ALS range of motion exercises

Range of Motion Exercises for ALS Patients

Exercise can be used to help ease the symptoms associated with ALS related to loss of muscle strength and its deteriorating effect on joint movement.

It is important, however, that those diagnosed with ALS seek medical advice before they embark on any exercise routine. One reason for this is that the wrong kind of exercise can actually have a detrimental effect on the individual.

Range of motion exercises can help individuals with ALS to maintain flexibility and mobility for as long as possible following their diagnosis .

Here we take a closer look at this type of exercise and how it can help during the progressive stages of ALS.

What are Range of Motion Exercises?

Range of motion (ROM), in a biological sense, refers to the amount of movement that is present in the joints of an individual. The elbow, for example, will have a different range of motion from a shoulder joint. If joints become stiff this can reduce the individual’s mobility and cause pain when movement is attempted.

As ALS progresses, range of motion exercises can help maintain or at least slow down the stiffening of the individual’s joints.

These exercise are usually divided into active and passive.

  • An active exercise would be something like stretching, which the individual can do on their own.
  • A passive exercise is administered by a caregiver or health visitor, usually when the individual is unable to do it on their own.

Benefits of Range of Motion Exercises

ALS range of motion exercises can benefit individuals at various stages of the disease:

  • Moving the joints every day ensures that range of motion and comfort is maintained over a longer period of time.
  • It can prevent or minimize discomfort and pain for the individual.
  • In the earlier stages of the disease, it can help maintain mobility.
  • Exercises target different parts of the body. If initial weakness is in the legs, for example, the focus of the exercise will be on the knee and hip joints.
  • The range of exercises can be adapted depending on the individual’s needs.

Range of Motion Exercise Guidelines

ALS patient performing range of motion exercises with a physiotherapist

Exercise after an ALS diagnosis is a complicated issue, as certain regimes may affect the individual in a detrimental way.

It’s advised to work out any potential range of motion exercise regime with a healthcare professional who has experience in dealing with ALS patients.

  • The exercises should be performed everyday and care should be taken to begin each one slowly.
  • Individuals should ideally repeat each one 10 times and move to the point of resistance for the joint, holding for about half a minute.
  • It’s important not to force any stretch, even if range of movement has decreased.
  • Caregivers applying ROM exercises should carefully watch the patient’s face for a response if they are unable to communicate clearly.

Examples of Range of Motion Exercises

Whilst active range of motion exercises can be performed by the individual themselves, passive ROMs are more complicated because they need to be performed with the help of a caregiver.

Some examples of range of motion exercises include:

Lower Extremity

All these exercises should be performed lying down.

  • Hip and Knee Flexion: Bend the knee, holding the base of the heel and underneath the knee joint or upper calf. Gently bend the knee towards the chest in a straight line. Be careful not to twist the hip joint. Move back and forwards slowly.
  • Hip Rotation: Again, lift the knee, holding the leg just below the joint around the calf. Hold the top the thigh and move it up to a 90° angle. Slowly bring the foot towards you to the point of resistance but no further.
  • Hamstring Stretch: Support the knee and the heel with your hands but keep the leg straight. Lift slowly to stretch the hamstring at the back of the thigh. Lower again and repeat.

Upper Extremity

These can be carried out either whilst sitting in a chair or when lying down.

  • Shoulder Flexion and Extension: Hold the wrist and the elbow. Gently turn the wrist towards the head and move the arm slowly up above the head. Bring the arm back to the original position and repeat.
  • Shoulder Rotation: Place one hand under the elbow and hold the wrist with the other. Pull the arm gently out to the side at shoulder level. Move the hand back and forwards to move the joint in the shoulder.
  • Neck Rotation: Turn the head slowly to the right and then return to the center. Next, turn the neck to the right. Tilt the head slowly to one side and then the other.

With all ALS range of motion exercises, it is really important to ensure that the individual does not go beyond the point of resistance.

For the caregiver, this can be challenging, but it’s all about moving things slowly and stopping when you have reached that point. It’s better to under rotate a joint than to move it too far.