exercise therapy goniometer range of motion measurements of joints joints range

1. Range Of Motion

2. 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

3. PLANES AND AXIS
• Osteo-kinematic motions are described to be taking
place in 3 cardinal planes and axis

5. A frontal or coronal axis lies parallel to the transverse suture of the
skull. It is also horizontal and at right angle to the sagittal axis.
Movement about frontal axis occurs in a sagittal plane. Flexion and
extension (except of the thumb) occurs about a frontal axis and in a
sagittal plane.
A sagittal or antero-posterior axis lies parallel to the sagittal suture
of the skull, i.e., in an antero-posterior direction. Movement about this
axis occurs in a frontal plane. Abduction and adduction (except pf the
thumb) and side flexion movements are said to take about a sagittal
axis and in a frontal plane.
 A vertical axis lies parallel to the line of gravity and movement about
it occurs in a horizontal plane. Rotation occurs about a vertical axis
and in a horizontal plane

6. 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.

7. 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

8. 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

9. FACTORS DETERMINING AMOUNT
OF ROM
Integrity
Of Joint
SurfaceRELIABILI
TY
Amount
Of
Scarring
Present
AG
E
GEND
ER
Shape Of
Articulati
ng
Surface
Healt
h Of
Joint
Various
diseases/
pathologic
al
conditions
Health Of
Surroundi
ng
Tissues
Mobilty &
Pliabilty Of
Soft Tissue

10. 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

11. Prerequisite Skills For Measuring
ROM
• The therapist should be skilled in
 Correct positioning
 Stabilization for measurement
 Palpation
 Alignment
 Recording measurements accurately
 Documentation

12. 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

13. RECORD THE STARTING POSITION.
REMOVE THE GONIOMETER
STABILIZE THE PROXIMAL JOINT
SEGMENT
MOVE THE DISTAL
SEGMENT
THROUGH FULL
ROM
REALIGN THE GONIOMETER. PALPATE THE ANATOMICAL LAND
MARKS AGAIN IF NECESSARY
RECORD THE ROM

14. 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

15. What is Goniometry?
• The term goniometry is derived from two Greek words :
Gonia-metron
• Therefore, goniometry refers to the measurement of angles, in
particular the measurement of angles created at human joints
by the bones.
ANGL
E
MEASU
RE

16. 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) BubbleGoniometer
• Electrogoniometer
• Digital Goniometer
• Tape Measurements
• Smartphone Devices
• Use of malleable wires/sheets (in cases of
deformities)

19. Spinal
Goniometer

20. UNIVERSAL GONIOMETER
• A universal Goniometer may be
constructed of metal or plastic and it has 3
parts :-
1. Body of
Goniometer2. Stationary
arm
3. Movable arm
(placed over the Joint being
measured)
(aligned parallel with the longitudinal axis of
the fixed part)
(aligned parallel with the longitudinal axis of
the movable part)

22. Precautions !!!
1. Joint irritability status
2. Presence of Pain
3. Instability
4. Recent trauma
5. Is it really important to assess accurate
ROM ??

23. 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.

24. 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

25. ABNORMAL END-FEEL DESCRIPTION EXAMPLES
Soft Occurs sooner or later in the Soft tissue edema
ROM than is usual or in a
joint
Synovitis
that normally has a firm or
hard end-feel . Feels boggy.
Firm Occurs sooner or later in the Increased muscular tonus
ROM than is usual or in a
joint
Capsular , muscular ,
that normally has a soft or ligamentous, and fascial
hard end-feel. shortening
Hard Occurs sooner or later in the Chondromalacia
ROM than is usual or in a
joint
Osteoarthritis
that normally has a soft or Loose bodies in joint
firm end-feel. A bony grating Myositis ossificans
or bony block is felt. Fracture
Empty No real end-feel because
pain
Acute joint inflammation
prevents reaching end of Bursitis
ROM. No resistance is felt Abscess
except for patient’s protective Fracture

26. 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

27. Shoulder ROM
FLEXION:
 Motion: 0-180º
 Position: Subject supine with knees flexed or sitting. elbow
extended with the palm facing the body
 Goniometer: Axis at the acromion process, laterally
through the head of the humerus.
 Stationary arm is placed along the mid-axillary line of the
trunk
 Moving arm place along the lateral mid-line of the
humerus in line with the lateral epicondyle.

