MEDICAL PHYSICAL AND REHABILITATION JANUARY 2017

DEPARTMENT
MEDICAL FACULTY
HASANUDDIN UNIVERSITY

RANGE OF MOTION AND DOUBLE-CRUTCH USAGE

BY:
Siti Hawa Binti Abd Rani C111 12 818
Fatin Najihah Binti Razali C111 12 821

SUPERVISOR:
dr. Anshory Sahlan, Sp. KFR

FOR CLINICAL POSTING OF

MEDICAL PHYSICAL AND REHABILITATION DEPARTMENT
MEDICAL FACULTY
HASANUDDIN UNIVERSITY
MAKASSAR
2017
RANGE OF MOTION

Range of motion (ROM) exercises are done to preserve flexibility and mobility of the
joints on which they are performed. These exercises reduce stiffness and will prevent or at least
slow down the freezing of your joints as the disease progresses and you move less often. Range
of motion is the term that is used to describe the amount of movement you have at each joint.
Every joint in the body has a "normal" range of motion. Joints maintain their normal range of
motion by being moved. It is therefore very important to move all your joints every day. Stiff
joints can cause pain and can make it hard for you to do your normal daily activities.

There are different kinds of ROM exercises. There are stretching exercises you can do
yourself when you still have the muscle strength to move your joints through their complete
ranges. These are called Active ROM exercises. There are Self-ROM exercises which involve
using a stronger arm to assist a weaker arm to perform the exercises, eliminating the need for
caregiver assistance. Then there are Passive ROM exercises which are done by a caregiver. Often
a combination of the types of ROM exercises above will be used. For instance if you have
strong arms but very weak legs, he would use an active ROM program for the arms
independently and a passive ROM program for the legs. Even within a limb the type of exercise
used can vary depending on the strength of the different muscle groups. PALS with increased
muscle tone (spasticity) will also need to learn techniques to decrease the tone before exercising.

Fatigue will only increase your weakness and rob you of energy that you need for your
daily routines and the activities you enjoy. If you find that your prescribed set of exercises tires
you, talk to your therapist. Changes can be made that will eliminate the risk of fatigue. Similarly,
none of your exercises should cause you pain. If you do experience pain when exercising, stop
that exercise and talk to your therapist. It may be that you are not doing the exercise correctly, or
perhaps some modification to your exercise program must be made. If your joints are very
painful and swollen, move them gently through their range of motion. These exercises should be
done slowly and steadily. It is important with ROM exercises not to force movements and to stop
a movement if it causes you pain. Damage to the joint space can occur if too much force is
applied. Joint range of motion is done on one joint at a time. Stabilize with one hand just above
the joint and place your other hand below the joint to move the part through its full range of
motion. Your physical therapist will tell you how many times to do each one.
Normal values for range of motion of the joints

Joint Motion Range ()

Hip Flexion 0-125
Extension 115-0
Hyperextension 0-15
Abduction 0-45
Adduction 45-0
Lateral rotation 0-45
Medial rotation 0-45
Knee Flexion 0-130
Extension 120-0
Ankle Plantar flexion 0-35
Dorsiflexion 0-25
Metatarsophalangeal joints Flexion 0-30
Extension 0-80
Interphalangeal joint of toes Flexion 0-50
Extension 50-0
Shoulder Flexion to 90 0-90
Extension 0-50
Abduction to 90 0-90
Adduction 90-0
Lateral rotation 0-90
Medial rotation 0-90
Elbow Flexion 0-160
Extension 145-0
Pronation 0-90
Supination 0-90
Wrist Flexion 0-90
Extension 0-70
Abduction 0-25
Adduction 0-65
Metacarpophalangeal joints Abduction 0-25
Adduction 25-0
Flexion 0-90
Extension 0-30
Interphalangeal proximal Flexion 0-120
joints of fingers Extension 120-0
Interphalangeal distal joints of Flexion 0-80
fingers Extension 80-0
Metacarpophalangeal joints of Abduction 0-50
thumb Adduction 40-0
Flexion 0-70
Extension 60-0
Interphalangeal joints of Flexion 0-90
thumb Extension 90-0

General instructions:

- Ideally, these exercises should be done once per day.

- Do each exercise 10 times or move to the point of resistance and hold for 30 seconds.
- Begin exercises slowly, doing each exercise a few times only and gradually build up to
more.
- Try to achieve full range of motion by moving until you feel a slight stretch, but don't
force a movement.
- Move only to the point of resistance. Do not force the movement.
- Keep limbs supported throughout motion.
- Move slowly, watching the patient's face for response to ROM.

