1. GONIOMETRY
a. Definition - 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.
b. For clarity of communication – measure one direction at a time (e.g. elbow
flexion = 130o
, not elbow flexion/extension 130o
/0o
)
GONIOMETER PARTS
Standard (universal) Goniometer
Gravity Goniometer (inclinometer)

2.  GONIOMETRY PROCEDURE
a. Position joint in zero position and stabilize proximal joint component
b. Move joint to end of range of motion (to assess quality of movement)
c. Determine end-feel at point where measurement will be taken (at end of
available range of motion)
d. Identify and palpate bony landmarks
e. Align goniometer with bony landmarks while holding joint at end of range
f. Read the goniometer
g. Record measurement (e.g. elbow flexion = 130o
)
POSITIONING
a. Start with joint at zero position - This is the reference point for the
measurement. If zero position can't be achieved, this must be documented.
b. permit complete range of motion
1) If you are assessing joint ROM, be sure that some other
structure (eg. a tight muscle) doesn't interfere.
2) If you are assessing some other structure (eg. a tight
muscle, pain limiting the motion) document exactly what is
limiting the range of motion. (eg. hamstring tightness at 65o
of
hip flexion)
STABILIZATION
a. Poor stabilization is the most frequent cause of invlaid measurements.
(eg. observe a "normal" ROM of elbow extension when movement of
shoulder and arm masks a limitation - actually measuring shoulder and arm
movement)
Poor Stabilization for Elbow Extension

3. b. Usually stabilize proximal joint components
c. Promote patient relaxation so voluntary muscle contraction doesn't
interfere
VALIDITY
a. Validity is a measurement concept that asks whether a measurement
system actually measures what it's supposed to (i.e., joint range of motion in
the case of goniometry)
b. Goniometric measurements can be invalid; usually because of poor
stabilization. (See positioning and stabilization)
RELIABILITY
a. Reliability is a measurement concept that asks whether successive
measurements are consistent, repeatable or reproducible. Upper extremity
measurements are more reliable than lower extremity measurements.
1) Intratester reliability (same tester on different occasions)-
measurement error should be less than 5 degrees
2) Intertester reliability (different testers) - measurement error
probably greater than 5 degrees

4. b. To maximize reliability always use the same:
1) Goniometer
2) Positioning
3) Procedure
4) Examiner
END FEEL
a. The quality of resistance at end of range
b. Each joint has a normal end feel at a normal point in the range of motion (ROM)
c. Incorrect end feel, or correct end feel at incorrect ROM indicate pathology
d. Terms: I suggest my terms for clarity of communication (to clearly identify the
structure that the tester feels is limiting the ROM). Other authors use different
terms - eg. hard, firm, soft, etc. I feel these "vague" terms lead to communication
errors.
Capsular - indicates that the joint capsule is limiting the ROM. Feels like
stretching a leather belt. Example - knee extension.
Ligamentous - indicates that ligament tightness is limiting the ROM. Feels
like stretching a leather belt. Example - wrist radial deviation.
Bony - indicates that bone touching bone is limiting the ROM. Feels like
pushing two wooden surfaces together. Example - elbow extension.>
Muscle Stretch - indicates that muscle tightness is limiting the ROM. Feels
like stretching a bicycle tire innertube. Example - hip flexion while
maintaining knee extension (straight leg raise) when hamstrings are tight.
Soft Tissue Approximation - indicates that subcutaneous tissues (muscle
bulk, fat) are pushing against each other and limiting the ROM. Feels like
squeezing two balloons together. Example - calf pressing against thigh
during knee flexion.
Springy - indicates that a loose body is limiting the ROM. Feels "bouncy"
like you are compressing a spring. Example - torn meniscal (knee) tissue
limiting knee extension.

5. Empty - indicates that the examiner did not reach the end feel (usually the
patient is not willing to allow motion to end of range because of anticipated
pain). Feels like the joint has more range available, but the patient is
purposefully preventing movement through the full ROM.
Testing End Feel for Elbow Extension

6. EXTREMIDAD SUPERIOR
SHOULDER FLEXION
Test Position
• Subject supine
• Flatten lumbar spine (flex knees)
• Shoulder no abduction, adduction
or rotation
• (Note: to measure gleno-humeral
motion, stabilize scapula)
Normal Range
(For shoulder complex flexion)
• 167o
+ or - 4.7o
(American
Academy of Orthopaedic
Surgeons)
• 150o
(American Medical
Association)
• 166o
(mean), 4.7o
(standard
deviation), (Boone and Azen)
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)
Normal End Feel
• Muscle Stretch

7. EXTENSION DEL HOMBRO
Test Position
• Subject prone
• Shoulder no abduction, adduction
or rotation
• (note: to measure gleno-humeral
motion, stabilize scapula)
Normal Range
(for shoulder complex flexion)
• 62o
+ or - 9.5o
(American
Academy of Orthopaedic
Surgeons)
• 50o
(American Medical
Association)
• 62.3o
(mean), 9.5o
(standard
deviation), (Boone and Azen)
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)
Normal End Feel
• Capsular or ligamentous