28. EXTENSION:
 Motion: 0-45º~60º from neutral position
 Position: Subject prone or sitting , elbow in slight flexion
with the palm facing the body.
 Goniometer: Axis at the acromion process, laterally through
the head of the humerus
 Stationary Arm aligned with mid- axillary line of the trunk
 Moving arm along the lateral mid-line of humerus in line
with lateral epicondyle

30. ABDUCTION:
 Motion:0-180º
 Position: Supine, prone or sitting with the limb in anatomic
position
 Goniometer: Axis at anterior portion of acromion process.
 Stationary arm at lateral aspect of anterior surface of chest
parallel to midline of sternum.
 Moving arm on anterior aspect of arm parallel to midline of
humerus and in line with medial epicondyle. OR Goniometer:
Axis at the posterior portion of the acromion process; Stationary
arm aligned parallel to spinous process of the vertebral colomn
Moving arm aligned with the midline of the humerus in line with
lateral epicondyle
ADDUCTION:
 Motion: 0-30º
 Aligment of goniometer is same as abduction.

32. EXTERNAL ROTATION:
 Motion: 0-90º
 Position: Supine. Shoulder is abducted to 90º. Elbow flexed with
forearm in neutral and perpendicular to table top such that the palm is
facing the feet. Elbow not supported. Humerus is fully supported on
the table. Stabilize the distal humerus, thorax, and scapula.
 Goniometer: Axis at olecranon process of the ulna.
 Stationary arm placed parallel to the table top or perpendicular to the
floor.
 Moving arm along the ulnar shaft aligned with the styloid process of
the ulna.
INTERNAL ROTATION:
 Motion: 0-65~90º
 Positioning and goniometer alignment is same as in external rotation

34. Radio-ulnar ROM
Supination:
 Motion: 0- 80º~ 90º
 Position: Subject sitting or supine, with the elbow flexed to 90º. Shoulder in zero
degrees of its’ ROM. Position starts midway between Supination and Pronation.
 Goniometer: Axis is medial to the ulnar styloid process.
 Stationary arm is aligned parallel to the anterior midline of the humerus.
 Moving arm across the ventral aspect of the wrist on a line between and
proximal to the styloid process of the radius and the ulna.
Pronation:
 Motion: 0- 80º~ 90º
 Position: same for supination.
 Goniometer: Axis is lateral to the ulnar styloid process.
 Stationary arm is aligned parallel to the anterior midline of the humerus.
 Moving arm across the dorsum of the wrist on a line between and proximal to
the styloid process of the radius and the ulna.

36. JOINT MOTION TESTING
POSITION
STABILIZATION MEASUREMENT
S
CERVICAL • FLEXION Sitting Shoulder &
chest
1 cm– 4.3 cm
• EXTENSION Shoulder &
chest to
prevent
extension of
thoracic &
lumbar spine
18.5 cm–22.4cm
• SIDE FLEXION To prevent
side flexion
of thoracic &
lumbar spine
10.7cm-12.9cm
• ROTATION To prevent
rotation of
thoracic &
lumbar
11cm-13.2cm
TAPE MEASUREMENTS OF THE
SPINE

37. JOINT MOTION TESTING
POSITION
STABILIZATION MEASUREMEN
TS
THORACIC • FLEXION STANDING PELVIS
To prevent
anterior
tilting
10 cms (4
inches)
• EXTENSION •If the subject
has balance
problems or
muscle
weakness in
the LE,
measurement
can be taken in
prone/side lying
To prevent
posterior
tilting
• LATERAL
FLEXION
To prevent lateral
tilting
15.9cm for rt LF
16.9cm for lt LF
• ROTATION SITTING To
prevent
rotation
45 degree
(universal
goniometer
)

38. JOINT MOTION TESTIN
G
POSITIO
N
STABILIZATIO
N
MEASUREMEN
TS
LUMBAR • FLEXION STANDING PELVIS
To prevent
anterior tilting
6.7cm in males
5.8cm in
females
Average
6.3cm-
6.9cm
(Modified
Schober
test)
•EXTENSION To prevent
posterior tilting
1.6cm (Modified
Schober Test)
•LATER
AL
FLEXIO
N
To prevent
lateral
tilting
25 – 30
degree by
AMA (double
inclinometer)

39. Demonstration
Schober’s Test For
Lumbar Spine Flexion

49. HFD Thomas
Test

50. KF
D

51. Equinu
s

52. TF
Malalignment

53. Genu
Recurvatum