Range of motion exercises

Definitions & Key takeaways

Range of motion (ROM) exercises are physical therapy exercises designed to increase movement and joint flexibility. As a healthcare provider, you might be required to assist patients with a range of motion exercises, to help improve a patient's joint stiffness, improve muscle strength and endurance, and reduce the risk of further injury.

There are three main groups of ROM exercises, which are active, active-assistive, and passive. In active ROM exercises, patients move their joints themselves. On the contrary, in active-assistive ROM exercises, patients may require your help to complete the full motion. Finally, in passive ROM exercises, the health care provider or a device moves the joint, without the active participation of the patient.

Chapters:

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Intro0:00–1:18

Range of motion, or ROM for short, is defined as the normal movement potential of a joint to the extent that is not causing any pain!
The range of motion is measured in degrees and it’s determined by the type of joint, its articular surfaces, regional muscles, ligaments, and tendons.
Now, during everyday activities, people typically use all of their joints through their complete range of motion. But this is not the case with some individuals.
Some of them have restricted movement due to pain, while others might have conditions that cause muscle weakness or paralysis that prevent them from completing the full motion.
Either way, if not treated, decreased range of motion can lead to muscle atrophy, which is the wasting away of muscles due to disuse and contractures, a condition where muscles and tendons are permanently shortened.
To prevent this, range-of-motion exercises, or ROM exercises, are prescribed for these individuals.Now, range of motion exercises are typically done to preserve a person’s joint and muscle function, but they can also be used to either increase or prevent further loss in the range of motion.

Range-of-motion exercises 1:18–2:24

They are usually done at least two times a day, and based on the client’s involvement, they can be subdivided into three groups.
The first group includes active range-of-motion exercises. These exercises are done by your client independently but with your verbal guidance and encouragement.
The second group covers active-assistive range-of-motion exercises. Here, clients require your help to complete the full motion.
These exercises are commonly prescribed to individuals that have some form of muscle weakness. The last group includes passive range-of-motion exercises, which are done by a nursing assistant without the active participation of the client.
These exercises are commonly done for comatose and paralyzed individuals. Now, let’s switch our focus to joint movements.

Joint movements2:24–4:47

But, before we start, think of a joint as the connection between two adjacent segments of the body. Now flexion, or bending, represents a decrease in the angle between the bones that make up the joint; while extension, or straightening, represents an increase in the angle between the bones that make up the joint.
There’s also hyperextension, which can be described as extending the joining beyond the normal straight position. Next, we have abduction, which is a movement of a body part away from the body’s midline; and adduction, which is a movement of a body part toward the body’s midline.
Next up are internal rotation, or turning the body part inwards toward the center of the body. For example the femur in the leg can internally rotate when you turn your foot towards the center of your body.
External rotation is turning a body part outwards away from the center of the body. So, if you turn your feet to point away from the midline of the body, the femur will externally rotate.
Now, let’s move on to more specific joint movements. Supination describes the rotation of the forearm so that the palm is facing upward, while pronation describes the rotation of the forearm so that the palm is facing downward.
These two movements are specific for elbow joints! Next, we have dorsiflexion, which refers to the movement of raising the foot and toes upwards toward your chin.
On the other hand, plantar flexion refers to the action in which your foot and toes point away from your chin. These two are specific for your ankles!
Opposition is a specific movement in which the thumb touches each finger of the same hand. The last joint movement is circumduction, which refers to a circular movement of a limb.
In other words, the proximal part of the limb is fixed, while the distal part is moving by describing a circle. Now, let’s demonstrate these movements, starting with the neck.

Neck4:47–5:36

Flexion of the neck refers to the motion of bringing the chin down to your chest; while extension refers to the action of returning the head to its normal position.
Hyperextension describes the bending of the head toward the back. The next one is lateral flexion, or bending of the head laterally and bringing the ear to your shoulder.
Finally, we have lateral rotation, which is the movement of the chin toward the shoulder. Remember that passive range of motion exercises of the neck is usually done by a physical therapist, but a nursing assistant might be able to assist depending on facility policy.Moving on to the upper limbs.

