ROM, PROM, and Goniometry

RANGE OF MOTION - the amount of movement that occurs at a joint

ACTIVE RANGE OF MOTION - the amount of movement the patient voluntarily moves the body part through without any external assistance.

PASSIVE RANGE OF MOTION  - the amount of movement that an external force (therapist) moves the body part through without any assistance from the patient 

The client performs AROM at affected joint & joints proximal and distal.

The therapist observes all joints separately, bilaterally and symmetrically

• Patient’s willingness to move the joint.
• Coordination.
• Level of consciousness.
• Attention span.
• Joint ROM.
• Movements that cause or increase pain.
• Muscle strength.
• Ability to follow instructions.
• Ability to perform functional activities.

• Muscle weakness.
• Pain.
• Inability to follow instructions.
• Unwillingness to move.

Amount of movement at join.

Greater than AROM due to elastic stretch of muscle tissue and decreased bulk

• Establish joints ROM.
• Determine quality of movement throughout ROM & end feel.
• Determine whether a capsule or non-capsular pattern is present.
• Presence of pain.

The sensation transmitted to the therapist’s hands at the extreme end of the passive ROM indicates the structures that limit the joint movement - may be normal (physiological) or abnormal (pathological)

1. Normal End Feel - when full Rom & normal anatomy of joint stops movement

2. Abnormal End Feel - decrease or increase in the ROM or normal ROM exists but other structures other than the normal anatomy stop joint movement

• 
• ROM is limited by length of muscle e.g. Hamstrings.

Unique anatomical structure of a joint determines the direction & magnitude of the joints ROM

• 1. Stretching of soft tissue
• 2. Stretching of ligaments or joint capsule
• 3. Apposition of soft tissue
• 3. Bone contacting bone

• An abrupt hard stop to movement when bone contacts bone, or a bony grating
• sensation, when rough articular surfaces pass over each other. Loose bodies, degenerative joint disease, dislocations, or a fracture.

Boggy sensation that indicates the presence of synovitis or soft tissue edema.

Synovitis - inflammation of a synovial membrane, usually painful, particularly on motion, and characterized by fluctuating swelling, due to effusion in a synovial sac. It may be caused by rheumatic fever, rheumatoid arthritis, tuberculosis, trauma, gout, or other conditions.

A springy sensation or a hard arrest to movements with some give, indicating muscular, capsular or ligamentous shortening.

A rebound is seen or felt and indicates the presences of an internal derangement. e.g. knee with a torn meniscus.

• No sensation (end feel) before the end of passive ROM due to pain. This may be caused by:
• ◦Extra-articular abscess
• ◦a neoplasm (abnormal growth of tissue)
• ◦acute bursitis (inflammation of a bursa, esp one in the shoulder joint)
• ◦joint inflammation
• ◦fracture

A hard sudden stop to passive movement that is often accompanied by pain is indicative of an acute or subacute arthritis, the presence of a severe active lesion or fracture.

• Junctions, or pivot points between two or more bones in the body.
• Movement of the body is mostly due to the motion of the joints.
• There are seven basic types of joints.

• 1. Hinge Joint
• 2. Pivot Joint
• 3. Ellipsoid Joint
• 4. Ball and Socket Joint
• 5. Plane Joint
• 6. Saddle Joint
• 7. Condyloid Joint

• Motion – Either active or passive
• ◦Active is the patients movement of his or her arm
• ◦Passive is the examiners movement of the patient’s arm

Extension – Natural movement opposite to flexion at the zero position.

Hyperextension – Unnatural motion opposite to flexion at the zero position.

Relative Angle and Absolute Angle.

Anatomical reference position

Angle at a joint formed between the longitudinal axes of adjacent body segments

The convention used for measuring relative joint angles is that in anatomical reference position, all joint angles are at 00.


Relative angles should consistently be measured on the same side of a given joint.

Horizontal reference and vertical reference

Angular orientation of a body segment with respect to a fixed line of reference.

Absolute angles should consistently be measured in the same direction form a single reference – either horizontal or vertical

Quantification of joint angles is complicated by the fact that joint motion is often accompanied by displacement of one bone with respect to the articulating bone at the joint. As a result, the location of the exact center of rotation at a given joint angle, or at a given instant it time during a dynamic movement, is called the instant center.

Instant center: Precisely located center of rotation at a joint at a given instant in time. The exact location of the instant center for a given joint may be determined through measurements taken from roentgenograms (x rays), which are usually taken at 100 intervals throughout the range of motion at the joint. An Instrumented spatial linkage involving intracortical pin fixation has been used to quantify relative linear and angular movements at the knee.

