ROM exams permeate the industry. From sit and reach tests in PE classes, to generalized fitness assessments used by personal trainers to Rehab Specialists seeking to improve functional outcomes to justify their treatments to insurance companies. It seems that everybody is using some form of ROM assessment.
My question is this, do ROM exams always tell us what we think they tell us? I’m not so sure that they always do. Here are 3 different interpretations of what could be behind ROM restrictions.
- Protective muscle guarding. Probably the most common view when it comes to ROM restrictions. The idea is that the body senses where it is unstable and then uses antagonist muscle tension to prevent further movement towards the unstable position. Let’s use calf tightness as an example. The protective muscle guarding folks would probably have you stretch the calves to release tightness or they may attempt to activate the anterior shin muscles to improve ankle dorsiflexion. Is protective muscle guarding always the real scenario? Not always, but sometimes.
- Joint impingement. This would be a less common view, but a nearly as frequent in the real-world scenario, of what leads to ROM restrictions. Think about the following example. Part of a clients’ compensatory movement pattern involves favoring an anterior tilted pelvis. Sitting, stand, walking, jumping, climbing, throwing… it doesn’t matter, they’re compensating by overutilizing an anterior pelvic tilt. Consider that an anterior pelvic tilt, which brings the front of the pelvis into closer proximity to the front of the femurs, is also hip flexion (shortened hip flexors and elongated hamstrings). It’s easy to see that for the APT favoring person, a lack of hip flexion would be a likely ROM exam result. Therefore, stretching the hammies and/or training the hip flexors to contract would only serve to encourage more anterior pelvic tilt. Is joint impingement always the real scenario? Not always, but sometimes.
- Scar tissue. Muscle tissue that’s been traumatized (tear, surgery, etc.) can end up with some adhesions (I think of it as muscle calluses) that are much less pliable than healthy non-traumatized tissues. This less flexible tissue can result in restricted ROM. Is scar tissue always the real scenario? Not always, but sometimes.
If you are utilizing ROM exams with your patients or clients as part of your corrective exerise approach, the fact that there is more than a single reason behind poor ROM results should be enough to make you start questioning the extent of the faith that you are currently placing in those ROM exams. If you’ve been trained to only ”see” ROM restrictions as stemming from muscle guarding, you’re going to make very poor exercise selections when you come across an impingement issue. The same would hold true if you’ve been trained to only ”see” impingement.
As a corrective exercise professional, I believe that we should be seeking to improve movement quality first and foremost. We need to be focused on the process of improving movement quality. If we do that job well, a likely end result will typically be increased movement quantity.
A major problem in our industry is that most professionals have it backwards. We seek movement quantity and then when it occurs, we tend to call it quality. But it’s very possible to increase ROM and then still have a lack of control within the recently increased ROM. Increased flexibility without a correlating increase in stability is a disaster waiting to happen. That’s risky business. Also, please keep in mind that not injurying a client is not to be equated with actually helping them. If we can keep our focus on the process of improving movement quality, nearly all of our clients and patients will reap the benefits of our corrective approaches.
Shawn Sherman, Developer of the RESET system