ROM END FEEL: End Feel when performing Range of Motion Testing
ROM Testing Progression:
- Active Free ROM Testing -the patient actively moves the joint through the motions, relating at which point the pain occurs in the available range.
- Active Assisted ROM Testing – the therapist assists by supporting the limb as the client moves within the pain-free range
- Passive Relaxed ROM Testing – the therapist moves the joint passively throught the motions of that joint, noting any restrictions or hypermobility in the range
- Passive Forced ROM Testing – when the end of the available passive range of motion is reached, the therapist applies a gradual controlled pressure (overpressure) to assess the quality of the tissue resistance to motion (ROM END FEEL)
- Active Resisted ROM Testing -either the patient is asked to contract the muscles while the therapist resists to prevent movement from occuring OR the therapist exerts pressure against the patient’s contraction so that the patient prevents movement from occurring.
ROM End Feel:
Normal End Feel
when the joint has full ROM and the range is stopped by the anatomy of the joint
Abnormal End Feel
When the range of the joint is less or greater than normal and is painful, or when a structure other than the normal anatomy of the joint stops the motion
3 Classic Normal End Feels:
- Bony End Feel – (bone to bone) – this is a hard, unyielding, abrupt sensation that is painless. Eexample: elbow extension
- Soft Tissue Approximation – full range of motion is restricted by the normal muscular bulk- feeling of soft compression and is panless. Tissue meets tissue. Example: flexion of the elbow -biceps
- Tissue Stretch – there is a firm, springy type of movement with a slight give towards the end of the range of motion- normal elastic resistance that is felt when stretching soft tissue. Example: lateral flexion of the cervical spine
6 Classic ABNORMAL End Feels:
- Bone to Bone ( Bony) End Feel – occurs when one would not expect to find a bone to bone end feel – hard, unyielding end feel. Restriction occurs before the normal end of range movement caused by osteophytes, degenerative joint disease, mal-union of joint following a fracture etc.
- Muscle Spasm End Feel – sudden and hard dramatic arrest of movement accompanied by pain which is invoked by the movement. Springy, rebound end feel. Reflexive (protective) muscle guarding designed to prevent further injury.
- Empty End Feel – No physical restriction to the movement but with considerable pain. Maybe full range of motion but with pain. Example: acute bursitis, joint inflammation
- Springy Block End Feel (Internal Derangement) – springy or rebound sensation in a non-capsular pattern. Usually occurs before the end of the normal ROM. Example: loose cartilage, meniscal tissue within joints (eg. torn meniscus won’t be able to extend knee fully)
- Leathery End Feel (Capsular Stretch End Feel) – similar to tissue stretch but occurs when the ROM is reduced. Hard Capsular – thick quality and the limitation comes on abruptly. Soft Capsular- more often seen with acute conditions-stiffness occurs early in the range, increasing until the end of the range is reached.
- Boggy or Soft End Feel – occurs if you have a joint effusion or edema – mushy with soft quality to it -may indicate acute inflammation. Example: acute moderate to severe sprain, ligamentous injury
ROM TESTING: 4 CLASSIC PATTERNS / RESULTS
- Strong & Pain- Free ROM Movement- likely no lesion on the contractile tissue
- Strong & Painful ROM Movement – may indicate a local lesion of the muscle or tendon that is contracting ex. muscle strain, tendonitis
- Weak & Pain- Free ROM Movement – may indicate a rupture of a muscle or lack of integrity of the nerve supply to that muscle
- Weak & Painful ROM Movement – may indicate severe lesion around that joint eg. dislocation or fracture