Can our interpretations of ROM be wrong?

Every corrective exercise system on the market that I’ve come across places very high value on some incarnation of a ROM assessment. In each instance, the intent of the ROM exams is to help practitioners make appropriate corrective exercise selections.

For example, some systems utilize dynamic ROM tests. Typically, practitioners of these systems seek to observe deviations from an idealized way of performing a specific exercise. A common exercise used would be a squat pattern variation. Possibly, while performing a system’s chosen version of a squat, a client’s knee may track inward too dramatically or there’s too much forward motion of the trunk (according to the specific testing parameters of the system). Typically it’s noted and a series of “correctives” are undertaken to “correct” the aberrant motion that’s unpleasing to the trained eye of the system’s proponents.

Other systems on the market are incorporating static ROM tests. This can take the form of a posture analysis or maybe it’s a joint by joint approach to assess active/passive ROM that is then typically compared to a population standard or for an individual’s assymetries. Depending upon the clinician’s findings with the ROM exam, specific exercises are then selected as correctives that attempt to address the undesirable ROM findings.

I take no issue with a system for using dynamic or static ROM assessments if they are using these tools properly. What do I mean by properly? ROM assessments are wonderfully useful tools for confirming functional improvement outcomes for our clients and patients after performing correctives but horrible at setting up consistently effective corrective exercise strategies. I now understand that trusting ROM assessments as corrective exercise guides leads to the generation of very inconsistent strategies (it’s nearly a 50/50 proposition). If half of the time a ROM exam is giving us a great plan and the other half of the time it’s leading us down the wrong path, doesn’t it rather nicely explain why some clients respond really well while others seem to never get really amazing results?

Polar OppositesĀ 
Let’s check out a couple of scenarios that will illustrate the extreme unreliability of ROM exams as corrective strategy-makers.

We’ll say that Client A’s body is favoring a posterior pelvic tilt (PPT). Every movement that Client A attempts is performed from a starting posture that includes a PPT. Generally speaking, a person favoring PPT would probably have “active” hip extensors and lumbar flexors and “underactive” hip flexors and spinal errectors. Tight hammie’s/weak hip flexors could obviously lead to limited a hip flexion ROM exam result.

Conversely, we’ll say that Client B’s body is favoring an anterior pelvic tilt (APT). Every movement that this client attempts is performed from a starting posture that includes an APT. In contrast to the PPT favoring client, an APT favoring client will probably have “active” hip flexors and lumbar extensors and some “under-active” hip extensors and lumbar flexors. If a person is in possession of “extra-active” hip flexors/lumbar extensors, it’s pretty easy to see that there could be a degree of approximation of the ASIS and anterior femur from the get-go. This person is starting all movments from a position of hip flexion. Due to these active hip flexors and lumbar extensors, a common and realistic end result for this person could also be limited hip flexion observation during a ROM assessment.

These are two opposite scenarios (PPT and APT) that can yield the exact same observation – limited hip flexion. So how can we trust what we are seeing? How should we interpret this conundrum? I say we don’t. Dropping the idea that ROM exams are useful as corrective exercise strategy-makers is a tough but necessary step if corrective exercise professionals want to start delivering amazing results with very high consistency!

NO ROM? Now what?
My suggestion is that we start identifying patterns of movement that, when motion into a specific pattern is encouraged (passively or actively), result in either increased or decreased efficiency. Within the RESET system, we call a pattern that increases neuromuscular inefficiency the compensatory pattern. The polar opposite pattern, which not only incorporates opposite motions but also generally yields improved functionality (increased neuromuscular efficiency), we call the RESET or restoration pattern. When one accurately identifies these two patterns, they’re on their way to delivering consistently amazing corrective exercise results with nearly all clients.

Corrective exercise pro’s need to begin grasping the importance of eschewing ROM as meaningful guides. We need to start gravitating towards the idea that accurately identifying compensatory and restorative patterns through neuroproprio-response testing is the key to any effective corrective strategy. Once we do this, the entire industry will see a surge in corrective exercise results and a corresponding interest in utilizing truly corrective exercise to get the most out of our active lifestyles.

In the following video, you will see a very obvious ROM asymmetry. What’s interesting is that when I pursued the classical corrective approach, poor outcomes ensued. When I pursued a counter-intuitive (for most) approach, a good outcome was realized. Please check this out!

One thought on “Can our interpretations of ROM be wrong?

  1. Powerful! Anyone who has done their due diligence understands that using ROM as a baseline for programming is playing a losing game! Contemplating why this is tight or why this leads to that is purely a waste of time. Time that could be spent doing something else productive like what the client needs and pays you for; which is exercise! I think some trainers get so caught up in sounding intelligent and speculating why things are tight and explaining this in a way gives them some sort of self glorification (I know because I WAS that trainer). But in the end what is most important is whether the client gets lasting results or not.

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