GONIOMETRY

PRESENTED BY :

MALEEHA AMJED
About The Topic
 What is Goniometry?
• The term goniometry is derived from two Greek words :
Gonia-metron

ANGLE MEASURE

• Therefore, goniometry refers to the measurement of

angles, in particular the measurement of angles created
at human joints by the bones.
 PARTS OF MOTOR
EXAMINATION
1. Nutrition Of Muscle
2. Muscle Tone
3. Reflexes
4. Range Of Motion and TCD’s
5. Manual Muscle Testing
 Why Is It Performed ?
• Determining the presence of joint
impairment
• Developing treatment goals.
• Evaluating progress or lack of progress.
• Modifying treatment.
• Motivating the subject.
• Research
 JOINT PLAY

ARTHROKINEMATIC

COMPONENT
MOVEMENT
JOINT MOTION

PHYSIOLOGICAL/
ANATOMICAL
OSTEOKINEMATIC
MOVEMENT
(Functional)
 PLANES AND AXIS
• Osteo-kinematic motions are described to be taking
place in 3 cardinal planes and axis
 Synovial joint
• Most evolved & hence most mobile type of
joints
• The ends of bony components are free to
move in relation to one another
• Bony components are indirectly
connected to one another by means of a
joint capsule that encloses the joint
 Joint Ranges
Active ROM Passive ROM

• Active motion is the unassisted voluntary

movement of a joint. (Quality of ROM)
• Passive motion is attained by the examiner
without the patient’s assistance. (Quantity of
ROM )
• ** Normally, PROM is slightly greater than
AROM because joints have a small amount of
motion at the end range that is not under
voluntary control.
The barrier Concept
physiologic motion is limited by a
physiologic barrier

tension develops within the

surrounding tissues
(joint capsule, ligaments and
connective tissue)
additional amount of passive range of
motion can be performed
the anatomic barrier
cannot be exceeded
without disrupting
the joints integrity
 SUBDIVISION OF JROM
• Initial ROM
• Middle ROM
• End ROM
Subdivision of
ROM as per
Muscle Work
ACTIVE INSUFFICIENCY?
• Shortest
Flex your wrist
completely possible length of
muscle

• A muscle cant
contract
Attempt to
tighten your fist maximally
across both
joints together

• The multi joint

Much force than long finger flexors
in slightly enter active
extended position
insufficiency
when wrist flexes
 PASSIVE INSUFFICIENCY?
• LONGEST POSSIBLE LENGTH OF MUSCLE
• Muscle cant stretch maximally at both joints together

FLEXION OF THE
FINGERS IS A RESULT
OF INSUFFICIENT
EXTENSIBILTY OF THE
FINGER FLEXORS
STRETCHED OVER
EXTENDED WRIST

EXTENSION OF THE
FINGERS IS A RESULT
OF INSUFFICIENT
LENGTH OF THE
FINGER EXTENSORS
STRETCHED OVER
FLEXED WRIST
 Other Examples of AI PI In Body and
its clinical relevance with
Goniometry
• BICEPS : At the top of curl, (when biceps begin to smash
against forearm), when elbows are lifted
**Shortens biceps over both the shoulder & elbow blade
• Simultaneously lengthening the TRICEPS

• HAMS : When reaching to touch toes

**Lengthening felt as a stretch

• RECTUS FEMORIS : Hip flexion with knee extension(70

degree) is less than hip flexion with knees bent (120 degree)

• GASTROCNEMIUS : Seated calf / heel raise places the

gastrocnemius into active insufficiency since the knee flexes
too much & ankle performs plantarflexion
 MEASURING
JOINT RANGE OF MOTION
• Range Of Motion (ROM) is the arc of motion
that occurs at a joint or a series of joints.

