GONIOMETRY BASIC CHARACTERISTICS OF A GONIOMETER

- It is a very basic evaluation procedure the joint range of
motion, both active and passive ROM.
- Measurement of angles
- Important part of comprehensive of joints and surrounding
soft tissue
- This technique may be used as a diagnostic or therapeutic
measure to determine the functional status of a patient
with a musculoskeletal or neurological disability.
WHY IS GONIOMETRY IMPORTANT?
- Enables the therapist to measure abnormalities in the
joint range of motion objectively
- Makes it possible to monitor changes in the joint range of
motion
- Provide basis for:
 Determine presence and absence of impairment
 Establishing diagnosis
 Developing prognosis, treatment goal and plan
of care
 Evaluate progress or lack of progress
 Modifying treatment
 Motivating the subject
 Researching effectiveness of therapeutic
technique
 Fabricating orthosis & adaptive equipment
OBJECTIVELY VS. SUBJECTIVELY
 OBJECTIVELY – there are devices used to get the
measurement/rate/range
 SUBJECTIVELY – based on your patient’s response, or what
your patient says
GONIOMETER
- An instrument used to measure range of motion or angle
- Also called ARTHROMETER
- Used to determine both a particular joint position and the
total amount of motion available at a joint
 Protractor can either be a full circle or a half circle
protractor
 Protractor should have a graduation of 1°.
 Protractors should be numbered in each direction of 0-180
degrees and 180° - 0° for half circle protractors.
 Arm or lever length should be 12-16 inches (shorter for
finger goniometer)
 The pivot rivet or fulcrum should allow free, smooth
motion and should be more secure.
 A prominent line should extend from the pivot to the distal
tip of the moving arm with clearly marked extension of the
baseline of the protractor throughout the length of the
stationary arm
 Each arm should be moveable
THREE SYSTEMS OF NUMERICAL EXPRESSION IN GONIOMETRY
1. 0-180 DEGREES SCALE
 Also called as NEUTRAL ZERO METHOD
 A system of expression most frequently used by
physical therapist
 Erect anatomical position, the joints are at 0°.
 The arc of motion begins at 0° progressing
towards 180°
2. 180-0 DEGREES SCALE
 A reverse of 0-180° system, thus, under this
system the numerical value decreases as
movement occurs
 This system did not popularized & was not
favorably endorsed by doctors
 180 at anatomic position and proceeds to an arc
towards 0°
3. 360 DEGREES SCALE
 Requires the use of full circle goniometer
 Did not popularize because of difficulty in
interpreting very large numbers
 Not all joints can be measured under 360-
degree scale
 Anatomic position starts at 180°

Basic parts of a Goniometer REQUIREMENTS OF A GONIOMETER

 FULCRUM or PIVOT RIVET – it is the approximate location  Simple

of the axis of goniometer  Portable
 PROTRACTOR/BODY – contains the angle of measurement  Accurate
 MOVEABLE ARM (DISTAL) – attached to the fulcrum in the  Durable
center of the body of the goniometer that permits the arm  Easily duplicated
to move freely on the body. It is aligned with the distal
JOINT MOTION
segments of the joint.
 STATIONARY ARM – - Amount of motion available at a joint
structural part of the body - In order to assess for the ROM:
of the goniometer and  The therapist must understand the anatomy of
cannot be moved area involved
independently of the  Bony configuration of the joint, the soft tissue in
body. It is aligned with the the area, the movements that take place at the
proximal segment of the joint and the limiting factors of the joint
joint. - Normal ROM is a.k.a. Anatomic or Physiologic ROM
 WINDOW – permits the examiner to read the scale on the because the normal range refers to the joint range within
body of instrument the anatomic limits of joint structures
 - When ROM exceeds or fails to reach normal anatomic  Coordination
ROM, it is considered pathologic.  Muscle strength and joint ROM