Upper extremities5:36–7:48

In the shoulders, flexion refers to the action of raising the arm above the head; while extension refers to the motion of bringing the arm back to its starting position.
Hyperextension is the opposite of flexion, meaning the arm is moved backward. Next, we have abduction, or moving the arm away from the body like lifting it to the side and then above the head; and adduction, or bringing the arms down and across the body.
Now, to perform rotation, lift your arm to the same level as your shoulder and bend the elbow. To do internal rotation, turn the forearm so the fingers are pointing down.
On the other hand, to do external rotation, turn the forearm so the fingers are pointing up. Next up is the elbow joint.
Here, we have flexion, or the movement of the forearm toward the shoulder; and extension, or the movement of the forearm away from the shoulder.
Switching gears and moving on to the wrist. Flexion of the wrist is the motion of bending the hand down; while the extension is the action of returning the hand to its normal position.
Hyperextension is done by bending the hand up. Another two movements of the wrist joint include radial deviation, or bending of the hand toward the thumb; and ulnar deviation, or bending of the hand toward the fifth finger.
Finally, the fingers. Here we have flexion, the action of bending the fingers and making a fist; extension, the action of straightening the fingers and opening the hand; and hyperextension, or the bending of the fingers backward.
In addition, abduction spreads your fingers apart; while adduction brings them together.Now, let’s demonstrate the movements in joints of the lower limb, starting with the hip.

Lower extremities7:48–9:16

Flexion of the hip is the action of raising the leg forward, like you’re kicking the ball. On the other hand, extension refers to the action of returning the leg to its starting position.
In hyperextension, the leg is moved backward, toward your back. Next, we have abduction, or moving the leg away from the body; and adduction, or bringing the leg back and across the body’s midline.
To do the internal rotation, rotate the foot and leg inward. On the other hand, to do the external rotation, rotate the foot and leg outward.
Next up is the knee. Here flexion refers to the motion of bending the lower leg toward the back; while extension refers to the action of moving the lower leg away from the back to its starting position.
Now, let’s cover the foot movements called inversion and eversion. Inversion is done by moving your sole inward; while eversion is done by rotating your sole outward.
Finally, just like in fingers, there are four types of movements in toes, including flexion, extension, abduction, and adduction.
Now, before you start, check with the nurse and the plan of care for any specific guidelines or instructions. Next, make sure you’re using good body mechanics when you assist clients with these exercises.

Common care tips9:16–11:00

To help ensure your client can reach the prescribed range of motion, remove pillows and other positioning devices that might restrict their movement.
Position the client so that you can complete all exercises without repositioning. Follow the anatomy of the body and go through exercises systematically, for example, from shoulders to fingers.
This way you’ll make sure that all exercises will be done. To preserve the function of the whole body, do the same exercises on both sides of the body, but avoid exercising on painful joints.
Support moving segments of the person’s body to prevent pain, discomfort, and potential injuries. Make sure that the movement is slow and gentle.
It must not exceed the prescribed range of motion! Also, continuously check on the person by observing their facial expression and asking if they’re experiencing any pain, discomfort, or if they need to rest.With clients that are unable to speak, be sure to observe for signs of pain such as restlessness or grimacing.
Make sure to take a break when you notice spasticity, which refers to a continuous contraction of a muscle. Finally, encourage the client to be active and help as much as possible!When assisting a client with range of motion exercises, there are a couple things you should report to the nurse right away.

Reporting and documentation11:00–11:53

A client’s vital signs like heart rate and respiratory rate will increase during activity but they must return to resting rates once the activity is done.
If they remain high, inform the nurse immediately. Additionally, inform the nurse if the client has any decrease to their usual muscle strength or range of motion.
Also, tell the nurse if you notice the exercised body part is red, tender, swollen, or painful to the touch. When you complete the activity, don’t forget to document the time and date, the body part that was exercised, and any unusual observations during the range of motion exercises.

Recap11:53–12:40

All right, as a quick recap... Range of motion, or ROM for short, is defined as the normal movement potential of a joint to the extent that is not causing any pain.
As a nursing assistant, you’ll be asked to assist the client with range of motion exercises to preserve a client’s joint and muscle function, but they can also be used to either increase or prevent further loss in the range of motion.
Based on the client’s involvement, they can be subdivided into three groups: active, active-assistive, and passive range-of-motion exercises.
During the activity, make sure the movement is slow and gentle to prevent