Maintaining Range to Maintain Mobility
If you have not received skilled instruction on how to perform range of motion, it may be beneficial to learn how to gently perform stretches firmly to safely prevent and improve any limitations, but also while not causing injury.
Given this month’s theme of “mobility,” I considered many ways to approach this article. As a physical therapist, I concluded that range of motion has the greatest impact on a person’s ability to move, as well as to be comfortable. I recently saw a gentleman who is about 40 years old, and he has cerebral palsy with significant spasticity and multiple contractures. Contractures are abnormal shortening of muscle tissue, which has become highly resistant to stretching. Even though he is fully grown, his range has declined over the past two years to the point where he can no longer reach the joystick on his power wheelchair. This demonstrates the need for range of motion exercises to be a lifelong practice.
Range of motion refers to the full movement potential of a joint. There are several factors that can limit the full range of any joint:
• Bony growth: there are certain neurological injuries that can cause excess bone to grow in joints, and even cause calcification in muscle. This cannot be corrected with home exercise. This bone shows up on x-rays, and there is a hard end of the range because of the bone stopping on bone without the typical join cushioning.
• Muscle length: this is the most common cause for limited range. Muscles can get tighter, and shorter, and a joint will be cannot move as far as it was built to reach because the muscle and tendon is not long enough.
• Pain: if it hurts to move through a range, it is natural to not move into pain. We see this whenever a person is limping to avoid feeling more pain in whatever joint is injured.
• Inflammation: this is generally associated with pain. If there is fluid in any joint space, the ability for the bones and joint structures to move around the inflammation is restricted.
• Spasticity: if there is a neurological injury that causes increased tone in muscles, this can be strong enough to limit joint movement. Range of motion exercises will be altered and have a different goal depending on the