Texas State University

Department of Health and Human Performance

AT 3112 – Clinical Assessment II Laboratory

Spring 2021

Lab #1 – Lower Extremity Goniometry Techniques

Name: Leigha Daryanani Score (28 points) _______________

Lab Day and Time: T 4 PM

PART I – BACKGROUND AND SIGNIFICANCE:

In previous orthopedic assessment courses, you learned that goniometry involves the measurement of
angles created by the bones of the body at the joints. These joint movements are measured by a
goniometer. Whether you use a traditional (below) or a digital goniometer, every goniometer has a
stationary arm, a moving arm, and the fulcrum (axis). The fulcrum of the goniometer is aligned with
the axis of the joint being measured. The stationary arm of the goniometer will be aligned with the
inactive part of the joint measured, while the moving arm is placed on the part of the limb which is
moved in the joint’s motion. The total range of motion at any given joint is measured with a goniometer
in degrees, and typically the values range from 0o to 180o.

When measuring knee flexion, for example, the stationary (“proximal”) arm of the goniometer is aligned
with the long axis of the femur (using the greater trochanter of the femur as the proximal anatomical
landmark), while the moving (“distal”) arm is aligned with the long axis of the fibula, using the patient’s
lateral malleolus process as the distal anatomical landmark. The fulcrum (axis) of the goniometer is
aligned with the knee joint over the lateral joint margin.
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PART I – BACKGROUND AND SIGNIFICANCE—continued:

Quantifying your patient’s range of motion with a goniometer is important for several reasons. With acute
injuries, knowing the mobility of a joint is important in establishing a clinical diagnosis, as well as
determining the presence or absence of dysfunction. In chronic conditions, goniometry can reveal the
progression of the disease/disorder.

Repeated, objective measurements of joint motion help the clinician to assess the amount of progress or
lack of improvement that a patient is making during the rehabilitation program. One example of this is the
progressive nature of osteoarthritis, with the patient’s range of motion typically decreasing as the disease
progresses. Goniometric values not only provide motivation for the patient when there are improvements
but can also alert the clinician of the need for modifications if the treatment protocol has not been
effective.

PART II – DEFINITION OF TERMS:

See Chapter 8: Range of Motion Assessment in the Reiman (2016) textbook for definitions of the following
terms below (1 point each, 3 points total) – complete this exercise at home…

Term: Definition:
Active range of motion Movement of a joint provided entirely by the individual performing the
(AROM) exercise

Passive range of motion Movement applied to a joint solely by another person or machine
(PROM)

Resistive range of Movement made by the patient against the efforts of the therapist, or one forced
motion (RROM) by the operator against the resistance of the patient
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PART III – DETERMINATION OF END FEEL (4 points possible)

The order of the orthopedic physical examination typically progresses from the evaluation of active
range of motion (AROM) to passive range of motion (PROM), at which time the clinician moves the
patient’s body part(s) through the various anatomical motions possible at that joint. The PROM values
can be measured with a goniometer, but are more commonly judged in comparison to: (a) the amount of
AROM that was possible at the joint, and (b) the characteristics and quality of the feeling at the end of
the available range of motion, a term known as end-feel.

To evaluate end-feel, Cyriax (1983) advised the clinician to apply overpressure at the end of the passive
range of motion to determine what structures are being stressed. The different normal (physiological) end-
feels identified by Cyriax are “soft”, “firm” and “hard”. Please refer to page 11 in your Starkey & Brown
Handbook (2015) for the pathological (abnormal) end-feels to passive range of motion (PROM).

Provide one (1) LOWER EXTREMITY EXAMPLE for each of the following ABNORMAL end-feels:
(1 point each; 4 pts. total)

Soft Soft Tissue edema

Firm Osteoarthritis

Hard Fracture

Empty Bursits
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PART IV: LOWER EXTREMITY GONIOMETRIC MEASUREMENTS (8 points possible)

Prior to obtaining these active range of motion measurements on your lab partner, review the 10
recommended steps suggested by Reiman (2016) in Chapter 8 - Range of Motion Assessment (p. 151).
(NOTE: These 10 steps are included in the PowerPoint slides that accompany this lab).