FACTORS THAT DETERMINE THE EXTENT OF ANATOMIC RANGE PASSIVE ROM

 Shape of joint surfaces - Amount of motion attained by the examiner without

 Joint capsule assistance from the subject
 Ligaments - Patient is relaxed and plays no active role during motion
 Muscle bulk - Gives information about:
 Surrounding musculotendinous and bony structures  The integrity of the articular surfaces and
extensibility of joint capsule, associated
ANATOMIC POSITION
ligaments, muscle, fascia, & skin
- The starting position for measuring all ROM  Used to determined LOM
 Detect pain
ARHTROKINEMATICS  Assess what tissue is limiting motion

- Movement of joint surfaces LAG PHENOMENON

- Involves spin, roll, slide
- Movements include slides (glide) in translatory motion, a
spin and roll in rotary or angular motion
OSTEOKINEMATICS
- Refers to the movement of the shafts of bones, rather than
the movements of joint surfaces
- It takes place on the cardinal planes of the body around
three corresponding axes.
- Difference between active and passive ROM
END FEEL
- Feeling experience by an examiner as a barrier to further
motion at the end of a passive ROM
- Help examiner to assess the type of pathology present to
determine a prognosis for the condition and learn severity
or stage of the problem

PLANES AND AXES NORMAL END FEELS (Magee)

 PLANES – sagittal, frontal, transverse
 AXES – medial, lateral, anterior, posterior, vertical
 SINGLE AXIS – SINGLE PLANE - only motions occurring in a
single plane
SAGITTAL PLANE
- Divides body into right and left halves
- Flexion and extension movements
FRONTAL PLANE
- Divides body into anterior and posterior halves
- Abduction and adduction movements
1. BONE-TO-BONE (HARD) - A hard, unyielding sensation that
is painless; there bone to bone approximation such as
elbow extension
2. SOFT-TISSUE APPROXIMATION (SOFT) – Yielding
compression (mushy feel) that stops further movement
such as elbow flexion
3. TISSUE STRETCH (FIRM) – toward the end of ROM, there is
a feeling of springy or elastic resistance, most common
type of normal end feel. It is found when the capsule and
ligaments are the primary restraints to movement such as
shoulder rotation.
PATHOLOGICAL/ABNORMAL END FEELS