• 1. Goniometer
• 2. Electrogoniometer (elgon)
• 3. Inclinometer

Goniometers are commonly used by clinicians for direct measurement of relative joint angles on a live human subject.

• Goniometer: is essentially a protractor with two long arms attaches.
• • One arm is fixed so that it extends from the protractor at angle of 0⁰.
• • The other arm extends from the center of the protractor and is free to rotate.
• • The center of the protractor is aligned over the joint center, and the two arms are aligned over the longitudinal axes of the two body segments that connect at the joint.
• • Accuracy depends positioning of goniometer
• • Place marks on the skin

a goniometer with an electrical potentiometer at its vertex

• devices used for direct assessment of human body segment angles
• • Usually gravitationally based

• Passive Joint Range of Movement:
• 1. Expose the area
• 2. Explanation and instruction – explain verbally or demonstrate by passively moving patient’s limb through test movement.
• 3. Assessment of the normal ROM –uninvolved side first –involved side
•        * if uninvolved side can’t be used - rely on past experience taking into account age, sex, dominance & occupation
• 4. Measurement procedure:
• –patient position
• –trick movements or substitute
• –stabilization
• –measurement

• Most common device used to measure joint angles or ROM.
• 180-360 degree protractor
•     One axis which joins two arms
•     One stationary arm ◦One moveable arm Size of goniometer is determined by size of the joint being assessed

Goniometer placement: The goniometer should be placed lateral to the joint, just off the surface of the limb .

• Axis: The axis of the goniometer should be placed over the axis of movement of the joint
• ◦Eg. Bony prominance
• ◦Anatomical landmark

Stationary arm: lies parallel to the longitudinal axis of the fixed proximal joint segment and/or points toward a distant bony prominence

It lies parallel to the to the longitudinal axis of the moving distal joint segment and/or points toward a distant bony prominence

• Two types
• ◦Translational –Center of Mass
•       – A ball being thrown
• ◦Rotational –Limbs
•        –A gate swinging open.

The focus for Range of motion testing is rotational motion

• ROM is a measure of joint flexibility by observing the number of degrees a joint can move through from a set neutral position. Goniometers are the measuring devices ◦Goniometer pin is placed over the joint and two arms are aligned with the limbs connected to the
• joint.
• A proficiency in anatomical landmark location aids in more accurate measurements.

• A limited range of motion can be caused by several things.
• ◦Muscle weakness
• ◦Trauma/Injury ◦Nerve damage
• ◦Spine damage
• ◦Arthritis                                                   

This test is a basis for finding greater ailments.

Tests serve as a baseline for documentation of interventions, and responses.

• RANGE OF MOTION ◦the amount of movement that occurs at a joint
• ACTIVE RANGE OF MOTION ◦the amount of movement the patient voluntarily moves the body part through without any external assistance.
• PASSIVE RANGE OF MOTION ◦the amount of movement that an external force (therapist) moves the body part through without any assistance from the patient

In a region where there is a recent dislocation or unhealed fracture.

Immediately following surgery to tendons, ligaments, muscles, joint capsules or skin. }

When myositis ossificans is present (is an unusual condition that often occurs in athletes who sustain a blunt injury that causes deep tissue bleeding).

• 1. Infectious or inflammatory process in a joint
• 2. Patient is on medication for pain or muscle relaxants
• 3. Osteoporosis or fragile bones is a factor 4. In assessing hyper mobile or subluxed joints
• 5. Painful conditions
• 6. Hemophilia
• 7. Hematoma in the region especially in the elbow, hip or knee
• 8. If bony ankylosis is suspected (stiffness or fixation of a joint by disease or surgery) 
• 9. After an injury disrupting soft tissue (tendons, muscles or ligaments)
• 10.  In the region of a newly united fracture 11.  After prolonged immobilization of a part

Client performs AROM at affected joint & joints proximal and distal.

Therapist observes all joints separately, bilaterally and symmetrically

• Patient’s willingness to move the joint.
• } Coordination.
• } Level of consciousness.
• } Attention span.
• } Joint ROM.
• } Movements that cause or increase pain.
• } Muscle strength.
• } Ability to follow instructions.
• } Ability to perform functional activities.

• } Restricted joint mobility.
• } Muscle weakness.
• } Pain.
• } Inability to follow instructions.
• } Unwillingness to move.

• 1. amount of movement at joint
• 2. greater than AROM due to elastic stretch of muscle tissue and decreased bulk

• 1. establish joints ROM
• 2. determine quality of movement throughout ROM & end feel
• 3. determine whether a capsule or noncapsular pattern is present
• 4. presence of pain