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C.H.A.R.T.S.
"R" Stands for Range Of Motion (ROM)
During your client assessment, you will want to evaluate the range of motion, particularly of the area related to the chief complaint. You are looking for the 3 R's (Range or quantity, Resistance or quality/willingness to move, and Reactivity to the movement). Be especially attentive to the "Comparable Sign." The comparable sign is the client's chief complaint or symptom. If you have your client perform an action that causes pain, however it is not the same pain that he is usually complaining about, then it is not the comparable sign. Reproducing the symptoms/comparable sign will help you figure out the source of the problem.
First have your client perform the movement actively. If he feels symptoms, then you take him through the movement passively. Lastly, test that movement resistively to assess strength. With each of these, you are always looking for the 3 R's. If there is pain prior to applying resistant, your client is highly reactive. Pain with resistance means he is moderately reactive. While pain after resistance means low reactivity.
A normal result of active range of motion is as follows:
-smooth motion at all speeds
-full ROM
-Pain free
-Normal strength
Abnormal result of active range of motion is:
-client resists movement
-painful area in the movement
-pain at end range
-compensations are observed
-you hear joint noises/crackling
Limited active range of motion may be a sign of the following:
-weakness
-tightness
-nerve issues
-internal derangement (you can use special tests to figure this out)
-pain
-tight joint capsule
What does Passive Testing tell you (you take your client through the movement)?
-Normal and pain free means no lesion
-Normal and painful may mean a minor sprain
-Hypomobile and painfree may mean a muscle contracture or joint adhesion
-Hypomobile and painful means acute sprain with guarding
-Hypermobile and painfree means a complete rupture of the tendon
-Hypermobile and painful may mean a partial tear
What does Resistive Testing tell you?
-Strong and no pain: no lesion
-Strong and painful: minor lesion
-Weak and painless: nerve damage or complete rupture
-Weak and painful: partial rupture
When performing Resistive Testing, remember the following:
-Isolate one motion for the test
-Test one joint at a time
-Test the motion at its mid range
-Increase your applied resistance slowly (do not crank on it)
-Hold the resistance 5 seconds
The above information should help a great deal in figuring out the cause of your client's condition.