TRANSVERSE PLANE 1. MUSCLE SPASM

- Vibrant Twang
- Divides body into upper and lower portions - Invoked by movement, with a sudden dramatic
- Medial and lateral rotations arrest of movement often accompanied by pain
- Fairly abrupt stop with a mild “rebounding”
OBLIQUE PLANE sensation secondary to metabolic and circulatory
- Movement that occurs in combination of each type of changes
planes in different axis 2. MUSCLE GUARDING
- Cannot be measured by goniometer - Protective mechanism of body by involuntary
contraction of the muscle in response to acute
RANGE OF MOTION pain to prevent injury
3. MUSCLE SPASTICITY
ACTIVE ROM - Clasped Knife Phenomenon
- Velocity dependent increase in muscle tone
- Refers to amount of joint motion by a subject unassisted
during PROM 2° to CNS involvement
voluntary
- Form of muscle hypertonicity that offers
- Gives the examiner information about:
increased resistance to stretch involving
 The patient’s willingness to move
primarily the flexors in the upper limb and
 Assess abnormal movements extensors in the lower limb.
 4. CAPSULAR
- Resistance through range
- Firm limitation yet resilient with maintained
force; occurs prematurely early in the range
- HARD CAPSULAR – end feel has a thicker
stretching quality; more chronic conditions
- SOFT CAPUSLAR (boggy) – soft mushy resistance
which is similar to normal tissue stretch end feel
but with a restricted ROM. A result of synovitis,
soft tissue edema, or hemarthrosis.
5. BONE TO BONE ABNORMAL ENDFEEL (BONY BLOCK)
- Similar to the normal bone-to-bone type, but the
restriction occurs before the end of ROM
- Sudden, abrupt limitation of motion, no giving
sensation occurs with prolonged pressure
(osteophyte formation)
6. SPRINGY BLOCK
- Rubbery rebound with firm, unyielding
resistance such as displaced meniscus
- Rebound effect with a thick stretching feel,
although it is not as stretchy as a hard capsular
end feel
- Usually indicates an internal derangement within
the joint
7. LAXITY
- Loose excessive mobility beyond the normal
anatomic ROM
8. EMPTY
- Detected when movement produces
considerable pain
- movement cannot be performed or stopped
because of the pain
- patient voluntary prevents the passive motion or
requests the motion to stop due to severe pain
- no tissue resistance is felt or no end-feel at all
MUSCLE LENGTH TESTING
MUSCLE LENGTH
- greatest extensibility of a muscle-tendon unit
MUSCLE LENGTH TESTING
- maximal distance between the proximal and the distal
attachments of a muscle to bone
ONE-JOINT MUSCLES
TWO-JOINT MUSCLES
PASSIVE INSUFFICIENCY
- inability of a muscle to lengthen and allow full ROM at all
the joints the muscle crosses
ACTIVE INSUFFICIENY
- shortened muscle
FACTORS AFFECTING ROM
 Age
 Gender
 Muscle Bulk or Body Mass Index
 Disease
 Occupation/Recreation
VALIDITY
- The degree to which an instrument measures what is
purported to measure
- Extent to which it fulfills its purpose
RELIABILITY
- The amount of consistency between successive
measurements of the same variable, on same subjects,
under the same conditions.
- Measurement is consistent, repeatable, and reproducible
- Goniometric reliability is maximized by standardized:
 Measuring device
 Positioning and landmarks
 Procedure
 Examiner
FACTORS TO CONSIDER WHEN DOING GONIOMETRY
STARTING POSITION
 Position assumed by the patient before the measurement
is made
 Important part of goniometry because it is used to place
the joints in a zero starting position and to help stabilize
the proximal joint segment
 Essential for the following reasons:
 Permits a complete ROM
 Facilitates isolation and performance of the
movements
 Provides stabilization for the proximal joint
segment
 Allows the goniometer or measuring instrument
to be placed more accurately
 Joint position is less likely of substitute during
measurement
 Allows for easy detection of substitute or
abnormal movements
 Takes into consideration the “zero position” which
is essential to good goniometry
STABLIZATION
 Recommended testing position helps to stabilize the
subject’s body & proximal joint segment so that a motion
can be isolated to the joint being examined
 Can be supplemented by manual stabilization provider by
the examiner
AXIS OF MOTION
- Center of rotation that generally refers to the axis of the
joint
- Refers to the point in the arc of movement where the
motion occurs
- Pivot/fulcrum of the goniometer is usually placed over the
axis of motion
- No specific landmark for axis of motion, usually falls where
the two arm bisects each other
LOCATION OF THE MOVEABLE ARM
- a lever arm is attached at the protractor that is placed
parallel to the long axis of the moving limb or moving side
of the angle
LOCATION OF THE STATIONARY OR FIXED ARM
- a lever arm attached at the protractor that is placed
parallel to the long axis of the stationary limb or
apparently fixed side of the joint
REMEMBER!
 When aligning the arms and reading the scale of the
goniometer, the examiner must be at eye level with the
goniometer to avoid parallax.
 If the examiner is higher or lower than the goniometer, the
