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Is It Time to Get Rid of Range of Motion Measurements?

POSTED ON IN Latest News Neck/Cervical BY Chris 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?

    comments

    Angilna says

    Love your writing style!

    replies

    David Davenport says

    But Dr. Centeno, on this same " Is it time to retire range of motion ..." page, under "Related Posts," I see:
    "Beware of Lost Hip Range of Motion due to Arthritis!"
    My question is, is hip range of motion still important, or not?

    replies

    Chris Centeno says

    David,
    I can understand that seeming odd! The "Related Posts" are automatically generated by having a similar subject, in this case ROM. Unfortunately, the program doesn't select them based on relevance. The point of the article is that ROM as a single diagnostic tool does not adequately describe what's going on with a joint. One example would be hypermobility, total ROM looks normal, but there can be severe damage occurring on a day to day basis. That said, maintaining Hip Range of Motion is important and certain types of physical therapy like Egoscue are very helpfulin accomplishing that.

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    Lina Torelli says

    what kind of excercise or. ohysical therapy would be helpful for limited extension if an arthritiic knee?

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    Chris Centeno says

    Lina,
    It really depends on the knee. When we treat an arthritic knee we look at the low back, hip, ankle and knee ligaments. What's going on in those areas (some likely causative) along with the degree of arthritis and whether there are bone spurs, etc., would dictate physical therapy.

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    About the Author

    Chris Centeno

    Christopher J. Centeno, M.D. is an international expert and specialist in regenerative medicine and the clinical use of mesenchymal stem cells in orthopedics. He is board certified in physical medicine as well as rehabilitation and in pain management through The American Board of Physical Medicine and Rehabilitation.…

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