Musculoskeletal examination -
range of motion
Warren Jahn, DC*
200 E. Roosevelt Rd.
Lombard, Illinois 60148
The normal ranges of movement and their accurate
measurement for each of the joints are summarized. Pre-
sented are charts to enhance the recording of data col-
lected on joint examination.
An understanding of the normal and pathological bio-
mechanics of joints is important to the chiropractic physi-
cian. It is the foundation for prescribing intelligently, a
meaningful therapeutic regime, and knowing when to
modify and terminate the treatment program.
Range of motion measurements have a genuinely
motivating effect on the patient, who learns by figures
which are personal, vivid and meaningful, that they are
progressing on their way to recovery.
The most widely used instrument is the universal goni-
ometer. It is basically a protractor, to the center of
which two arms or levers are attached. Usually only one
of the arms is moveable. Many variations in design are
possible. 136
The goniometer should be simple, durable, portable,
and applicable to all joints, or to as many joints as feas-
ible in persons with a variety of body builds and for dif-
ferent ages. The measurements should be accurate and
repeatable by the physician and/or assistant. A standard-
ized system of measuring should be followed such as the
one outlined by the "Guides to the Evaluation of Per-
manent Impairment".'
The goniometer should have the following character-
istics:
1. Made of metal (clear plastic goniometers are desir-
able but the coloring matter used to fill the marking
grooves tends to wash out with time or the eleva-
tions wear down).
2. A full or half circle protractor.
3. A protractor marked in graduations of one degree
for accuracy and large enough to be read easily.
4. The protractor should be numbered in each direc-
tion from zero to 180 degrees and from 180 degrees
to zero.
5. The arms should be at approximately 12 to 16
inches long.
6. The fulcrum should permit free, smooth motion but
should also have a mechanism that can be secured
to prevent slippage.
Guidelines for normal range of motion have been sug-
gested by many. 15'10'22'37-42 In 1959 the Executive Com-
mittee of the American Academy of Orthopaedic Sur-
geons appointed a committee to study joint motion.
From the findings of the Committee on Joint Motion in
*Faculty member, National College of Chiropractic, Lombard, Illinois
The Journal of the CCA / Volume 23 No. 2 / June 1979
conjunction with various Academy members and in con-
sultation with the American Society for Surgery, the
AAOS published a pamphlet entitled: "Joint Motion-
Method of Measuring and Recording". This pamphlet
contains the suggested normal values for ranges of
motion.43 These normal values are considered by most
authorities to serve as a guide and not a standard.43'"
(See Table 1)
Any system for recording measurements should be
rapid, accurate and easily interpreted. The following are
recommended components of the recording system.
1. Identification of a joint or region
To avoid confusion and to properly indicate area
of involvement the joint or region should be clearly
identified.
2. Identification of the joint motion
The terms should follow the standard nomen-
clature of the Nomina Anatomica and an attempt
made to identify the joints in which motion can be
measured (e.g. hind foot, can be measured for
inversion and eversion at the subtalar joint).
3. Zero or Neutral Position (O Pos.)
It is first necessary to ascertain if the patient is
capable of assuming the prescribed neutral position
for each joint. If the position cannot be assumed,
then the degree of deviation from the prescribed
neutral position should be recorded.
4. Ankylosis
Ankylosis is the immobility and consolidation of
a joint in one or more planes.
5. Active Ranges of Motion (Act. ROM)
The active ranges of motion are measured with
the patient performing the prescribed motion.
Three readings should be taken and then averaged.
These readings should be taken during the initial
examination and used for later reference and com-
parison.
6. Passive Ranges of Motion (Pas. ROM)
Passive ranges of motion usually are measured if
clinically warranted. The examiner moves the joint
while the patient is passive. These ranges of motion
can be used to differentiate between muscle and
joint abnormalities. (e.g. if the patient can actively
move a joint a certain amount and the examiner
can possibly move the joint further; this may
indicate muscle involvement.)
7. Painful or Non-Painful (P or NP)
The examiner should indicate which movements
involve pain or the lack of pain.
8. Normal Values
"The average ranges of joint motion cannot be
accurately determined, due to the wide variation in
51
Range of motion