alignment and scales may be distorted.
RECORDING OF RESULTS IN GONIOMETRY
1. Results should always be expressed as a range rather than
a single numerical value
 CORRECT: 0-120°
 INCORRECT: 120°
2. Always remember that goniometry is a measurement of
movement, therefore, identify the movements and not
the muscle.
 CORRECT: Elbow flexion 0-140°
 INCORRECT: Elbow flexor 0-140°
3. Always specify the joints being tested
4. Always specify the laterality of the joint
5. Always state whether the ROM was measured actively or
passively
6. If a special goniometer is used, specify the type of
goniometer used.
7. Any modifications made during the measurement should
be specified and noted.
POSSIBLE SOURCES OF ERROR
 Failure to read at eye level causing parallax distortion
 Poor stabilization of the subject
 Incorrect landmark identification
 Failure to read proper scale
 Lack of patient cooperation
TYPES OF GONIOMETER
UNIVERSAL GONIOMETER
- Most common instrument used to measure joint position
in the clinical setting; used to measure joint position and
ROM at almost all joints of the body
ARTHRODIAL PROTRACTOR
- Used to measure neck or cervical ROM
INCLINOMETER
- Gravity Dependent Goniometers
- A 360° scale goniometer that uses gravity’s effect on
pointers and fluids levels to measure joint position and
motion such as mobility of the thoracolumbar supine
METAL GONIOMETER
- A 180° scale goniometer used to measure limb ROM
- X-Ray Goniometer
FINGER GONIOMETER
- Used to measure finger ROM
PROSUPINATOR
- It is designed to make measurement of forearm pronation
& supination, wrist ulnar & radial deviation
BIPLANE GONIOMETER
- Used to measure ankle dorsiflexion/plantarflexion
PLURI-DIG
- A one-handed finger goniometer that measures finger
flexion/extension from the dorsum
DIGIT-O-METER GAUGE
- A clear plastic gauge with a 10cm scale, used to measure
finger flexion & finger-thumb opposition
LCD or DIGITAL GONIOMETER
- A battery-operated goniometer that has adjustable
protractor so that it can adapt to different size of joints
being measured
FULL CIRCLE GONIOMETER
- A 360° scale that comes in varying lengths, a type of
universal goniometer
PENDULUM GONIOMETER
- Consists of a 360° protractor with a weighted pointer
hanging from the center of the protractor
FLUID (BUBBLE) GONIOMETER
- Has a fluid-filled circular chamber containing an air bubble
- 360° scale
ELECTROGONIOMETERS
- Used primarily in research to obtain dynamic joint
measurements
- Uses potentiometer to measure joint motion and position
ADJUSTABLE WALL GONIOMETER
- Evaluate ROM and posture more effectively
GONIOMETER QUIZ
_____________________ 1. end feel has a thicker stretching quality
_____________________ 2. Shortened muscle
_____________________ 3. Rebound effect with a thick stretching
feel, although it is not as stretchy as a hard capsular end feel
_____________________ 4. It is a very basic evaluation procedure
measuring the joint range of motion, both active and passive ROM.
_____________________ 5. Other term for goniometer
_____________________ 6. Detected when movement produces
considerable pain
_____________________ 7. Refers to amount of joint motion by a
subject unassisted voluntary
_____________________ 8. Most common instrument used to
measure joint position in the clinical setting
_____________________ 9. This technique may be used as a
diagnostic or therapeutic measure to determine the functional status
of a patient with a musculoskeletal or neurological disability.
_____________________ 10. Inability of muscle to lengthen further.
_____________________ 11. Requires the use of full circle
goniometer
_____________________ 12. Similar to the normal bone-to-bone
type, but the restriction occurs before the end of ROM
_____________________ 13. Feeling experience by an examiner as a
barrier to further motion at the end of a passive ROM
_____________________ 14. a lever arm is attached at the
protractor that is placed parallel to the long axis of the moving limb
or moving side of the angle
_____________________ 15. Used to determine both a particular
joint position and the total amount of motion available at a joint
_____________________ 16. A reverse of 0-180° system, thus,
under this system the numerical value decreases as movement
occurs
_____________________ 17. Important part of goniometry because
it is used to place the joints in a zero starting position and to help
stabilize the proximal joint segment
_____________________ 18. greatest extensibility of a muscle-
tendon unit
_____________________ 19. The amount of consistency between
successive measurements of the same variable, on same subjects,
under the same conditions.
_____________________ 20. Firm limitation yet resilient with
maintained force; occurs prematurely early in the range
_____________________ 21. Invoked by movement, with a sudden
dramatic arrest of movement often accompanied by pain
_____________________ 22. It is found when the capsule and
ligaments are the primary restraints to movement such as shoulder
rotation.
_____________________ 23. Has a fluid-filled circular chamber
containing an air bubble
