Support Where Necessary
Ensure that your clients are safe throughout all movements, that they are supported and able to either complete the movement or get back to the starting position safely!
Have them support themselves on the massage table, a chair or any other sturdy structure if need be.
Monitor the client’s movements closely with view to support or guide them if necessary.
In PROM one of your hands should stabilize the extremity while the other manipulates the limb.
Pre-existing Conditions
Clients presenting with pre-existing conditions like dislocations, joint replacements, fractures, advanced pathologies, profound tissue damage, etc., will NOT undergo ROM testing.
Avoid Tension
Have your client as relaxed as possible during the tests. If they are tense, afraid, or feel unsafe in your hands, their muscles will tense and guard the body part trying to avoid pain not allowing full ROM.
This can happen on an unconscious level as well. It is essential that all tests are performed gently, assuring the client and having them trust that it will not hurt and they can stop at any stage they feel pain.
Extra Careful With PROM
There is particular concern for safety in PROM. During AROM the clients know that they can stop at any sign of pain as they have control over the movement. But do they trust you to stop in time as well in PROM?
Trust can be a very important issue and if trust is not established this might result in a false negative. In anticipation of pain the client will stop (AROM) or tell you to stop (PROM) before they actually can feel a physical restriction.
Gently Nudge Them On
In such cases try to find out where their restriction lies by asking them to point to where it hurts or feels restricted.
If they cannot perform a movement to the end of the expected ROM and they don’t feel anything yet, ask them to gently proceed with the movement to a point where they actually can feel the limitation. If the ROM test is terminated prior to that, valuable information will be lost.