Table 1 - Joint Ranges of Motion

SPINE ELBOW KNEE

CERVICAL Flexion 150° Flexion 1350
Flexion 450 Extension 0.5° Extension 00
Extension 450 Pronation 800 Rotation
Lat. flexion 450 Supination 80° Internal 100
Rotation 600 External 100
Atlanto-Occipital
Flex-Ext 150
Rotation 0-4o
Atlas-Axis ANKLE
Rotation 450 WRIST Plantar Flexion 500
Flexion
Extension
800800 Dorsiflexion 200
THORACIC & LUMBAR Ulnar deviation 300
Flexion 800 Radial Deviation 200
Extension 20-300
Lat. flexion 350 FOOT
Rotation (T) 450 Hind Foot
Inversion 50
Eversion 50
THUMB Fore Foot
UPPER EXTREMITY Carpal-metacarpal Inversion 350
SHOULDER Flexion 150 Eversion 150
Flexion 1800 Extension 200 Abduction 100
Extension 600 Metacarpal-Phalangeal Adduction 200
Horizontal Flex 1350 Flexion 500
Abduction 1800 Extension 00
Adduction 750 Interphalangeal
Rotation & Arm at Side Flexion 800 TOES
Internal 80° Extension 200 Great Toe
External 600 Abduction 700 Proximal Joint
Rotation & Arm in Abduction Adduction 00 Flexion 450
Internal 700 Extension 700
External 900 Interphalangeal Joint
Flexion 900
Extension 00
FINGERS Second-Fifth Toes
Proximal Joint LOWER EXTREMITY Proximal Joint
Flexion 900
HIP Flexion 400
Extension 30-450 Flexion 1200 Extension 400
Mid I.P. Joint Extension 300 Mid I.P. Joint
Flexion 1000 Abduction 45-500 Flexion 350
Extension 00 Adduction 20-300 Extension 00
Dist. I.P. Joint Rotation Distal I.P. Joint
Flexion 900 Internal 35-450 Flexion 600
Extension 00 External 35-450 Extension 00

the degrees of motion amongst individuals of vary- 9. Impairment Rating Values

ing physical build and age groups. The listed esti-
mates are to serve merely as a guide, and not as a
standard. The patient's opposite extremity is
perhaps the best "normal" standard. In those
instances when the opposite extremity has been
injured, or is not present, these figures may prove
helpful."43
52
These listed values are the least amount of ROM
that the Committee on Rating of Mental and Physi-
cal Impairment deems necessary for a patient to
function in society.'
The tables shown incorporate the aforementioned
recommendations and may serve as a guide for the
physician. (See Figures 1-7)
The Journal of the CCA / Volume 23 No. 2 / June 1979
 Range of motion

SPINE
CERVICAL

THORACIC & LUMBAR

0 Pos.* Ank.+ Active ROM Average P3 NP4 Pas.ROM

___________ ~~
~~12 -3 Act.ROM

1 2
|lexion / 800 / 900

Extension 20300 300,_____

Lat.Flexion Rt. _______T/1350
/ 200 T____=
I___________ ILt. I 350/ 200 T-
T
Rotation Rt. _
I_I_I I 450 / 300 ___ ___

Lt. __ _ _ _ / 450 / 300 __ _ _

* 0 Pos. = Zero or neutral position

+ Ank. + ankylosis
1 -normal values - Joint Motion - Method of Measuring and Recording - AAOS
2 -ROM that the Committee on Rating of Mental and Physical Impairment deems necessary
for a patient to function in society
3 - Painful
4 - Non-painful
Figure 1 - Forms for Recording Spinal Movements
The Journal of the CCA / Volume 23 No. 2 / June 1979 53
Range of motion

UPPER EXTREMITY
SHOULDER

ELBOW

* 0 Pos. = Zero or neutral position

+ Ank. = ankylosis
1 - normal values - Joint Motion - Method of Measuring and Recording - AAOS
2 - ROM that the Committee on Rating of Mental and Physical Impairment deems necessary
for a patient to function in society
3 - Painful
4 - Non-painful
Figure 2 - Forms for Recording Shoulder and Elbow Movements
54 The Journal of the CCA / Volume 23 No. 2 / June 1979
 Range of motion

