Measurement Review:
The goniometer will be the tool you will be required to use if asked to measure a
patient’s ROM. So lets make sure you understand how to properly use the device before
we begin. The goniometer is made up of an axis (the hinge), a stable arm,
and the mobilizing arm.
- Axis (AX): The center of the goniometer should always be placed next to the axis of the anatomical joint.
- Stable arm (SA): Placed proximal to the anatomical.
- Mobile arm (MA): placed distal to the joint and as the name refers will be moving.
Always assure that the patient is in a stable position and to support the extremity being tested.
Before preforming the actual measurement ensure the patient is in a favorable position. Then assist them through the desired motion (PROM), while explaining what you would like them to do. Once you have your goniometer in place, have the subject perform the desired motion unassisted. The below will walk you through the starting position (SP) to have the patient in, as well as, how to position the goniometer.
| Testing: | Starting Position | Axis | Stationary Arm | Mobilizing Arm | Motion |
|---|---|---|---|---|---|
| Hip Flexion (120-130º) | Lying on back (supine) with hips extended | Greater trochanter | Lateral longitudinal axis of trunk | Lateral longitudinal axis of femur | Bend hip and knee up towards the chest and contralateral leg flat on table. |
| Thomas Test-hip flexion contracture test. | Supine | Greater trochanter | Lateral longitudinal axis of trunk | Lateral longitudinal axis of femur | -Bring both legs up towards chest. -Lower one leg to table, while keeping other flexed. -Angle between table and extended leg determines amount of hip flexion contracture |
| Hip Extension (0º) | Lying on stomach (prone) with hips relaxed | Greater trochanter | Lateral longitudinal axis of trunk | Lateral longitudinal axis of femur | Lift leg off table towards buttocks |
| Straight Leg Raise (90º)-(Testing for proximal hamstring tightness.) | Supine | Greater trochanter | Lateral longitudinal axis of trunk | Lateral longitudinal axis of femur | Raise the leg upwards, making sure to keep knee extended and contralateral leg straight on table. |
| Hip Abduction/Adduction (45º/30º) | Supine | ASIS | ASIS-from side being measure to contralateral (horizontal) | Anterior longitudinal axis of femur | ABD: with all joints extended move leg away from midline. ADD: move towards and past midline |
| Internal/ External Hip Rotation (45º) | Sitting (can also be preformed lying down with different method) | Middle patella | Perpendicular to floor | Anterior longitudinal axis of tibia (midline) | Keep pelvis level. INT: move leg out and away from midline EXT: move leg out and towards midline |
| Femoral Anteversion (20º) | Prone with hip extended and knee flexed 90º | Middle patella | Perpendicular with the floor | Anterior longitudinal axis of tibia | Rotate the limb to until you feel the prominence of the trochanter reach it's max. |
| Knee Flexion (135º) | Prone | Through lateral epicondyle | Lateral longitudinal axis of femur | longitudinal axis of fibula | Bend knee up towards buttocks as far as possible. |
| Knee Extension (0º) | Prone or supine | Lateral epicondyle | Lateral longitudinal axis of femur | Lateral longitudinal axis of fibula | Extend knee |
| Ankle Dorsiflexion (20º) | Supine -knee bent -knee straight (gastoc tightness) | Just distal and posterior | Lateral longitudinal axis of fibula | Lateral longitudinal axis of 5th metatarsal | Align subtalar joint in neutral to slight inversion while bending foot up. |
| Ankle Plantarflexion (45º) | Align subtalar joint in neutral to slight inversion while bending foot up. | Just distal and posterior to lateral malleolus | Lateral longitudinal axis of fibula | Lateral longitudinal axis of 5th metatarsal | Keep knee extended, moving foot down towards table |
| Hindfoot Inversion/Eversion (5º ea) | Prone | Posterior calcaneus | Parallel to posterior longitudinal axis of tibia | Parallel to line bisecting calcaneus into right and left halves | Bring hind foot medially (inversion) or laterally (eversion) |
| Forefoot Inversion/Eversion (35º/15º) | Supine or sitting | Midway between malleoli | Parallel to anterior longitudinal axis of tibia | Anterior longitudinal axis of 2nd metatarsal | Knee flexed or extended, bring forefoot medial (inversion) or laterally (eversion) |
| Toe Out | Prone with hip extended and knee flexed to 90º | Center of heel subtalar joint in neutral | Parallel to long axis of thigh | Bisecting the heel towards the 2nd toe | Externally rotate-Focus on alignment of the hind foot to thigh rather than the foot. |
Subtalar Neutral:
- Describes the neutral alignment between the subtalar, talonavicular and calacneocuboid joints.
- You can easily explain, palpate, and orient a subject into this position by:
- palpating both sides of the talus
- Grasping the forefoot along the metatarsal heads (with thumb and index finger)
- manipulating the forefoot (side to side) until both side are equally prominent
- this can be preformed with the subject lying prone or in my opinion the easiest method, having the subject in sitting position (making sure to also control dorsi & plantar flexion).
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