Lower Extremity Passive ROM Exercises

Lower extremity passive exercises are for someone else to stretch your hips, legs, and knees if
you are unable to do this yourself. These exercises should be done slowly and gently while you
are lying on your back. Each exercise should be done ten times on each leg each day.

Hip and Knee Flexion

Cradle the leg by placing one hand

under the bent knee. With the other
hand, grasp the heel for stabilization.
Lift the knee and bend it toward the
chest, with the knee cappointed toward
the ceiling. Do not allow the hip to
twist during this movement. The foot
should stay in a straight line with the
hip and not swing in or out. The leg is
then lowered to the starting position.
Hip Rotation

Place one hand on the thigh and other

hand just below the knee. Bend the
knee halfway to the chest so that there
is a 90 degree angle at the hip and
knee. Pull the foot toward you and then
push it away. Remember, do not go
beyond the point of resistance or pain.
Lower leg to starting position.

Hip Abduction

Cradle the leg by placing your hand

under the knee and holding it. Place the
other hand under the heel to stabilize
the hip joint. Keeping the knee straight,
move the leg along the surface of the
bed, toward you and away from the
other leg, to approximately 45 degrees.
Then bring the leg back to the other
leg.

Ankle Rotation

With the knee straight and one hand

holding the ankle steady, place the
other hand around the foot and
turn foot inward, then outward.
Toe Flexion and Extension

With one hand, stabilize the foot just

below the toes. With the other hand,
gently move each or all of the toes
forward and backward.

Toe extension Toe flexion

Upper Extremity Passive ROM Exercises

Upper extremity, passive ROM exercises teach someone else how to stretch your arms if you are
unable to move your arms by yourself. These exercises should be done slowly and gently, and
can be done with the person sitting in a chair or lying down. Do each exercise ten times.

Elbow Flexion and Extension

Hold the upper arm with one hand and

forearm with the other hand. Bend the
arm at the elbow so that the hand touches
the shoulder. Then straighten the arm all
the way out.

Shoulder Flexion and Extension

Hold the wrist with one hand. With the

other hand, grasp the elbow joint to
stabilize it. Turn the palm inward, facing
the body, and keep the elbow relatively
straight. Move the arm from the side of
the body over the head.
Shoulder Internal and External
Rotation

Place one hand under the elbow. With

your other hand, hold the forearm. Bring
arm out to the side to shoulder level.
Turn arm so that the hand points to the
ceiling. Then turn arm back down so that
hand points to floor and the upper arm is
twisting in the shoulder joint.

Horizontal Shoulder Abduction

Place hands behind or above head.

Gently touch elbows to bed and hold as
tolerated.

Stretch felt in chest. Pull arm across

chest. Stretch is felt in back of arm and
shoulder.
Finger and Wrist Flexion and
Extension

Hold the forearm above the wrist with

one hand and grasp the fingers with your
other hand. Holding the hand in this way,
bend the wrist back, about 90 degrees,
while straightening the fingers out. Then
bend the wrist the opposite direction,
about 90 degrees, while curling the
fingers into a fist.

Wrist flexion Wrist extension

Thumb Flexion and Extension

Move thumb to little finger. Then bend

and straighten the thumb out to the side
to stretch the "web space".
CRUTHCHES

There are 3 basic types of walking crutches and they are used to reduce weight bearing on one or
both legs, or to give additional support where balance is impaired and strength is inadequate.

Axillary Crutches
Elbow Crutches
Forearm Crutches

I. Axillary Crutches:

They are made of wood with an axillary pad, a hand piece and a rubber ferrule. The position of
the hand and the total length are usually adjustable. The axillary pad should rest against
the chest wall approximately 5 cm below the apex of the axilla and the hand grip should be
adjusted to allow the elbow to be slightly flexed when weight is not being taken. Weight is
transmitted down the arm to the hand piece. The elbow is extended. Weight should not be taken
through the axillary pad as this could lead to a neuropraxia of the radial nerve or brachial plexus.

Measurement of length. It is usually carried out with patient in lying.

With shoes off measure from apex of the axilla to the lower margin of the medial malleolus.
With shoes on 5cm below the apex of the axilla to a point 20 cm lateral to the heel of the shoe.
This tends to be less accurate than the first method.

The measurement from the axillary pad to the hand grip should be taken with the elbow slightly
flexed (approximately 15 degree) from a point 5 cm below the apex of the axilla to the styloid
process.