8. ABDUCCION DEL HOMBRO
Test Position
• Subject supine
• Shoulder 0o
flexion and extension
• Shoulder laterally (externally)
rotated
• Shoulder abducted
• Stabilize thorax (note: to measure
gleno-humeral motion, stabilize
scapula)
Normal Range
(for shoulder complex abduction)
• 184o
+ or - 7.0o
(American
Academy of Orthopaedic
Surgeons)
• 180o
(American Medical
Association)
• 184o
(mean), 7.0o
(standard
deviation), (Boone and Azen)
Goniometer Alignment
• Axis – center of humeral head
near acromion process
• Stationary arm – parallel to
sternum
• Moving arm – aligned with midline
of humerus
Normal End Feel
• Muscle Stretch

9. ROTACION INTERNA DEL HOMBRO
Test Position
• Subject supine
• Shoulder 90o
abduction
• Forearm neutral
• Elbow flexed 90o
• Stabilize arm
Normal Range
• 69o
+ or - 4.6o
(American
Academy of Orthopaedic
Surgeons)
• 90o
(American Medical
Association)
• 68.8o
(mean), 4.6o
(standard
deviation), (Boone and Azen)
Goniometer Alignment
• Axis – olecranon process of ulna
• Stationary arm – aligned vertically
• Moving arm – aligned with ulna
(styloid process)
Normal End Feel
• Capsular

10. ROTACION EXTERNA DEL HOMBRO
Test Position
• Subject supine
• Shoulder 90o
abduction
• Forearm neutral
• Elbow flexed 90o
• Stabilize arm
Normal Range
• 104o
+ or - 8.5o
(American
Academy of Orthopaedic
Surgeons)
• 90o
(American Medical
Association)
• 103o
(mean), 8.5o
(standard
deviation), (Boone and Azen)
Goniometer Alignment
• Axis – olecranon process of ulna
• Stationary arm – aligned vertically
• Moving arm – aligned with ulna
Normal End Feel
• Capsular

11. (styloid process)
FLEXION DEL ANTEBRAZO
Test Position
• Subject supine
• Shoulder neutral (arm at side)
• Forearm supinated
• Elbow flexed
• Stabilize arm
Normal Range
• 141.0o
+ or - 4.9o
(American
Academy of Orthopaedic
Surgeons)
• 140.0o
(American Medical
Association)
• 142.9o
(mean), 5.6o
(standard
deviation), (Boone and Azen)
Goniometer Alignment
• Axis – lateral epicondyle of
humerus
• Stationary arm – aligned with
humerus (center of acromion
process)
• Moving arm – aligned with radius
(styloid process)
Normal End Feel
• Soft tissue approximation
(capsular for thin subjects)

12. EXTENSION DEL CODO
Test Position
• Subject supine
• Shoulder neutral (arm at side)
• Forearm supinated
• Elbow extended
• Stabilize arm
Normal Range
• 0.3o
+ or - 2.0o
(American
Academy of Orthopaedic
Surgeons)
• 0.0o
(American Medical
Association)
• 0.6o
(mean), 3.1o
(standard
deviation), (Boone and Azen)
Goniometer Alignment
• Axis – lateral epicondyle of
humerus
• Stationary arm – aligned with
humerus (center of acromion
process)
• Moving arm – aligned with radius
Normal End Feel
• Bone on bone

13. (styloid process)
FOREARM SUPINATION
Test Position
• Subject sitting
• Shoulder neutral (arm at side)
• Elbow flexed to 90o
• Stabilize arm
• Supinate forearm
Normal Range
• 81o
+ or - 4.0o
(American
Academy of Orthopaedic
Surgeons)
• 80o
(American Medical
Association)
• 82.1o
(mean), 3.8o
(standard

14. deviation), (Boone and Azen)
Goniometer Alignment
• Axis – medial to ulnar styloid
• Stationary arm – parallel to
humerus
• Moving arm – aligned with ventral
aspect of radius
Normal End Feel
• Capsular
FOREARM PRONATION
Test Position Normal Range

15. • Subject sitting
• Shoulder neutral (arm at side)
• Elbow flexed to 90o
• Stabilize arm
• Pronate forearm
• 75o
+ or - 5.3o
(American
Academy of Orthopaedic
Surgeons)
• 80o
(American Medical
Association)
• 75.8o
(mean), 5.1o
(standard
deviation), (Boone and Azen)
Goniometer Alignment
• Axis – lateral to ulnar styloid
• Stationary arm – parallel to
humerus
• Moving arm – aligned with dorsum
of radius
Normal End Feel
• Capsular
WRIST FLEXION
Test Position
• Subject seated
• Forearm stabilized on table
• Flex wrist (fingers relaxed)
Normal Range
• 75o
+ or - 6.6o
(American
Academy of Orthopaedic
Surgeons)
• 60o
(American Medical
Association)

