Most PF-ROM exercise are very simple, like "hip circles": just use whatever comfortable range of motion you have.
PF-ROM is physical therapy talk for “pain free range of motion.” When a therapist evaluates an injury, he or she will be interested to see how far you can move affected joints without hurting. Sometimes, of course, you can’t move at all without pain. But in most injuries, even many serious ones, you will have at least some painless movement. And whatever you’ve got, you should use. When you are hurt, the pain-free range is your new best friend: that’s the range you’ll be exercising in for a while. Pain free range of motion exercises are also known as “early mobilization.”
Use it or lose it
“Use it or lose it,” they say. And it’s true. While many seemingly simple medical questions are controversial, this one appears to be straightforward: plenty of recent research demonstrates that early mobilization is A Very Good Thing. Safe tissue loading is probably actually anti-inflammatory.1
A 2006 study of people with surgically repaired Achilles tendon ruptures showed that early mobilization “reduces range of motion loss, increases blood supply, and reduces the degree of muscle atrophy that typically occurs after Achilles tendon rupture, thereby decreasing the time to resumption of normal activities.”2 Also this year, researchers in Australia showed that people with hip fractures get better much more quickly if they start walking sooner.3 In 2004, researchers compared 97 whiplash victims treated with collar therapy (immobilization) 103 treated with early mobilization, and the mobilization group improved much more.4
Every injury is a challenge, and challenges are met by breaking them up into smaller, more manageable steps. Pain free range of motion exercises are the “baby steps” that you take at the beginning of a recovery process. When injuries are new, your tissues are fragile and it’s very important to avoid the risk of re-injury, or of collateral injury. Working in your PF-ROM is an inherently safe, easy way to begin the process of rehabilitation — and the sooner you start, the sooner you can get on to bigger challenges.
PF-ROM exercises exist at the easy end of a spectrum of intensity in exercise therapies:
|Mobilize!||25–75||light, very easy|
|Strength Training||6–12||moderate to high|
As you start to heal, you usually don’t have to continue to be so careful. In fact, later in the subacute and chronic stages of healing from serious injuries, people progress to mobilization exercises, and then usually have to deliberately leave their pain-free range and start doing “no pain, no gain” exercises (NPNG-ROM?), endurance and/or strength training, in order to make further progress — the cliché of agonizing daily physical therapy.
But pf-rom is also ideal for old injuries …
PF-ROM exercises and chronic pain
In cases of chronic pain — either injuries that aren’t healing normally, or undiagnosed pain problems that do not go away in a reasonable time-frame — pain free range of motion exercises once again can become relevant. If you are suffering from chronic pain, “baby steps” may once again be necessary in order to heal. Here are three example scenarios:
After months of severe pain, a runner who could not bring herself to rest enough initially to let her shin splints heal develops a “pain syndrome.” That is, the pain of her injury becomes self-sustaining, a neurological problem in which her nerve endings are oversensitized, and now she hurts regardless of whether not anything is still “wrong” with her shins. This is now a much more difficult problem, and the only way she can get out of it is to rest much more completely than she ever would have had to if she’d rested properly in the first place — and “baby steps” are required to learn to use her legs without pain again.
Another common scenario is the patient with severe generalized myofascial pain syndrome — a plague of muscle knots that sustain and complicate an injury, or have completely overshadowed it.
Or consider the person — perhaps you? — who constantly re-injures himself, setting up a vicious cycle of chronic inflammation and extreme vulnerability to re-injury, where the slighest impact or over-stretch sets things off again.
There many variations on these stories. The common theme is that people who have been in pain for a long time often need to “reset” their rehabilitation, come to terms with the fact that the original injury is no longer really the issue, and they have to start over with easy therapeutic exercises and other positive inputs.
How to do it
PF-ROM exercises are easy to improvise, which is why I am happy to recommend them as self-treatment. As long as you honour the spirit of the exercise — pain free! — it is virtually impossible to hurt yourself, or even to waste your time.
Explore the pain-free range of motion of an affected joint. See how far you can go before it hurts. And then repeat that movement rhythmically for 1-10 minutes per session, 1-10 sessions per day. I am suggesting a wide range of possibilities there, because there are so many different variables. Use your judgement, and generally let pain by your guide: if the movement begins to hurt, obviously you should stop.
Often it is necessary to make a movement easier in order to make it pain free, and this is where creativity and experience become important. Here are three examples of improvisations to make range of motion exercises easy enough to be painless:
Frozen shoulder — Frozen shoulder is often so painful that there is basically no such thing as a pain-free range: any attempt to move the shoulder is painful. But by “dangling” the arm, tiny muscle contractions can get the shoulder joint moving painlessly — or without any increase in pain, at any rate.
Ripped biceps — I don’t mean well-defined, I mean torn! A severe muscle strain can make it virtually impossible to contract a muscle without pain. A ripped biceps muscle may not be able to lift the weight of the forearm painlessly … so help it. Reach over with the other hand, and provide enough assistance that the damaged biceps can “lift” your forearm.
Back pain — Acute back pain can be so severe thay any movement causes spasms. So get into the water, where you are much lighter! Even a bathtub may suffice. It is usually possible to do some hip circles in a pool, or to gently flex and extend the lumbar spine in the bathtub (the heat helps too). Water is a terrific place to do pain free range of motion exercises for injuries that are complicated by gravity.
What if you really, truly have no pain-free range of motion?
Then go to the adjacent joints and start moving them! There’s always something. Start where you can.
About Paul Ingraham
I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter., or subscribe:
- Fu S, Thompson CL, Ali A, et al. Mechanical loading inhibits cartilage inflammatory signalling via an HDAC6 and IFT-dependent mechanism regulating primary cilia elongation. Osteoarthritis Cartilage. 2019 Jul;27(7):1064–1074. PubMed 30922983 ❐ PainSci Bibliography 52660 ❐
This is a highly technical petri-dish study of the effect of “exercise” (mechanical loading) on the inflammation signalling of cartilage cells. Basically, they mechanically stressed samples of excised cartilage and cartilage cells. The surprising, good-news result was that the researchers reported that moderate loading actually reduced inflammation. That is, fewer inflammatory signals were produced by the cells.
While it is a near certainty that too much loading would increase inflammatory signalling, it is nifty that mechanical loading in the “just right” Goldilocks zone might actually be anti-inflammatory. This implies a specific and substantive way in which “exercise is medicine.”
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- Oldmeadow LB, Edwards ER, Kimmel LA, et al. No rest for the wounded: early ambulation after hip surgery accelerates recovery. ANZ J Surg. 2006 Jul;76(7):607–611. PubMed 16813627 ❐
- Schnabel M, Ferrari R, Vassiliou T, Kaluza G. Randomised, controlled outcome study of active mobilisation compared with collar therapy for whiplash injury. Emerg Med J. 2004 May;21(3):306–310. PainSci Bibliography 56517 ❐