Range of Motion Testing Essentials for Shoulder, Hip, Knee, and Ankle

Consistent ROM Testing Sequence (Use This Every Time)

Use a repeatable order so your findings are comparable across sessions and between clinicians:

• 1) Observe posture and starting position (neutral alignment, symmetry, resting muscle tone).
• 2) AROM first (patient moves): note range, pain, quality, substitutions.
• 3) PROM second (you move): note end-feel, stiffness, pain response, guarding.
• 4) Measure: goniometer when possible; otherwise a documented visual estimate.
• 5) Document: degrees, pain (location/intensity), quality, substitutions, and stabilization used.

AROM vs PROM: What Each Suggests

Active Range of Motion (AROM)

What it tests: willingness to move, motor control, strength through range, symptom behavior during self-driven movement.

• Pain-limited AROM: patient stops due to pain; range may improve with PROM if pain is tolerable and tissue allows.
• Weakness-limited AROM: patient cannot reach range but PROM is near full; often shows shaking, compensations, or inability to hold end range.
• Stiffness-limited AROM: patient reports “tight” and both AROM and PROM are similarly limited, often with a firm end-feel.

Passive Range of Motion (PROM)

What it tests: tissue extensibility, joint mobility limits, irritability, and end-feel without active muscle contribution.

• Pain-limited PROM: early pain before expected end range; may show guarding or empty end-feel.
• Stiffness-limited PROM: firm or hard end-feel at reduced range; pain may be minimal or appear at end range.
• AROM limited & PROM full: suggests weakness, poor motor control, apprehension, or pain inhibition rather than capsular restriction.

Quick Interpretation Pattern

Goniometry Fundamentals (Step-by-Step)

Use the same landmarks and positions each time. Small setup differences can change the reading more than true clinical change.

Step 1: Choose the correct patient position

• Position to minimize substitutions and allow stabilization (often supine/prone for hip; supine for knee; seated/supine for shoulder depending on motion).
• Expose landmarks while maintaining comfort and privacy.

Step 2: Identify bony landmarks (before moving)

Palpate and mark (mentally or with skin-safe marker) the axis and reference lines. If you cannot reliably palpate, your measurement will be unreliable.

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Step 3: Align the goniometer

• Axis (fulcrum): placed over the joint’s approximate axis of rotation.
• Stationary arm: aligned with the proximal segment reference line.
• Moving arm: aligned with the distal segment reference line; it follows the moving segment.

Step 4: Stabilize the proximal segment

Stabilization prevents “false ROM” from adjacent joints or trunk motion. Stabilize with your hand, belt, table contact, or patient cueing.

Step 5: Move through ROM and read at end range

• For AROM: patient moves; you align and read at end range.
• For PROM: you move to first resistance or symptom limit; read at end range.
• Keep the goniometer aligned; re-check landmarks before reading.

Step 6: Record consistently

Document degrees, pain, end-feel/quality, and substitutions. Example format:

Shoulder flexion AROM: 0–145° (pain 3/10 anterior shoulder at 130–145°, scapular elevation substitution)  PROM: 0–160° (firm end-feel, pain 2/10 end range)

When You Don’t Have a Goniometer (Visual Estimate)

Visual estimation can be useful for screening and quick re-checks, but it is less precise and more prone to bias. If you use it, be explicit.

How to do a structured visual estimate

• Use reference angles: 0°, 45°, 90°, 120°, 180°.
• Use body landmarks: e.g., “hip flexion to thigh parallel with table” approximates ~90° in many body types (not exact).
• Compare sides when appropriate: note asymmetry in degrees or “within ~10°.”
• State method in documentation: “visual estimate” and the limitation.

Documentation example

Ankle DF AROM (visual estimate): ~5° past neutral with knee flexed; pain 0/10; heel remains down

Shoulder ROM Testing Essentials

Key motions to test

• Flexion
• Abduction
• External rotation (ER)
• Internal rotation (IR)

Shoulder flexion (AROM/PROM)

Setup: Supine or standing. Supine reduces lumbar extension substitution.

Stabilization: Prevent rib flare/lumbar extension; monitor scapular motion.

Common substitutions to watch: lumbar extension, rib flare, scapular elevation/early upward rotation, trunk lean.

Goniometer landmarks (typical): Axis near lateral aspect of greater tubercle; stationary arm parallel to midaxillary line of thorax; moving arm aligned with lateral midline of humerus toward lateral epicondyle.

Shoulder abduction

Setup: Supine or standing; palm up can reduce impingement-like symptoms for some.

Stabilization: Prevent trunk lateral flexion; monitor scapular hiking.

Substitutions: trunk side-bend, shoulder elevation, external rotation drift to “find space.”

Goniometer landmarks (typical): Axis near anterior aspect of acromion; stationary arm parallel to sternum; moving arm along midline of humerus toward medial epicondyle.

