Front Matter

Chapter 6 Manual Therapy 127

tissue technique such as ischemic compression.
Table  6.3 shows a list of end‐feels with their
associated sensations.

Assessment of PROM

In addition to end‐feel, assessment of PROM
provides the examiner with information
about the quantity of joint osteokinematic
motion. Quantity of motion is measured with
a goniometer and documented in degrees.
Goniometry provides a baseline measure­
ment from which the effectiveness of the
treatment can be determined. If the contralat­
eral side is without pathology, its ROM can be
used as normal.
A goniometer consists of a fulcrum, a proximal
arm (stable arm), and a distal arm (moving arm).
When measuring the quantity of joint ROM,
the fulcrum is lined up with the approximate
joint axis, the proximal arm is lined up with a
specific proximal bony landmark, and the dis­
tal arm is lined up with a specific distal bony
landmark. Each joint has specific bony land­
marks to insure reproducibility. See Chapter  5
for the landmarks for each joint.

Technique

When assessing PROM, the proximal bony seg­
ment is stabilized and the distal bony segment is
mobilized. In order for the measurement to be
accurate, the patient’s muscles must be relaxed.
The limb is positioned such that joint motion is
not restricted by multijoint muscle tightness. For
example, shoulder flexion ROM must be per­
formed with the elbow in flexion. If the elbow
were extended, ROM would be limited by the
biceps muscle becoming taut. Proper sequencing
for PROM includes moving the joint through the
available PROM, applying overpressure, noting
the end‐feel, and measuring ROM with a goni­
ometer (Figure 6.6). Once end‐feel is determined,
the goniometer is placed on the limb and the
angle is measured. The therapist must be careful
not to block motion with the stabilizing or
mobilizing hand. If a restriction is noted, the
contralateral side is measured.

Treatment of limited PROM

As a treatment, PROM is used as a general
technique to maintain or increase ROM. The

assessment and treatment techniques are iden­

tical except that during treatment the end range

of the movement is held for 10–20 seconds and

repeated 3–5 times. With proper client instruc­

tion, this treatment can be added to the home

program.

Flexibility

Flexibility refers to muscle length and should

not be confused with joint PROM. It is assessed

separately and is an important component of

a thorough musculoskeletal exam. Clinically,

two‐joint or multijoint muscles are most com­

monly tight and/or injured.

Assessment of muscle flexibility

Muscle flexibility is assessed by placing the

limb in the position that is opposite of the

action(s) of the muscle being tested. For

example, the actions of the biceps brachii

muscle are to extend the shoulder and flex

Figure 6.6 Measurement of the shoulder in flexion.

The joint is moved through the available passive range

of motion (PROM) noting the end‐feel. The goniometer is

then placed on the limb and the angle is measured.