Differentiating Active, Passive, and Resisted Range of Motion in Clinical Assessment

PROM is the most critical tool for isolating joint-specific issues. Because the patient's muscles are not contracting, any pain or restriction felt during PROM is likely related to the passive structures of the joint, such as the joint capsule, ligaments, or intra-articular surfaces.

Clinical Pearl: If PROM is greater than AROM, the problem is likely "active" in nature (e.g., muscle weakness or a nerve issue). If PROM and AROM are both limited and equal, the problem is likely "passive" in nature (e.g., a joint contracture or capsular tightness).

Resisted Range of Motion (RROM)

Resisted Range of Motion, often referred to as Manual Muscle Testing (MMT), is used to assess the integrity and strength of the contractile tissues (muscles and tendons). To perform this, the clinician asks the patient to attempt a movement while the clinician applies an opposing force to prevent the movement from occurring.

RROM is specifically designed to stress the muscle-tendon unit. If a patient experiences pain during RROM but has full, pain-free PROM, the clinician can narrow the source of the pain down to the muscle or the tendon rather than the joint itself.

The Differential Diagnosis Framework

To master movement testing, you must learn to synthesize these three findings. The following table serves as a mental heuristic for clinical reasoning:

Worked Example: The Shoulder

Imagine a patient presents with lateral shoulder pain. Let's apply the testing sequence:

1. AROM: The patient attempts to lift their arm to the side. They stop at 90 degrees due to sharp pain.
2. PROM: The clinician lifts the patient's arm to 170 degrees. The patient feels a "stretch" but no sharp pain.
3. RROM: The clinician asks the patient to hold their arm at 90 degrees while the clinician pushes down. The patient experiences sharp pain.

Analysis:

• Since PROM > AROM, we know the joint itself is capable of moving through a large range.
• Since RROM is painful, we have isolated the pain to the contractile tissue.
• Conclusion: The pathology is likely in the rotator cuff muscles or tendons (e.g., tendinopathy or a tear), rather than the glenohumeral joint capsule.

Exam Tip: Always test the "unaffected" side first. This provides a baseline for what is "normal" for that specific patient's anatomy and flexibility.

By following this systematic approach—moving from the most holistic (AROM) to the most specific (RROM)—you can effectively filter out irrelevant structures and focus your treatment on the true source of the patient's dysfunction.