Range of Motion — Lower Extremities (Hip, Knee, Ankle)

1Step-by-Step Procedure

1. 1

   Wash hands.

2. 2

   Identify the resident and explain the procedure.

3. 3

   Raise the bed to a comfortable working height; lower the side rail on the working side.

4. 4

   Position the resident supine with legs straight.

5. 5

   Expose only the leg being exercised; keep the resident otherwise draped.

6. 6

   Hip flexion/extension: support the leg at the knee and ankle; lift the leg, bending the knee and bringing it toward the chest (hip flexion), then return to flat (extension). Perform 3–5 repetitions.

7. 7

   Hip abduction/adduction: keeping the leg straight, move it out to the side (abduction), then return it to the midline (adduction). Perform 3–5 repetitions.

8. 8

   Hip internal/external rotation: with the leg straight, roll the leg inward (internal rotation) then outward (external rotation). Perform 3–5 repetitions.

9. 9

   Knee flexion/extension: support the thigh and ankle; bend the knee, bringing the heel toward the buttocks (flexion), then straighten (extension). Perform 3–5 repetitions.

10. 10

    Ankle dorsiflexion/plantar flexion: support the lower leg; gently push the foot upward toward the shin (dorsiflexion), then point the foot downward (plantar flexion). Perform 3–5 repetitions.

11. 11

    Ankle eversion/inversion: turn the sole of the foot outward (eversion), then inward (inversion). Perform 3–5 repetitions.

12. 12

    Toe flexion/extension: gently curl the toes (flexion) then straighten them (extension). Perform 3–5 repetitions.

13. 13

    Never force any joint; stop at the point of resistance or if the resident reports pain.

14. 14

    Reposition the resident comfortably after completing all lower extremity exercises.

15. 15

    Lower the bed; raise the side rail.

16. 16

    Wash hands and document.

What the Examiner Is Watching For

• ✓

  Leg is supported at the knee and ankle for all movements.

• ✓

  All joints are exercised: hip, knee, ankle, and toes.

• ✓

  Movements are slow, smooth, and controlled.

• ✓

  Candidate stops if the resident reports discomfort.

• ✓

  Each motion is repeated 3–5 times.

Common Mistakes That Cause Failure

• ⚠

  Supporting only the ankle without supporting the knee — this strains the joint.

• ⚠

  Forcing the leg past natural resistance.

• ⚠

  Forgetting the ankle inversion/eversion movements.

• ⚠

  Moving too fast and losing control of the heavy lower extremity.

• ⚠

  Not covering the resident adequately during the exercise, compromising privacy.

Tips for Exam Day

• →

  Lower extremities are heavy — position yourself close to the bed and use good body mechanics.

• →

  Support at knee and ankle for every lower extremity movement.

• →

  Move through all three joints: hip, knee, ankle (and toes).

• →

  Slow, deliberate movements demonstrate competence.