• Three notation systems have been used to

define ROM :
1. The 0 to 180 degree system
2. The 180 to 0 degree system
3. The 360 degree system

 Most commonly used is the 0 to 180 degree

notation system
Prerequisite Knowledge For Measuring
ROM
a) Normal ROM’s (Range)
b) Joint Structure And Function
c) Recommended positioning for self and
patient
d) Bony landmarks related to each joint
e) Alignment of Goniometer
f) Normal end-feel
g) Factors that can alter normal ROM
 Integrity Of
Joint Amount Of
GENDER RELIABILITY Surface Scarring
AGE
Present

FACTORS DETERMINING AMOUNT OF ROM

Shape Of Healt Various Health Of Mobilty &

Articulating h Of diseases/ Surroundin Pliabilty Of Soft
Surface Joint pathologica g Tissues Tissue
l conditions
 Common pathological causes of
ROM Restriction
• Skin/soft tissue contracture
• Arthritis
• Fracture
• Burns
• Muscle weakness/paralysis
• Pain
• Edema
• Spasticity
• Presence of foreign body in the joint
 Prerequisite Skills For Measuring
ROM
• The therapist should be skilled in
 Correct positioning (Pt/ Pt Jt/ PT And
GM)
 Stabilization for measurement
 Palpation
 Alignment
 Recording measurements accurately
 Documentation
• Visual observation of the joint and its
adjacent area is important to look for :
a) Compensatory motions
b) Posture
c) Muscle contour
d) Skin creases
e) Facial expressions
 Testing Procedure
PLACE THE SUBJECT IN TESTING
POSITION

STABILIZE THE PROXIMAL JOINT SEGMENT

MOVE THE DISTAL JOINT SEGMENT TO ZERO STARTING POSITION. SLOWLY

MOVE THE DISTAL JOINT SEGMENT TO THE END OF PASSIVE ROM AND
DETERMINE END FEEL

MAKE VISUAL ESTIMATE OF THE ROM

RETURN THE DISTAL JOINT SEGMENT TO THE STARTING

POSITION

PALPATE THE BONY ANATOMICAL LANDMARKS

ALIGN THE GONIOMETER

 READ & RECORD THE STARTING POSITION.
REMOVE THE GONIOMETER

STABILIZE THE PROXIMAL JOINT SEGMENT

MOVE THE DISTAL SEGMENT

THROUGH FULL ROM

REPLACE & REALIGN THE GONIOMETER. PALPATE THE ANATOMICAL LAND

MARKS AGAIN IF NECESSARY

READ & RECORD THE ROM

 Joint Mobility Scale
Hyper Mobility Exercise, Bracing
(Mild, Moderate, surgery
Severe)

Normal mobility Normal function

N

Hypo Mobility Exercise,

(Mild, Moderate, Mobilization, surgery
Severe)
 Documentation
• Hypo Mobility : A motion that does not start with 0
degree or ends prematurely indicates joint
hypomobility
 Example : if knee joint has 30 degree of
hypomobility in flexion, it would be recorded as 30
– 135 deg

• Hyper Mobility : Joint hypermobility at the

beginning of the range is noted by inclusion of a
zero between the starting & ending measurements
 Example : if the elbow joint has 5 degree of
hypermobility in extension and 140 degree of
flexion , it would be recorded as 5 – 0 – 140 deg
 Types of Goniometer
• Full Circle Manual Universal Goniometer (360)
• Half circle manual Goniometer (180)
• Gravity Goniometer :-
• a) Double Inclinometer (used for spine
goniometry)
• b) Pendulum Inclinometer
• c) Bubble Goniometer
• Electrogoniometer
• Digital Goniometer
• Tape Measurements
• Smartphone Devices
• Use of malleable wires/sheets (in cases of deformities)
Spinal Goniometer
 UNIVERSAL
GONIOMETER
• A universal Goniometer may be
constructed of metal or plastic and it has
3 parts :-
(placed over the Joint being measured)

1. Body of Goniometer
(aligned parallel with the longitudinal axis of the
fixed part)
2. Stationary arm
(aligned parallel with the longitudinal axis of the
movable part)
3. Movable arm
 Demonstration
Shoulder
Knee
Cervical spine
 Precautions !!!
1. Joint irritability status
2. Presence of Pain
3. Instability
4. Recent trauma
5. Is it really important to assess accurate
ROM ??
Functional Ranges of various joint in
various activities
 Walking
 Stair ascending descending
 Sitting
 Squatting
 Cross leg sitting
 Self Feeding
 Back reach
 Neck reach
 Etc….
 ROM Required In ADL’s

