Goniometry refers to the measurement of joint angles in the human body. It is an important part of a physical examination to determine range of motion, evaluate progress, and modify treatment. There are different types of goniometers used to measure motion in various planes at joints like the shoulder, elbow, wrist, fingers, hip, and spine. Factors like a person's age, joint health, surrounding soft tissues, and pathological conditions can impact the normal range of motion values. Proper positioning, stabilization, and identification of bony landmarks is required to accurately measure and document a joint's range of motion.

1. GONIOMETRY
PRESENTED BY :
MALEEHA AMJED
Final Year Student
Bachelors Of Physiotherapy

2. About The Topic

3. 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.
ANGLE MEASURE

4. PARTS OF MOTOR EXAMINATION
1. Nutrition Of Muscle
2. Muscle Tone
3. Reflexes
4. Range Of Motion and TCD’s
5. Manual Muscle Testing

5. 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

6. JOINT MOTION
ARTHROKINEMATIC
JOINT PLAY
COMPONENT MOVEMENT
OSTEOKINEMATIC
PHYSIOLOGICAL/
ANATOMICAL MOVEMENT
(Functional)

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

9. Synovial joint
• Most evolved & hence most mobile type of
joints
• The ends of bony components are free to
move in relation to one another
• Bony components are indirectly connected to
one another by means of a joint capsule that
encloses the joint

10. 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.

11. The barrier Concept

12. physiologic motion is limited
by a physiologic barrier
tension develops within the
surrounding tissues
(joint capsule, ligaments
and connective tissue)

13. additional amount of passive
range of motion can be performed the anatomic
barrier cannot be
exceeded without
disrupting the
joints integrity

14. SUBDIVISION OF JROM
• Initial ROM
• Middle ROM
• End ROM

15. Subdivision of ROM
as per Muscle
Work

16. ACTIVE INSUFFICIENCY?
Flex your wrist
completely
Attempt to
tighten your
fist
• A muscle
cantcontractmaximally
across both joints
together
Much force
than in
slightly
extended
position
• The multi joint long
finger flexors enter
active insufficiency
when wrist flexes
• Shortest possible
length of muscle

17. PASSIVE INSUFFICIENCY?
FLEXION OF THE FINGERS
IS A RESULT OF
INSUFFICIENT
EXTENSIBILTY OF THE
FINGER FLEXORS
STRETCHED OVER
EXTENDED WRIST
EXTENSION OF THE
FINGERS IS A RESULT OF
INSUFFICIENT LENGTH OF
THE FINGER EXTENSORS
STRETCHED OVER FLEXED
WRIST
• LONGEST POSSIBLE LENGTH OF MUSCLE
• Muscle cant stretch maximally at both joints together

18. Other Examples of AI PI In Body and its
clinical relevance with Goniometry
• BICEPS : At the top of curl, (when biceps begin to smash against
forearm), when elbows are lifted
**Shortens biceps over both the shoulder & elbow blade
• Simultaneously lengthening the TRICEPS
• HAMS : When reaching to touch toes
**Lengthening felt as a stretch
• RECTUS FEMORIS : Hip flexion with knee extension(70 degree) is
less than hip flexion with knees bent (120 degree)
• GASTROCNEMIUS : Seated calf / heel raise places the
gastrocnemius into active insufficiency since the knee flexes too
much & ankle performs plantarflexion

19. 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

20. 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

21. FACTORS DETERMINING AMOUNT OF ROM
Integrity Of
Joint
SurfaceRELIABILITY
Amount Of
Scarring
Present
AGE
GENDER
Shape Of
Articulating
Surface
Health
Of
Joint
Various
diseases/
pathological
conditions
Health Of
Surrounding
Tissues
Mobilty &
Pliabilty Of Soft
Tissue

22. 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

23. Prerequisite Skills For Measuring ROM
• The therapist should be skilled in
 Correct positioning (Pt/ Pt Jt/ PT And GM)
 Stabilization for measurement
 Palpation
 Alignment
 Recording measurements accurately
 Documentation

24. • Visual observation of the joint and its adjacent
area is important to look for :
a) Compensatory motions
b) Posture
c) Muscle contour
d) Skin creases
e) Facial expressions

25. 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

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

27. Joint Mobility Scale
Hyper Mobility
(Mild, Moderate,
Severe)
Exercise, Bracing
surgery
Normal mobility Normal function
Hypo Mobility
(Mild, Moderate,
Severe)
Exercise, Mobilization,
surgery
N

28. 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

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

32. Spinal Goniometer

33. UNIVERSAL GONIOMETER
• A universal Goniometer may be constructed of
metal or plastic and it has 3 parts :-
1. Body of Goniometer
2. 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)

35. Demonstration
Shoulder
Knee
Cervical spine

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

37. Functional Ranges of various joint in
various activities
 Walking
 Stair ascending descending
 Sitting
 Squatting
 Cross leg sitting
 Self Feeding
 Back reach
 Neck reach
 Etc….

