Some of the most valuable assessment information is derived from relatively simple procedures such as passive range-of-motion tests. While many massage practitioners have been exposed to the fundamental concepts of active and passive range-of-motion testing, most have not learned how to use this information effectively in a clinical environment.
In this article, we will focus particular attention on the “end feel” that is evaluated during passive range-of-motion testing. Valuable information can be derived from thorough examination of the end feel.
To perform a passive movement evaluation, the practitioner instructs the client to relax as much as possible preceding the movement. It is important to have the greatest degree of muscular relaxation prior to beginning the movement, to improve the accuracy of the evaluation and eliminate muscular effort as the cause of any pain that is felt.
One of the most important factors to investigate with passive range-of-motion testing is the end feel. The end feel is the quality of movement perceived by the practitioner at the very end of the available range of motion. The end feel can reveal a great deal about the nature of various pathologies. James Cyriax, the British orthopedic physician who developed one of the most commonly used systems for physical examination, specified six different end feels when he first described them in his writings.1
Bone to bone – This is the sensation when motion is stopped by two bones contacting one another. An example is the end feel for extension of the elbow.
Muscle spasm – When muscles are in spasm, they may abruptly halt motion prior to what should be the normal range of motion. It is likely that pain will be felt at the end of this range, because the muscle in spasm will be stretched.