_____________________ 24. no tissue resistance is felt or no end-
feel at all
_____________________ 25. soft mushy resistance which is similar
to normal tissue stretch end feel but with a restricted ROM.
_____________________ 26. Center of rotation that generally refers
to the axis of the joint
_____________________ 27. Measurement is consistent,
repeatable, and reproducible
_____________________ 28. Yielding compression (mushy feel) that
stops further movement such as elbow flexion
_____________________ 29. The degree to which an instrument
measures what is purported to measure
_____________________ 30. Protective mechanism of body by
involuntary contraction of the muscle in response to acute pain to
prevent injury
_____________________ 31. Sudden, abrupt limitation of motion,
no giving sensation occurs with prolonged pressure (osteophyte
formation)
_____________________ 32. Consists of a 360 protractor with a
weighted pointer hanging from the center of the protractor
_____________________ 33. Amount of motion available at the
joint
_____________________ 34. Used to measure neck or cervical ROM
_____________________ 35. Loose excessive mobility beyond the
normal anatomic ROM
_____________________ 36. The starting position for measuring all
ROM
_____________________ 37. Did not popularize because of
difficulty in interpreting very large numbers
_____________________ 38. Refers to the movement of the shafts
of bones, rather than the movements of joint surfaces
_____________________ 39. Movements include slides (glide) in
translatory motion, a spin and roll in rotary or angular motion
_____________________ 40. Also called Gravity Dependent
Goniometers
_____________________ 41. Form of muscle hypertonicity that
offers increased resistance to stretch involving primarily the flexors
in the upper limb and extensors in the lower limb.
_____________________ 42. Recommended testing position helps
to _____ the subject’s body & proximal joint segment so that a
motion can be isolated to the joint being examined
_____________________ 43. The arc of motion begins at 0°
progressing towards 180°
_____________________ 44. instrument used to measure range of
motion or angle
_____________________ 45. Important part of comprehensive of
joints and surrounding soft tissue
_____________________ 46. usually placed over the axis of motion
_____________________ 47. maximal distance between the
proximal and the distal attachments of a muscle to bone
_____________________ 48. Fairly abrupt stop with a mild
"rebounding" sensation secondary to metabolic and circulatory
changes
_____________________ 49. Patient is relaxed and plays no active
role during motion.
_____________________ 50. Amount of motion attained by the
examiner without assistance from the subject
TRUE OR FALSE. Underline the statement which made it wrong and
write the correct answer.
_____________________ 1. One arm should moveable and the 2.
other is static 3.
_____________________ 2. The pivot rivet or fulcrum should allow 4.
free, smooth motion and should be more secure. 5.
_____________________ 3. Laxity usually indicates an internal 6.
derangement within the joint 7.
8.
_____________________ 4. Protractor can either be a full circle
only. Requirements of a Goniometer
_____________________ 5. When aligning the arms and reading the 1.
scale of the goniometer, the examiner must be at any level with the 2.
goniometer to avoid parallax. 3.
_____________________ 6. Objective refers to your patient’s 4.
response. 5.
_____________________ 7. Starting position allows for complicated
detection of substitute or abnormal movements Factors affecting ROM
1.
_____________________ 8. Always specify the joints being tested 2.
3.
_____________________ 9. If a special goniometer is used, specify 4.
the type of goniometer used. 5.
_____________________ 10. the protractor should have a
graduation of two degrees. Pathological/Abnormal End Feels
_____________________ 11. Any modifications made during the 1.
measurement should be specified and noted. 2.
3.
_____________________ 12. Starting position in ROM Facilitates 4.
isolation and performance of the movements 5.
_____________________ 13. An oblique plane can be measured by 6.
a goniometer 7.
_____________________ 14. If the examiner is higher or lower than 8.
the goniometer, the alignment and scales may be distorted.
Basic Parts of a Goniometer
_____________________ 15. 180 – 0 degrees is also called as
Neutral Zero Method.
_____________________ 16. In reliability, measurement is
consistent, repeatable, and reproducible

_____________________ 17. Hard Capsular is end feel has a thicker

stretching quality and more chronic conditions
_____________________ 18. When ROM exceeds or fails to reach
normal anatomic ROM, it is considered not pathologic.
_____________________ 19. Active ROM gives information about
the integrity of the articular surfaces and extensibility of joint
capsule, associated
_____________________ 20. Results should always be expressed as
a range rather than a single numerical value

Why is Goniometry important?

1.