Comprehensive Lower Extremity and Spine Range of Motion Techniques

 

Lower Extremity

Combined Hip and Knee: Flexion and Extension

In order to fully extend hip flexion, hamstring muscle tension must be released by flexing the knee. The rectus femoris muscle must be released from tension by flexing the hip in order to achieve full range of knee flexion.

Hand Placement and Procedure

Using the lower hand under the heel and the palm and fingers of the top hand under the patient's knee, support and elevate the patient's leg.
Swing the fingers to the side of the thigh as the knee flexes to its maximum extent.

Hip: Extension (Hyperextension)

In cases where the patient's motion is normal or near-normal, prone or side lying must be used.

Hand Placement and Procedure

When a patient is prone, elevate their thigh by placing the bottom hand beneath their knee and use the upper hand or arm to stabilize their pelvis. In the event that the patient is side-lying, position the bottom hand beneath the thigh and place it on the anterior surface. Use the top hand to stabilize the pelvis. Avoid flexing the knee to its maximum range when extending your hips since the two-joint rectus femoris will then limit your range of motion.

NOTE:

To access the possible range of the muscle, simply extend the knee as far as the muscle permits without moving the hip if the hamstrings are so tight that it prevents the knee from going into extension.

Elongation of the Two-Joint Rectus Femoris Muscle

Either place the patient prone or supine with their knee bent over the edge of the treatment table.

Hand Placement and Procedure

In a supine position, flex the opposing lower extremity's hip and knee and place the foot on the treatment table to support the lumbar spine (hook-lying).
Use your top hand to stabilize your pelvis when you're prone.
When the patient's anterior thigh experiences tissue resistance, the patient's knee has reached its maximum range of motion.

Hip: Abduction and Adduction

Hand Placement and Procedure.

Using the upper hand under the knee and the lower hand under the ankle, support the patient's leg. The opposing leg must be slightly abducted in order to achieve full range of motion. When performing abduction and adduction, maintain the patient's hip and knee in extension and neutral to rotation.

Hip: Internal (Medial) and External (Lateral) Rotation

Hand Positioning and Operation with the Knee and Hip Extended

• Grasp the patient's upper leg just in front of their knee and their lower leg just in front of their ankle.
• Rotate the leg both inside and outside.

Positioning the Hand and Rotating with the Knee and Hip Flexed

• Reach 90 degrees with the patient's hip and knee; use the top hand to support the knee.
• If the knee is unstable, support the proximal calf and knee with the bottom hand while cradling the thigh.
• Move the leg in a pendulum-like motion to rotate the femur.
• Although this hand placement helps to support the knees somewhat, it should be utilized cautiously if there is instability in the knees.

Ankle: Dorsiflexion

Hand Placement and Procedure

• Using the top hand, stabilize the area surrounding the malleoli.
• Using the bottom hand, cup the patient's heel, then slide the forearm along the bottom of the foot.
• Using the thumb and fingers, pull the calcaneus distally while pressing upward with the forearm.

NOTE:

The ankle joint can be fully extended if the knee is flexed. The two-joint gastrocnemius muscle can extend its range when the knee is extended, however the gastrocnemius also restricts the whole range of dorsiflexion. To give the joint and the muscle range, apply dorsiflexion in both knee positions.

Ankle: Plantarflexion

Hand Placement and Procedure

• Use your bottom hand to support the heel.
• Press the top hand into plantarflexion by placing it on the dorsum of the foot.

NOTE:

This motion may not be necessary in bedridden individuals because the weight of the blankets and gravity tend to cause the ankle to assume a plantarflexed position.

Subtalar (Lower Ankle) Joint: Inversion and Eversion

Hand Placement and Procedure

• Place the fingers lateral to the joint on either side of the heel and the thumb medial using the bottom hand.
• The heel may be turned both ways.

NOTE:

The foot's supination and eversion can be coupled, as well as its pronation and eversion.

Transverse Tarsal Joint

Hand Placement and Procedure

• Using one hand, stabilize the patient's calcaneus and talus.
• Grip the cuboid and navicular with the other hand.
• Alternately raise and drop the arch to gently rotate the midfoot.

Joints of the Toes: Flexion and Extension and Abduction and Adduction (Metatarsophalangeal and Interphalangeal Joints)

Hand Placement and Procedure

• Using one hand, stabilize the bone closest to the intended joint, and use the other to slide the bone farther away.
• The method is identical to that for finger ROM.
• If caution is used not to put undue strain on any structures, it is possible to move multiple toe joints at once.

Cervical Spine

Flexion (Forward Bending)

Procedure

• To flex the head on the neck, raise the head as if nodding (chin toward larynx).
• After nodding fully, raise the head toward the sternum while maintaining cervical spine flexion.

Extension (Backward Bending or Hyperextension)

Tip the head backward.

NOTE:

To extend the cervical spine in its entirety when the patient is supine, the head must clear the end of the tab, which only extends the upper cervical spine. Additionally, the patient may be sitting or prone.

Lateral Flexion (Side Bending) and Rotation

Procedure

As you guide the head and neck into side bending (approximate the ear toward the shoulder) and rotation (rotate from side to side), keep the cervical spine neutral to flexion and extension.

Lumbar Spine

Flexion

Hand Placement and Procedure

Maintain the cervical spine neutral to flexion and extension as you move the head and neck into side bending (approximately the ear toward the shoulder) and rotation (rotate from side to side).

Extension

The patient should be positioned prone for hyperextension, or full extension.

Hand Placement and Procedure

Raise your thighs until the lumbar spine expands and the pelvis rotates anteriorly, using your hands underneath your thighs.

Rotation

With their feet resting on the table and their hips and knees bent, place the patient in the hook-lying position.

Hand Placement and Procedure

• Once the pelvis on the other side lifts off the treatment table, push both of the patient's knees laterally in the same direction.
• Carry out the opposite direction.
• Use the top hand to stabilize the patient's chest.

 

CLINICAL TIP

1. It is possible to provide ROM that is both effective and efficient by combining multiple joint motions that result in oblique, functional, or diagonal patterns that cross multiple planes. 
2. For instance, shoulder flexion combined with abduction and lateral rotation, or wrist flexion combined with ulnar deviation.
3. Make use of patterns that imitate functional actions, such as rotating the neck and moving the hand behind the head as when combing hair.
4. For PROM, AROM, or A-AROM procedures, proprioceptive neuromuscular facilitation (PNF) patterns of movement may be employed with good results.