The human body’s capacity for movement is defined by its Range of Motion (ROM), which represents the full potential of a joint to move in all directions. This movement potential involves a complex interplay of bones, cartilage, ligaments, tendons, and surrounding muscles. Limited Range of Motion (LROM) occurs when a joint cannot move through its normal, expected arc of movement. This reduction signals an underlying issue that restricts the joint’s mechanical function.
Defining Limited Range of Motion
Limited Range of Motion is a quantifiable reduction from established norms for a specific joint, considering the person’s age and gender. Healthcare professionals assess movement using two primary measurements: active ROM and passive ROM.
Active ROM is the extent of movement a person achieves independently by contracting their own muscles. Passive ROM is the amount of movement achievable when an external force, such as a physical therapist, moves the joint while the patient remains relaxed.
Comparing these measurements helps identify the source of the limitation. If active ROM is restricted but passive ROM is full, the issue may be muscle weakness or pain. A restriction in both suggests a structural problem within the joint itself. Professionals typically use a handheld device called a goniometer to measure the joint angles in degrees, which allows for objective assessment and tracking of any changes.
Primary Causes of Reduced Mobility
Restriction in joint movement originates from distinct problems affecting joint structures, surrounding soft tissues, or the neurological system. These issues are often categorized into structural, soft tissue, and neurological causes.
Structural Issues
Articular and structural issues involve damage to the joint itself, such as the gradual wear and tear seen in osteoarthritis, where cartilage breaks down and bone spurs may form. Inflammatory conditions, like rheumatoid arthritis, cause swelling and erosion within the joint capsule, physically restricting movement.
Soft Tissue Issues
Problems with surrounding soft tissue often involve the ligaments, tendons, and muscles that cross the joint. Following injury or surgery, scar tissue (adhesions) can physically tether moving parts, preventing full movement. Prolonged immobilization can also lead to contractures, where muscles and connective tissues shorten and become resistant to stretching, locking the joint into a limited position.
Neurological Issues
Neurological issues occur when the brain or nerves cannot properly signal the muscles to move the joint. Conditions such as stroke or cerebral palsy can result in muscle spasticity or paralysis, interfering with the motor control required for complete joint movement. Direct trauma, including fractures, dislocations, or severe ligament tears, can also cause immediate LROM due to mechanical obstruction, swelling, or instability.
The Impact on Daily Life
A reduction in joint movement translates into significant functional limitations that interfere with Activities of Daily Living (ADLs). Routine actions like reaching overhead or bending down become difficult when motion is restricted in the shoulder or hip. Limited mobility in the lower body (hips, knees, and ankles) affects the ability to walk, stand, and transfer, increasing the risk of falls.
The inability to perform basic self-care tasks, including bathing, dressing, and grooming, can lead to a loss of independence. LROM is often accompanied by pain and persistent stiffness, which can lead to a cycle of reduced activity and further loss of motion. To cope, a person may adopt compensatory movements, overusing other joints or muscle groups, potentially leading to secondary injuries.
Therapeutic Approaches to Restoring Motion
Interventions for LROM focus on addressing the underlying cause and restoring mechanical capacity for movement. Treatment typically involves a combination of physical therapy, medication, and sometimes surgery.
Physical Therapy and Rehabilitation
Physical therapy programs involve specific exercises designed to increase flexibility and strength. Techniques include stretching shortened muscles and manual therapy (joint mobilization and soft tissue manipulation) to break up scar tissue and improve joint mechanics.
Medication
Medication is used alongside therapy to manage symptoms. Non-steroidal anti-inflammatory drugs (NSAIDs) reduce swelling, and pain relievers facilitate participation in therapeutic exercises. This allows the individual to push the joint toward its full range without severe discomfort.
Surgical Intervention
In cases of mechanical obstruction or severe joint damage, surgery may be necessary. Procedures like arthroscopy remove bone spurs or loose bodies. Joint replacement can restore the full mechanics of the joint. Surgery may also be used to release soft tissue contractures resistant to conservative stretching.