Range of Motion (ROM) PDF

Range of Motion (ROM) Hip Flexion: Patient Position: Supine. Goniometer Alignment: Fulcrum: Greater trochanter of the femur. Proximal Arm: Midline of the pelvis. Distal Arm: Midline of the femur, aligned with the lateral epicondyle. Procedure: The patient flexes the hip by bringing the thigh...

Range of Motion (ROM) Hip Flexion: Patient Position: Supine. Goniometer Alignment: Fulcrum: Greater trochanter of the femur. Proximal Arm: Midline of the pelvis. Distal Arm: Midline of the femur, aligned with the lateral epicondyle. Procedure: The patient flexes the hip by bringing the thigh towards the chest. Stabilize the pelvis to prevent posterior tilting. Normal ROM: 0–120°. Hip Extension: Patient Position: Prone. Goniometer Alignment: Same as hip flexion. Procedure: The patient extends the leg backward while keeping the knee straight. Stabilize the pelvis to prevent anterior tilting. Normal ROM: 0–20°. Hip Abduction: Patient Position: Supine. Goniometer Alignment: Fulcrum: ASIS of the tested leg. Proximal Arm: Horizontal line connecting both ASIS. Distal Arm: Midline of the femur, aligned with the patella. Procedure: The patient moves the leg laterally, away from the midline. Normal ROM: 0–45°. Hip Adduction: Patient Position: Supine. Goniometer Alignment: Same as hip abduction. Procedure: The patient moves the leg medially, crossing the midline. Ensure the opposite leg is abducted to allow full range. Normal ROM: 0–30°. Hip Internal Rotation: Patient Position: Sitting with knees flexed to 90°. Goniometer Alignment: Fulcrum: Center of the patella. Proximal Arm: Perpendicular to the floor. Distal Arm: Midline of the tibia. Procedure: The patient rotates the lower leg outward, causing the femur to rotate internally. Normal ROM: 0–45°. Hip External Rotation: Patient Position: Sitting with knees flexed to 90°. Goniometer Alignment: Same as hip internal rotation. Procedure: The patient rotates the lower leg inward, causing the femur to rotate externally. Normal ROM: 0–45°. Manual Muscle Testing (MMT) Hip Flexion: Patient Position: Sitting on the edge of a table. Procedure: The patient lifts the thigh off the table while the therapist applies downward resistance at the anterior thigh. Muscle Tested: Iliopsoas. Hip Extension: Patient Position: Prone. Procedure: The patient lifts the leg off the table while the therapist applies resistance at the posterior thigh. Muscles Tested: Gluteus maximus and hamstrings. Hip Abduction: Patient Position: Side-lying with the tested leg on top. Procedure: The patient lifts the leg upward while the therapist applies resistance at the lateral thigh. Muscle Tested: Gluteus medius. Hip Adduction: Patient Position: Side-lying with the tested leg on the bottom. Procedure: The patient lifts the bottom leg upward while the therapist applies resistance at the medial thigh. Muscle Tested: Adductor group. Hip Internal Rotation: Patient Position: Sitting with knees flexed to 90°. Procedure: The patient rotates the lower leg outward while the therapist applies resistance at the lateral aspect of the lower leg. Muscle Tested: Gluteus minimus and tensor fasciae latae. Hip External Rotation: Patient Position: Sitting with knees flexed to 90°. Procedure: The patient rotates the lower leg inward while the therapist applies resistance at the medial aspect of the lower leg. Muscle Tested: Piriformis and deep external rotators. KNEE Range of Motion (ROM) Knee Flexion: Patient Position: Supine. Goniometer Alignment: Fulcrum: Lateral epicondyle of the femur. Proximal Arm: Midline of the femur (toward greater trochanter). Distal Arm: Midline of the fibula (toward lateral malleolus). Procedure: The patient bends the knee, bringing the heel toward the buttocks. Normal ROM: 0–135°. Knee Extension: Patient Position: Supine with a towel roll under the ankle. Goniometer Alignment: Same as knee flexion. Procedure: The patient straightens the knee. Normal ROM: 0°. Manual Muscle Testing (MMT) Knee Flexion: Patient Position: Prone with legs extended. Procedure: The patient bends the knee while