Range of motion Contents Definition Type of ROM

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 = 130 o)

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°) • Subject supine • Flatten lumbar spine (flex knees) • 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 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 glenohumeral 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. Hip flexion (0~120°) • • Test Position • Subject supine • Allow knee to flex (to avoid limitation by tight hamstrings) • Stabilize pelvis to prevent rotation, Hip flex. 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 5 th 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 C 7 • 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 C 7 and S 1

THORACO-LUMBAR SPINE BACKWARD BENDING (extenion) • Test Position • Subject standing • Extend thoracic and lumbar spines • Tape Measure Alignment • Spinous processes of C 7 and S 1

THORACO-LUMBAR SPINE SIDEBENDING • • Test Position Subject standing Stabilize pelvis Sidebend thoracic and lumbar spines Goniometer Alignment Axis - S 1 spinous process Stationary arm - vertical Moving arm - C 7 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