Range-of-Motion Charts (Upper Body and Lower Body)

Chart Review by Lucy Whyte Ferguson, DC

Title:

Range-of-Motion Charts (Upper Body and Lower Body)

Authors:

Richard Finn and C.M. Shifflett

Part #:

C-227

These charts are very useful tools for the health care practitioner who treats myofascial pain syndrome. They combine information from Travell and Simons' Myofascial Pain and Dysfunction: The Trigger Point Manual (volumes 1 and 2), and Anatomy Trains, by Tom Myers.

In order to identify the source of myofascial pain, it is very instructive to have the patient go through a series of tests to assess range and patterns of motion. David Simons, MD, has often commented that one of the most reliable ways to identify the muscle that has trigger points responsible for pain is to find the muscle that is painful at the end of a range of motion. Furthermore, in order to restore body balance and reduce the load on muscles with active trigger points, it is helpful to restore normal ranges of motion, even when the motion is not painful. These charts are very complete in the range-of-motion testing that they include, and clearly reflect considerable clinical knowledge on the part of Finn and Shifflett.

I have one criticism of the charts that in no way undermines their usefulness. Two of the tests suggested for strength testing often reflect problems other than myofascial trigger points. For example, when the patient has difficulty going up on toe, the muscle weakness usually involved is a combination of the gastrocnemius and soleus muscles, rather than the posterior tibialis. The usual reason for this weakness is a nerve problem, likely to originate in the lower back. Posterior tibialis weakness is usually reflected in the patient's history of instability and ease of spraining the ankle. A similar comment can be made about the arm abduction, deltoid test. Here, common reasons for weakness include not only myofascial trigger points, but also joint dysfunction or subluxation of the humerus in the glenoid fossa, and tears of rotator cuff muscles (especially supraspinatus) or of the labrum.

But these reasons make these tests all the more important. If test results do not improve dramatically (and continue to improve) with myofascial treatment therapy, the practitioner will know to refer the patient to another health professional to assess these potentially serious problems. Myofascial release techniques are often sufficient to correct a subluxation of the humerus and improve shoulder mechanics, but not always. And serious tears of the rotator cuff muscles or labrum will likely require surgical attention. The myofascial practitioner who makes appropriate referrals when necessary often becomes part of the rehabilitation team after surgery. Therefore, all of the tests noted in these charts are very useful in clinical practice and should enhance the skills of practitioners and the health of their clients/patients.

Dr. Ferguson's Rating:

9.5 out of 10