the therapist applies resistance at the distal posterior leg. Muscle Tested: Hamstrings. Knee Extension: Patient Position: Sitting with legs hanging off the table. Procedure: The patient straightens the knee while the therapist applies resistance at the distal anterior leg. Muscle Tested: Quadriceps femoris. ANKLE Range of Motion (ROM) Ankle Dorsiflexion: Patient Position: Sitting with knees flexed to 90°. Goniometer Alignment: Fulcrum: Lateral malleolus. Proximal Arm: Midline of the fibula (toward fibular head). Distal Arm: Parallel to the 5th metatarsal. Normal ROM: 0–20°. Ankle Plantarflexion: Patient Position: Sitting with knees flexed to 90°. Goniometer Alignment: Same as dorsiflexion. Normal ROM: 0–50°. Ankle Inversion: Patient Position: Sitting or supine. Goniometer Alignment: Fulcrum: Anterior aspect of the ankle, midway between malleoli. Proximal Arm: Midline of the tibia. Distal Arm: Midline of the 2nd metatarsal. Normal ROM: 0–35°. Ankle Eversion: Patient Position: Sitting or supine. Goniometer Alignment: Same as inversion. Normal ROM: 0–15°. Manual Muscle Testing (MMT) Ankle Dorsiflexion and Inversion: Patient Position: Sitting with legs hanging off the table. Procedure: The patient dorsiflexes and inverts the foot while the therapist applies resistance at the dorsomedial foot. Muscle Tested: Tibialis anterior. Ankle Plantarflexion: Patient Position: Standing on one leg. Procedure: The patient performs heel raises. Grade based on the number of repetitions: 5/5: 25 raises. 4/5: 10–24 raises. 3/5: 1–9 raises. Muscle Tested: Gastrocnemius and soleus. Ankle Inversion: Patient Position: Sitting or supine. Procedure: The patient inverts the foot while the therapist applies resistance at the medial border of the foot. Muscle Tested: Tibialis posterior. Ankle Eversion: Patient Position: Sitting or supine. Procedure: The patient everts the foot while the therapist applies resistance at the lateral border of the foot. Muscle Tested: Peroneus longus and brevis. FOOT Range of Motion (ROM) Great Toe Extension: Normal ROM: 0–70°. Manual Muscle Testing (MMT) Toe Flexion: Muscles Tested: Flexor digitorum brevis and flexor hallucis longus. Toe Extension: Muscles Tested: Extensor digitorum longus and extensor hallucis longus. To perform manual muscle tests (MMTs) in greater detail for the hip, knee, ankle, and foot, follow these steps for each joint and muscle group: Hip Hip Flexion (Iliopsoas): Patient Position: Sitting on the edge of the examination table, with knees flexed at 90°. Therapist Position: Stand in front of the patient, with one hand stabilizing the pelvis and the other hand positioned on the anterior thigh. Procedure: Instruct the patient to lift their thigh towards their chest (hip flexion). As the patient performs the movement, the therapist applies downward resistance on the thigh just above the knee, ensuring stabilization to isolate the iliopsoas. Grading: 5/5: Full ROM against maximal resistance. 4/5: Full ROM against moderate resistance. 3/5: Full ROM against gravity only. 2/5: Partial ROM without gravity (side-lying). 1/5: Palpable muscle contraction but no movement. Hip Extension (Gluteus Maximus and Hamstrings): Patient Position: Prone with legs extended. Therapist Position: Stand beside the patient, with one hand stabilizing the pelvis and the other applying resistance to the posterior thigh. Procedure: Instruct the patient to lift their leg off the table while keeping the knee straight. Apply downward resistance on the posterior thigh. Variation for Gluteus Maximus Isolation: Bend the knee to 90° to reduce hamstring involvement. Hip Abduction (Gluteus Medius): Patient Position: Side-lying with the tested leg on top and the bottom leg bent for support. Therapist Position: Stand behind the patient. Stabilize the pelvis with one hand and place the other hand on the lateral thigh. Procedure: Instruct the patient to lift the top leg upward without rotating it. Apply downward resistance at the lateral thigh. Hip Adduction (Adductor Group): Patient Position: Side-lying with the tested leg on the bottom