16. • 76.4o
(mean), 6.3o
(standard
deviation), (Boone and Azen)
Goniometer Alignment
• Axis – lateral wrist (triquetrum)
• Stationary arm – aligned with ulna
• Moving arm – aligned with fifth
metacarpal
Normal End Feel
• Capsular
WRIST EXTENSION
Test Position
• Subject seated
• Forearm stabilized on table
• Extend wrist (fingers relaxed)
Normal Range
• 74o
+ or - 6.6o
(American
Academy of Orthopaedic
Surgeons)
• 60o
(American Medical
Association)
• 74.9o
(mean), 6.4o
(standard
deviation), (Boone and Azen)

17. Goniometer Alignment
• Axis – lateral wrist (triquetrum)
• Stationary arm – aligned with ulna
• Moving arm – aligned with fifth
metacarpal
Normal End Feel
• Capsular
WRIST RADIAL DEVIATION
Test Position
• Subject sitting with forearm resting
on table
• Stabilize forearm to prevent
pronation or supination
Normal Range
• 21o
+ or - 4o
(American Academy
of Orthopaedic Surgeons)
• 20o
(American Medical
Association)
• 21.5o
(mean), 4.0o
(standard
deviation), (Boon and Azen)
Goniometer Alignment
• Axis – capitate
• Stationary arm – aligned with
forearm (lateral epicondyle)
• Moving arm – aligned with
metacarpal of middle finger
Normal End Feel
• Ligamentous (ulnar collateral
ligament)

18. WRIST ULNAR DEVIATION
Test Position
• Subject sitting with forearm resting
on table
• Stabilize forearm to prevent
pronation or supination
Normal Range
• 35o
+ or - 3.8o
(American Academy
of Orthopaedic Surgeons)
• 30o
(American Medical
Association)
• 36.0o
(mean), 3.8o
(standard
deviation), (Boon and Azen)
Goniometer Alignment
• Axis – capitate
• Stationary arm – aligned with
forearm (lateral epicondyle)
• Moving arm – aligned with
metacarpal of middle finger
Normal End Feel
• Ligamentous (radial collateral
ligament)
METACARPOPHALANGEAL JOINT FLEXION

19. Test Position
• Subject sitting with forearm resting
on table
• Wrist and interphalangeal joints
relaxed
• Forearm neutral
• Stabilize metacarpal to prevent
motion
Normal Range
• 86o
(index), 91o
(long), 99o
(ring),
105o
(little) (American Academy of
Orthopaedic Surgeons - active
motion)
• 90o
(American Medical
Association)
Goniometer Alignment
• dorsal metacarpophalangeal joint
• Stationary arm – aligned with
metacarpal
• Moving arm – aligned with
proximal phalange
Normal End Feel
• capsular

20. METACARPOPHALANGEAL JOINT EXTENSION
Test Position
• Subject sitting with forearm resting
on table
• Wrist and interphalangeal joints
relaxed
• Forearm neutral
• Stabilize metacarpal to prevent
motion
Normal Range
• 22o
(index), 18o
(long), 23o
(ring),
19o
(little) (American Academy of
Orthopaedic Surgeons - active
motion)
• 20o
(American Medical
Association)
Goniometer Alignment
• dorsal metacarpophalangeal joint
• Stationary arm – aligned with
metacarpal
• Moving arm – aligned with
proximal phalange
Normal End Feel
• capsular

21. METACARPOPHALANGEAL JOINT ABDUCTION
Test Position
• Subject sitting with forearm resting
on table
• Wrist neutral
• Forearm neutral
• Stabilize metacarpal to prevent
motion
Normal Range
• ???
Goniometer Alignment
• dorsal metacarpophalangeal joint
• Stationary arm – aligned with
metacarpal
• Moving arm – aligned with
proximal phalange
Normal End Feel
• capsular

22. METACARPOPHALANGEAL JOINT ADDUCTION
Test Position
• Subject sitting with forearm resting
on table
• Wrist neutral
• Forearm neutral
• Stabilize metacarpal to prevent
motion
Normal Range
• ???
Goniometer Alignment
• dorsal metacarpophalangeal joint
• Stationary arm – aligned with
metacarpal
• Moving arm – aligned with
proximal phalange
Normal End Feel
• capsular

