Range of motion

Contents

• Definition
• Type of ROM
• Components of range of motion
• Goniometry
• Measurement
 Definition

•  Range of motion (ROM) is the term that is

used to describe the amount of movement you
have at each joint.
 Type of ROM

• Active Range of Motion

• Passive Range of Motion
 Active Range of Motion

• Dynamic flexibility
• Physiological movements
• Joint motion that occurs because of muscle
contraction
 Passive Range of Motion

• Static flexibility
• Movement that is performed completely by the
examiner
• Endpoints in the range of motion
 Components of range of motion
• Sex
• Age
• Race
• Shape of the bone and cartilage
• Muscle power and tone
• Muscle bulk
• Ligaments and joint capsule laxity
• Extensibility of the skin and subcutaneous tissue
 Goniometry

• measuring the available range of motion or the

position of a joint
• typically this is a measure of PASSIVE motion
• If you are documenting active range of
motion, document that this is so
 Goniometry

• Stationary arm : placed parallel with the

longitudinal axis of the fixed part
• Movable arm : along the longitudinal axis of
the movable segment
• Axis of rotation(pin) : at the intersection of the
stationary & movable arms
Goniometry
 Goniometry procedure
• position joint in zero position and stabilize proximal
joint component
• move joint to end of range of motion (to assess quality of
movement)
• determine end-feel at point where measurement will be
taken ( at end of available range of motion)
• identify and palpate bony landmarks
• align goniometer with bony landmarks while holding
joint at end of range
• read the goniometer
• record measurement (e.g. elbow flexion = 130o)
 Type of Goniometer
① full-circle manual
universal goniometer
most versatile &popular

② Gonoimeters for single

joint motion
 Type of Goniometer
③ fluid inclinometer

④ pendulum inclinometer

⑤ electrogoniometer
 Measurement

•Upper Ext.

•Lower Ext.

•Spine
 Upper Ext.
Test Position Shoulder flexion (0~180°)
Goniometer Alignment
• Subject supine
• Flatten lumbar spine (flex knees) • Axis – center of humeral head near
• Shoulder no abduction, adduction or rotation acromion process
• (note: to measure gleno-humeral motion, • Stationary arm – parallel mid-axillary line
stabilize scapula) • Moving arm – aligned with midline of
  humerus (lateral epicondyle)
 Shoulder extension (0~60°)
Test Position
• Subject prone
• Shoulder no abduction,
adduction or rotation
• (note: to measure gleno-humeral
motion, stabilize scapula)

Goniometer Alignment
• Axis – center of humeral head near acromion process
• Stationary arm – parallel mid-axillary line
• Moving arm – aligned with midline of humerus (lateral
epicondyle)
Shoulder abduction (0~180°)
Test Position
• Subject supine
• Shoulder 0° flexion and extension
• Shoulder laterally (externally) rotated
• Shoulder abducted
• Stabilize thorax (note: to measure gleno-
humeral motion, stabilize scapula)
 Shoulder abduction (0~180°)
Goniometer Alignment
• Axis – center of humeral head near acromion
process
• Stationary arm – parallel to sternum
• Moving arm – aligned with midline of
humerus
 Shoulder external rotation (0~90°)
Test Position 
• Subject supine 
• Shoulder 90° abduction
• Forearm neutral
• Elbow flexed 90°
• Stabilize arm

Goniometer Alignment 
• Axis – olecranon process of ulna
• Stationary arm – aligned vertically
• Moving arm – aligned with ulna (styloid process)
 Shoulder internal rotation (0~70°)
Test Position
• Subject supine
• Shoulder 90° abduction
• Forearm neutral
• Elbow flexed 90°
• Stabilize arm
 

Goniometer Alignment
• Axis – olecranon process of ulna
• Stationary arm – aligned vertically
• Moving arm – aligned with ulna (styloid process)
 Elbow flexion (0~150°)
Test Position
• Subject supine
• Shoulder neutral (arm at side)
• Forearm supinated
• Elbow flexed
• Stabilize arm

Goniometer Alignment
• Axis – lateral epicondyle of humerus
• Stationary arm – aligned with humerus (center of acromion
process)
• Moving arm – aligned with radius (styloid process)
 Elbow extension (150~0°)
Test Position 
• Subject supine
• Shoulder neutral (arm at side)
• Forearm supinated
• Elbow extended
• Stabilize arm

