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)

 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 65 o 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

 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
 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.
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

 EXTREMIDAD SUPERIOR

SHOULDER FLEXION

Test Position Normal Range

• Subject supine (For shoulder complex flexion)

• Flatten lumbar spine (flex knees)
• Shoulder no abduction, adduction
or rotation
• (Note: to measure gleno-humeral
motion, stabilize scapula)
• 167o + or - 4.7o (American
Academy of Orthopaedic
Surgeons)
• 150o (American Medical
Association)

• 166o (mean), 4.7o (standard

deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel

• Axis – center of humeral head • Muscle Stretch

near acromion process
• Stationary arm – parallel mid-
axillary line

• Moving arm – aligned with midline

of humerus (lateral epicondyle)
 EXTENSION DEL HOMBRO
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)
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)
Normal End Feel
• Capsular or ligamentous
 ABDUCCION DEL HOMBRO

Test Position Normal Range

• Subject supine (for shoulder complex abduction)

• Shoulder 0o flexion and extension
• Shoulder laterally (externally)
rotated
• Shoulder abducted
• Stabilize thorax (note: to measure
gleno-humeral motion, stabilize
scapula)
Goniometer Alignment
• 184o + or - 7.0o (American
Academy of Orthopaedic
Surgeons)
• 180o (American Medical
Association)
• 184o (mean), 7.0o (standard
deviation), (Boone and Azen)
Normal End Feel

• Axis – center of humeral head • Muscle Stretch

near acromion process
• Stationary arm – parallel to
sternum

• Moving arm – aligned with midline

of humerus
 ROTACION INTERNA DEL HOMBRO

Test Position Normal Range

• Subject supine • 69o + or - 4.6o (American

• Shoulder 90o abduction Academy of Orthopaedic
• Forearm neutral Surgeons)
• Elbow flexed 90o • 90o (American Medical
• Stabilize arm Association)

• 68.8o (mean), 4.6o (standard

deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel

• Axis – olecranon process of ulna • Capsular

• Stationary arm – aligned vertically

• Moving arm – aligned with ulna

(styloid process)
 ROTACION EXTERNA DEL HOMBRO

Test Position Normal Range

• Subject supine • 104o + or - 8.5o (American

• Shoulder 90o abduction Academy of Orthopaedic
• Forearm neutral Surgeons)
• Elbow flexed 90o • 90o (American Medical
• Stabilize arm Association)

• 103o (mean), 8.5o (standard

deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel

• Axis – olecranon process of ulna • Capsular

• Stationary arm – aligned vertically

• Moving arm – aligned with ulna

 (styloid process)

FLEXION DEL ANTEBRAZO

Test Position Normal Range

• Subject supine • 141.0o + or - 4.9o (American

• Shoulder neutral (arm at side) Academy of Orthopaedic
• Forearm supinated Surgeons)
• Elbow flexed • 140.0o (American Medical
• Stabilize arm Association)

• 142.9o (mean), 5.6o (standard

deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel

• Axis – lateral epicondyle of • Soft tissue approximation

humerus (capsular for thin subjects)
• Stationary arm – aligned with
humerus (center of acromion
process)

• Moving arm – aligned with radius

(styloid process)
 EXTENSION DEL CODO

Test Position Normal Range

• Subject supine • 0.3o + or - 2.0o (American

• Shoulder neutral (arm at side) Academy of Orthopaedic
• Forearm supinated Surgeons)
• Elbow extended • 0.0o (American Medical
• Stabilize arm Association)

• 0.6o (mean), 3.1o (standard

deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel

• Axis – lateral epicondyle of • Bone on bone

humerus
• Stationary arm – aligned with
humerus (center of acromion
process)

• Moving arm – aligned with radius

 (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
 deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel

• Axis – medial to ulnar styloid • Capsular

• Stationary arm – parallel to
humerus

• Moving arm – aligned with ventral

aspect of radius

FOREARM PRONATION

Test Position Normal Range

• Subject sitting • 75o + or - 5.3o (American
• Shoulder neutral (arm at side) Academy of Orthopaedic
• Elbow flexed to 90o Surgeons)
• Stabilize arm • 80o (American Medical
Association)
• Pronate forearm
• 75.8o (mean), 5.1o (standard
deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel

