ROM ends if …
- there is a restriction to the movement
- the client feels pain or discomfort
- the client compensates by moving other body parts
Restriction
When referring to restrictions in this text we are generally referring to hinderances, obstacles or blockages that prevent the movement from happening.
In most cases something is holding back, like a short Pectoralis Minor preventing the retraction of the scapula for example.
Pain or Discomfort
As a therapist, pain is your friend – it tells you where the restriction is!
Only let the client move to the first place they can feel pain or restriction. This is usually suffices to get information about what structures are involved.
In most cases it is not only unnecessary but can even be harmful to push beyond this barrier. Additionally muscles often tense due to pain restricting movement even further.
Sometimes however one has to go through restriction or pain in order to get more information, for example when establishing the presence of a painful arc in conditions like Subacromial Bursitis or with Supraspinatus Tendon problems.
In those cases negotiate with the client whether it is OK to proceed without illiciting too much discomfort.
In AROM make sure they move slowly so they can stop at any time and ensure the pain is not too excessive. As for PROM, move slowly and carefully monitor your client’s reactions.
If it is too uncomfortable don’t do it!
Compensation
When over period of time ROM is restricted for whatever reason, the clients will often unconsciously learn to substitute lack of movement in one area by moving somewhere else.
This especially is the case when they have had pain for some time already.
For example if someone wants to get the cookies from the jar on top of the cupboard but their arm cannot go into sufficient flexion to reach them, they will engage other muscles to help out.
They might extend the spine more, laterally flex their spine, elevate their shoulder, get onto the tips of their toes, plantarflex their feet, fully extend knees and elbows as well as the wrists. Whatever it takes they will do, they’ll even get a chair.
So depending on how big the problem is, a lot of compensatory movement might be happening.
Over time these new movements will then form the “normal” movement patterns. Now often some muscles or structures will be heavily burdened as they are performing the work of others. They are doing a job they are not designed for in addition to their own workload.
Think of an office where ten people are employed. Now five of them don’t do their share of work. That might be because they are lazy, sick or for whatever reason. The work then is either not getting done and/or the ones who are actually working will get stressed by the additional work load.
So by overworking those auxillary muscles secondary problem areas start to manifest and more new compensatory patterns will emerge.