Goniometer Alignment 
• Axis – lateral epicondyle of humerus
• Stationary arm – aligned with humerus (center of acromion
process)
• Moving arm – aligned with radius (styloid process)
 Forearm pronation (0~80°)
Test Position
• Subject sitting
• Shoulder neutral (arm at side)
• Elbow flexed to 90°
• Stabilize arm
• Pronate forearm

Goniometer Alignment
• Axis – lateral to ulnar styloid
• Stationary arm – parallel to humerus
• Moving arm – aligned with dorsum of radius
 Forearm supination (0~80°)
Test Position
• Subject sitting
• Shoulder neutral (arm at side)
• Elbow flexed to 90°
• Stabilize arm
• Supinate forearm

Goniometer Alignment
• Axis – medial to ulnar styloid
• Stationary arm – parallel to humerus
• Moving arm – aligned with ventral aspect of radius
 Wrist flexion (0~80°)
Test Position
• Subject seated
• Forearm stabilized on table
• Flex wrist
(fingers relaxed)
 

Goniometer Alignment
• Axis – lateral wrist (triquetrum)
• Stationary arm – aligned with ulna
• Moving arm – aligned with fifth metacarpal
 Wrist extension (0~70°)
Test Position 
• Subject seated
• Forearm stabilized on table
• Extend wrist
(fingers relaxed)

Goniometer Alignment 
• Axis – lateral wrist (triquetrum)
• Stationary arm – aligned with ulna
• Moving arm – aligned with fifth metacarpal
 Radial deviation (0~20°)
Test Position
• Subject sitting with forearm
resting on table
• Stabilize forearm to prevent
pronation or supination

Goniometer Alignment
• Axis – capitate
• Stationary arm – aligned with forearm (lateral epicondyle)
• Moving arm – aligned with metacarpal of middle finger
 Ulnar deviation (0~30°)
Test Position
• Subject sitting with forearm
resting on table
• Stabilize forearm to prevent
pronation or supination

Goniometer Alignment
• Axis – capitate
• Stationary arm – aligned with forearm (lateral epicondyle)
• Moving arm – aligned with metacarpal of middle finger
 Lower Ext.
Test Position 
• Subject supine
• Allow knee to flex (to avoid
limitation by tight hamstrings)
• Stabilize pelvis to prevent
rotation, Hip flex.

Hip flexion (0~120°)

• Goniometer Alignment
• Axis – greater trochanter
• Stationary arm – aligned with midline of plevis
• Moving arm – aligned with femur (lateral epicondyle)
 Hip extension (0~30°)
Test Position
• Subject prone
• Stabilize pelvis to prevent rotation
• Extend hip
 

Goniometer Alignment
• Axis – greater trochanter
• Stationary arm – aligned with midline of plevis
• Moving arm – aligned with femur (lateral epicondyle)
 Hip abduction (0~45°)
Test Position
• Subject supine
• Stabilize pelvis to prevent
pelvic list
• Abduct hip
 

Goniometer Alignment
• Axis – anterior superior iliac spine (ASIS)
• Stationary arm – aligned with opposite ASIS
• Moving arm – aligned with femur (center of patella)
 Hip adduction (0~30°)
Test Position
• Subject supine
• Stabilize pelvis to prevent pelvic
list
• Abduct opposite hip (to allow
room for tested limb to adduct)
• Adduct hip

Goniometer Alignment
• Axis – anterior superior iliac spine (ASIS)
• Stationary arm – aligned with opposite ASIS
• Moving arm – aligned with femur (center of patella)
 Hip internal rotation (0~45°)
Test Position
• Subject sitting on table
• knee flexed
• Stabilize distal thigh
• medially (internally) rotate hip

Goniometer Alignment
• Axis – center of patella
• Stationary arm – aligned vertically
• Moving arm – aligned with leg (crest of tibia)
 Hip external rotation (0~45°)
• Test Position
• Subject sitting on table
• knee flexed
• Stabilize distal thigh
• hip laterally (externally)
rotated

• Goniometer Alignment
• Axis – center of patella
• Stationary arm – aligned vertically
• Moving arm – aligned with leg (crest of tibia)
 Knee flexion (0~135°)
• Test Position
• Subject supine
• Allow hip to flex
• Flex knee

