RANGE -OFMOTION EXERCISES

Abigail N. Filio-Monge, RN, MAN

Overview Exercise is any physical activity involving muscles that elevates the heart rate above resting levels.

Overview
Exercise reduces joint pain and stiffness, and increases flexibility, muscle strength, and endurance. It also helps with weight reduction and contributes to an improved sense of wellbeing.

BENEFITS OF EXERCISES
Normalizes glucose tolerance Improves gait and balance Improves cardiovascular function Increases energy Promotes bone density Improves mobility Promotes weight loss Reduces blood pressure Lowers cholesterol Promotes rest and relaxation Improves sleep -----data from Fleming, J.M. (2001). Successful aging.

Types of Exercise
Type
Aerobic

Function
Improve cardiovascular fitness Assist with weight control Improve general functional ability

Examples
Rowing Jumping rope Walking Running Kickboxing Swimming

Types of Exercise
Type
Strengthening

Function

Examples

Maintain or Weight increase muscle training strength Calisthenics Physical labor Tai chi Yoga

Types of Exercise
Type
Isometric

Function
Maintain muscle tone and strength

Examples
Quadriceps setting Gluteal setting Triceps setting

Types of Exercise
Type
Isotonic

Function
Increase and maintain muscle tone and strength Shape muscles Maintain joint mobility Improve cardiovascular fitness

Examples
Weight lifting Working with pulleys Range-ofmotion exercises Performance of activities of daily living (ADL)

Types of Exercise
Type Function Examples
Exercise equipment Resistive water exercises Isokinetic Condition muscle groups

Types of Exercise
Type
Range-of-Motion (ROM)

Function
Maintain joint movement Maintain or increase flexibility

Examples
Adduction and abduction Flexion and contraction

Range-of-Motion Exercises
Is the ability to move all joints through the full extent of intended function. Each joint must be kept actively moving for the joints to maintain mobility, the muscles to maintain strength, and the cardiovascular system to function adequately.

Range-of-Motion Exercises
Active range-of-motion (ROM) activities are performed independently by the client. During active ROM exercises, the client moves various muscle groups.

Range-of-Motion Exercises
Passive range-of-motion (ROM) exercises are done by the nurse to help maintain or restore a clients mobility by achieving several outcomes.

Outcomes of Passive ROM Exercises

Prevention of contractures Improves muscle strength and tone Increases circulation Decrease vascular complications of immobility Facilitates client comfort

1. Temporomandibular Joint (TMJ) (Synovial Joint)

JOINT MOVEMENT a. Open mouth. b. Close mouth. c. Protrusion: Push out lower jaw. RANGE 1-2.5 inches Complete closure 0.5 inch Masseter, temporalis Pterygoideus lateralis MUSCLE GROUP (S)

d. Retrusion: Tuck in lower 0.5 inch jaw. e. Lateral motion: Slide jaw 0.5 inch from side to side.

Pterygoideus lateralis Pterygoideus medialis

2. Cervical Spine (Pivot Joint)

JOINT MOVEMENT a. Flexion: Rest chin on chest. b. Extension: return head to midline c. Hyperextension: Tilt head back. d. Lateral Flexion: Move head to touch ear to shoulder. e. Rotation: Turn head to look to side. RANGE 45 degrees each side 45 degrees 10 degrees 40 degrees each side 90 degrees each side MUSCLE GROUP (S) Sternocleidomastoid Trapezius Trapezius Sternocleidomastoid

Sternocleidomastoid, Trapezius

3. Shoulder (Ball-and-Socket Joint)

JOINT MOVEMENT a. Flexion: Raise straight arm forward to a position above the head. RANGE 180 degrees MUSCLE GROUP (S) Pectoralis major, Coracobrachialis, Deltoid, biceps brachii Latessimus dorsi, deltoid, triceps brachii, teres major Latessimus dorsi, deltoid, teres major

b. Extension: return straight 180 degrees arm forward and down to side of body. c. Hyperextension: move 50 degrees straight arm behind body

3. Shoulder (Ball-and-Socket Joint)

JOINT MOVEMENT RANGE MUSCLE GROUP (S) Deltoid, supraspinatus d. Abduction: move straight 180 degrees laterally from side to a position above the head, palm facing away from head. e. Adduction: move straight 230 degrees arm downward laterally and across front of body as far as possible. f. Circumduction: move 360 degrees straight arm in a full circle.