23. INTERPHALANGEAL JOINT FLEXION
Note: This page demonstrates the technique for index proximal interphalangeal
joint flexion. The technique for all other interphalangeal joints is similar. Simply
align the goniometer over the proximal and distal joint partners (bones) for the joint
you wish to measure.
Test Position
• Subject sitting with forearm resting
on table
• Wrist, metacarpal, and non-tested
interphalangeal joints relaxed
• Forearm neutral
• Stabilize proximal bone to prevent
motion
Normal Range
American Academy of Orthopaedic
Surgeons
• PIP fingers - 102o
(index), 105o
(long), 108o
(ring), 106o
(little)
( active motion)
• DIP fingers - 72o
(index), 71o
(long), 63o
(ring), 65o
(little) ( active
motion)
• IP thumb - 73o
American Medical Association
• 100o
(PIP fingers), 70o
(DIP
fingers), 80o
(IP thumb)
Normal End Feel

24. Goniometer Alignment
• dorsal proximal interphalangeal
joint
• Stationary arm – aligned with
proximal phalange
• Moving arm – aligned with middle
phalange
Proximal Interphalangeal Finger Joints
• bone on bone (if tissues overlying
palmar aspect of bones is thin)
• soft tissue approximation (if tissues
overlying palmar aspect of bones
is thick)
Distal Interphalangeal Finger Joints and
Thumb Interphalangeal Joint
• capsular
THUMB CARPOMETACARPAL JOINT FLEXION

25. Test Position
• Subject sitting with forearm
supinated and resting on table
• Wrist neutral
• Stabilize carpals to prevent wrist
motion
Normal Range
• ???
Goniometer Alignment Normal End Feel

26. • Axis – carpometacarpal joint
• Stationary arm – aligned with
radius
• Moving arm – aligned with
metacarpal of thumb
• Capsular
THUMB CARPOMETACARPAL JOINT EXTENSION
Test Position
• Subject sitting with forearm
supinated and resting on table
• Wrist neutral
• Stabilize carpals to prevent wrist
motion
Normal Range
• ???
Goniometer Alignment
• Axis – carpometacarpal joint
• Stationary arm – aligned with
Normal End Feel
• Capsular

27. radius
• Moving arm – aligned with
metacarpal of thumb
THUMB CARPOMETACARPAL JOINT ABDUCTION
Test Position
• Subject sitting with forearm resting
on table
• Wrist neutral
• Forearm neutral
• Stabilize carpals to prevent wrist
motion
Normal Range
• 70o
(American Academy of
Orthopaedic Surgeons)
Goniometer Alignment
• Axis – radial styloid
• Stationary arm – aligned with
metacarpal of index finger
• Moving arm – aligned with
metacarpal of thumb
Normal End Feel
• Muscle stretch (adductor pollicus,
skin, fascia)

28. THUMB CARPOMETACARPAL JOINT ADDUCTION
Note: Thumb adduction is the return to neutral from thumb abduction. Thumb
adduction is rarely measured, probably because it is rarely limited.
Test Position
• Subject sitting with forearm resting
on table
• Wrist neutral
• Forearm neutral
• Stabilize carpals to prevent wrist
motion
Normal Range
• 0o
???
Goniometer Alignment
• Axis – radial styloid
• Stationary arm – aligned with
metacarpal of index finger
• Moving arm – aligned with
metacarpal of thumb
Normal End Feel
• Soft tissue approximation
THUMB CARPOMETACARPAL JOINT OPPOSITION

29. Note: Opposition of the thumb causes the pad of the thumb to face (oppose) the
pads of the fingers. Opposition cannot be measured with a goniometer. The
American Academy of Orthopaedic Surgeons suggests that opposition range is
normal when the tip of the thumb can touch the base of the fifth finger. When range
is not adequate, a ruler can be used to measure the distance between the tip of the
thumb and the base of the fifth finger.
Test Position
• Subject sitting with forearm
supinated and resting on table
• Wrist neutral
• Stabilize fifth metacarpal
Normal Range
• Able to touch tip of thumb to base
of fifth finger (American Academy
of Orthopaedic Surgeons)
Goniometer Alignment
• Goniometer cannot be used
• Use a ruler to measure distance
between tip of thumb and base of
fifth finger
Normal End Feel
• Capsular or soft tissue
approximation

30. EXTREMIDAD INFERIOR
HIP FLEXION
Test Position
• Subject supine
• Allow knee to flex (to avoid
limitation by tight hamstrings)
• Stabilize pelvis to prevent rotation
• Flex hip
Normal Range
• 121.0o
+ or - 6.4o
(American
Academy of Orthopaedic
Surgeons)
• 100.0o
(American Medical
Association)
• 122.3o
(mean), 6.1o
(standard
deviation), (Boone and Azen)

31. Goniometer Alignment
• Axis – greater trochanter
• Stationary arm – aligned with
midline of plevis
• Moving arm – aligned with femur
(lateral epicondyle)
Normal End Feel
• Capsular
HIP EXTENSION
Test Position
• Subject prone
• Stabilize pelvis to prevent rotation
• Extend hip
Normal Range
• 12.0o
+ or - 5.4o
(American
Academy of Orthopaedic
Surgeons)
• 30.0o
(American Medical
Association)
• 9.8o
(mean), 6.8o
(standard
deviation), (Boone and Azen)
Goniometer Alignment
• Axis – greater trochanter
Normal End Feel

