Course:KIN355/2020 Projects/Altering Range of Motion
Defining the Concept and Its Importance
Range of Motion (ROM) can be operationally defined as the maximum degree of movement that a joint undergoes during exercise performance (Schoenfeld & Grgic, 2020). Therefore, when concerned with the alteration of ROM, the focus is put on changing a joints' movement capabilities through exercise and the factors that contribute to that change. The movement capabilities of a joint can range from flexion, extension, adduction, abduction, and lateral and medial rotation (Schoenfeld & Grgic, 2020). Within the scope of ROM, there are three different types of exercises that are all important in the alteration of a joints' potential: active, passive, and active-assist (Page, 2012). Active range of motion (AROM) is the movement of the joint conducted entirely by the individual, whereas passive range of motion (PROM) is movement provided by a joint with the assistance of a partner (Page, 2012). On the other hand, active-assist (AA) range of motion is a form of movement with partial-assistance. As a whole, ROM is dependent on joint range and muscle length, reflecting the properties of bony structure, muscle and connective tissue (Mandrusiak, Giraud, MacDonald, Wilson, & Watter, 2010).
In a broader sense, ROM is a factor contributing to a person's musculoskeletal conditions (BC Government). With this in mind, it is important to understand and recognize that the quality of human movement has a direct relationship with ROM (Page, 2012). One way to quantifiably increase the ROM of a joint is through stretching, impacting muscular, and connective tissue flexibility (Page, 2012). Physical fitness, one of the most important health aspects in childhood, is a product of flexibility in certain domains. For example, it is known that children with low hamstring flexibility (in turn low ROM at the hip joint) are at a higher risk of developing spinal conditions, neck tension, and lower back pain that can persist into adulthood (Lambert, et al., 2017). In addition, ROM has been suggested to influence the parameters of muscular performance in those muscles surrounding the joint, as well as play an important role in the prevention and avoidance of injuries obtained from partaking in physical activity (Ferreria, Teexeria-Salmela, & Guimaraes, 2007; Ferreria, Teexeria-Salmela, & Guimaraes, 2007). In essence, it is important for early childhood educators to implement this into their lesson plans to ensure a child's healthy development, motor behaviors, and ultimately a comprehensive relationship with physical activity.
Role in Childhood Development and Contemporary Considerations
ROM underlies all of human movement, therefore it is of paramount importance when considering the role it plays in lifespan childhood development. As a fetus, the impacts of limited joint movement can be observed amongst those with Arthrogryposis: a syndrome characterized by multiple joint contractures and therefore decreasing the amount of movement performed by the fetus in utero (Kowalczyk & Felus, 2016). Inherently, this lack of joint movement results in abnormal connective tissue surrounding the joint which are not stretched to their normal length (Ferguson & Wainwright, 2013). Stretching, specifically active stretching, of the muscle fibers is crucial to increasing ROM (Page, 2012). Consequently, this further impacts the development of growing muscles and tendons ultimately resulting in muscle weakness and stiffness (Ferguson & Wainwright, 2013). This immobility further impacts the range of motion through the joint surfaces becoming incongruent and flattened (Ferguson & Wainwright, 2013). Shifting the focus from a limited range of motion, one can also look at how hypermobility impacts the development on children. Abstract Background Generalised Joint Hypermobility (GJH) refers to the ability to move the joint beyond the normal range (Juul-Kristensen, Ostengaard, Hansen, Boyle, Junge, & Hestbaek, 2017). When a child is double-jointed or has GJH, there is evidence to suggest it can reduce the total muscle strength, specifically concerning the knee joint and the hamstring-quadriceps muscles (Scheper, Engelbert, Rameckers, Verbunt, Remvig, & Juul-Kristensen, 2013). In addition, children shown to have hypermobility in their joints have delayed/insufficient motor capability characterized as clumsiness and poor coordination (Scheper, Engelbert, Rameckers, Verbunt, Remvig, & Juul-Kristensen, 2013). When unaccompanied with pain, termed Joint Hypermobility Syndrome (JHS), there is also an increased association with injuries such as sprains, back pain, and stress fractures (Russek & Errico, 2016). However, the increase in ROM can be an advantage in sport participation (Scheper, Engelbert, Rameckers, Verbunt, Remvig, & Juul-Kristensen, 2013).
Maintaining a broad ROM is crucial due to the fact that muscles will only gain strength in the range in which they are capable of moving (McKay, Baldwin, Ferreira, Simic, Vanicek, & Burns, 2017). In light of these two extremes, one can take away the importance of having comprehensive joint mobility especially in childhood, for it plays a role in musculoskeletal health, gross motor skill acquisition, and a child's subsequent relationship with physical activity and sport.