Look up what the range of normal active range of motion (AROM) value is for each of the selected
anatomical motions in the table below, and then use a goniometer on your partner to find their AROM is
on both their right and left sides. Please write down the author(s), title, and page number of the reference
you used for your “normal” AROM values. (0.5 point each; 8 points total)

Lab Partner’s Name (printed):

Lab Partner’s Signature:

Lab Partner’s Lab Partner’s

Range of
Normal Measured Right Measured Left
AROM Limb AROM Limb AROM Quality/Type of
Anatomical Motion: Values: Value: Value: End-Feel:
Hip joint 0-120 degrees
flexion

Hip joint 0-50 degrees

ABduction

Talocrural joint 0-50 degrees

plantar flexion

Talocrural joint 0-30 degrees

dorsiflexion

SOURCE/REFERENCE TEXT used for NORMAL AROM VALUES:

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V. INTRARATER AND INTERRATER RELIABILITY OF GONIOMETRIC MEASUREMENTS

(0.5 point each; 7 points total)

Working in groups of 3 and taking turns playing the role of the clinician and the patient, have the other 2
people in your group use a universal (standard) goniometer to measure knee flexion AROM in your
patient’s dominant limbs. Follow the standard goniometry procedures presented in lab today to the
nearest whole degree.

Component of a Universal Goniometer Anatomical Landmarks used for Knee

Flexion
Stationary (“Proximal”) Arm __lateral thigh______________
Axis (“Fulcrum”) __lateral knee______________
Moving (“Distal’) Arm __Lower leg________________
This lab activity is designed to support our discussion in lecture about evidence-based practices (EBP),
and to perhaps demonstrate the potential sources of error associated with multiple clinical measurements
by the same clinician and by different clinicians measuring the same objective anatomical value. Both of
the other members of your triad should measure your active knee flexion range of motion 3 times each,
and record the values in the table below. When you’ve obtained all the goniometric measures, use this
website, https://www.mathsisfun.com/data/standard-deviation-calculator.html, to determine the 3-TRIAL
AVERAGE and STANDARD DEVIATION of these measurements for Clinician 1 and Clinician 2.

Identify the following:

Patient (your name): _

Clinician 1 Name:

Clinician 2 Name:

Dominant Limb – Knee Flexion Active Range of Motion

(AROM)
(0.5 point each value; 7 points total)
Clinician 1 Clinician 2 Difference between values
Patient AROM Measurements AROM Measurements (indicate + or -)
Trial
1
Trial
2
Trial
3
3-Trial Average

Standard Deviation
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PART VI: LAB WRITE-UP QUESTIONS (Please TYPE your answers; 6 points possible)

In the terminology of clinical goniometry, stabilization is defined as isolating the desired motion of a
particular joint while eliminating unwanted motion from nearby joint(s).

To get accurate ROM measurements, you must position and stabilize the patient appropriately before obtaining
the AROM and RROM values. Most often, we will stabilize the proximal joint segment and ask the patient to
move (or we will move) the distal segment.

Errors in goniometric measurements are introduced when the patient is allowed to add extraneous or
substitute motions at other joints to make it appear that more AROM is possible at the joint of interest.

Please answer the following question with regard to the key concepts of stabilization and substitution:

1. Identify the possible substitutions that a patient might use while you are obtaining trunk extension
(spine extension) AROM goniometric measurements. Briefly describe how you would be proactive
and prevent the patient from making these substitutions? (3 points)
A substitution to look for in a patient performing trunk extension could be the position of the patients arms in
external rotation which would substitute for manual resistance. If I saw this I would have the patient relax and
perform trunk extension again, the correct way after explaining what to do again.

2. Identify the possible substitutions that a patient might use while you are obtaining hip abduction
AROM goniometric measurements from a standing position. Briefly describe how you would be
proactive and prevent the patient from making these substitutions? (3 points)

A substitution a patient might make for hip abduction would be rotating the leg/foot to where the patient’s
toes are pointing the sky. This would provide an inaccurate measurement for hip abduction. To prevent the
patient from making this substitution, I would monitor their foot position as well as emphasize the importance
of not rotating the leg being measured.

RAH: revised 1/12/2021