32. • Stationary arm – aligned with
midline of plevis
• Moving arm – aligned with femur
(lateral epicondyle)
• Capsular or ligamentous
HIP ABDUCTION
Test Position
• Subject supine
• Stabilize pelvis to prevent pelvic
list
• Abduct hip
Normal Range
• 41.0o
+ or - 6.0o
(American
Academy of Orthopaedic
Surgeons)
• 40.0o
(American Medical
Association)
• 45.9o
(mean), 9.3o
(standard
deviation), (Boone and Azen)
Goniometer Alignment
• Axis – anterior superior iliac spine
Normal End Feel

33. (ASIS)
• Stationary arm – aligned with
opposite ASIS
• Moving arm – aligned with femur
(center of patella)
• Capsular or ligamentous
HIP ADDUCTION
Test Position
• Subject supine
• Stabilize pelvis to prevent pelvic
list
• Abduct opposite hip (to allow room
for tested limb to adduct)
• Adduct hip
Normal Range
• 27.0o
+ or - 3.6o
(American
Academy of Orthopaedic
Surgeons)
• 20.0o
(American Medical
Association)
• 26.9o
(mean), 4.1o
(standard
deviation), (Boone and Azen)
Goniometer Alignment
• Axis – anterior superior iliac spine
Normal End Feel

34. (ASIS)
• Stationary arm – aligned with
opposite ASIS
• Moving arm – aligned with femur
(center of patella)
• Capsular or ligamentous
HIP MEDIAL (INTERNAL) ROTATION
Test Position
• Subject sitting on table
• knee flexed
• Stabilize distal thigh
• medially (internally) rotate hip
Normal Range
• 44.0o
+ or - 4.3o
(American
Academy of Orthopaedic
Surgeons)
• 40.0o
(American Medical
Association)
• 47.3o
(mean), 6.0o
(standard
deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel

35. • Axis – center of patella
• Stationary arm – aligned vertically
• Moving arm – aligned with leg
(crest of tibia)
• Capsular
HIP LATERAL (EXTERNAL) ROTATION
Test Position
• Subject sitting on table
• knee flexed
• Stabilize distal thigh
• hip laterally (externally) rotated
Normal Range
• 44.0o
+ or - 4.8o
(American
Academy of Orthopaedic
Surgeons)
• 50.0o
(American Medical
Association)
• 47.2o
(mean), 6.3o
(standard
deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel

36. • Axis – center of patella
• Stationary arm – aligned vertically
• Moving arm – aligned with leg
(crest of tibia)
• Capsular
KNEE FLEXION
Knee flexion should be measured with the subject supine. This position allows
assessment of the joint range of motion without interference from tightness in the
rectus femoris muscle. If the examiner wishes to assess length of the rectus
femoris, have the patient lie prone (see 2nd illustration).
Test Position
• Subject supine
• Allow hip to flex
• Flex knee
Normal Range
• 141o
+ or - 5.3o
(American
Academy of Orthopaedic
Surgeons)
• 150o
(American Medical
Association)
• 142.5o
(mean), 5.4o
, (standard
deviation) (Boone and Azen)
Goniometer Alignment Normal End Feel

37. • Axis – lateral epicondyle of femur
• Stationary arm – aligned with
greater trochanter
• Moving arm – aligned with lateral
malleolus
• Soft tissue approximation
Supine Position (Rectus Femoris Limiting)
KNEE EXTENSION

38. Test Position
• Subject prone
• Stabilize femur
• Extend Knee
Normal Range
• minus 2.0o
+ or - 3.0o
(American
Academy of Orthopaedic
Surgeons)
Goniometer Alignment
• Axis – lateral epicondyle of femur
• Stationary arm – aligned with
greater trochanter
• Moving arm – aligned with lateral
malleolus
Normal End Feel
• Capsular
ANKLE DORSIFLEXION

39. Pronation of the sub-talar joint can compensate for a loss of ankle joint dorsiflexion
range of motion. To avoid measurement error (by accidentally including sub-talar
pronation), the sub-talar joint must be stabilized in its neutral position. To assess
the range of JOINT motion, flex the knee (first illustration). To assess tightness of
the gastrocnemius muscle, extend the knee (second illustration).
Test Position
• Subject prone
• Flex knee
• Stabilize sub-talar in neutral
• Dorsiflex ankle by pushing through
5th metatarsal head
Normal Range
• 13o
+ or - 4.4o
(American Academy
of Orthopaedic Surgeons)
• 20o
(American Medical
Association)
• 12.6o
(mean), 4.4o
, (standard
deviation) (Boone and Azen)
Goniometer Alignment
• Axis – lateral malleolus
Normal End Feel
• Capsular

