Following my post on ‘Magic Tricks for the Shoulder‘ I got a few questions. The questions relate to how to increase ROM in general. So I thought I would start with a general joint ROM post. Then maybe pick one or two specific joints over the next few weeks.
There may be many reasons why a joint has limited ROM. There will be structural limits, but there may well also be artificial limits that our brain has set. We all see the difference in ROM after a warm up or after using manual therapy techniques.
Strategies to Increase ROM
I’m not a big fan of static stretching, it may have it’s place. It’s main benefit is not in any way structural. The only thing static stretching has been proven to do is increase the persons tolerance of the stretch. If this is your desired effect, then static stretching is perfect.
However, I personally prefer a more movement based approach. When I am trying to increase ROM the first thing is which plane are you trying to increase. If the joint is only limited in one plane you can choose if you go directly after that plane, or you start by taking advantage of the other two (see step two for more on this). The choice of strategy will depend on many things relating to the patient, their injury and their history.
Step One – Positioning
Take up all the range in the plane you are trying to increase. For example, if hip extension is limited position the patient with the limited side in hip extension. Stride stance if it’s very limited. Maybe use a step if you need to be a little more aggressive.
Step Two – Choosing your Planes
Now they are in position, it is time to move. I think the temptation here is to go straight after the dysfunction, trying to drive more hip extension in our example. Though this isn’t wrong by any means, it’s quite aggressive…I prefer a different tactic 🙂
A quick example of why I wouldn’t go straight after the hip extension. If it is a back pain patient the is aggravated by lumbar extension. In this case going straight for sagittal plane motion may be a little irritating for them.
For me, this is where you can take advantage of the motions they do have. Once positioned at or near end of range drive motion through the other planes. In our example of trying to increase hip extension this would mean frontal or transverse plane motion.
Step Three – Driving the Motion
Once you’ve chosen the plane/planes are going to use you now have to choose how to drive it. In our hip extension example I would probably choose a pelvis driver, seems to be less provocative. In their stride stance ask them to sway their pelvis left to right in the frontal plane. Or if you have chosen the transverse plane, a gentle rotation side to side works great too.
My Progressions to Increase ROM
My strategy is as above, but my progression for increasing hip extension would be as follows:
- Position at end of range in the sagittal plane (hip extended)
- Choose your motions for movement (for me frontal plane first, then transverse)
- Drive motions in those planes:
- 2×10 reps in the frontal plane with pelvis driver
- 2×10 reps in the transverse plane with pelvis driver
- Short rest
- Repeat frontal and transverse plane drivers
- I often add sagittal driver at this point if the patient can tolerate it.
On a subsequent visit, it may be a case of repeating this. Though if I want to increase the load on the hip I will use hand drivers in the 3 planes, but only if the patient can tolerate that.
Hope this has been helpful, might go through a few joint specific examples in the near future 🙂
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