WRIST

O Pos.* Ank.+ Active ROM Average P3 NP4 Pas.ROM

__________ _______
|_____ 1 2 3 Act.ROM
Flexion Rt. _ __ _O / 800
01 /
70o2
7
__________ _
| Lt. | _______ ___ / 800 70

Extension Rt. _ _______ / 700 / 600

L________ _ |Lt. _ | 700 / 60 |

Ulnar Dev. Rt. _ _ _ / 300 / 300 _______

_________ _
| Lt. _ _______ /
300 / 300 |_| _
|
Radial Dev. _Rt. _ _ _ / 20 / 20 |
I Lt. 1 ____ __
200 / 200 _ __ __ _

FINGERS

0 Pos.* Ank.+ Active ROM Average | P3 NP4 Pas.ROM

1 2 3 Act.ROM
Proximal Joint

Flexion Rt. I
L 90 / o90 1 1
L ___
[Lt.l r_ -_ __ /
900 900 ____ __ _

Extension Rt. | _______ /30-45 / _ |_

____________
Lt. |30 450

Mid I.P. Joint

Flexion Rt. _______ / 1000 / 1000

. 1000 1000

xtension Rt. 1 / 00 / --

I Lt. | I _ / 0 o /

ist. I.P. Joint

Flexion Rt. _ _ ___ / 900 / 700

Lt. _ _ __ 9o00 700

Extension Rt. |____ / 0 / __ _

______ ~Lt. _ _I / 00/~_ _

* 0 Pos. - Zero or neutral position
+ Ank. - ankylosis
1 - normal values - Joint Motion - Method of Measuring and Recording - AAOS
2 - ROM that the Committee on Rating of Mental and Physical Impairment deems necessary for
a patient to function in society
3 - Painful
4 - Non-painful
Figure 3 Forms for Recording Wrist and Finger Movements
-

The Journal of the CCA / Volume 23 No. 2 / June 1979 55

Range of motion

THUMB

0 Pos.* Ank.+ Active ROM Average | 3 NP4] Pas.ROM

1 L2 13
~~1
~~ Act.ROM
Carpal-Metacarpal
1 2
lexion Rt. / 150 / 150 |

Lt. __ _ __ _ _/ 5 150_ _ _ _

Extension Rt. _______ / 200 / 300

_Lt. __
I_T
I_r /, 200 / 300 ____=
etacarpal-Phalangeal

lexion Rt. _______ / 500 / 600 _ _=

_______ ___ Lt. _ _ __/ 500 / 600 _ _ _ _

Extension Rt. _ 1 1/, 0o /,

_ _ _ _ _
ILt. _ _ / 0 0 _ _ _ _

Interphalangeal
lexion Rt. _ __T_I_I_, 800 / 800 __I_T
_______ ___ Lt _ _ _ _/ 800 / 800 _ _ _ _

Extension Rt. _ _______ / 200 / - _ _

I__________ ILt. _ _
T_T_T_,/ 200 / -- T T _=

bduction Rt. _ / 700 / -- ____

I____ _
ILt. T_ 1_ / 700 / --
T T _

dduction Rt./ 00 / Io
___________ ILt. T T_1_T_T , o0 /-- T T T
* 0 Pos. = Zero or neutral position
+ Ank. = ankylosis
1 - normal values - Joint Motion - Method of Measuring and Recording - AAOS
2 - ROM that the Committee on Rating of Mental and Physical Impairment deems necessary for
a patient to function in society
3 - Painful
4 - Non-painful
Figure 4 - Form for Recording Thumb Movements
56 The Journal of the CCA / Volume 23 No. 2 / June 1979
 Range ofmotion

LOWER EXTREMITY
HIP

0 Pos.* Ank.+ Active ROM Average | 3 NP 4 PaS.ROM

~~1 2 3 Act.ROM

Flexion Rt. 1 1_ 1__1_ / 1200 / 1000 2__

______ _____ Lt. _ _ _ _ 1200 / 1000
Extension Rt. _ T 1 / / 300
300
Lt. 1 T 1 1 300 / 300 T__
Abduction Rt. ____T_ 1 1_1 , 45-50 / 400
I_
Lt. T_ 1 1_1 / 45-50°0/ 400 T _1 _ ]
Adduction Rt.l _ T r __ / 20-30 / 200 1 11
Lt.- _ _ 20-300 20 _ _ _