• Axis – lateral to ulnar styloid • Capsular

• Stationary arm – parallel to
humerus

• Moving arm – aligned with dorsum

of radius

WRIST FLEXION

Test Position Normal Range

• Subject seated • 75o + or - 6.6o (American

• Forearm stabilized on table Academy of Orthopaedic
• Flex wrist (fingers relaxed) Surgeons)
• 60o (American Medical
Association)
 • 76.4o (mean), 6.3o (standard
deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel

• Axis – lateral wrist (triquetrum)

• Stationary arm – aligned with ulna
• Capsular
• Moving arm – aligned with fifth
metacarpal

WRIST EXTENSION

Test Position Normal Range

• Subject seated • 74o + or - 6.6o (American

• Forearm stabilized on table Academy of Orthopaedic
• Extend wrist (fingers relaxed) Surgeons)
• 60o (American Medical
Association)

• 74.9o (mean), 6.4o (standard

deviation), (Boone and Azen)
 Goniometer Alignment Normal End Feel

• Axis – lateral wrist (triquetrum) • Capsular

• Stationary arm – aligned with ulna

• Moving arm – aligned with fifth

metacarpal

WRIST RADIAL DEVIATION

Test Position Normal Range

• Subject sitting with forearm resting • 21 + or - 4o (American Academy
o

on table of Orthopaedic Surgeons)

• Stabilize forearm to prevent
pronation or supination
Goniometer Alignment
• Axis – capitate
• Stationary arm – aligned with
forearm (lateral epicondyle)
• 20o (American Medical
Association)
• 21.5o (mean), 4.0o (standard
deviation), (Boon and Azen)
Normal End Feel
• Ligamentous (ulnar collateral
ligament)

• Moving arm – aligned with

metacarpal of middle finger
 WRIST ULNAR DEVIATION

Test Position Normal Range

• Subject sitting with forearm resting • 35o + or - 3.8o (American Academy

on table of Orthopaedic Surgeons)
• 30o (American Medical
• Stabilize forearm to prevent Association)
pronation or supination
• 36.0o (mean), 3.8o (standard
deviation), (Boon and Azen)
Goniometer Alignment Normal End Feel

• Axis – capitate • Ligamentous (radial collateral

• Stationary arm – aligned with ligament)
forearm (lateral epicondyle)

• Moving arm – aligned with

metacarpal of middle finger

METACARPOPHALANGEAL JOINT FLEXION

 Test Position Normal Range

• Subject sitting with forearm resting • 86o (index), 91o (long), 99o (ring),
on table 105o (little) (American Academy of
• Wrist and interphalangeal joints Orthopaedic Surgeons - active
relaxed motion)
• Forearm neutral
• 90o (American Medical
• Stabilize metacarpal to prevent Association)
motion
Goniometer Alignment Normal End Feel

• dorsal metacarpophalangeal joint • capsular

• Stationary arm – aligned with
metacarpal

• Moving arm – aligned with

proximal phalange
 METACARPOPHALANGEAL JOINT EXTENSION

Test Position Normal Range

• Subject sitting with forearm resting • 22o (index), 18o (long), 23o (ring),
on table 19o (little) (American Academy of
• Wrist and interphalangeal joints Orthopaedic Surgeons - active
relaxed motion)
• Forearm neutral
• 20o (American Medical
• Stabilize metacarpal to prevent Association)
motion
Goniometer Alignment Normal End Feel

• dorsal metacarpophalangeal joint • capsular

• Stationary arm – aligned with
metacarpal

• Moving arm – aligned with

proximal phalange
 METACARPOPHALANGEAL JOINT ABDUCTION

Test Position Normal Range

• Subject sitting with forearm resting • ???

on table
• Wrist neutral
• Forearm neutral

• Stabilize metacarpal to prevent

motion
Goniometer Alignment Normal End Feel

• dorsal metacarpophalangeal joint • capsular

• Stationary arm – aligned with
metacarpal

• Moving arm – aligned with

proximal phalange
 METACARPOPHALANGEAL JOINT ADDUCTION

Test Position Normal Range

• Subject sitting with forearm resting • ???

on table
• Wrist neutral
• Forearm neutral

• Stabilize metacarpal to prevent

motion
Goniometer Alignment Normal End Feel

• dorsal metacarpophalangeal joint • capsular

• Stationary arm – aligned with
metacarpal

• Moving arm – aligned with

proximal phalange
 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 Normal Range

