When evaluating the patient’s range of motion,
if we look at active,
passive, and resistive range of motion,
we can evaluate the myofascial tissues
or strain and the joint tissues or sprain.
Let's talk about what these three terms mean.
Active range of motion
is when the patient does the motion
that you asked them to do on their own.
So would rotate your head to the right, please, Deb? As far as you can?
Now that’s active range of motion
of right rotation.
Passive range of motion is when the clinician
moves the joint through its range of motion
passively without interplay of the patient.
So I’m going to move your head to the right, Deb. You let me do it, okay?
This is passive right rotation of cervical spine.
The most accurate way to measure a joint
is with passive range of motion.
Because what happens sometimes
with active range of motion
if the patient has a muscle injury,
they will guard and won’t go as far
as the true movement is.
And lastly with range of motion,
you can do a resistive range of motion and look for pain with resistance or without pain.
So, Deb would you rotate your head to the right?
Now I’m going to put my hand on her chin,
and hold that, and resist her movement.
That’s good.
And I’m going to ask her
if that causes her any pain or not.
In evaluating a patient for a strain
or injury to the muscle,
or a sprain - injury to the joint,
by doing active, passive and resistive ranges of motion,
we can differentiate between these two diagnostic entities.
If we differentiate between these two,
our clinical treatment can be more specific
improving the prognosis of our patients.
So let's evaluate a patient with a sprain.
We start with passive range of motion.
And we’ll do active range of motion.
And then we’ll do resistive range of motion.
With passive range of motion,
we have the patient
move their head with the doctor moving it.
Okay? So I’m moving the head - and this is passive - and ask the patient what bothers them.
In a sprain, that will be positive
because we’re moving the joints.
Then we have the patient
move their head actively.
So will you rotate for me, Deb?
To the right?
And go to left
and ask them if that bothers them.
In a sprain, that will also bother them
because we’re moving the joints.
Now we’re going to check
resistive range of motion
and check for the integrity of the muscles.
So will you rotate your head gently
against my hand?
Relax.
Let's do this way gently against my hand.
Now, if that does not cause pain,
and we have pain with both active
and passive ranges of motion,
now what we have is a sprain.
Let's evaluate a patient that has just a strain.
We’re going to start with
passive range of motion.
So, I’m going to move the patient’s head
in rotation
and ask them if it bothers them.
In a strain with passive range of motion,
that will not bother them.
Now I’m going to have the patient
do it themselves for active range of motion.
Will you move now?
Okay, will you move this way?
With the active range of motion,
we’re moving the muscles
which are injured and that will cause them pain.
Now we’re going to do resistive range of motion.
Rotate to the right gently a little bit
and to the left.
If that causes them discomfort,
we know we’re dealing with a strain because we’re causing contraction to the muscles
and if the muscles were injured.
Now, we’ve done rotation maneuvers.
In your patient, you may need to do extension maneuvers,
or you may need to do a flexion maneuvers forward,
to identify the area of the muscles involved
and the joints involved,
we’re doing active, passive,
and resistive ranges of motion
of the cervical or the lumbar spine.
Wherever the patient has their chief complaint
following trauma,
you can identify whether the patient has had
an injury to the ligaments of their facet capsules,
or whether they've had an injury to the muscles
or the paraspinal muscles as in strain or both.