Pectoralis major, teres major

Deltoid, Coracobrachialis Latessimus dorsi, teres major

3. Shoulder (Ball-and-Socket Joint)

JOINT MOVEMENT g. External Rotation: bent arm lateral, parallel to floor, palm down, rotate shoulder so fingers point up. h. Internal Rotation: bent arm lateral, parallel to floor, rotate shoulder so fingers point down. RANGE 90 degrees MUSCLE GROUP (S) Infraspinatus, teres minor, Deltoid

90 degrees

Subscapularis, Pectoralis major, latissimus dorsi, teres major

4. Elbow (Hinge Joint)

JOINT MOVEMENT RANGE MUSCLE GROUP (S) biceps brachii, brachialis, brachioradialis triceps brachii Biceps brachii, supinator Pronator teres, pronator quadratus a. Flexion: bend elbow, move 150 degrees lower arm towards shoulder, palm facing shoulder. b. Extension: straighten lower arm forward and downward. c. Rotation for supination: elbow bent, turn hand and forearm so palm is facing upward. d. Rotation for pronation: elbow bent, turn hand and forearm so palm is facing downward. 150 degrees 70 degrees to 90 degrees 70 degrees to 90 degrees

5. Wrist (Condyloid Joint)

JOINT MOVEMENT a. Flexion: bend wrist so fingers move toward inner aspect of forearm. RANGE MUSCLE GROUP (S) 80 degrees to Flexor carpi radialis, flexor 90 degrees carpi ulnaris

b. Extension: straighten 80 degrees to Extensor carpi radialis hand to same plane as arm. 90 degrees longus, extensor carpi radialis brevis, extensor carpi ulnaris c. Hyperextension: bend 80 degrees to Extensor carpi radialis wrist so fingers move back 90 degrees longus, extensor carpi as far as possible. radialis brevis, extensor carpi ulnaris

5. Wrist (Condyloid Joint)

JOINT MOVEMENT d. Radial Flexion: abduction - bend wrist laterally toward thumb. e. Ulnar flexion: adduction bend wrist laterally away from thumb. RANGE Up to 20 degrees MUSCLE GROUP (S) Extensor carpi radialis longus, extensor carpi radialis brevis, flexor carpi radialis

30 degrees to extensor carpi ulnaris, flexor 50 degrees carpi ulnaris

6. Hand and Fingers (Condyloid and Hinge Joint)

JOINT MOVEMENT a. Flexion: make a fist. b. Extension: straighten fingers. c. Hyperextension: bend fingers back as far as possible. RANGE 90 degrees 90 degrees MUSCLE GROUP (S) Interosseus dorsalis manus, flexor digitorum superficialis

Extensor indicis, extensor digiti minimi 30 degrees to Extensor indicis, extensor 50 degrees digiti minimi

6. Hand and Fingers (Condyloid and Hinge Joint)

JOINT MOVEMENT RANGE MUSCLE GROUP (S) Interosseus dorsalis manus Interosseus palmares d. Abduction: spread fingers 25 degrees apart. e. Adduction: bring fingers together. 25 degrees

7. Thumb (Saddle Joint)

JOINT MOVEMENT RANGE MUSCLE GROUP (S) Flexor pollicis brevis, opponens pollicis Extensor pollicis brevis, extensor pollicis longus a. Flexion: move thumb across 90 degrees palmar surface of hand. b. Extension: move thumb 90 degrees away from hand.