40. • Stationary arm – aligned with
fibular head
• Moving arm – aligned with fifth
metatarsal
Assessing Gastrocnemius Tightness (muscle stretch end-feel)
ANKLE PLANTARFLEXION

41. Test Position
• Subject supine
• Extend knee
• Stabilize leg
• Plantarflex ankle
Normal Range
• 56o
+ or - 6.1o
(American Academy
of Orthopaedic Surgeons)
• 40o
(American Medical
Association)
• 56.2o
(mean), 6.1o
, (standard
deviation) (Boone and Azen)
Goniometer Alignment
• Axis – lateral malleolus
• Stationary arm – aligned with
fibular head
• Moving arm – aligned with fifth
metatarsal
Normal End Feel
• Capsular
CALCANEAL INVERSION

42. Test Position
• Subject prone
• Stabilize tibia in sagittal plane
(rotate hip or pelvis to align tibia)
• Invert calcaneus
Normal Range
• 2/3 of total range from extreme of
inversion to extreme of eversion
should be inversion. About 20o
inversion (and 10o
eversion) on
average (Seibel MO: Foot
Function: A Programmed Text,p.
72, Baltimore, Williams & Wilkins,
1988)
• 37.0o
+ or - 4.5o
(American
Academy of Orthopaedic
Surgeons)
Goniometer Alignment
• Axis – automatically positioned by
Normal End Feel

43. alignment of goniometer arms
• Stationary arm – aligned with
midline of leg
• Moving arm – aligned with midline
of calcaneus
• Capsular
CALCANEAL EVERSION
Test Position
• Subject prone
• Stabilize tibia in sagittal plane
(rotate hip or pelvis to align tibia)
• Evert calcaneus
Normal Range
• 1/3 of total range from extreme of
inversion to extreme of eversion
should be eversion. About 10o
eversion (and 20o
inversion) on
average (Seibel MO: Foot
Function: A Programmed Text,p.
72, Baltimore, Williams & Wilkins,
1988)

44. • 21.0o
+ or - 5.0o
(American
Academy of Orthopaedic
Surgeons)
Goniometer Alignment
• Axis – automatically positioned by
alignment of goniometer arms
• Stationary arm – aligned with
midline of leg
• Moving arm – aligned with midline
of calcaneus
Normal End Feel
• Capsular
MIDTARSAL INVERSION
Test Position
• Subject supine
• Stabilize calcaneus and talus
• Invert forefoot
Normal Range
• ???
Goniometer Alignment Normal End Feel

45. • Axis – automatically positioned by
alignment of goniometer arms
• Stationary arm – aligned with
midline of leg
• Moving arm – aligned with plantar
aspect of metatarsal heads
• Capsular
MIDTARSAL EVERSION
Test Position
• Subject supine
• Stabilize calcaneus and talus
• Evert forefoot
Normal Range
• ???
Goniometer Alignment
• Axis – automatically positioned by
alignment of goniometer arms
• Stationary arm – aligned with
midline of leg
• Moving arm – aligned with plantar
Normal End Feel
• Capsular

46. aspect of metatarsal heads
METATARSOPHALANGEAL JOINT DORSIFLEXION
(Extension)
Range of first metatarsophalangeal (MTP) joint dorsiflexion is functionally important
for gait. The available range of 1st MTP joint dorsiflexion depends on the position
of the 1st ray. A plantarflexed 1st ray allows greater range of 1st MTP dorsiflexion.
I recommend stabilizing the 1st ray in plantarflexion to measure maximum range of
1st MTP dorsiflexion. The first photo demonstrates a good method for measuring
1st or 5th MTP joint dorsiflexion by placing the goniometer alongside the bones.
This technique cannot be used for the 2nd, 3rd, or 4th MTP joints. The second
photo shows a technique for measuring these joints.
Test Position
• Subject supine
• Stabilize 1st metatarsal in
plantarflexion
• Dorsiflex MTP
Normal Range
• 1st - 65o
to 75o
(slightly less at
lesser MTPs) is the minimum
required for normal gait (Root,
Orien, Weed. Normal and
Abnormal Function of the Foot, pp.
60-61, Clinical Biomechanics
Corp., Los Angeles, 1977.)
• 1st - 50o
, 2nd - 40o
, 3rd - 30o
, 4th
- 20o
, 5th - 10o
(American Medical
Association)

47. Goniometer Alignment
• Axis – medial to center of
metararsal head
• Stationary arm – aligned
metatarsal
• Moving arm – aligned with
proximal phalange
Normal End Feel
• Capsular
Assessing MTP Dorsiflexion by Placing Goniometer on Dorsum of Bones
(requires modified goniometer)
METATARSOPHALANGEAL JOINT PLANTARFLEXION
(Flexion)