• Subject sitting with forearm resting American Academy of Orthopaedic

on table
• Wrist, metacarpal, and non-tested
interphalangeal joints relaxed
• Forearm neutral
• Stabilize proximal bone to prevent
motion
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
 Proximal Interphalangeal Finger Joints

Goniometer Alignment • bone on bone (if tissues overlying

palmar aspect of bones is thin)
• dorsal proximal interphalangeal • soft tissue approximation (if tissues
joint overlying palmar aspect of bones
• Stationary arm – aligned with is thick)
proximal phalange
Distal Interphalangeal Finger Joints and
• Moving arm – aligned with middle Thumb Interphalangeal Joint
phalange
• capsular

THUMB CARPOMETACARPAL JOINT FLEXION

 Test Position Normal Range

• Subject sitting with forearm • ???

supinated and resting on table
• Wrist neutral

• Stabilize carpals to prevent wrist

motion
Goniometer Alignment Normal End Feel
• Axis – carpometacarpal joint • Capsular
• Stationary arm – aligned with
radius

• Moving arm – aligned with

metacarpal of thumb

THUMB CARPOMETACARPAL JOINT EXTENSION

Test Position Normal Range

• Subject sitting with forearm • ???

supinated and resting on table
• Wrist neutral

• Stabilize carpals to prevent wrist

motion
Goniometer Alignment Normal End Feel

• Axis – carpometacarpal joint • Capsular

• Stationary arm – aligned with
 radius

• Moving arm – aligned with

metacarpal of thumb

THUMB CARPOMETACARPAL JOINT ABDUCTION

Test Position Normal Range

• Subject sitting with forearm resting • 70o (American Academy of

on table Orthopaedic Surgeons)
• Wrist neutral
• Forearm neutral

• Stabilize carpals to prevent wrist

motion
Goniometer Alignment Normal End Feel

• Axis – radial styloid • Muscle stretch (adductor pollicus,

• Stationary arm – aligned with skin, fascia)
metacarpal of index finger

• Moving arm – aligned with

metacarpal of thumb
 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 Normal Range

• Subject sitting with forearm resting • 0o ???
on table
• Wrist neutral
• Forearm neutral

• Stabilize carpals to prevent wrist

motion
Goniometer Alignment Normal End Feel
• Axis – radial styloid • Soft tissue approximation
• Stationary arm – aligned with
metacarpal of index finger

• Moving arm – aligned with

metacarpal of thumb

THUMB CARPOMETACARPAL JOINT OPPOSITION

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 Normal Range

• Subject sitting with forearm • Able to touch tip of thumb to base

supinated and resting on table of fifth finger (American Academy
• Wrist neutral of Orthopaedic Surgeons)

• Stabilize fifth metacarpal

Goniometer Alignment Normal End Feel

• Goniometer cannot be used • Capsular or soft tissue

approximation
• Use a ruler to measure distance
between tip of thumb and base of
fifth finger
 EXTREMIDAD INFERIOR

HIP FLEXION

Test Position Normal Range

• Subject supine • 121.0o + or - 6.4o (American

• Allow knee to flex (to avoid
limitation by tight hamstrings)
• Stabilize pelvis to prevent rotation
• Flex hip
Academy of Orthopaedic
Surgeons)
• 100.0o (American Medical
Association)
• 122.3o (mean), 6.1o (standard
deviation), (Boone and Azen)
 Goniometer Alignment Normal End Feel

• Axis – greater trochanter

• Stationary arm – aligned with
midline of plevis • Capsular

• Moving arm – aligned with femur

(lateral epicondyle)

HIP EXTENSION

Test Position Normal Range

• Subject prone • 12.0o + or - 5.4o (American

• Stabilize pelvis to prevent rotation Academy of Orthopaedic
• Extend hip Surgeons)
• 30.0o (American Medical
Association)

• 9.8o (mean), 6.8o (standard

deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel

• Axis – greater trochanter

• Stationary arm – aligned with
midline of plevis

• Moving arm – aligned with femur • Capsular or ligamentous

(lateral epicondyle)