• Goniometer Alignment
• Axis – lateral epicondyle of femur
• Stationary arm – aligned with greater trochanter
• Moving arm – aligned with lateral malleolus
 Knee extension (135~0°)
• Test Position
• Subject prone
• Stabilize femur
• Extend Knee

• Goniometer Alignment
• Axis – lateral epicondyle of femur
• Stationary arm – aligned with greater trochanter
• Moving arm – aligned with lateral malleolus
 Ankle plantar flexion (0~50°)
• Test Position
• Subject supine
• Extend knee
• Stabilize leg
• Plantarflex ankle

• Goniometer Alignment
• Axis – lateral malleolus
• Stationary arm – aligned with fibular head
• Moving arm – aligned with fifth metatarsal
 Ankle dorsiflexion (0~20°)
• Test Position
• Subject prone
• Flex knee
• Stabilize sub-talar in neutral
• Dorsiflex ankle by pushing
through 5th metatarsal head

• Goniometer Alignment
• Axis – lateral malleolus
• Stationary arm – aligned with fibular head
• Moving arm – aligned with fifth metatarsal
 Ankle inversion (0~35°)
• Test Position
• Subject prone
• Stabilize tibia in sagittal plane
(rotate hip or pelvis to align
tibia)
• Invert calcaneus

• Goniometer Alignment
• Axis – automatically positioned by alignment of goniometer
arms
• Stationary arm – aligned with midline of leg
• Moving arm – aligned with midline of calcaneus
 Ankle eversion (0~15°)
• Test Position
• Subject supine
• Stabilize calcaneus and talus
• Evert forefoot

• Goniometer Alignment
• Axis – automatically positioned by alignment of goniometer
arms
• Stationary arm – aligned with midline of leg
• Moving arm – aligned with plantar aspect of metatarsal heads
 Spine
CERVICAL SPINE FORWARD BENDING (flexion)

Test Position
• Subject sitting with lumbar
and thoracic spines supported
• Stabilize lumbar and thoracic
spines
• Flex cervical spine

• Goniometer Alignment
• Axis – external auditory meatus
• Stationary arm – vertical
• Moving arm – aligned with nostrils
 CERVICAL SPINE BACKWARD BENDING
(extension)
• Test Position
• Subject sitting with lumbar and
thoracic spines supported
• Stabilize lumbar and thoracic spines
• Mouth relaxed and slightly open
• Extend cervical spine

• Goniometer Alignment
• Axis – external auditory meatus
• Stationary arm – vertical
• Moving arm – aligned with nostrils
 CERVICAL SPINE SIDEBENDING
• Test Position
• Subject sitting with lumbar and
thoracic spines supported
• Stabilize lumbar and thoracic
spines
• Sidebend cervical spine

• Goniometer Alignment
• Axis – spinous process of C7
• Stationary arm – spinous processes of thoracic spine
• Moving arm – posterior midline of head at occipital
protuberance
 CERVICAL SPINE ROTATION
• Test Position
• Subject sitting with lumbar and
thoracic spines supported
• Stabilize lumbar and thoracic
spines
• Rotate cervical spine

• Goniometer Alignment
• Axis – center of superior aspect of head
• Stationary arm – aligned with acromion processes
• Moving arm – aligned with tip of nose
 THORACO-LUMBAR SPINE
FORWARD BENDING (flexion)

• Test Position • Tape Measure Alignment

• Subject standing • Spinous processes of C7 and
• Flex thoracic and lumbar S1
spines
 THORACO-LUMBAR SPINE
BACKWARD BENDING (extenion)

• Test Position • Tape Measure Alignment

• Subject standing • Spinous processes of C7 and
• Extend thoracic and lumbar S1
spines
 THORACO-LUMBAR SPINE
SIDEBENDING
• Test Position
• Subject standing
• Stabilize pelvis
• Sidebend thoracic and
lumbar spines

• Goniometer Alignment
• Axis - S1 spinous process
• Stationary arm - vertical
• Moving arm - C7 spinous process
 THORACO-LUMBAR SPINE
ROTATION
• Test Position
• Subject sitting
• Stabilize pelvis
• Do not allow sidebending, forward
bending or backward bending
• Rotate thoracic and lumbar spines

• Goniometer Alignment
• Axis - center of superior aspect of head
• Stationary arm - aligned with anterior superior iliac spines
• Moving arm - aligned with acromion processes