Edmund M. Kosmahl, PT, EdD

a. the quality of resistance at end of range

b. each joint has a normal end feel at a normal point in the range of motion (ROM)

c. incorrect end feel, or correct end feel at incorrect ROM indicate pathology

d. Terms: I suggest my terms for clarity of communication (to clearly identify the structure that the tester feels is limiting the ROM). Other authors use different terms - eg. hard, firm, soft, etc. I feel these "vague" terms lead to communication errors.

Capsular - indicates that the joint capsule is limiting the ROM. Feels like stretching a leather belt. Example - knee extension.

Ligamentous - indicates that ligament tightness is limiting the ROM. Feels like stretching a leather belt. Example - wrist radial deviation.

Bony - indicates that bone touching bone is limiting the ROM. Feels like pushing two wooden surfaces together. Example - elbow extension.>

Muscle Stretch - indicates that muscle tightness is limiting the ROM. Feels like stretching a bicycle tire innertube. Example - hip flexion while maintaining knee extension (straight leg raise) when hamstrings are tight.

Soft Tissue Approximation - indicates that subcutaneous tissues (muscle bulk, fat) are pushing against each other and limiting the ROM. Feels like squeezing two balloons together. Example - calf pressing against thigh during knee flexion.

Springy - indicates that a loose body is limiting the ROM. Feels "bouncy" like you are compressing a spring. Example - torn meniscal (knee) tissue limiting knee extension.

Empty - indicates that the examiner did not reach the end feel (usually the patient is not willing to allow motion to end of range because of anticipated pain). Feels like the joint has more range available, but the patient is purposefully preventing movement through the full ROM.