ROM Exercises

Shoulder Flexion and Extension

Grasp the patients arm under the elbow with your
lower hand.
With the top hand, cross over and grasp the wrist
and palm of the patients hand.
Lift the arm through the available range and
return.
Shoulder Hyperextension
To obtain extension past zero, position the
patients shoulder at the edge of the bed when
supine or position the patient side-lying, prone, or
sitting.
Shoulder Abduction and Adduction
Use the same hand placement as with flexion, but
move the arm out to the side. The elbow may be
flexed.
To reach full range of abduction, there must be
external rotation of the humerus and upward
rotation of the scapula.
Shoulder Internal and External Rotation
If possible, the arm is abducted to 90 ; the
elbow is flexed to 90 ; and the forearm is held
in neutral position. Rotation may also be
performed with the patients arm at the side of
the thorax, but full internal rotation is not
possible in this position.
Grasp the hand and the wrist with your index
finger between the patients thumb and index
finger.
Place your thumb and the rest of your fingers on
either side of the patients wrist, thereby
stabilizing the wrist.
With the other hand, stabilize the elbow.
Rotate the humerus by moving the forearm like

a spoke on a wheel.
Horizontal Abduction and Adduction
To reach full horizontal abduction, position the
patients shoulder at the edge of the table.
Begin with the arm either flexed or abducted
90 .
Hand placement is the same as with flexion,
but turn your body and face the patients head
as you move the patients arm out to the side
and then across the body.
Scapula Elavation and Depression
Position the patient prone, with his or her arm
at the side, or side lying, facing toward you.
Drape the patients arm over your bottom arm.
Cup the top hand over the acromion process
and place the other hand around the inferior
angle of the scapula.
For elevation, depression, protraction, and
retraction, the clavicle also moves as the
scapular motions are directed at the acromion
process.
For rotation, direct the scapular motions at the
inferior angle of the scapula while
simultaneously pushing the acromion in the
opposite direction to create a force couple
turning effect
Elbow Flexion and Extension
Hand placement is the same as with shoulder
flexion except the motion occurs at the elbow
as it is flexed and extended.
Control forearm supination and pronation with
your fingers around the distal forearm.
Perform elbow flexion and extension with the
forearm pronated as well as supinated. The
scapula should not tip forward when the elbow

extends, as it disguises the true range.

Elongation of two-joint biceps brachii muscles
To extend the shoulder beyond zero, position
the patients shoulder at the edge of the table
when supine or position the patient prone
lying, sitting, or standing.
First, pronate the patients forearm by grasping
the wrist and extend the elbow while
supporting it.
Then, extend (hyperextend) the shoulder to the
point of tissue resistance in the anterior arm
region. At this point, full available lengthening
of the two-joint muscle is reached.
Elongation of two-joint long head of triceps brachii muscles
When near-normal range of the triceps brachii
muscle is available, the patient must be sitting
or standing to reach the full ROM. With
marked limitation in muscle range, ROM can
be performed in the supine position.
First, fully flex the patients elbow with one
hand on the distal forearm.
Then, flex the shoulder by lifting up on the
humerus with the other hand under the elbow.
Full available range is reached when
discomfort is experienced in the posterior arm
region.
Forearm Pronation and Supination
Grasp the patients wrist, supporting the hand
with the index finger and placing the thumb
and the rest of the fingers on either side of the
distal forearm.
Stabilize the elbow with the other hand. The
motion is a rolling of the radius around the
ulna at the distal radius
Alternative hand placement: Sandwich the
patients distal forearm between the palms of

both hands.
NOTE: Pronation and supination should be
performed with the elbow both flexed and
extended.
Wrist: Flexion (Palmar Flexion) and Extension (Dorsiflexion); Radial (Abduction) and
Ulnar (Adduction) Deviation
For all wrist motions, grasp the patients hand
just distal to the joint with one hand and
stabilize the forearm with your other hand.
NOTE: The range of the extrinsic muscles to
the fingers affects the range at the wrist if
tension is placed on the tendons as they cross
into the fingers. To obtain full range of the
wrist joint, allow the fingers to move freely as
you move the wrist.

Hand: Cupping and Flattening the Arch of the Hand at the Carpometacarpal and
Intermetacarpal Joints
Face the patients hand; place the fingers of
both of your hands in the palms of the patients
hand and your thenar eminences on the
posterior aspect.
Roll the metacarpals palmarward to increase
the arch and dorsalward to flatten it.
Alternate Hand Placement One hand is
placed on the posterior aspect of the patients
hand, with the fingers and thumb cupping the
metacarpals.
Joints of the Thumb and Fingers: Flexionand Extension and Abduction and Adduction
Depending on the position of the patient,
stabilize the forearm and hand on the bed or
table or against your body.
Move each joint of the patients hand
individually by stabilizing the proximal bone
with the index finger and thumb of one hand