48. The first photo demonstrates a good method for measuring 1st or 5th MTP joint
plantarflexion by placing the goniometer alongside the bones. This technique
cannot be used for the 2nd, 3rd, or 4th MTP joints. The second photo shows a
technique for measuring these joints.
Test Position
• Subject supine
• Stabilize 1st metatarsal
• Plantarflex MTP
Normal Range
• 1st - 30o
, 2nd - 30o
, 3rd - 20o
, 4th
- 10o
, 5th - 10o
(American Medical
Association)
Goniometer Alignment
• Axis – medial to center of
metararsal head
• Stationary arm – aligned
metatarsal
• Moving arm – aligned with
proximal phalange
Normal End Feel
• Capsular
Assessing MTP Plantarflexion by Placing Goniometer on Dorsum of
Bones
(requires modified goniometer)

49. METATARSOPHALANGEAL JOINT ABDUCTION

50. Test Position
• Foot flat on table
• Stabilize metatarsal
• Abduct MTP
Normal Range
• ???
Goniometer Alignment
• Axis – dorsum of center of
metararsal head
• Stationary arm – aligned with
metatarsal
• Moving arm – aligned with
proximal phalange
Normal End Feel
• Capsular
METATARSOPHALANGEAL JOINT ADDUCTION

51. Test Position
• Foot flat on table
• Stabilize metatarsal
• Adduct MTP
Normal Range
• ???
Goniometer Alignment
• Axis – dorsum of center of
metararsal head
• Stationary arm – aligned with
metatarsal
• Moving arm – aligned with
proximal phalange
Normal End Feel
• Capsular
COLUMNA VERTEBRAL

52. CERVICAL SPINE FORWARD BENDING (flexion)
Test Position
• Subject sitting with lumbar and
thoracic spines supported
• Stabilize lumbar and thoracic
spines
• Flex cervical spine
Normal Range
• 75.5o
+ or - 8.5o
(20 - 29 yrs.),
70.5o
+ or - 17.5o
(30 - 49 yrs.),
64.5o
+ or - 7o
(>50 yrs.) (American
Academy of Orthopaedic
Surgeons)
• 60o
(American Medical
Association)
Goniometer Alignment
• Axis – external auditory meatus
• Stationary arm – vertical
• Moving arm – aligned with nostrils
Normal End Feel
• Capsular or ligamentous
CERVICAL SPINE BACKWARD BENDING (extension)

53. NOTE: The position of the mouth influences the available range of cervical
backward bending. With the mouth closed, thghtness of the infrahyoid and
suprahyoid muscles can limit range of cervical backward bending. If you wish to
assess the range of the cervical spine, the mouth should be relaxed and slightly
open.
Test Position
• Subject sitting with lumbar and
thoracic spines supported
• Stabilize lumbar and thoracic
spines
• Mouth relaxed and slightly open
• Extend cervical spine
Normal Range
• 75.5o
+ or - 8.5o
(20 - 29 yrs.),
70.5o
+ or - 17.5o
(30 - 49 yrs.),
64.5o
+ or - 7o
(>50 yrs.) (American
Academy of Orthopaedic
Surgeons)
• 75o
(American Medical
Association)
Goniometer Alignment
• Axis – external auditory meatus
• Stationary arm – vertical
• Moving arm – aligned with nostrils
Normal End Feel
• Bony or Capsular
CERVICAL SPINE SIDEBENDING

54. Test Position
• Subject sitting with lumbar and
thoracic spines supported
• Stabilize lumbar and thoracic
spines
• Sidebend cervical spine
Normal Range (unilateral)
• 50.5o
+ or - 5.5o
(20 - 29 yrs.),
46.5o
+ or - 6.5o
(30 - 49 yrs.), 40o
+ or - 8.5o
(>50 yrs.) (American
Academy of Orthopaedic
Surgeons)
• 45o
(American Medical
Association)
Goniometer Alignment
• Axis – spinous process of C7
• Stationary arm – spinous
processes of thoracic spine
• Moving arm – posterior midline of
head at occipital protuberance
Normal End Feel
• Capsular or ligamentous

55. CERVICAL SPINE ROTATION
Test Position
• Subject sitting with lumbar and
thoracic spines supported
• Stabilize lumbar and thoracic
spines
• Rotate cervical spine
Normal Range (unilateral)
• 91.5o
+ or - 5.5o
(20 - 29 yrs.), 81o
+ or - 6.5o
(30 - 49 yrs.), 77.5o
+ or
- 7.5o
(>50 yrs.) (American
Academy of Orthopaedic
Surgeons)
• 80o
(American Medical
Association)
Goniometer Alignment
• Axis – center of superior aspect of
head
• Stationary arm – aligned with
acromion processes
• Moving arm – aligned with tip of
nose
Normal End Feel
• Capsular or ligamentous

56. THORACO-LUMBAR SPINE FORWARD BENDING (flexion)
TEST DE SHOBER
NOTE: There are several methods for measuring the range of motion of the lumbar
and thoracic spines. Each method has its own advantages and disadvantages (no
method is completely valid or reliable, and normal values are not well established
for any method). The method illustrated here is a good compromise. Take a
baseline measurement with the patient standing upright, then take a second
measurement with the subject in the forward bending position. Note the difference.

