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

• Subject supine • Flatten lumbar spine (flex knees) • Shoulder no abduction, adduction or

rotation • (note: to measure gleno-humeral

motion, stabilize scapula)  

Shoulder flexion (0~180°)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 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

SpineCERVICAL 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• Subject standing • Flex thoracic and

lumbar spines

• Tape Measure Alignment

• Spinous processes of C7 and S1

THORACO-LUMBAR SPINE BACKWARD BENDING

(extenion)

• Test Position• Subject standing • Extend thoracic and

lumbar spines

• Tape Measure Alignment

• Spinous processes of C7 and S1

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