Which term does the nurse document when turning a joint inward while performing a range of motion ROM exercise?

Range of motion (ROM) measures the distance and direction that a joint can stretch. This varies from person to person. Think back to gym class. Some people could touch their toes, even palm the floor. Others couldn't reach their ankles. Knowing what your ROM is can protect you from overdoing things and getting hurt.

Read on to learn more about the ranges of motion that are typically considered normal for various joints throughout the body.

Joints and Movements

Mention joints of the body, and most people think of their knees. You have many other joints, some you might not even realize. Joints are anywhere on your body where your bones, tendons, ligaments, cartilage, and muscles attach.

Most joints allow for a certain amount of movement in one or more directions. Physical therapists use a device called a goniometer to measure your ROM. The device has two arms with a hinge in the middle. Your therapist will measure the degree to which you can straighten, bend, or rotate your joint.

Each joint has different ranges of motion for each type of movement it can perform. A few, like the joints in your skull, don't allow any movement.

Joint Movements

You need to be able to move your joints to do basic tasks like washing your hair. You also need to be able to move well enough to exercise and stay healthy. Some everyday joint movements include:

• Extension: Straightening a joint. When you straighten your knee or elbow, for example, you increase the angle between the bones at these joints.
• Flexion: Bending a joint. When you bend your knee or elbow, you decrease the angle of the bones at these joints.
• Abduction: Movement away from the center of your body. A good example is doing jumping jacks or lifting your arm or leg to get dressed.
• Adduction: Movement back to the center of the body. A good example is returning your arm to your side after waving or standing with your legs together.

Some joints, like your shoulders, are ball-and-socket types. They can move in many different directions. Other joints, like your knees and elbows, are hinge joints designed to open and close in one direction.

Normal Ranges of Motion By Joint

Your physical therapist or exercise physiologist will measure and record your ROM. Then they'll compare it to the standard ROM value for that joint. During your medical history, they'll ask for your age. ROM standards differ based on how old you are.

Commonly used ROM values can differ in exact values, depending on the source. However, they are generally within a similar range.

Below are generally accepted values for a normal ROM for some individual joints as measured in degrees.

Hip

• Flexion: 100 degrees
• Backward extension: 30 degrees
• Abduction: 0 degrees
• Adduction: 20 degrees
• Lateral rotation (rotation away from the center of the body): 60 degrees
• Medial rotation (rotation towards the center of the body): 40 degrees

Knee

• Flexion: 150 degrees
• Extension: 120 degrees

Ankle

• Plantar flexion (downward movement): 40 degrees
• Dorsiflexion (upward movement towards the shin): 20 degrees

Foot

• Inversion (inward roll of the sole): 30 degrees
• Eversion (outward roll of the sole): 20 degrees

Metatarsophalangeal Joint of the Foot

These joints connect your toe bones to your foot bones.

• Flexion: 30 degrees
• Extension: 80 degrees

Interphalangeal Joint of the Toe

These joints are the middle knuckles of the toes. They allow you to bend your toes.

• Flexion: 50 degrees
• Extension: 50 degrees

Shoulder

• Flexion: 50 degrees
• Extension: 150 degrees
• Abduction: 150 degrees
• Adduction: 30 degrees
• Lateral rotation: 90 degrees
• Medial rotation: 90 degrees

Elbow

• Flexion: 150 degrees
• Pronation (rotation inward): 80 degrees
• Supination (rotation outward): 80 degrees

Wrist

• Flexion: 60 degrees
• Extension: 60 degrees
• Abduction: 20 degrees
• Adduction: 30 degrees

Metacarpophalangeal (MCP)

These joints are where your finger bones meet your hand bones.

• Abduction: 25 degrees
• Adduction: 20 degrees
• Flexion: 80 degrees
• Extension: 30 degrees

Interphalangeal Proximal (PIP) Joint of the Finger

These are the middle knuckles of your fingers.

• Flexion: 120 degrees
• Extension: 120 degrees

Interphalangeal Distal (DIP) Joint of the Finger

These are the knuckles just below your fingernails.

• Flexion: 80 degrees
• Extension: 80 degrees

Metacarpophalangeal Joint of the Thumb

This is where your thumb meets your hand bones.

• Abduction: 50 degrees
• Adduction: 40 degrees
• Flexion: 60 degrees
• Extension: 60 degrees

Interphalangeal Joint of the Thumb

This is the middle knuckle of your thumb.

• Flexion: 80 degrees
• Extension: 90 degrees

Factors Influencing ROM

Two significant factors that can affect your ROM are your age and sex. Researchers studied the range of motion of eight joints in 40 men and women. They had the participants do different exercises and measured how far they could move each joint. They also recorded how long it took them to do each exercise.

The researchers found nearly a 45% difference between the younger and older participants on foot exercises. The exercises measured the ability to rotate the foot inward and outward. They say even older adults without joint problems can have a smaller ROM than younger people. Older people can also take longer to reach their full ROM for any given joint.

The researchers also reported that the women participants had nearly 30% more ROM in their hands than the men.

Stretching is believed to increase joint flexibility. In another study, researchers compared ROM values before and after stretching in a group of men and women in their early 20s. The stretching helped improve muscle stiffness in both sexes. However, it only increased ROM in the women.

Limited Range of Motion

Limited ROM is when you can't move a joint as fully and easily as it should move. This can be due to a problem within the joint or injuries to the joint's soft tissues. Arthritis is the most common cause of stiff joints and limited ROM.

Regaining ROM in a joint is one of the first phases of injury rehabilitation. Physical therapists often prescribe specific ROM exercises for each joint.

Exercising, stretching, and other forms of regular daily movement help you maintain the ROM you have. If you have limited ROM, static stretching has been shown to increase joint ROM. This involves stretching a muscle as much as possible and holding the position for 15 to 20 seconds.

One study also found that applying heat while stretching can be helpful. Participants who used heat during stretching saw a slight improvement in ROM compared to those who stretched without heat.

Types of Exercises for Increased ROM

Physical therapists often prescribe specific ROM exercises tailored for each joint and condition. These exercises take into account the swelling, pain, and stiffness you have.

There are three types of ROM exercises:

• Active range of motion:You perform these exercises without assistance to improve your ROM or to prevent other problems from occurring.
• Active assistive range of motion:You do these exercises with your therapist's help. This form is for when your muscles are too weak to complete the full range of motion, or it's too painful for you.
• Passive range of motion: You don't do anything at all. Your therapist, or a machine, moves your joint and stretches the muscles. This kind of exercise usually occurs during the first stages of recovery after a procedure.

If you have limited ROM, your exercises would be designed to increase your flexibility over time gradually.

Summary

Range of motion, or ROM, is how much you can move or stretch a particular joint. Knowing what your ROM is can help protect you from an injury. Many factors can affect ROM, such as your age, sex, injuries, and arthritis.

This article provides generally accepted ROM ranges for joints that you can use for comparison. If you think you need help, see a doctor and ask about physical therapy. Physical therapists can prescribe exercises to help increase your ROM.

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