and the top leg supported by the therapist or resting on a stool. Therapist Position: Stand behind the patient. Support the top leg as needed and apply resistance to the medial thigh of the bottom leg. Procedure: Instruct the patient to lift the bottom leg upward. Apply downward resistance at the medial thigh. Hip Internal Rotation (Gluteus Minimus and Tensor Fasciae Latae): Patient Position: Sitting with knees flexed to 90° and feet unsupported. Therapist Position: Kneel or sit in front of the patient, stabilizing the distal thigh with one hand. Place the other hand on the lateral side of the lower leg. Procedure: Instruct the patient to move their lower leg outward. Apply inward resistance at the lateral lower leg. Hip External Rotation (Piriformis and Deep Rotators): Patient Position: Sitting with knees flexed to 90° and feet unsupported. Therapist Position: Kneel or sit in front of the patient, stabilizing the distal thigh with one hand. Place the other hand on the medial side of the lower leg. Procedure: Instruct the patient to move their lower leg inward. Apply outward resistance at the medial lower leg. Knee Knee Flexion (Hamstrings): Patient Position: Prone with legs extended. Therapist Position: Stand beside the patient. Stabilize the thigh with one hand and place the other hand on the posterior distal leg. Procedure: Instruct the patient to bend their knee as far as possible. Apply resistance at the distal posterior leg by pushing downward. Variation for Medial or Lateral Hamstrings: Rotate the foot inward (medial hamstrings) or outward (lateral hamstrings). Knee Extension (Quadriceps Femoris): Patient Position: Sitting with legs hanging off the table and a towel roll under the distal thigh if needed for support. Therapist Position: Stand in front of the patient. Stabilize the distal thigh with one hand and place the other hand on the anterior distal leg. Procedure: Instruct the patient to straighten their knee fully. Apply downward resistance at the distal anterior leg. Ankle and Foot Ankle Dorsiflexion and Inversion (Tibialis Anterior): Patient Position: Sitting with legs hanging off the table. Therapist Position: Sit in front of the patient. Stabilize the lower leg with one hand and place the other hand on the dorsomedial aspect of the foot. Procedure: Instruct the patient to dorsiflex and invert their foot. Apply resistance by pushing the foot into plantarflexion and eversion. Ankle Plantarflexion (Gastrocnemius and Soleus): Patient Position: Standing on one leg with the knee extended (gastrocnemius) or flexed (soleus). Therapist Position: Observe from the side. Procedure: Instruct the patient to perform as many heel raises as possible. Resistance is graded based on the number of repetitions: 5/5: 25 raises. 4/5: 10–24 raises. 3/5: 1–9 raises. Ankle Inversion (Tibialis Posterior): Patient Position: Sitting or supine. Therapist Position: Stabilize the lower leg with one hand and place the other hand on the medial border of the foot. Procedure: Instruct the patient to invert the foot. Apply resistance by pushing the foot outward. Ankle Eversion (Peroneus Longus and Brevis): Patient Position: Sitting or supine. Therapist Position: Stabilize the lower leg with one hand and place the other hand on the lateral border of the foot. Procedure: Instruct the patient to evert the foot. Apply resistance by pushing the foot inward. Toe Flexion (Flexor Digitorum Brevis and Flexor Hallucis Longus): Patient Position: Sitting or supine. Therapist Position: Stabilize the midfoot with one hand and use the other hand to apply resistance to the plantar surface of the toes. Procedure: Instruct the patient to curl their toes. Apply resistance by attempting to straighten them. Toe Extension (Extensor Digitorum Longus and Extensor Hallucis Longus): Patient Position: Sitting or supine. Therapist Position: Stabilize the midfoot with one hand and use the other hand to apply resistance to the dorsal surface of the toes. Procedure: Instruct the patient to straighten their toes. Apply resistance by attempting to curl them downward.