Is It Time to Get Rid of Range of Motion Measurements?
POSTED ON 12/15/2016 IN Spine BY Christopher Centeno
If you read my blog, you likely know that I love to be a bit irreverent, especially if it provokes discussion about why we all do the stupid stuff we do. Medicine is rife with sacred cows that nobody dares to touch. One of those in the world of orthopedics and pain medicine is range of motion. I'd like to explore why this is, for the most part, an oversimplified and silly measurement through a new paper that uses it as a golden metric of neck problems.
What Is Range of Motion?
In the spine or in a joint, range of motion is how far you can turn your head, bend your back, or move the joint. It's a simple measurement that can be easily measured with tools that have been around for centuries. However, we're in the midst of a technological revolution that will make the industrial revolution look like a tame English garden party. So why are we still relying on a measurement that can be performed with instruments invented in the 1700s?
The Case for Range of Motion
Range of motion (aka ROM) is the sum total of the joint's ability to function correctly and thus have full and normal motion. If anything is wrong with the joint, it's ROM can be impacted. In the spine, since the ROM we measure is the sum total of the movement of many joints, it tells you something about the state of the whole structure.
The Case for Ditching This Silly Measurement
I can't tell you how many patients I have seen with damaged joints and spines who still have normal ROM. Why? The most frequent cause is instability. The ligaments that hold the joint together have been damaged, and the structure has yet to respond by growing bone spurs. In this case, the joint has major damage that will accelerate arthritis and cause disability, but the range of motion is normal. Now let's go the other direction. An arthritic joint has lost range of motion due to bone spurs, which cause a true block to movement beyond a certain degree. Even if some biologic therapy takes 100% of the patient's pain away, the range of motion won't change. In addition, many patients are walking around right now with abnormal range of motion with no pain and who don't consider themselves disabled.
The New Whiplash Study
The new research used neck ROM measured across many studies to determine if this was different between normal control patients, those with garden-variety neck pain, and those with whiplash. Across more than twenty-three hundred patients, whiplash patients had the least ROM, followed by neck pain patients. Both had less ROM than healthy control patients. The upshot? While it's comforting to see that whiplash patients have a few degrees less range of motion than either garden-variety neck pain or healthy people, I think this measurement does more harm than good. Why? It gives many a physician and physical therapist a false sense of security that if there is no range of motion problem, there's nothing wrong. I can't tell you how many seriously injured patients I've seen through the years who have been told there is nothing wrong with them because they have no range of motion loss. So given that we're embarking on 2017 and the future is almost here, do you think that we can finally either ditch this ancient measurement or at least relegate it to a place where every health professional understands that it needs to be taken with a big grain of salt?
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