Range of Motion Exercises

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Spine

Spinal cord and nerves. These "electrical cables" travel through the spinal canal carrying messages between your brain and muscles. Nerve roots branch out from the spinal cord through openings in the vertebrae (foramen).

Intervertrebral disks. In between your vertebrae are flexible intervertebral disks. They act as shock absorbers when you walk or run.

Intervertebral disks are flat and round and about a half inch thick. They are made up of two components:

  • Annulus fibrosus. This is the tough, flexible outer ring of the disk.
  • Nucleus pulposus. This is the soft, jelly-like center of the disk.                                                                                                                                                                                                                                                                                                                     

    Cervical radiculopathy most often arises from degenerative changes that occur in the spine as we age or from an injury that causes a herniated, or bulging, intervertebral disk.

    Degenerative changes. As the disks in the spine age, they lose height and begin to bulge. They also lose water content, begin to dry out, and become stiffer. This problem causes settling, or collapse, of the disk spaces and loss of disk space height.

    (Left) Side view of a healthy cervical vertebra and disk. (Right) A disk that has degenerated and collapsed.

    As the disks lose height, the vertebrae move closer together. The body responds to the collapsed disk by forming more bone —called bone spurs—around the disk to strengthen it. These bone spurs contribute to the stiffening of the spine. They may also narrow the foramen—the small openings on each side of the spinal column where the nerve roots exit—and pinch the nerve root.

    Degenerative changes in the disks are often called arthritis or spondylosis. These changes are normal and they occur in everyone. In fact, nearly half of all people middle-aged and older have worn disks and pinched nerves that do not cause painful symptoms. It is not known why some patients develop symptoms and others do not.

    Herniated disk (side view and cross section)

    Herniated disk. A disk herniates when its jelly-like center (nucleus) pushes against its outer ring (annulus). If the disk is very worn or injured, the nucleus may squeeze all the way through. When the herniated disk bulges out toward the spinal canal, it puts pressure on the sensitive nerve root, causing pain and weakness in the area the nerve supplies.

    A herniated disk often occurs with lifting, pulling, bending, or twisting movements.

    Symptoms

    In most cases, the pain of cervical radiculopathy starts at the neck and travels down the arm in the area served by the damaged nerve. This pain is usually described as burning or sharp. Certain neck movements—like extending or straining the neck or turning the head—may increase the pain. Other symptoms include:

  • Tingling or the feeling of "pins and needles" in the fingers or hand
  • Weakness in the muscles of the arm, shoulder, or hand
  • Loss of sensation
  • Some patients report that pain decreases when they place their hands on top of their head. This movement may             temporarily relieve pressure on the nerve root.

Range of motion refers to the distance and direction a joint moves between a flexed (bent) position and an extended (stretched) position. It also refers to therapeutic exercises designed to increase this distance in a joint's movement.

A number of health issues contribute to restricted range of motion, including:

  • Problems with body mechanics
  • Swelling
  • Inflammation
  • Muscle spasms
  • Infection
  • Disease, such as arthritis

Range of motion is also one of the dimensions used in Functional Capacity Evaluations to measure and determine joint flexibility.

There are three types of range of motion exercises:

Passive Range of Motion (PROM): With PROM, the client applies no effort to move the joint, which is moved through a variety of stretching exercises by a physical therapist or with the help of equipment.

Active Assisted Range of Motion (AAROM): With AAROM, the client uses the muscles around a weak joint to complete stretching exercises with the help of a physical therapist or equipment.

Active Range of Motion (AROM): With AROM, the client performs stretching exercises, moving the muscles around a weak joint without any aid.