38. ROM Required In ADL’s
ASCENDING STAIRS REQUIRES
BETWEEN
47 - 66 DEGREE OF HIP FLEXION
DEPENDING ON STAIR
DIMENSION
DESCENDING STAIRS REQUIRES AN
AVERAGE OF
21 - 36 DEGREE OF DORSIFLEXION,
86.9 - 107 DEGREE OF KNEE FLEXION
DEPENDING ON STAIR DIMENSIONS

39. Rising from a chair requires a mean range of
knee flexion of 90.1 - 95.0 degree and
full dorsiflexion ROM depending on height
of seat
Sitting in a chair with an
average seat height requires
112 degrees of hip flexion

40. Drinking from a cup requires about
130 degree of elbow flexion
36 to 52 degrees of shoulder flexion
Reaching objects on a high shelf
require
148 degrees of shoulder flexion

41. Using a telephone requires
approx 40 degrees of wrist
extension
Approximately
50 degrees of pronation
occur while reading a newspaper
Reaching behind the head
requires about
112 degrees of abduction
of the shoulder

42. 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.

43. NORMAL END-FEEL DESCRIPTION EXAMPLE
Soft Soft Tissue Approximation Knee flexion (contact
between soft tissue of
posterior leg and posterior
thigh)
Firm Muscular stretch
Capsular stretch
Ligamentous stretch
Hip flexion with knee
straight (passive elastic
tension of hamstring
muscles)
Extension of
metacarpophalangeal joints
of fingers
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 of humerus)

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

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

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

47. JOINT MOTION TESTING
POSITION
STABILIZATION MEASUREMENTS
LUMBAR • FLEXION
•EXTENSION
•LATERAL
FLEXION
STANDING PELVIS
To prevent
anterior tilting
To prevent
posterior tilting
To prevent
lateral tilting
6.7cm in males
5.8cm in females
Average
6.3cm-6.9cm
(Modified
Schober test)
1.6cm (Modified
Schober Test)
25 – 30 degree
by AMA (double
inclinometer)

48. Demonstration
Schober’s Test For
Lumbar Spine Flexion

49. 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

59. HFD Thomas Test

60. KFD

61. Equinus

62. TF Malalignment

63. Genu Recurvatum

64. CERVICAL SPINE
JOINT ROM
Flexion 0º to 45º
Extension 0º to 45º
Lateral flexion 0º to 45º
Rotation 0º to 60º
THORACIC AND LUMBAR
SPINE
JOINT ROM
Flexion 0º to 80º
Extension 0º to 30º
Lateral flexion 0º to 40º
Rotation 0º to 45º

65. SHOULDER
JOINT ROM
Flexion 0º to 180º
Extension 0º to 60º
Abduction 0º to 180º
Adduction 0º
Horizontal abduction 0º to 40º
Horizontal Adduction 0º to 130º
Internal rotation
Arm in Abduction 0º to 70º
Arm in Adduction 0º to 60º
External rotation
Arm in Abduction 0º to 90º
Arm in Adduction 0º to 80º

66. ELBOW
JOINT ROM
Flexion 0º to 135º - 150º
Extension 0º
FOREARM
JOINT ROM
Pronation 0º to 80º - 90º
Supination 0º to 80º - 90º

67. WRIST
JOINT ROM
Flexion 0º to 80º
Extension 0º to 70º
Ulnar
deviation
(adduction)
0º to 30º
Radial
deviation
(abduction)
0º to 20º
THUMB
JOINT ROM
DIP flexion 0º to 80º - 90º
MCP flexion 0º to 50º
Adduction, radial
and palmar
0º
Palmar
abduction
0º to 50º
Radial abduction
Opposition
0º to 50º

68. FINGERS
JOINT ROM
MCP flexion 0º to 90º
MCP hyperextension 0º to 15º - 45º
PIP flexion 0º to 110º
DIP flexion 0º to 80º
abduction 0º to 25º

69. HIP
JOINT ROM
Flexion 0º to 120º (bent
knee)
Extension 0º to 30º
Abduction 0º to 40º
Adduction 0º to 35º
Internal rotation 0º to 45º
External rotation 0º to 45º
KNEE
JOINT ROM
Flexion 0º to 135º

70. ANKLE AND FOOT
JOINT ROM
Plantar flexion 0º to 50º
Dorsiflexion 0º to 15º
Inversion 0º to 35º
Eversion 0º to 20º

71. SOURCES
• Measurement of Joint Motion : A Guide
to Goniometry, 4th Edition, by Cynthia C. Norkin
• Physical Rehabilitation 6th Edition SuSan B.
O’Sullivan
• Magee (2002). Orthopedic physical Assessment (4th
ed.). Phil: Saunders.
• Kisner C, & Colby LA (2002). Therapeutic
exercise: Foundations and techniques (4th ed.). PA:
FA Davis.
• The Principles of Exercise Therapy (Fourth
Edition): M. Dena Gardiner.