HIP ABDUCTION

Test Position Normal Range

• Subject supine • 41.0o + or - 6.0o (American

• Stabilize pelvis to prevent pelvic Academy of Orthopaedic
list Surgeons)
• Abduct hip • 40.0o (American Medical
Association)

• 45.9o (mean), 9.3o (standard

deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel

• Axis – anterior superior iliac spine

 (ASIS)
• Stationary arm – aligned with
opposite ASIS
• Capsular or ligamentous
• Moving arm – aligned with femur
(center of patella)

HIP ADDUCTION

Test Position Normal Range

• Subject supine • 27.0o + or - 3.6o (American

• Stabilize pelvis to prevent pelvic Academy of Orthopaedic
list Surgeons)
• Abduct opposite hip (to allow room • 20.0o (American Medical
for tested limb to adduct) Association)

• Adduct hip • 26.9o (mean), 4.1o (standard

deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel

• Axis – anterior superior iliac spine

 (ASIS)
• Stationary arm – aligned with
opposite ASIS
• Moving arm – aligned with femur
(center of patella)
HIP MEDIAL (INTERNAL) ROTATION
Test Position
• Subject sitting on table
• knee flexed
• Stabilize distal thigh
• medially (internally) rotate hip
Goniometer Alignment
• Capsular or ligamentous
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)
Normal End Feel
• Axis – center of patella
• Stationary arm – aligned vertically

• Moving arm – aligned with leg • Capsular

(crest of tibia)

HIP LATERAL (EXTERNAL) ROTATION

Test Position Normal Range

• Subject sitting on table • 44.0 + or - 4.8o (American
o

• knee flexed Academy of Orthopaedic

• Stabilize distal thigh Surgeons)
• hip laterally (externally) rotated • 50.0o (American Medical
Association)

• 47.2o (mean), 6.3o (standard

deviation), (Boone and Azen)
Goniometer Alignment Normal End Feel
 • Axis – center of patella
• Stationary arm – aligned vertically

• Moving arm – aligned with leg • Capsular

(crest of tibia)

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 Normal Range

• Subject supine • 141o + or - 5.3o (American

• Allow hip to flex Academy of Orthopaedic
Surgeons)
• Flex knee • 150o (American Medical
Association)

• 142.5o (mean), 5.4o, (standard

deviation) (Boone and Azen)
Goniometer Alignment Normal End Feel
• Axis – lateral epicondyle of femur
• Stationary arm – aligned with
greater trochanter • Soft tissue approximation

• Moving arm – aligned with lateral

malleolus

Supine Position (Rectus Femoris Limiting)

KNEE EXTENSION
 Test Position Normal Range

• Subject prone • minus 2.0o + or - 3.0o (American

• Stabilize femur Academy of Orthopaedic
Surgeons)
• Extend Knee
Goniometer Alignment Normal End Feel

• Axis – lateral epicondyle of femur

• Stationary arm – aligned with
greater trochanter • Capsular

• Moving arm – aligned with lateral

malleolus

ANKLE DORSIFLEXION
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 Normal Range

• Subject prone • 13o + or - 4.4o (American Academy

• Flex knee
• Stabilize sub-talar in neutral
• Dorsiflex ankle by pushing through
5th metatarsal head
of Orthopaedic Surgeons)
• 20o (American Medical
Association)
• 12.6o (mean), 4.4o, (standard
deviation) (Boone and Azen)

Goniometer Alignment Normal End Feel

• Axis – lateral malleolus • Capsular

• Stationary arm – aligned with
fibular head

• Moving arm – aligned with fifth

metatarsal

Assessing Gastrocnemius Tightness (muscle stretch end-feel)

ANKLE PLANTARFLEXION
 Test Position Normal Range

• Subject supine • 56o + or - 6.1o (American Academy

• Extend knee of Orthopaedic Surgeons)
• Stabilize leg • 40o (American Medical
Association)
• Plantarflex ankle
• 56.2o (mean), 6.1o, (standard
deviation) (Boone and Azen)
Goniometer Alignment Normal End Feel

• Axis – lateral malleolus • Capsular

• Stationary arm – aligned with
fibular head

• Moving arm – aligned with fifth

metatarsal

CALCANEAL INVERSION
 Test Position Normal Range

• Subject prone • 2/3 of total range from extreme of

• Stabilize tibia in sagittal plane
(rotate hip or pelvis to align tibia)
• Invert calcaneus
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 Normal End Feel

