The document describes the starting position, range of motion, precautions, and factors limiting range of motion for various neck and trunk motions including flexion, extension, rotation, lateral flexion, and hyperextension. The neck motions include flexion from 0-45 degrees, extension from 45-0 degrees, rotation from 0-60 degrees to each side, and lateral flexion from 0-45-60 degrees to each side. Trunk motions include flexion of approximately 4 inches, hyperextension of 2 inches, and lateral flexion and rotation measuring differences in distances between starting and ending positions using landmarks like spinous processes.

2. NECK FLEXION
Starting & ending position
Sitting with trunk well
supported , neck in the
anatomical position , hand
placed on the lap. &shoulder
joints are relaxed.
Axis – external auditory meatus
Stationary arm – vertical
Moving arm – aligned with
nostrils
ROM From 0 – 45 degrees

3. NECK FLEXION
Precaution
Prevent trunk flexion.
Prevent neck rotation and lateral flexion.
Factors limiting ROM
Tension of the extensor muscles of neck (posterior
muscles of neck) .
Tension of the ligaments
Longitudinal ligament.
Interspinal & supraspinal ligaments.
 Bony blockage: contact of lower lips of vertebral
bodies with surface of subjacent vertebrae anteriorly.

4. NECK Extension
Starting & ending position
Just as for flexion
Axis – external auditor meatus
Stationary arm – vertical
Moving arm – aligned with
nostrils
ROM From 45 – 0 for
extension
From o- 45 for hyper
extension

5. NECK Extension
Precaution
Just as for flexion
Factors limiting ROM
Tension of flexors muscles of neck ( ventral neck
muscles)
Approximation of spinous process.

6. Starting & ending position
Just as for flexion& extension
Axis : placed over the center of the top
of the head.
Stationary arm: placed in the line
with the acromion process of the side
being measured.
Moving arm placed in the line with
the tip of the nose.
ROM
From 0 – 60-75 degrees in each
direction.
The distance is approximately 5 in to
each side as measured by tape.
CERVICAL ROTATION

7. CERVICAL ROTATION
precaution
Prevent trunk rotation
Prevent scapular elevation.
Tape measurement
 Place measuring tape on the mid-line of the chin and
the acromion process, measure the difference between
the starting and ending position
The difference in the measurement is the amount of
range of motion.

8. CERVICAL lateral flexion ( side
flexion)
Starting & ending position
Sitting with trunk well supported , neck in
the anatomical position , hand placed on the
lap. &shoulder joints are relaxed.
Axis : placed over the spinous process of
C7 .
Stationary arm: placed along the
thoracic spinous processes.
Moving arm placed over the external
occipital protuberance of the occipital
bone.
ROM From 0 – 45-60 degrees in each
direction.
The distance is approximately 5 in to each
side as measured by tape.

9. CERVICAL lateral flexion ( side
flexion)
Precaution
Prevent trunk lateral flexion to the test side.
Tape measurement
Between mastoid process of the temporal bone and
the acromion process of the scapula..

10. Trunk Flexion
Starting position: the tape is
placed proximally on the
spinous process of C7 and
distally to S1.
Ending position: following
flexion of the vertebrae using
the same land mark.
Calculate the difference in
distance between starting and
ending positions.
ROM Approximately 4 in.
The difference between starting
and ending positions.

11. Trunk Flexion
Precaution
 The pelvis and hip joints are stabilized.
Factors limiting motion
 Tension of spinal extensor muscles.
Contact of last ribes with abdomin.
Bony blockage: contact of lips of vertebral bodies
with subjacent vertebrae anterriorly.
Tension of ligaments:
Posterior longitudinal
Inter spinal ligament.
Supra spinal ligament.

12. Trunk HyperextensionThe tape alignment is just the same as
for trunk flexion
ROM 2 inches
Precautions
Prevent hip extension.
Prevent trunk rotation.
Factors Limiting ROM
Tension of anterior abdominal
muscles ( muscles of trunk flexion)
Contact of spinous processes.
Tension of longitudinal ligament of
spine.

13. Thoracic and lumbar lateral
flexion
Position
Standing erect.
Axis - S1 spinous process
Stationary arm - vertical
Moving arm - C7 spinous process
Stabilization
The pelvis is stabilized.

14. Thoracic and lumbar lateral
flexion
Measuring tape
Starting position: place one end of measuring tape on the
tip of the middle finger and other on the tip of the lateral
malleolus.
Measure the difference in inches following the lateral
flexion motion
Precautions
Avoid trunk flexion, extension and rotation
Prevent lateral tilting of the pelvis.
Factors limiting normal ROM
Contact of lips pf vertebral bodies with subjacent
vertebrae laterally.

15. Trunk Rotation
Position
Sitting without back support, feet flat
on the floor.
Axis - center of superior aspect of head
Stationary arm - aligned with anterior
superior iliac spines
Moving arm - aligned with acromion
processes
Normal Range 45o
Stabilization
The pelvis is stabilized.

16. Trunk Rotation
Precautions
Prevent pelvis rotation.
Avoid trunk flexion, extension and lateral flexion.
Factors limiting normal RON
Tension of oblique abdominal muscle of opposite side
being tested.
In thoracic area: tension of costovertebral ligament.
In lumbar area: interlocking of articular facets.