DESCENDING STAIRS REQUIRES

ASCENDING STAIRS AN AVERAGE OF
REQUIRES BETWEEN 21 - 36 DEGREE OF DORSIFLEXION,
47 - 66 DEGREE OF HIP 86.9 - 107 DEGREE OF KNEE
FLEXION DEPENDING ON FLEXION DEPENDING ON STAIR
STAIR DIMENSION DIMENSIONS
 Sitting in a chair with an Rising from a chair requires a mean range
average seat height of
requires knee flexion of 90.1 - 95.0 degree and
112 degrees of hip flexion full dorsiflexion ROM depending on height
Drinking from a cup requires
about 130 degree of elbow
flexion
36 to 52 degrees of shoulder
flexion
Reaching objects on a high shelf
require
148 degrees of shoulder flexion
 Using a telephone
requires approx 40
degrees of wrist
extension

Reaching behind the head

requires about
112 degrees of abduction
of the shoulder
Approximately
50 degrees of pronation
occur while reading a newspaper
 END-FEEL
• 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
motion 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 DESCRIPTION EXAMPLE
Soft Soft Tissue Approximation Knee flexion (contact
between soft tissue of
posterior leg and posterior
thigh)

Firm Muscular stretch Hip flexion with knee

straight (passive elastic
tension of hamstring
muscles)

Capsular stretch Extension of

metacarpophalangeal
joints of fingers

Ligamentous stretch Forearm supination

(tension in the palmar
radioulnar ligament of the
inferior radioulnar joint)

Hard Bone contacting bone Elbow extension

(olecranon process of the
ulna and olecranon fossa
of humerus)
ABNORMAL END-FEEL DESCRIPTION
Soft Occurs sooner or later in the
ROM than is usual or in a
joint that normally has a
firm or hard end-feel . Feels
boggy.
Firm Occurs sooner or later in the
ROM than is usual or in a
joint that normally has a soft
or hard end-feel.
EXAMPLES
Soft tissue edema
Synovitis
Increased muscular tonus
Capsular , muscular ,
ligamentous, and fascial
shortening

Hard Occurs sooner or later in the Chondromalacia

ROM than is usual or in a Osteoarthritis
joint that normally has a soft Loose bodies in joint
or firm end-feel. A bony Myositis ossificans
grating or bony block is felt. Fracture

Empty No real end-feel because Acute joint inflammation

pain prevents reaching end Bursitis
of ROM. No resistance is felt Abscess
except for patient’s Fracture
protective muscle splinting Psychogenic disorder
or muscle spasm.
 TAPE MEASUREMENTS OF THE
JOINTSPINE
MOTION TESTING STABILIZATIO MEASUREMENTS
POSITION N
CERVICAL • FLEXION Sitting Shoulder & 1 cm– 4.3 cm
chest

• EXTENSION 18.5 cm–22.4cm

Shoulder &
chest to
prevent
extension of
thoracic &
• SIDE FLEXION lumbar spine 10.7cm-12.9cm

To prevent side
flexion of
thoracic &
• ROTATION lumbar spine 11cm-13.2cm

To prevent
rotation of
JOINT MOTION TESTING STABILIZATION MEASUREMEN
POSITION TS
THORACIC • FLEXION STANDING PELVIS 10 cms (4
To prevent inches)
anterior tilting