57. Test Position
• Subject standing
• Flex thoracic and lumbar spines
Normal Range
• 10 cm (Norkin and White)
Tape Measure Alignment
• Spinous processes of C7 and S1
Normal End Feel
• Capsular or ligamentous

58. THORACO-LUMBAR SPINE BACKWARD BENDING (extenion)
NOTE: There are several methods for measuring the range of motion of the lumbar
and thoracic spines. Each method has its own advantages and disadvantages (no
method is completely valid or reliable, and normal values are not well established
for any method). The method illustrated here is a good compromise. Take a
baseline measurement with the patient standing upright, then take a second
measurement with the subject in the backward bending position. Note the
difference.

59. Test Position
• Subject standing
• Extend thoracic and lumbar spines
Normal Range
• ???
Tape Measure Alignment
• Spinous processes of C7 and S1
Normal End Feel
• Capsular or ligamentous
(sometimes bony)
THORACO-LUMBAR SPINE SIDEBENDING

60. NOTE: There are several methods for measuring the range of motion of the lumbar
and thoracic spines. Each method has its own advantages and disadvantages (no
method is completely valid or reliable, and normal values are not well established
for any method). The method illustrated here is a good compromise.
Test Position
• Subject standing
• Stabilize pelvis
• Sidebend thoracic and lumbar
spines
Normal Range (unilateral)
• RIGHT:
o 20 - 29 yrs 37.6o
+ or - 5.8o
o 30 - 39 yrs 35.3o
+ or - 6.5o
o 40 - 49 yrs 27.1o
+ or - 6.5o
o 50 - 59 yrs 25.3o
+ or - 6.2o
o 60 - 69 yrs 20.2o
+ or - 4.8o
o 70 - 79 yrs 18.0o
+ or - 4.7o
o (Fitzgerald, Wynveen,
Rheault et al)
• LEFT:
o 20 - 29 yrs 38.7o
+ or - 5.7o
o 30 - 39 yrs 36.5o
+ or - 6.0o
o 40 - 49 yrs 28.5o
+ or - 5.2o
o 50 - 59 yrs 26.8o
+ or - 6.4o
o 60 - 69 yrs 20.3o
+ or - 5.3o

61. o 70 - 79 yrs 18.9o
+ or - 6.0o
o (Fitzgerald, Wynveen,
Rheault et al)
• 25o
(American Medical
Association)
Goniometer Alignment
• Axis - S1 spinous process
• Stationary arm - vertical
• Moving arm - C7 spinous process
Normal End Feel
• Capsular or ligamentous
ROTACION DEL TRONCO
NOTE: There are several methods for measuring the range of motion of the lumbar
and thoracic spines. Each method has its own advantages and disadvantages (no
method is completely valid or reliable, and normal values are not well established
for any method). The method illustrated here is a good compromise.
Test Position
• Subject sitting
• Stabilize pelvis
• Do not allow sidebending, forward
bending or backward bending
Normal Range (unilateral)
• 45o
(American Medical
Association)

62. • 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
Normal End Feel
• Capsular or ligamentous
TEMPEROMANDIBULAR JOINT OPENING
Ruler Method
Alternate Method

63. Test Position
• Subject sitting
• Stabilize cervical spine
• Open Mouth
Normal Range
• 35 to 50 mm (Magee)
• two and 1/2 flexed PIPs (Friedman
and Weisberg)
Ruler Alignment
• Use a ruler to measure the
distance between the upper and
lower incisors
• Alternate method - have the
subject flex the proximal
interphalangeal joints (PIPs) of the
fingers and assess how many
PIPs can fit between the teeth
Normal End Feel
• Capsular or ligamentous

64. TEMPEROMANDIBULAR JOINT PROTRUSION
Test Position
• Subject sitting
• Stabilize cervical spine
• Protrude mandible forward
Normal Range
• 3 to 5 mm (Magee)
Ruler Alignment
• Use a ruler to measure the
distance between the upper and
lower incisors
Normal End Feel
• Capsular or ligamentous

65. TEMPEROMANDIBULAR JOINT LATERAL DEVIATION
Test Position
• Subject sitting
• Stabilize cervical spine
• Deviate mandible laterally
Normal Range
• 10 to 15mm (Magee)
Ruler Alignment
• 1 - Identify points on the upper and
lower teeth that are aligned when
the mouth is in resting position
(upper and lower incisors in this
illustration)
• 2 - Deviate the mandible laterally
and use a ruler to measure the
distance between the two points
(upper and lower incisors in this
illustration)
Normal End Feel
• Capsular or ligamentous