END FEEL
END FEEL
• "End Feel" is a type of sensation or feeling that the examiner experienced when the joint is
at the end of its available passive range of motion in assessment.
• There are multiple types of joint end-feels all of which are different for each individual.
• The end of each motion at each joint is limited from further movement by particular
anatomical structures.
• The type of structure that limits a joint has a characteristic feel, which may be detected by
the therapist performing the passive ROM.
• This feeling, which is experienced by the therapist, as resistance or a barrier to further
motion, is called the end-feel.
• Normal end feel is when the joint has full ROM and the range is stopped by the anatomy of the
joint.
• 3 Classic Normal End Feels
1. Bony End Feel (bone to bone): this is a hard, unyielding, abrupt sensation that is painless. Eg
elbow extension.
2. Soft Tissue Approximation: full range of motion is restricted by the normal muscular bulk, feeling
of soft compression, and is painless. Tissue meets tissue. Eg flexion of the elbow, by biceps.
3. Tissue Stretch: there is a firm, springy type of movement with a slight give towards the end of the
range of motion, normal elastic resistance that is felt when stretching soft tissue. eg lateral flexion
of the cervical spine.
NORMAL END FEEL
End-Feel Structure Examples
Soft Soft tissue approximation Knee flexion (contact between soft
tissue of posterior leg and posterior
thigh)
Firm Muscular Stretch Hip flexion with the knee straight
(passive elastic tension of hamstring
muscles
Capsular Stretch Extension of metacarpophalangeal
joints of fingers (tension in the
anterior capsule)
Ligamentous Stretch Forearm supination (tension in the
palmar radioulnar ligament of the
inferior radioulnar joint, interosseous
membrane, oblique cord)
Hard Bone Contacting Bone Elbow extension (contact between the
olecranon process of the ulna and the
olecranon fossa of the humerus
Abnormal End Feel:
• It is when the range of the joint is less or greater than normal and is painful, or when a structure
other than the normal anatomy of the joint stops the motion
6 Classic Abnormal End Feels
1. Bone to Bone (Bony) End Feel: occurs when one would not expect to find a bone to bone end feel,
hard, unyielding end feel. Restriction occurs before the normal end of range movement caused by
osteophytes, degenerative joint disease, mal-union of joint following a fracture etc.
2. Muscle Spasm End Feel: sudden and hard dramatic arrest of movement accompanied by pain
which is invoked by the movement. Springy, rebound end feel. Reflexive (protective) muscle
guarding designed to prevent further injury.
3. Empty End Feel: No physical restriction to the movement but with considerable pain. Maybe full
range of motion but with pain. Example: acute bursitis, joint inflammation
4. Springy Block End Feel (Internal Derangement): springy or rebound sensation in a
non-capsular pattern. Usually occurs before the end of the normal ROM. eg: loose
cartilage, meniscal tissue within joints (eg. torn meniscus won’t be able to extend knee
fully)
5. Leathery End Feel (Capsular Stretch End Feel): similar to tissue stretch but occurs when
the ROM is reduced. Hard Capsular – thick quality and the limitation comes on abruptly.
Soft Capsular- more often seen with acute conditions, stiffness occurs early in the range,
increasing until the end of the range is reached.
6. Boggy or Soft End Feel: occurs if you have a joint effusion or edema, mushy with soft
quality to it -may indicate acute inflammation. eg acute moderate to severe sprain,
ligamentous injury.
Abnormal End Feel Examples
END FEEL EXAMINATION
• When assessing passive movement, the examiner should apply overpressure at the end of the
ROM to determine the quality of end feel ( the sensation the examiner "feels" in the joint as it
reaches the end of the ROM ) of each passive movement.
• Passive ROM, particularly towards the end of the motion, must be performed slowly and carefully
when testing end feel.
• Secure stabilization of the bone proximal to the joint being tested is critical in preventing multiple
joints and structure from moving and interfering with the determination of the end feel
• To be sure that severe symptoms are not provoked. If the patient is able to hold a position at the
end of the physiological ROM without provoking symptoms or if the symptoms ease quickly after
returning to the resting position, then the end feel can be tested.
THANK
YOU
