Performing Range-of-Motion Exercises

Range-of-motion (ROM) exercises keep joints working when a patient cannot move them enough on their own, after surgery, after a stroke, with arthritis, or during prolonged bed rest. Done consistently, they hold off the stiffness, contractures, and clots that immobility causes.

What ROM Exercises Are

ROM exercises move a joint through its normal range to keep it functional. There are three types, defined by how much the patient does:

1. Passive (PROM). You move the joint through its full range with no help from the patient. Used for the unconscious, paralyzed, or otherwise unable to move.
2. Active (AROM). The patient does the movement independently, when they have the strength and coordination.
3. Active-assistive (AAROM). The patient moves with some help from you, which builds strength and coordination.

Benefits

1. Prevent muscle atrophy and joint contractures.
2. Build muscle strength and endurance, supporting posture and stability.
3. Maintain or improve joint flexibility, by promoting lubrication and movement.
4. Promote circulation and lower thromboembolism risk.
5. Reduce pain and stiffness.
6. Support coordination and balance, which helps prevent falls.
7. Improve functional independence for daily tasks like dressing, bathing, and walking.

Contraindications and Precautions

Assess first, then avoid or modify ROM with:

• Acute joint inflammation or infection. Defer until it subsides.
• Recent fractures or surgery without clearance. Start only when the physician approves.
• Severe osteoporosis. Keep movements gentle and supervised; fragile bones fracture easily.
• Severe cardiopulmonary conditions. Activity raises oxygen demand and cardiac workload.
• Uncontrolled pain. Control pain before starting.
• Muscle or tendon rupture. Postpone until healing is sufficient or a therapist guides it.

Movements

These movements apply to each major joint: neck, shoulders, elbows, wrists, fingers, hips, knees, ankles, and toes.

Movement Term	Definition	Examples
Flexion	Bending a joint to decrease the angle between two body parts.	Bending the elbow or knee; flexing the neck to lower the chin toward the chest .
Extension	Straightening a joint to increase the angle between two body parts.	Straightening the elbow or knee; lifting the head from a flexed to neutral position.
Abduction	Moving a limb away from the midline of the body.	Lifting the arm or leg sideways away from the body; spreading the fingers apart.
Adduction	Moving a limb toward the midline of the body.	Bringing the arm or leg back toward the body.
Rotation	Turning a body part around its axis.	Rotating the head side to side; rotating the shoulder inward or outward.
Internal Rotation	Moving a limb inward toward the midline of the body.	Rotating the shoulder inward so the thumb points toward the body.
External Rotation	Moving a limb outward, away from the midline of the body.	Rotating the shoulder outward so the palm faces forward or up.
Circumduction	Moving a body part in a circular motion .	Making circles with the arm at the shoulder joint.
Dorsiflexion	Bending the foot upward toward the shin.	Lifting the toes off the ground while keeping the heel down.
Plantarflexion	Pointing the foot downward away from the leg.	Standing on tiptoes; pressing a gas pedal.
Supination	Rotating the forearm or hand so the palm faces upward .	Holding a bowl of soup (palm up).
Pronation	Rotating the forearm or hand so the palm faces downward .	Pouring out a bowl of soup (palm down).
Inversion	Turning the sole of the foot inward .	Rolling onto the outer edge of the foot .
Eversion	Turning the sole of the foot outward .	Rolling onto the inner edge of the foot .

Nursing Assessment

• Assess level of consciousness, pain, and willingness to participate.
• Evaluate joint mobility, muscle strength, and any stiffness or swelling for a baseline.
• Review the history and physician orders to confirm no contraindications.
• Inspect for contractures, deformities, or assistive devices.

How to Perform ROM Exercises

1. Explain the procedure and its purpose.
2. Wash your hands and glove if needed.
3. Set up the space: privacy, a warm well-lit room, the near bed rail down, and the bed at working height.
4. Position the patient (supine, side-lying, or sitting) for the joints you are working, using pillows for alignment.
5. Support the joint with one hand above and one below while you guide the movement, to keep alignment and avoid stress.
6. Work head to toe: neck (if allowed), then shoulders, elbows, wrists, fingers, hips, knees, ankles, and toes. Repeat each movement about 5-10 times, as tolerated.
7. Move gently through each range (flexion, extension, rotation) without force. No jerky movements, and never push past resistance.
8. Watch for pain. Read facial expressions and verbal cues, and pause if discomfort appears.
9. Let the patient do as much as they can independently or with assistance.
10. Complete the recommended repetitions or as tolerated.

After the Procedure

1. Reposition the patient comfortably to reduce pressure ulcer risk.
2. Lower the bed and lock the brakes to prevent falls.
3. Put the call light within reach.
4. Do gentle stretching or relaxation to ease muscle tension.
5. Wash your hands again before documenting.
6. Document the joints exercised, the type of ROM, repetitions, tolerance, and any abnormal findings like limited range, swelling, or pain.

General Nursing Considerations

• Assess baseline mobility and activity tolerance as a reference point.
• Work within the patient's comfort zone; never force a joint.
• Use slow, controlled movements and watch nonverbal cues.
• Encourage the patient to stay engaged.
• Collaborate with physical therapy on advanced mobility plans.
• Teach the patient and family why regular ROM matters, so care continues at home.