• Axis – automatically positioned by

 alignment of goniometer arms
• Stationary arm – aligned with
midline of leg
• Moving arm – aligned with midline
of calcaneus
CALCANEAL EVERSION
Test Position
• Subject prone
• Stabilize tibia in sagittal plane
(rotate hip or pelvis to align tibia)
• Evert calcaneus
• Capsular
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)
 • 21.0o + or - 5.0o (American
Academy of Orthopaedic
Surgeons)
Goniometer Alignment Normal End Feel

• Axis – automatically positioned by

alignment of goniometer arms
• Stationary arm – aligned with • Capsular
midline of leg

• Moving arm – aligned with midline

of calcaneus

MIDTARSAL INVERSION

Test Position Normal Range

• Subject supine • ???

• Stabilize calcaneus and talus

• Invert forefoot
Goniometer Alignment Normal End Feel
• Axis – automatically positioned by
alignment of goniometer arms
• Stationary arm – aligned with
midline of leg
• Capsular
• Moving arm – aligned with plantar
aspect of metatarsal heads

MIDTARSAL EVERSION

Test Position Normal Range

• Subject supine • ???

• Stabilize calcaneus and talus

• Evert forefoot
Goniometer Alignment Normal End Feel

• Axis – automatically positioned by

alignment of goniometer arms
• Stationary arm – aligned with • Capsular
midline of leg

• Moving arm – aligned with plantar

 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 Normal Range

• Subject supine • 1st - 65o to 75o (slightly less at
• Stabilize 1st metatarsal in lesser MTPs) is the minimum
plantarflexion required for normal gait (Root,
Orien, Weed. Normal and
• Dorsiflex MTP 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)
 Goniometer Alignment Normal End Feel
• Axis – medial to center of • Capsular
metararsal head
• Stationary arm – aligned
metatarsal

• Moving arm – aligned with

proximal phalange

Assessing MTP Dorsiflexion by Placing Goniometer on Dorsum of Bones

(requires modified goniometer)

METATARSOPHALANGEAL JOINT PLANTARFLEXION

(Flexion)
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 Normal Range

• Subject supine • 1st - 30o , 2nd - 30o , 3rd - 20o , 4th

• Stabilize 1st metatarsal - 10o , 5th - 10o (American Medical
Association)
• Plantarflex MTP
Goniometer Alignment Normal End Feel

• Axis – medial to center of • Capsular

metararsal head
• Stationary arm – aligned
metatarsal

• Moving arm – aligned with

proximal phalange

Assessing MTP Plantarflexion by Placing Goniometer on Dorsum of

Bones

(requires modified goniometer)

METATARSOPHALANGEAL JOINT ABDUCTION
 Test Position Normal Range

• Foot flat on table • ???

• Stabilize metatarsal

• Abduct MTP
Goniometer Alignment Normal End Feel

• Axis – dorsum of center of • Capsular

metararsal head
• Stationary arm – aligned with
metatarsal

• Moving arm – aligned with

proximal phalange

METATARSOPHALANGEAL JOINT ADDUCTION

 Test Position Normal Range

• Foot flat on table • ???

• Stabilize metatarsal

• Adduct MTP
Goniometer Alignment Normal End Feel

• Axis – dorsum of center of • Capsular

metararsal head
• Stationary arm – aligned with
metatarsal

• Moving arm – aligned with

proximal phalange

COLUMNA VERTEBRAL
 CERVICAL SPINE FORWARD BENDING (flexion)

Test Position Normal Range

• Subject sitting with lumbar and • 75.5o + or - 8.5o (20 - 29 yrs.),

thoracic spines supported 70.5o + or - 17.5o (30 - 49 yrs.),
• Stabilize lumbar and thoracic 64.5o + or - 7o (>50 yrs.) (American
spines Academy of Orthopaedic
Surgeons)
• Flex cervical spine
• 60o (American Medical
Association)
Goniometer Alignment Normal End Feel

• Axis – external auditory meatus • Capsular or ligamentous

• Stationary arm – vertical

• Moving arm – aligned with nostrils

CERVICAL SPINE BACKWARD BENDING (extension)

