What is range of motion and why is it important to maintain after a spinal cord injury?

Range of motion is a term that we use as therapists to indicate the flexibility of someone’s arms, legs or trunk. And so, we often discuss range of motion in that we would like the extremities—the legs and the arms—to be stretched and maintain their flexibility, which is really important for those mobility skills. The activities that person will be doing throughout that day in order to have that flexibility, they need to maintain their range of motion, as well as to be able to sit in the wheelchair in a way that is stable, and upright and prevents pressure ulcers.

Range of motion is the amount of movement that's available at any given joint in our body. So, for instance, my wrist, it's how far does it bend back and how far does it bend forward. That's important because it allows our body to move, and in order to be able to move appropriately, we need to have as much flexibility and as much motion in every single joint in our body as normal parameters. With a spinal cord injury that can be impacted by loss of muscle use where the joints don't get moved as frequently-people may be sitting in their chair 15 hours a day and we don't want them to get stuck in a bent-chair seated position, we want them to be able to stretch out straight and lie down in bed and be in a full relaxed position. So range of motion as we refer to it in spinal cord injury, is the act of taking somebody through the full movement of each of their joints in order to preserve that movement. The physical therapist will-well there are several ways when somebody is newly injured and not able to do it themselves-the physical therapist will do the movement for the person, and as the person starts to learn better mobility skills in moving their body around in space, we will teach that person how to do that themselves so they stretch each joints just in the same way that if you don't have a spinal cord injury, you need to do a stretching program. We teach you how to do your own self-stretching program, and if you're not able to do your own self-stretching program, we'll teach how to teach somebody else to do it for you, and what your needs are in that area.

With range of motion what we want to do is teach the family and the patient how to instruct somebody if they can’t do the range of motion independently on stretching their legs on a daily basis. It’s the same thing if you or I were going to get up in the morning and stretch, you feel better afterwards. But for someone with a spinal cord injury, it’s more important because we want to make sure that the muscles of their legs stay long, lean and flexible. Part of that is teaching the patient and the family, if the family is going to be able to help with it, the appropriate techniques in order to perform. You see in movies all the time, the very dramatic scene in the hospital where they’re going back and forth, and faster, faster and push harder. And truthfully we don’t teach that because it’s not appropriate. It’s great for a Hollywood movie, but it’s not appropriate for real life. If you do the very fast and very hard stretching it can actually make somebody’s’ spasticity worse. So we teach the appropriate sequencing, we want to keep that person’s legs long, lean and flexible, like I said, so that if they’re going to get return of movement, their legs will be ready for it. And if they’re not at this time going to get that return of movement, what we can do is prepare their body for when that time comes.