Range of Motion (ROM)
The range of motion of a joint is typically tested in 3 ways.
I’ll be restricting my post to the first two, which are active and passive ranges of motion.
The final range testing is done through what’s termed joint play. This is done by the physiotherapist using very specific movements of joints when they’re held in specific test positions and will give information on the integrity of the joints’ ability to glide on each other properly.
Active ROM is tested by asking you to move through as much range of motion that you can.
For example, if I were to test your shoulder’s active ROM, I’d simply ask you to lift your arm straight overhead as far as you can. I could further differentiate between shoulder flexion (straight overhead from in front of you), shoulder abduction (lifting your arm overhead from the side) and shoulder extension (moving your arm backwards and up).
While fairly easy to test, I don’t find active ROM appropriate for all areas of the body and very seldom test the lower back for active ROM. I prefer to teach a majority of my clients (especially those looking to relieve low back pain) to minimize lumbar spine movements.
Passive ROM is tested typically at the end of active ROM, and usually only if there are deficits in the available range when completed actively. This gives us a baseline level of knowledge on how far your joints are actually able to move (total range) and how far you’re able to move within that range (available range).
As with ROM testing, strength testing can take o many forms but I’ll just highlight a few here today. These are: manual muscle tests (MMTs), resisted isometric movements (RIMs) and functional movement tests/screens.
MMTs can be used to test specific muscle groups by placing those muscles in specific test positions and then challenging them. This gives the physiotherapist key information on how well a certain muscle or muscle group may be functioning.
RIMs are tests designed to compare the function of contractile tissues (e.g. muscle) with the function of inert or non-contractile tissue (e.g. ligaments). In the proper RIM test position, contractile elements (along with nerves) are challenged. Inert tissue, should not. This allows the the physiotherapist to distinguish between damage to inert tissue (ligament sprains) or damage to contractile tissue (strains of the muscle).
Functional movement tests/screens are based on taking you through specific movements to see how you do. These can include many different positions or exercises such as squats, lunges, push ups, or planks. The results of these tests give information on qualities such as balance, control, body awareness, strength, coordination, injury risk and many others.
In fact, a failed functional test could very well become your treatment exercise!
The last of the tests are called special tests. These are designed to test very specific outcomes and in the hands of a skilled clinician can yield important information that may help elucidate a physiotherapy diagnosis. Some examples of these tests include ligament stability tests (e.g. Lachman’s test for the ACL), nerve or vascular tests (e.g. Roos stress test for thoracic outlet syndrome) and specific injury tests (e.g. Neer’s test for shoulder impingement).
So there you have it, a brief outline of the information gathering process.
While these tests are important in their own right, it’s just as important to look at the whole clinical picture which includes the medical history, the observation and the results of the physical examination. By the end of this week, I’ll put it all together and show you how all this information forms the basis of a treatment plan.
Yours in movement.