapists will endeavor to enable you to move your body by yourself. Many times this is not possible, so your therapist may assist you with the range of motion or may complete the ROM for you. If you have a contracture, or a joint that has decreased ROM that cannot passively be moved throughout the full range, your therapist will perform a gentle end-range stretch. End-range stretch consists of pulling your body to the end of the existing ROM and then sequentially stretching beyond that point.
Adjunct Treatments
Range of motion therapy is rarely effective when completed as the sole therapy intervention. Therapists use electrical stimulation, ultrasound, moist heat and infrared treatment to prepare the muscle fibers to allow for increased stretch. If a contracture is present, your therapist will use a brace or splint to provide a static stretch over several hours to increase and preserve your ROM.
Qualified Providers
Physical, occupational and speech therapists are specially trained in providing range of motion therapy. Nurses, doctors and physician assistants use range of motion as part of their evaluation tools and understand the basics of range of motion, but are rarely trained to provide detailed direction for ROM therapy. Certified nursing assistants, or CNAs, are trained in basic range of motion therapy, but can only perform ROM at the direction of a doctor and therapist. Specialized CNAs part of a Restorative Nursing team are specially trained and directed by therapists to provide long-term customized ROM therapy nursing homes.
Risks
Like all therapy approaches, range of motion has risks. The most likely negative side effect of ROM therapy is pain during or after treatment, which you can address by pre-medication, pre-treatment moist heat or post-treatment ice or heat. Furthermore, during ROM treatment for contractures, you will likely experience micro-tears of your muscles which can, over time, increase your muscle fiber length and effectively increase overall ROM. However, inexperienced ROM providers could severely tear your muscle fibers if too much force is applied, which is why you should seek training from a therapist prior to administering ROM treatment.
