Applying steady pressure for 15 to 30 seconds at the end of flexion and extension results in stretching (Figure 1). Range of motion and stretching exercises are often performed together to help maintain and improve range of motion that
is often limited by the soft tissues. It is critical that you do not exceed a range of motion that is comfortable for the
patient. If pain is inflicted, active use of the limb and joint may be reduced. Use analgesics to maximize comfort. Keep in
mind that when patients are nonambulatory, both the injured area and the other portions of the body become less extensible
and can create secondary problems. Be careful to not focus on only one region but consider the entire patient. Additional
benefits from range of motion and stretching exercises are pain reduction, enhanced blood and lymphatic flow, and improved
synovial fluid production and diffusion of nutrients.25
Figure 1. A range of motion exercise of a dog's elbow. While holding the humerus stationary and in a neutral position to
isolate the elbow joint, slowly flex and then extend the elbow.
When performing range of motion exercises, make sure to have the patient in a quiet environment with little external stimuli.
Use adequate support and padding to ensure patient comfort. Lightly stroke and massage the limb to be manipulated for a few
minutes before range of motion exercise. The joint motion should be smooth and controlled, with steady motion through a comfortable
range of extension and flexion. Ideally, the range of motion should involve only one joint at a time while the other joints
assume a neutral position. The excursive movements should start small and increase until the endpoint of the range of motion
is reached and the patient appears to slightly resist, indicated by tensing its limb muscles or turning its head toward the
therapist to indicate early discomfort.
As patient comfort allows, encourage incremental increases in range of motion. With repeated range of motion sessions combined
with some stretching at the end of motion, gradual increases in joint excursion may be expected over the course of several
days to weeks. If much joint capsule fibrosis is present, however, the gains in motion may be less pronounced. Fifteen to
20 repetitions performed two to four times a day is likely sufficient. If you use true stretching, take the joint slightly
beyond comfortable flexion, and hold it for at least 15 to 30 seconds. Then take the joint slightly beyond comfortable extension,
and hold it for at least 15 to 30 seconds.
Special cases, such as articular fractures, physeal fractures, joint contractures, and immobilized joints, may require adaptations
to routine stretching and range of motion protocols. Motions can graduate to a bicycling motion that can simulate or exaggerate
a functional range of motion of all joints simultaneously in a limb. You can objectively assess improved range of motion by
using a goniometer; be sure to record the angle measurements in the medical record. The unaffected contralateral limb can
often be used as a reference. Improvements achieved with range of motion exercises will be slow and gradual. Safety is important,
and it is recommended to have a handler restrain the patient during the initial sessions.
Therapeutic exercises are some of the most beneficial activities in a physical rehabilitation program.2-4,28-31 The degree of activity allowed depends on the surgical procedure performed, the condition of the tissues involved, and the
stage of tissue healing.32 Relatively slow and low-impact exercises are initiated early in the postoperative period, and as limb use and patient comfort
allow, more advanced exercises should be instituted. In all cases, the stage of healing and the strength of tissues must be
considered so that excessive forces are not placed on healing tissues, causing tissue damage.