• EXTENSION •If the subject To prevent

has balance posterior tilting
problems or
muscle
weakness in the
LE,
measurement
can be taken in
prone/side lying
• LATERAL To prevent
FLEXION lateral tilting 15.9cm for rt LF
16.9cm for lt LF
• ROTATION To prevent
SITTING rotation 45 degree
(universal
goniometer)
JOINT MOTION TESTING STABILIZATIO MEASUREMEN
POSITION N TS
LUMBAR • FLEXION STANDING PELVIS 6.7cm in males
To prevent 5.8cm in
anterior tilting females
Average
6.3cm-6.9cm
(Modified
Schober test)
•EXTENSION To prevent
posterior 1.6cm
tilting (Modified
•LATERAL Schober Test)
FLEXION To prevent
lateral tilting 25 – 30 degree
by AMA (double
inclinometer)
 Demonstration
Schober’s Test For
Lumbar Spine Flexion
Capsular & Non-capsular Pattern Of
Movement Restriction
• Cyriax proposed that pathological
conditions involving the entire joint capsule
cause a particular pattern of restriction
involving most of the passive motions of
the joint. This pattern is called as capsular
pattern
• Restriction caused by condition involving
structures other than the entire joint
capsule is called as non-capsular pattern
• Example – Adhesive Capsulitis Shoulder
HFD Thomas Test
KFD
Equinus
TF Malalignment
Genu Recurvatum
 THORACIC AND LUMBAR
AVERAGE ROM SPINE
JOINT ROM

CERVICAL SPINE Flexion 0º to 80º

80º

JOINT ROM Extension 0º to 30º

30º
Lateral 0º to 40º
40º
Flexion 0ºº to
flexion
45º
45º
Rotation 0º to 45º
45º
Extension 0ºº to
45º
45º
Lateral flexion 0ºº to
45º
45º
Rotation 0ºº to
 SHOULDER
JOINT ROM
Flexion 0º to 180º
180º
Extension 0º to 60º
60º
Abduction 0º to 180º
180º
Adduction 0ºº
Horizontal abduction 0º to 40º
40º
Horizontal Adduction 0º to 130º
130º
Internal rotation  
Arm in Abduction 0º to 70º
70º
Arm in Adduction 0º to 60º
60º
External rotation  
Arm in Abduction 0º to 90º
90º
Arm in Adduction 0º to 80º
80º
 ELBOW
JOINT ROM
Flexion 0º to 135º
135º - 150º
Extension 0ºº

FOREARM
JOINT ROM
Pronation 0º to 80º
80º - 90º
Supination 0º to 80º
80º - 90º
 WRIST THUMB
JOINT ROM JOINT ROM
Flexion 0º to 80º
80º DIP flexion 0º to 80º
80º -
90º
Extensio 0º to 70º
70º
n MCP flexion 0º to 50º
50º
Ulnar 0º to 30º
30º Adduction, 0ºº
deviation radial and
(adducti palmar
on) Palmar 0º to 50º
50º
Radial 0º to 20º
20º abduction
deviation Radial 0º to 50º
50º
(abducti abduction
on) Opposition
 FINGERS
JOINT ROM
MCP flexion 0º to 90º
90º
MCP 0º to 15º
15º - 45º
hyperextension
PIP flexion 0º to 110º
110º
DIP flexion 0º to 80º
80º
abduction 0º to 25º
25º
 HIP
JOINT ROM
Flexion 0º to 120º
120º
(bent knee)
KNEE
Extension 0º to 30º
30º
JOINT ROM
Abduction 0º to 40º
40º
Flexion 0ºº to
Adduction 0º to 35º
35º 135º
135º
Internal 0º to 45º
45º
rotation
External 0º to 45º
45º
rotation
 ANKLE AND FOOT
JOINT ROM
Plantar flexion 0º to 50º
50º
Dorsiflexion 0º to 15º
15º
Inversion 0º to 35º
35º
Eversion 0º to 20º
20º
 SOURCES
• Measurement of Joint Motion : A Guide
to Goniometry, 4th Edition, by Cynthia C. Norkin
• Physical Rehabilitation 6th Edition SuSan B.
O’Sullivan
• Magee (2002). Orthopedic physical
Assessment (4th ed.). Phil: Saunders.
• Kisner C, & Colby LA (2002). Therapeutic
exercise: Foundations and techniques (4th ed.).
PA: FA Davis.
• The Principles of Exercise Therapy (Fourth
Edition): M. Dena Gardiner.