II. Elbow Crutches:

They are made of metal and have a metal or plastic forearm band. They are usually adjustable in
length by means of a press clip or metal button and have a rubber ferrule. These crutches are
particularly suitable for patients with good balance and strong arms. Weight is transmitted
exactly the same way as axillary crutches.

Measurement of length It is usually carried out with patient in lying with shoes on. The elbow
slightly flexed (approximately 15 degree) and the measurement is taken from the ulnar styloid to
a point 20 cm lateral to the heal of the shoe. Once the patient is standing with support, the length
must be checked.
 II. Forearm Crutches/ Gutter crutches/ Adjustable arthritic crutches:

They are made of metal with a padded forearm support and strap, an adjustable hand piece and a
rubber ferrule. These are used for patients with rheumatoid disease, who require some form of
support but cannot take weight through hands, wrists and elbows because of deformity
and/or pain.

Measurement of length If the patient can stand, it is better to assess the required length in this
position from elbow to the floor. Measurement can be carried out with the patient lying with
shoes on, and is taken from the point of flexed elbow to 20 cm lateral to the heel.

Crutch Basics

While you are moving around with crutches:

Let your hands carry your weight, not your armpits.

Look forward when you are walking, not down at your feet.

Use a chair with armrests to make sitting and standing easier.

Make sure your crutches have been adjusted to your height. The top should be 1 to 1 1/2 inches
(2.5 to 4 centimeters) below your armpit. The handles should be at hip level.

Your elbows should be slightly bent when you hold the handles.

Keep the tips of your crutches about 3 inches (7.5 centimeters) away from your feet so that you
do not trip.

Rest your crutches upside down when you are not using them so that they do not fall down.
 Walking and Turning

When you walk using crutches, you will move your crutches forward ahead of your weak leg.

1. Place your crutches about 1 foot (30 centimeters) in front of you, slightly wider apart than
your body.

2. Lean on the handles of your crutches and move your body forward. Use the crutches for
support. DO NOT step forward on your weak leg.

3. Finish the step by swinging your strong leg forward.

4. Repeat steps 1 through 3 to move forward.

5. Turn by pivoting on your strong leg, not your weak leg.

Sitting and Standing

To sit down:

Back up to a chair, bed, or toilet until the seat touches the back of your legs.

Move your weak leg forward, and balance on your strong leg.
 Hold both crutches in your hand on the same side as your weak leg.

Using your free hand, grab the armrest, the seat of the chair, or the bed or toilet.

Slowly sit down.

To stand up:

Move to the front of your seat and move your weak leg forward.

Hold both crutches in your hand on the same side as your weak leg.

Use your free hand to help you push up from your seat to stand up.

Balance on your strong leg while you place a crutch in each hand.
Stairs

Avoid stairs until you are ready to use them. Before you can go up and down them on your feet,
you can sit down and scoot up or down, one step at a time.

When you are ready to go up and down stairs on your feet, follow these steps. At first, be sure to
practice them with help from someone to support you.

To go up stairs:

1. Step up with your strong leg first.

2. Bring the crutches up, one in each arm.

3. Place your weight on the strong leg and then bring your weak leg up.

To go down stairs:

1. Put your crutches on the step below first, one in each arm.

2. Move your weak leg forward and down. Follow with your strong leg.

3. If there is a handrail, you can hold onto it and hold both crutches on your other side in one
hand. This may feel awkward. So be sure to go slowly until you are comfortable
Non-weight-bearing

Non-weight-bearing is when there is no weight to be placed on the affected leg as per doctors
orders.

1. Standing on your unaffected leg, lift both crutches at the same time and place the crutches
one steps length in front of you.
2. Push down on the handgrips with your hands while squeezing the top of the crutches
between your chest and upper arms.
3. Putting your weight through the handgrips, hop forward with your unaffected leg to meet
the crutches.
4. Repeat the above 3 steps.
Partial weight-bearing

Partial weight-bearing is when put only half (50%) of the body weight through the affected leg
as per doctors orders. This means that they are able to rest some of their weight in the injured
leg, but still not enough that they would be able to walk normally.

1. Standing on your unaffected leg, lift both crutches at the same time and place the crutches
one steps length in front of you.
2. Bring the affected leg forward so that it is in line with the crutches. Only put up to 50%
of your body weight on this leg as place it on the ground.
3. Push down on the handgrips with your hands while squeezing the top of the crutches
between your chest and upper arms.
4. Putting your weight through the handgrips, hop forward with your unaffected leg to meet
the crutches, or slightly ahead of the crutches, making sure that only 50% of your body
weight is put through the affected leg.
5. Repeat the above steps