Children are constantly in a vulnerable state when it comes to their development. Depending on what movement opportunities are presented, the external environment is full of constraints that are readily impacting how the muscles, tendons, and bones interact to create locomotion (Jiang, de Armendi, & Smith, 2017). One topic of interest when it comes to childhood development is the Back to Sleep campaign of 1996, where parents were, and still are, advised to place their children in the supine position to sleep (Jones, 2004). Through research, it has been found that sleeping in the supine position can cause Positional Torticollis (Jones, 2004). This diagnosis is characterized by the unilateral tightening of the sternocleidomastoid, caused by the positional maintenance of an infant's head (Nilesh & Mukherji, 2013). Research has found that in a 2014 study, 46.4% of healthy newborns exhibited these cervical range of motion imbalances (Wittmeier, 2017). This ultimately results in a lateral preference for head position, paired with a restricted range of motion in the cervical region (Anteres, et al., 2018). The effects of this diagnosis ultimately affect force creation due to the limited range in which strength can evolve, resulting in delayed gross motor development throughout the lifespan (head control, running, throwing) (Siegenthaler, 2017).
Practical Applications
Game #1 - Balloon Volleyball
Purpose
This game is used to increase range of motion and strength in upper and lower extremities of the body (Therapy Fun Zone, 1970).
Target Age
Typically, anywhere from 5-12 years of age, however this game can be played at all ages.
Equipment needed
A balloon that is blown up with air from lungs not helium (Therapy Fun Zone, 1970).
A large open space such as a living room, outdoor space, classroom with desks moved to the side or a gymnasium.
Instructions
Find a partner or group to play with and space yourselves out. The object of this game is to keep the balloon off the ground. If the balloon hits the ground, then the game is over. and you “lose”. There is also the option of playing this individually and competing with others to see who can keep the balloon up the longest.
Modifications
This game can be modified in a couple different ways. If the balloon is too easy, then you can switch to a beach ball which is a little bit heavier. This makes it harder to move and get to the ball before it hits the ground since the ball will fall faster causing the participant to push their range of motion. Another way to modify this game is making it only lower body (foot volleyball). This works on the lower body range of motion specifically.
Game #2 – Animal Yoga
Purpose
This game is used to get children stretching their muscles and strengthening their capacity to move further and get their full range of motion while they also have fun (ExtendED notes, 2019).
Target Age
Typically, children 5-10 years old.
Equipment needed
The children and their body are the main things that are needed with an open space as well. You can also add in music to make the activity more enjoyable.
Instructions
This game is similar to normal yoga but with a twist that tends to intrigue young children. The children create poses to imitate their favorite animal. By conducting the activity in this way, the children will have more fun and not really think about how much they are really stretching and helping their range of motion, it will be more of a game for them. Then at the end you can explain what they just did so they understand how much little activities like this help with their healthy development.
Modifications
This activity could be turned into a game of charades, which makes the children still stretch their range of motion with their poses that they choose to do, but also gets them thinking. They could guess what animal and they could also try to guess how that pose is helping with increasing range of motion depending on their capabilities. Another fun way this activity could be modified is getting the children to work together in a group to bend and twist their bodies together to make one image. This really helps with range of motion because most children end up moving and twisting in ways that they never have before. They could become more aware of muscles and parts of their body they never knew existed which in turn will help them become more aware of how they need to develop their range of motion while they are young and developing so they don’t have problems later in life.
Summary
Insert video vignette...as per Section 4 requirements.
References
Anteres, J. B., Jones, M. A., King, J. M., Chen, T. M., Lee, C. M., Macintyre, S., et al. (2018). Non-surgical and Non-pharmacological Interventions for Congenital Muscular Torticollis in the 0-5 Year Age Group. Cochrane Library (3).
BC Government. (n.d.). Musculoskeletal Conditions.
ExtendED Notes. (2019, March). 7 Fun Games and Activities That Promote Balance and Coordination. https://www.extendednotes.com/after-school-articles/7-fun-games-and-activities-that-promote-balance-and-coordination.
Ferguson, J., & Wainwright, A. (2013). Arthrogryposis. Orthopaedics and Trauma , 27 (3), 171-180.
Ferreria, G. N., Teexeria-Salmela, L., & Guimaraes, C. Q. (2007). Gains in Flexibility Related to Measures of Muscular Performance: Impact of Flexibility on Muscular Performance. Clin J Sport Med. , 17 (4).
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Juul-Kristensen, B., Ostengaard, L., Hansen, S., Boyle, E., Junge, T., & Hestbaek, L. (2017). Generalised Joiny Hypermobility and Shoulder Joint Hypermobility,- Risk of Upper Body Musculoskeletal Symptoms and Reduced Quality of Life in the General Population. BMC Musculoskeletal Disorders , 18 (1), 1-9.
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Mandrusiak, A., Giraud, D., MacDonald, J., Wilson, C., & Watter, P. (2010). Muscle Length and Joint Range of Motion in Children with Cystic Fibrosis Compared to Children Developing Typically. Physiotherapy Canada , 62 (2), 141-146.
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Scheper, M. C., Engelbert, R. H., Rameckers, E. A., Verbunt, J., Remvig, L., & Juul-Kristensen, B. (2013). Children with Generalised Joint Hypermobility and Musculoskeletal Complaints: State of the Art on Diagnostics, Clinical Characteristics, and Treatment. BioMed Research International .
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