Int. Rot. Rt. / 35-45 / 400

Lt. I T T /
35-45°0 400 I 1 _
]
Ext. Rot. Rt. _
T_I_T_1 /
35-450/ . ~
500 _

~~~~~~~~~~~~~~~~ .
1_ 1
______ _____
Lt.1_ _ _ _ _ __ _ _ 35-450 500 _ _ _ _ _

KNEE

4
0 Pos.* Ank.+ Active ROM Average P3 NP Pas.ROM
1 2 3 Act.ROM
1 2
Flexion Rt.____ / 1350 / 1500 __ ____
__|_Lt._______I Lt. _ / 1350 / 1500 ____ ____15011
Extension Rt. _ _ ______ | _ / 00/ 00 _ _ _ _

I_____ _
ILt. I 1 _ / 00 /
,_oo° 00

Int. Rot. Rt. _______ ___ / 10 / -- _ _= ]

_Lt. I _
T_r_ __
/ 100 / -- _ _ _ _

Ext. Rot. | Rt. ___ _____ / 100 / -- _

0
_ _ _ _ _ _ _ _ _ _ _ Lt.
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 10 / / ________ --

* 0 Pos. - Zero or neutral position

+ Ank. = ankylosis
1 - normal values - Joint Motion - Method of Measuring and Recording - AAOS
2 - ROM that the Committee on Rating of Mental and Physical Impairment deems necessary for
a patient to function in society
3 - Painful
4 - Non-painful
Figure 5 - Forms for Recording Hip and Knee Movements
The Journal of the CCA / Volume 23 No. 2 / June 1979 57
Range of motion

ANKLE

FOOT

0 Pos.* Ank.+ Active ROM Average P3 NP 4 Pas.ROM

1 2 3 Act.ROM
Hind Foot

Inversion Rt. _ _ / 5 / -2
_ _ _ _ _ _ Lt. _ _ _ _ _ _ _ _ / 50 / _ _ _ _

Eversion Rt. _ _ ___|_| / 5 / __ |

Lt. ________| 50 / -- |
ore Foot

Inversion Rt. _
_______| / 350 / __ |
____________
|Lt. _
________| / 350 / __ |
version Rt. _ _______ / 150 / __ |
________
|_ _ Lt. _ _ / 150 / _ |
bduction Rt. _ / 100 / -- |
____
___ ___ Lt. _ _ __ _ _ __/ 100 / --_ _ _ _

dduction Rt. _ _______ / 200 / -- |

| ________ _
|Lt. _ _______ / 200 / -- |
* 0 Pos. = Zero or neutral position
+ Ank. = ankylosis
1 - normal values - Joint Motion - Method of Measuring and Recording - AAOS
2 - ROM that the Committee on Rating of Mental and Physical Impairment deems necessary for
a patient to function in society
3 - Painful
4 - Non-painful
Figure 6 - Forms for Recording Ankle and Foot Movements
58 The Journal of the CCA / Volume 23 No. 2 / June 1979
 Range of motion

TOES

0 Pos.* Ank.+ Active ROM Average P3 NP4 Pas.ROM

ii 213 Act.ROM
GREAT TOE
Proximal Joint
|Flexion |_Rt. _ _ / 4501 5002 _ _
____ ____ ___ Lt. _ _ _ _ _ _ _ __/ 450 500
_ _ _ _ /

Extension Rt. _ ________,/ 700 / 300 | _

____ ___ ___ Lt. _ _ __ _ _ __/ 700 / 300 _ _ _ _ _ _ _ _

Interphalangeal Joint
Flexion Rt. _
______|_, 900 / 300 | _

____ ____ ___ Lt. _ _ _ _ _ _ _ __/ 900 300

_ _ _ _ /

Extension Rt. ___ _ _ |

|-- __
Lt. _ _ _ _ _/ 00 / -_ _

SECOND-FIFTH TOES
Proximal Joint
Flexion Rt. | ______|_ / 400 / ** | _ _

Lt. _ ________ / 400 / **

Extension Rt. 40 ____ | / 00 / ** |

I Lt.| 400
Mid I.P. Joint
Flexion Rt.1 35___
Lt. 35

Extension Rt. _____0 /

Lt. _ _ _ _ _ _ _ _/ _ _ _

Distal I.P. Joint________

Flexion Rt. _____ _ /600 /*
Lt. --1600 /* __
Extension Rt. | __| / 0°/ ** |
_ Lt._ 00 * ___
* U Fos. = Zero or neutral position
+ Ank. = ankylosis
1 - normal values - Joint Motion - Method of Measuring and Recording - AAOS
2 - ROM that the Committee on Rating of Mental and Physical Impairment deems necessary for
a patient to function in society
3 - Painful
4 - Non-painful
** See the Guides
Figure 7 Form for Recording Motion of the Toes
-
The Journal of the CCA / Volume 23 No. 2 / June 1979 59
 Range of motion

21. : The measurement of joint motion. Part I Introductory

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60 The Journal of the CCA / Volume 23 No. 2 / June 1979