7. Thumb (Saddle Joint)

JOINT MOVEMENT RANGE MUSCLE GROUP (S) c. Abduction: move thumb 30 degrees Abductor pollicis brevis, laterally. abductor pollicis longus d. Adduction: move thumb back 30 degrees Adductor pollicis to hand. transversus, adductor pollicis obliquus e. Opposition: touch thumb to tip of each finger of same hand. touching Opponens pollicis, flexor pollicis brevis

8. Hip (Ball-and-Socket Joint)

JOINT MOVEMENT a. Flexion: move straight leg forward and upward. b. Extension: move leg back beside the other leg. c. Hyperextension: move leg behind body. RANGE 90 degrees to 120 degrees 90 degrees to 120 degrees 30 degrees to 50 degrees MUSCLE GROUP (S) Psoas major, iliacus, iliopsoas Gluteus maximus, adductor magnus, semitendinosus, semimembranosus Gluteus maximus, semitendinosus, semimembranosus

8. Hip (Ball-and-Socket Joint)

JOINT MOVEMENT d. Abduction: move leg laterally from midline. e. Adduction: move leg back past midline RANGE 40 degrees to 50 degrees 20 degrees to 30 degrees past midline MUSCLE GROUP (S) Gluteus medius, gluteus minimus Adductor magnus, adductor brevis, adductor longus

8. Hip (Ball-and-Socket Joint)

JOINT MOVEMENT f. Circumduction: move leg backward in a circle. RANGE 360 degrees MUSCLE GROUP (S) Psoas major, gluteus maximus, gluteus medius, adductor magnus Gluteus minimus, gluteus medius, tensor fasciae latae

g. Internal Rotation: turn 90 degrees foot and leg inward, pointing toes toward other leg. h. External rotation: turn 90 degrees foot and leg outward, pointing toes away from other leg.

Obturator externus, obturator internus, quadratus femoris

9. Knee (Hinge Joint)

JOINT MOVEMENT RANGE MUSCLE GROUP (S) a. Flexion: bend knee to 120 degrees to Biceps femoris, bring heel back toward 130 degrees semitendinosus, thigh. semimembranosus b. Extension: straighten 120 degrees to Rectus femoris, vastus each leg, place foot 130 degrees lateralis, vastus medialis, vastus intermedius beside other foot.

10. Ankle (Hinge Joint)

JOINT MOVEMENT RANGE MUSCLE GROUP (S) Gastrocnemius, soleus a. Plantar Flexion: point 45 degrees to toes downward. 50 degrees b. Dorsiflexion: point toes upward. 20 degrees

Peroneus tertius, tibialis anterior

11. Foot (Gliding Joint)

JOINT MOVEMENT RANGE MUSCLE GROUP (S) Peroneus longus, peroneus brevis Tibialis posterior, tibialis anterior a. Eversion: turn sole of 5 degrees foot laterally. b. Inversion: turn sole of 5 degrees foot medially.

12. Toes (Condyloid Joint)

JOINT MOVEMENT a. Flexion: curve toes downward. b. Extension: straighten toes. RANGE MUSCLE GROUP (S) 35 degrees to Flexor hallucis brevis, 60 degrees lumbricales pedis, flexor digitorum brevis 35 degrees to Extensor digitorum longus, 60 degrees extensor digitorum brevis, extensor hallucis longus

12. Toes (Condyloid Joint)

JOINT MOVEMENT c. Abduction: spread toes apart. d. Adduction: bring toes together. RANGE Up to 15 degrees Up to 15 degrees MUSCLE GROUP (S) Interosseus dorsales pedis, abductor hallucis adductor hallucis, interosseus plantares

Lets evaluate how far you know ROM exercises!!!!!

Identify the joint movement

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Retrusion: Tuck in lower jaw. Hyperextension: Tilt head back. Abduction: move straight laterally from side to a position above the head, palm facing away from head. Internal Rotation: bent arm lateral, parallel to floor, rotate shoulder so fingers point down. Flexion: bend elbow, move lower arm towards shoulder, palm facing shoulder. (elbow) Extension: straighten hand to same plane as arm. (Wrist) Extension: straighten fingers. (Hands and fingers) Adduction: bring fingers together. Opposition: touch thumb to tip of each finger of same hand. Abduction: move leg laterally from midline. (hip) Plantar Flexion: point toes downward. (ankle) Inversion: turn sole of foot medially. (foot) Flexion: make a fist. (Hand) Hyperextension: bend fingers back as far as possible.(hand) Extension: move thumb away from hand. (thumb)