and moving the distal bone with the index

finger and thumb of the other hand.
Alternative Procedure:
Several joints can be moved simultaneously if
proper stabi- lization is provided. Example: To
move all the metacarpopha- langeal joints of
digits 2 through 5, stabilize the metacarpals
with one hand and move all the proximal
phalanges with the other hand.
Elongation of Extrinsic Muscles of the Wrist and Hand: Flexor and Extensor Digitorum
Muscles
First, move the distal interphalangeal joint and stabilize it;
then move the proximal interphalangeal joint.
Hold both these joints at the end of their range; then move
the metacarpophalangeal joint to the end of the available
range.
Stabilize all the finger joints and begin to extend the wrist.
When the patient feels discomfort in the forearm, the
muscles are fully elongated.
Combined Hip and Knee: Flexionand Extension
To reach full range of hip flexion, the knee
must also be flexed to release tension on the
hamstring muscle group. To reach full range of
knee flexion, the hip must be flexed to release
tension on the rectus femoris muscle.
Support and lift the patients leg with the palm
and fingers of the top hand under the patients
knee and the lower hand under the heel.
As the knee flexes full range, swing the fingers
to the side of the thigh.
Hip: Extension (Hyperextension)
If the patient is prone, lift the thigh with the
bottom hand under the patients knee; stabilize
the pelvis with the top hand or arm.
If the patient is side-lying, bring the bottom

hand under the thigh and place the hand on the

anterior surface; sta- bilize the pelvis with the
top hand. For full range of hip ex- tension, do
not flex the knee full range, as the two-joint
rectus femoris would then restrict the range.

Elongation of the Two-Joint Hamstring Muscle Group

Place the lower hand under the patients heel and
the upper hand across the anterior aspect of the
patients knee.
Keep the knee in extension as the hip is flexed.
If the knee requires support, cradle the patients leg
in your lower arm with your elbow flexed under the
calf and your hand across the anterior aspect of the
patients knee. The other hand provides support or
stabilization where needed.

Elongation of the Two-Joint Rectus Femoris Muscle

When supine, stabilize the lumbar spine by
flexing the hip and knee of the opposite lower
extremity and placing the foot on the treatment
table (hook lying).
When prone, stabilize the pelvis with the top hand
Flex the patients knee until tissue resistance is
felt in the anterior thigh, which means the full
available range is reached.
Hip: Abduction and Adduction
Support the patients leg with the upper hand under
the knee and the lower hand under the ankle.
For full range of adduction, the opposite leg needs to
be in a partially abducted position.
Keep the patients hip and knee in extension and
neutral to rotation as abduction and adduction are
performed.

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

Hand Placement and Procedure with the Hip and Knee Extended
Grasp just proximal to the patients knee with the top
hand and just proximal to the ankle with the bottom
hand.
Roll the thigh inward and outward
Hand Placement and Procedure for Rotation with the Hip and Knee Flexed
Flex the patients hip and knee to 90 ; support the knee
with the top hand.
If the knee is unstable, cradle the thigh and support the
proximal calf and knee with the bottom hand.
Rotate the femur by moving the leg like a pendulum.
This hand placement provides some support to the
knee but should be used with caution if there is knee
instability.

Ankle: Dorsiflexion
Stabilize around the malleoli with the top hand.
Cup the patients heel with the bottom hand and
place the forearm along the bottom of the foot.
Pull the calcaneus distalward with the thumb and
fingers while pushing upward with the forearm.
Ankle: Plantarflexion
Support the heel with the bottom hand.
Place the top hand on the dorsum of the foot
and push it into plantarflexion.

Subtalar (Lower Ankle) Joint: Inversion and Eversion

Using the bottom hand, place the thumb medial
and the fingers lateral to the joint on either side
of the heel.

Turn the heel inward and outward.

Transverse Tarsal Joint
Stabilize the patients talus and calcaneus with
one hand.
With the other hand, grasp around the
navicular and cuboid.
Gently rotate the midfoot by lifting and
lowering the arch.

Joints of the Toes: Flexion and Extension and Abduction and Adduction
(Metatarsophalangeal and Interphalangeal Joints)
Stabilize the bone proximal to the joint that is
to be moved with one hand, and move the
distal bone with the other hand.
The technique is the same as for ROM of the
fingers.
Several joints of the toes can be moved
simultaneously if care is taken not to stress any
structure.

CERVICAL SPINE
Flexion (Forward Bending)
Lift the head as though it were nodding (chin
toward larynx) to flex the head on the neck.
Once full nodding is complete, continue to flex
the cervical spine and lift the head toward the
sternum.
Extension (Backward Bending or Hyperextension)
Tip the head backward.

Lateral Flexion (Side Bending) and Rotation

Maintain the cervical spine neutral to flexion

and extension as you direct the head and neck
into side bending (approximate the ear toward
the shoulder) and rotation (rotate from side to
side).

Lumbar Spine
Flexion
Bring both of the patients knees to the chest
by lifting under the knees (hip and knee
flexion).
Flexion of the spine occurs as the hips are
flexed full range and the pelvis starts to rotate
posteriorly.
Greater range of flexion can be obtained by
lifting under the patients sacrum with the
lower hand.

Extension
Position the patient prone for full extension
(hyperextension).
With hands under the thighs, lift the thighs
upward until the pelvis rotates anteriorly and
the lumbar spine extends.
Rotation
Position the patient in hook-lying with hips and
knees flexed and feet resting on the table.
Push both of the patients knees laterally in one
direction until the pelvis on the opposite side
comes up off the treatment table.
Stabilize the patients thorax with the top hand.
Repeat in the opposite direction.