What are the four types of therapeutic ROM?

October 2, 2025 •

4 min read

According to research from the National Institutes of Health, restricted range of motion is a leading cause of disability. Understanding the core principles and different techniques is crucial for effective rehabilitation. So, what are the four types of therapeutic ROM that physical therapists use?

Quick Summary

The four main types of therapeutic Range of Motion (ROM) are Active ROM, Active-Assistive ROM, Passive ROM, and Resistive ROM, each differing in the level of assistance required and the patient's effort.

Key Points

Active ROM: The patient moves the joint independently, building strength and flexibility without assistance.
Passive ROM: An external force moves the patient's joint, preventing stiffness and maintaining tissue health when the patient cannot move it themselves.
Active-Assistive ROM: The patient initiates movement with help from a therapist or device, bridging the gap between passive and active exercise.
Resistive ROM: The patient moves the joint against resistance, typically in advanced rehab, to build muscle strength and power.
Importance of Assessment: A physical therapist determines the correct ROM type based on the patient's needs, stage of recovery, and specific condition.
Progressive Recovery: Therapeutic ROM often starts with passive movements and progresses to active and resistive exercises as strength and mobility improve.
Prevents Contractures: Passive and active-assistive ROM are crucial for preventing joint stiffness and the development of contractures in immobile patients.

Understanding Range of Motion (ROM)

Range of Motion (ROM) is the measurement of movement around a specific joint or body part. It is a critical component of physical therapy and rehabilitation, particularly for individuals recovering from injury, surgery, or dealing with chronic conditions like arthritis. When a joint's movement is restricted, it can impact daily activities, cause pain, and lead to muscle weakness or atrophy. Therapeutic ROM is performed through specific exercises designed to increase joint movement and flexibility, helping to restore function and improve overall quality of life. Understanding these different types is key to a successful recovery.

Type 1: Active Range of Motion (AROM)

Active Range of Motion involves the patient independently moving a joint through its full available range without any external assistance. This type of exercise requires the patient to contract their own muscles, promoting muscle strength, endurance, and joint mobility. It is typically used in the later stages of rehabilitation when the patient has sufficient muscle strength and control to move the joint safely on their own. For example, a patient might perform active ROM exercises by lifting their arm over their head or bending their knee without any help.

Goals of Active ROM:

Increase muscle strength and endurance.
Improve joint flexibility and mobility.
Maintain existing range of motion.
Enhance coordination and motor control.

Type 2: Passive Range of Motion (PROM)

In Passive Range of Motion, an external force, such as a physical therapist, caregiver, or a machine, moves the patient's joint through its range of motion. The patient does not actively use their own muscles during PROM. This method is often used immediately after an injury or surgery, or for patients with paralysis, weakness, or unconsciousness. The primary goal of PROM is to prevent joint stiffness, contractures, and to maintain the integrity of the joint's tissues. It also helps to reduce pain and promote circulation in the affected area. An example is a therapist gently moving a patient's leg and foot to stretch the muscles and joint after knee surgery.

Benefits of Passive ROM:

Prevents joint stiffness and contractures.
Maintains flexibility of soft tissues and joint structures.
Reduces pain and muscle tension.
Improves circulation to the joint.

Type 3: Active-Assistive Range of Motion (AAROM)

Active-Assistive Range of Motion is a hybrid approach where the patient initiates the movement of the joint, but an external force provides partial assistance to complete the full range. This is crucial for patients who have some muscle control but are not strong enough to move the joint independently throughout its full arc of motion. The assistance can come from a therapist, a pulley system, or even the patient's other limb. AAROM helps strengthen the muscles while protecting the healing joint, and it serves as a bridge between passive and active exercises.

How Active-Assistive ROM works:

The patient uses their own muscles to begin the movement.
A therapist or device provides support to overcome weakness or pain.
It promotes muscle re-education and gradual strength gains.

Type 4: Resistive Range of Motion (RROM)

Resistive Range of Motion involves the patient moving a joint against an opposing, resistant force. This is a more advanced form of therapeutic exercise used to build significant muscle strength and power once a certain level of active ROM has been achieved. Resistance can be applied manually by a therapist or with equipment such as resistance bands, weights, or machines. The intensity of resistance can be progressively increased to challenge the muscles and promote greater strength and endurance. RROM is essential for helping patients regain the strength needed for functional daily activities and athletic performance.

Types of resistive exercises:

Manual Resistance: Therapist applies resistance against the patient's movement.
Mechanical Resistance: Uses equipment like weights or bands.
Isometrics: Muscle contraction without joint movement, used for early strengthening.

A Comparison of Therapeutic ROM Types


Feature	Active ROM (AROM)	Passive ROM (PROM)	Active-Assistive ROM (AAROM)	Resistive ROM (RROM)
Patient Effort	Full, independent effort	None	Partial effort, with assistance	Full effort against resistance
Therapist Role	Guidance and supervision	Full movement of joint	Assists to complete movement	Applies manual or mechanical resistance
Primary Goal	Strength and mobility	Prevent stiffness, maintain joint health	Progress from passive to active movement	Build muscle strength and power
Example	Patient independently lifts their arm	Therapist moves patient's relaxed arm	Patient lifts arm with therapist's help	Patient pushes against a band
Best For	Intermediate to late rehab stages	Early rehab, paralysis, severe pain	Transition from passive to active movement	Advanced strength and function

Conclusion: Selecting the Right Therapeutic ROM

Choosing the right type of therapeutic ROM is critical for a successful rehabilitation program and depends heavily on the patient's specific condition, stage of recovery, and overall health. A qualified healthcare professional, such as a physical or occupational therapist, will perform a comprehensive assessment to determine the most appropriate and effective type of ROM exercises. As recovery progresses, a patient's program will likely transition from passive and active-assistive exercises to active and resistive ones. This progressive approach ensures safety, promotes healing, and maximizes the potential for restoring full function and mobility, ultimately empowering the patient to regain independence.

To learn more about therapeutic exercises and conditions, visit the official website of the American Physical Therapy Association [https://www.apta.org/].

Frequently Asked Questions

The primary purpose of therapeutic ROM exercises is to improve joint flexibility, maintain or increase muscle strength, prevent joint stiffness, and restore functional movement after an injury, surgery, or due to a medical condition.

Active ROM requires the patient to move the joint using their own muscle power, while Passive ROM involves an external force (like a therapist or a machine) moving the joint without any effort from the patient.

Active-Assistive ROM is used when a patient has some muscle control but lacks the strength or endurance to move a joint through its full range of motion independently. It helps them gradually progress toward unassisted movement.

While some exercises can be performed independently, it is crucial to first consult a physical therapist. They can create a customized plan and ensure you are performing the correct type of ROM exercises safely and effectively for your specific condition.

A physical therapist assesses your condition, determines the appropriate type of ROM, and guides you through exercises. They may provide manual assistance, apply resistance, or use equipment to maximize your recovery and progress safely.

No, Resistive ROM is typically introduced in the later stages of rehabilitation when the patient has regained a baseline level of strength and stability. It is not suitable for early recovery or for joints that are too weak or painful to handle resistance.

The duration of therapeutic ROM sessions varies depending on the patient's condition and goals. A session might include various exercises for different joints and can last anywhere from 15 to 60 minutes, as determined by the therapist.