▶What is the difference between passive, active, and active-assisted range of motion?
Passive range of motion (PROM): the therapist moves the patient's joint through its available range while the patient is fully relaxed. PROM tells you the structural limit (how far the joint can go mechanically) and the end-feel. Active range of motion (AROM): the patient moves the joint themselves, using their own muscle power. AROM tells you functional mobility and whether the patient has enough strength and pain-free motion to move independently. Active-assisted range of motion (AAROM): the therapist guides and assists the patient's movement, used when the patient is weak or in pain and cannot move the joint alone. Typical pattern: PROM decreases after surgery (swelling, stiffness), AROM lags behind PROM (pain or weakness), AAROM bridges the gap. If PROM and AROM are equal, the movement is limited by pain or swelling, not weakness. If AROM is much less than PROM, the patient is weak or guarded.
▶How do you identify end-feel and what does each type indicate?
End-feel is the quality of resistance felt by the therapist at the end of joint range. Normal end-feels: firm (muscular, ligamentous, or bony resistance), elastic (springs back, as with hamstring tightness), or hard (bone-to-bone, as with a tight knee extension). Abnormal end-feels: soft (tissue edema or excessive fluid), empty (patient stops motion before true mechanical limit, usually from pain or fear), hard too early (bony block or heterotopic ossification, abnormal bone formation), or pain-limited (patient stops due to sharp pain, not mechanical restriction). End-feel helps diagnose: if ankle plantarflexion has a soft end-feel and decreased ROM, likely post-operative swelling; if it has a firm elastic feel, likely calf tightness; if hard, likely contracture or bony block. A normal, firm end-feel suggests structural mobility is intact; an abnormal end-feel warrants investigation.
▶What landmarks do you use for accurate goniometer placement?
Goniometer placement requires identifying bony landmarks on the patient's body. Shoulder flexion: fulcrum at the acromion process (lateral shoulder), stationary arm along the thorax midline, moving arm along the humerus. Elbow flexion: fulcrum at the lateral epicondyle, stationary arm along the humerus, moving arm along the radius or ulna. Hip flexion: fulcrum at the greater trochanter (lateral hip), stationary arm along the trunk or ilium, moving arm along the femur. Knee flexion: fulcrum at the lateral epicondyle of femur, stationary arm along the femur, moving arm along the tibia. Ankle plantarflexion/dorsiflexion: fulcrum at the lateral malleolus (ankle bone), stationary arm along the fibula, moving arm along the foot (fifth metatarsal). Accuracy depends on precise landmark identification and consistent placement; palpate landmarks before placing the goniometer.
▶How do you document range of motion clearly and track changes over time?
Standard notation: degrees of motion, e.g., 'R knee flexion 0–115°' means the knee starts at 0° (fully straight, called zero-starting position) and flexes to 115°. If there is a structural limitation preventing full straightening, note it: 'R knee extension 10–115° (contracture, 10° lack of extension).' Include PROM and AROM separately if they differ. Compare bilaterally: normal limb vs. affected limb. Document end-feel: 'R ankle dorsiflexion 15°, firm end-feel' vs. 'L ankle dorsiflexion 8°, soft end-feel.' Track over sessions: week 1 ROM 0–90°, week 2 ROM 0–105°, week 3 ROM 0–115°. Graph ROM over time so the patient sees improvement visually. Consistent, detailed documentation is essential for communication among clinicians and for medico-legal records.
▶What is the normal range of motion for major joints in adults?
Shoulder flexion: 0–180°, extension 0–60°, abduction 0–180°, internal rotation 0–70°, external rotation 0–90°. Elbow flexion 0–150°, extension 0°, pronation/supination 0–80°. Hip flexion 0–120°, extension 0–30°, abduction 0–45°, adduction 0–30°, internal rotation 0–45°, external rotation 0–45°. Knee flexion 0–135°, extension 0°, (extension >0° = genu recurvatum, abnormal). Ankle plantarflexion 0–50°, dorsiflexion 0–20°, inversion 0–35°, eversion 0–15°. Lumbar spine: flexion 80°, extension 25°, lateral flexion 35°. Cervical spine: flexion 45°, extension 45°, lateral flexion 45°, rotation 80°. Age and individual variation are normal; compare bilaterally and trend over time. Declines in ROM predict future disability in older adults.
▶How do you distinguish between structural limitations (joint stiffness) and neuromuscular limitations (weakness, guarding)?
PROM > AROM: neuromuscular limitation (weakness, pain-guarding, neurological deficit). PROM = AROM: structural limitation (joint stiffness, capsular tightness, bony block). Test PROM first in a very relaxed position (sitting, supported, patient fully relaxed); PROM tells structural capacity. Then test AROM with patient effort; if AROM much less than PROM, the patient is weak or guarding. Perform manual muscle testing (resistance against therapist's force) to confirm weakness. Assess for pain (does motion hurt?) and fear-avoidance (does the patient hesitate, anticipating pain?). Example: post-shoulder surgery with PROM 0–150° and AROM 0–80°. PROM > AROM indicates the joint is mobile enough but the patient is weak or guarding. Therapy: active-assisted ROM, pain-free strengthening. If PROM also limited (0–100°), the joint is stiff and needs mobilization, heat, or gentle stretching in addition to strengthening.
▶What role does range of motion assessment play in rehabilitation outcomes?
ROM is one of the primary outcome measures in rehabilitation: regaining normal ROM is often an early goal post-surgery or injury. Early ROM assessment establishes a baseline; repeated testing documents progress and informs the therapist whether treatment (mobilization, stretching, exercise) is working. ROM that improves weekly signals good healing and rehabilitation response. ROM that plateaus may indicate need for a technique change (different stretching method, manual therapy, heat). ROM that declines suggests re-injury, increased pain, or deconditioning. For return-to-sport or return-to-work clearance, ROM must meet functional thresholds (e.g., full shoulder external rotation for overhead athletes). ROM impairment (loss of 10–20% or more compared to the unaffected side) is a strong predictor of ongoing disability and re-injury risk, so addressing ROM early pays dividends.