 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 Normal Range

• Subject sitting with lumbar and
thoracic spines supported
• Stabilize lumbar and thoracic
spines
• Mouth relaxed and slightly open
• 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)

• Extend cervical spine • 75o (American Medical

Association)
Goniometer Alignment Normal End Feel
• Axis – external auditory meatus • Bony or Capsular
• Stationary arm – vertical

• Moving arm – aligned with nostrils

CERVICAL SPINE SIDEBENDING

 Test Position Normal Range (unilateral)

• Subject sitting with lumbar and • 50.5o + or - 5.5o (20 - 29 yrs.),

thoracic spines supported 46.5o + or - 6.5o (30 - 49 yrs.), 40o
• Stabilize lumbar and thoracic + or - 8.5o (>50 yrs.) (American
spines Academy of Orthopaedic
Surgeons)
• Sidebend cervical spine
• 45o (American Medical
Association)
Goniometer Alignment Normal End Feel

• Axis – spinous process of C7 • Capsular or ligamentous

• Stationary arm – spinous
processes of thoracic spine

• Moving arm – posterior midline of

head at occipital protuberance
 CERVICAL SPINE ROTATION

Test Position Normal Range (unilateral)

• Subject sitting with lumbar and
thoracic spines supported
• Stabilize lumbar and thoracic
spines
• Rotate cervical spine
Goniometer Alignment
• 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)
Normal End Feel

• Axis – center of superior aspect of • Capsular or ligamentous

head
• Stationary arm – aligned with
acromion processes

• Moving arm – aligned with tip of

nose
 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.
 Test Position Normal Range

• Subject standing • 10 cm (Norkin and White)

• Flex thoracic and lumbar spines

Tape Measure Alignment Normal End Feel

• Spinous processes of C7 and S1 • Capsular or ligamentous

 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.
 Test Position Normal Range

• Subject standing • ???

• Extend thoracic and lumbar spines

Tape Measure Alignment Normal End Feel

• Spinous processes of C7 and S1 • Capsular or ligamentous

(sometimes bony)

THORACO-LUMBAR SPINE SIDEBENDING

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 Normal Range (unilateral)

• Subject standing • RIGHT:
• Stabilize pelvis o 20 - 29 yrs 37.6o + or - 5.8o
o 30 - 39 yrs 35.3o + or - 6.5o
• Sidebend thoracic and lumbar o 40 - 49 yrs 27.1o + or - 6.5o
spines 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
 o 70 - 79 yrs 18.9o + or - 6.0o
o (Fitzgerald, Wynveen,
Rheault et al)

• 25o (American Medical

Association)
Goniometer Alignment Normal End Feel
• Axis - S1 spinous process • Capsular or ligamentous
• Stationary arm - vertical

• Moving arm - C7 spinous process

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 Normal Range (unilateral)

• Subject sitting • 45o (American Medical
• Stabilize pelvis Association)
• Do not allow sidebending, forward
bending or backward bending
• Rotate thoracic and lumbar spines
Goniometer Alignment Normal End Feel
• Axis - center of superior aspect of • Capsular or ligamentous
head
• Stationary arm - aligned with
anterior superior iliac spines

• Moving arm - aligned with

acromion processes

TEMPEROMANDIBULAR JOINT OPENING

Ruler Method

Alternate Method
 Test Position Normal Range

• Subject sitting • 35 to 50 mm (Magee)

• Stabilize cervical spine
• two and 1/2 flexed PIPs (Friedman
• Open Mouth and Weisberg)
Ruler Alignment Normal End Feel

• Use a ruler to measure the • Capsular or ligamentous

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
 TEMPEROMANDIBULAR JOINT PROTRUSION

Test Position Normal Range

• Subject sitting • 3 to 5 mm (Magee)

• Stabilize cervical spine

• Protrude mandible forward

Ruler Alignment Normal End Feel

• Use a ruler to measure the • Capsular or ligamentous

distance between the upper and
lower incisors
 TEMPEROMANDIBULAR JOINT LATERAL DEVIATION

Test Position Normal Range

• Subject sitting • 10 to 15mm (Magee)

• Stabilize cervical spine

• Deviate mandible laterally

Ruler Alignment Normal End Feel

• 1 - Identify points on the upper and • Capsular or ligamentous

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)