Decreased Range of Motion Due to Pain
Decreased range of motion (ROM) due to pain is a clinical finding where joint mobility is limited primarily because pain prevents full movement, rather than due to mechanical restrictions or structural abnormalities.
Mechanism and Clinical Significance
Decreased ROM due to pain occurs through several mechanisms:
Pain-related muscle guarding: When movement causes pain, protective muscle spasms limit motion to prevent further discomfort 1
Anticipatory pain avoidance: Patients limit their movement in anticipation of pain, creating a self-imposed restriction 1
Inflammatory processes: Pain from inflammation can restrict movement in affected joints 2
Neuromuscular inhibition: Pain signals can inhibit normal muscle activation patterns needed for full ROM 1
Clinical Assessment
When evaluating decreased ROM due to pain:
Differentiate from mechanical restriction: True mechanical restrictions (like bony impingement) will have a firm end-feel, while pain-limited ROM typically has a softer end-feel with patient resistance 1
Assess pain patterns: Note if pain occurs throughout the range or only at end-range 1
Compare active vs. passive ROM: With pain-limited ROM, passive movement may exceed active movement if the clinician can work through the patient's guarding 1
Document asymmetries: Asymmetrical ROM patterns may indicate underlying pathology, especially in trunk rotation 3
Common Clinical Presentations
Pain-limited ROM presents differently across various conditions:
Hip-related pain: Often shows decreased internal rotation, external rotation, flexion, adduction and abduction 1, 2
Knee conditions: May present with reduced flexion associated with osteophytosis, bony enlargement, and crepitus 2
Cervical spine disorders: Often shows altered ratios between upper and lower cervical ROM contributions 4
Shoulder conditions: Females with shoulder pain show significant ROM limitations particularly in extension 5
Diagnostic Considerations
The diagnostic value of ROM assessment in pain conditions is complex:
Limited diagnostic specificity: ROM testing alone has limited ability to confirm specific diagnoses like femoroacetabular impingement syndrome 1
Imaging correlation required: Diagnostic imaging should never be used in isolation but combined with the patient's symptoms and clinical signs 1
Gender differences: ROM limitations may present differently between males and females, with females generally having greater baseline ROM 5, 6
Age considerations: ROM average values for all joints decrease with advancing age for both men and women 6
Clinical Implications
Understanding pain-limited ROM has important treatment implications:
Addressing pain first: When ROM is limited primarily by pain rather than mechanical factors, pain management may need to precede mobility interventions 7
Muscle strength assessment: People with hip-related pain demonstrate lower strength in multiple planes that should be objectively measured 1
Functional performance evaluation: Assessment of functional tasks is recommended as people with pain-limited ROM often demonstrate impaired performance during functional tasks 1
BMI factor: Higher BMI is associated with lower ROM in patients with early osteoarthritis 2
Common Pitfalls
When assessing decreased ROM due to pain:
Misattributing cause: Don't assume all ROM limitations are structural - pain can be the primary limiting factor 1
Overreliance on imaging: MRI evidence of pathology should be interpreted with caution as asymptomatic individuals may show abnormalities 7
Neglecting functional assessment: ROM measurement alone provides incomplete information without functional task assessment 1
Ignoring asymmetries: Asymmetrical trunk motion may be a biomechanical factor contributing to pain conditions 3
By understanding that decreased ROM due to pain represents a protective response rather than just a mechanical limitation, clinicians can develop more effective treatment approaches that address both the pain and the resulting mobility restrictions.