Shoulder ER/IR (at 90° abduction)

Setup: Supine, shoulder abducted 90°, elbow flexed 90°, towel under humerus to align with scapular plane if needed.

Stabilization: Stabilize scapula/anterior shoulder to prevent anterior glide and scapular tilt.

Substitutions: scapular anterior tilt, lumbar extension, elbow drift, shoulder abduction angle changes.

Goniometer landmarks (typical): Axis at olecranon; stationary arm perpendicular to floor; moving arm aligned with ulna toward ulnar styloid.

Shoulder documentation checklist

• Degrees for AROM and PROM
• Pain location and intensity (e.g., “lateral shoulder 4/10 at end range”)
• Quality: smooth vs jerky, apprehension, guarding
• Substitutions: scapular hike, trunk extension/lean

Hip ROM Testing Essentials

Key motions to test

• Flexion
• Extension
• Abduction
• Internal rotation (IR)
• External rotation (ER)

Hip flexion

Setup: Supine. Test with knee flexed to reduce hamstring tension if the goal is hip joint range.

Stabilization: Prevent posterior pelvic tilt and lumbar flexion from “adding” range.

Substitutions: posterior pelvic tilt, contralateral hip flexion, abduction/ER drift.

Goniometer landmarks (typical): Axis at greater trochanter; stationary arm along midaxillary line of trunk; moving arm along lateral midline of femur toward lateral epicondyle.

Hip extension

Setup: Prone (knee straight) or side-lying. Prone reduces balance demands.

Stabilization: Prevent anterior pelvic tilt and lumbar extension.

Substitutions: lumbar extension, pelvic rotation, knee flexion (if glute weakness).

Goniometer landmarks (typical): Axis at greater trochanter; stationary arm along midaxillary line; moving arm along lateral femur.

Hip abduction

Setup: Supine; keep pelvis level.

Stabilization: Stabilize contralateral ASIS/pelvis to prevent pelvic hiking/rotation.

Substitutions: hip flexion/ER drift, pelvic lateral tilt, trunk rotation.

Goniometer landmarks (typical): Axis at ASIS of tested side; stationary arm toward opposite ASIS; moving arm along anterior midline of femur toward patella.

Hip IR/ER

Setup option A (seated): Hip and knee at 90°. Good for quick screening but watch pelvic motion.

Setup option B (prone): Knee flexed 90°. Often easier to stabilize pelvis.

Stabilization: Prevent pelvic rotation and lumbar movement.

Substitutions: pelvic rotation, hip abduction/adduction drift, trunk lean (seated).

Goniometer landmarks (typical): Axis at patella (or anterior knee); stationary arm perpendicular to floor; moving arm along anterior tibia toward midpoint between malleoli.

Hip documentation checklist

• Degrees AROM/PROM
• Pelvic stabilization used (e.g., “pelvis stabilized at ASIS”)
• Quality/end-feel (firm vs empty/guarded)
• Substitutions (posterior pelvic tilt, lumbar extension, pelvic rotation)

Knee ROM Testing Essentials

Key motions to test

• Flexion
• Extension (including hyperextension if present)

Knee flexion

Setup: Supine or prone. Supine is common and comfortable; prone can reduce hip flexion substitution.

Stabilization: Prevent hip rotation and excessive hip flexion (supine).

Substitutions: hip flexion, hip rotation, ankle plantarflexion (can make flexion look larger).

Goniometer landmarks (typical): Axis at lateral femoral epicondyle; stationary arm along lateral midline of femur toward greater trochanter; moving arm along lateral midline of fibula toward lateral malleolus.

Knee extension

Setup: Supine with heel supported (towel roll under ankle) to allow full extension.

Stabilization: Keep hip neutral; avoid external rotation that changes apparent alignment.

Substitutions: hip flexion/rotation, ankle plantarflexion, patient lifting heel to avoid terminal extension discomfort.

Measurement tip: Record lack of extension as negative or as “flexion contracture.” Example: -5° extension or “5° flexion contracture.”

Knee documentation checklist

• Flexion and extension degrees (note hyperextension if present)
• Pain (where and at what range)
• Quality: springy block, firm, guarding
• Effusion/soft tissue approximation limiting flexion (if observed)

Ankle ROM Testing Essentials

Key motions to test

• Dorsiflexion (DF) (knee extended and knee flexed)
• Plantarflexion (PF)
• Inversion
• Eversion

Ankle dorsiflexion (DF)

Why test with knee straight and bent: Knee extended biases gastrocnemius length; knee flexed reduces gastrocnemius contribution and can better reflect talocrural mobility/soleus length.

Setup: Supine or seated with ankle free. Ensure subtalar neutral as best as possible.

Stabilization: Stabilize tibia; prevent foot pronation from “creating” apparent DF.

Substitutions: midfoot pronation/arch collapse, toe extension, heel lift, tibial rotation.

Goniometer landmarks (typical): Axis just distal to lateral malleolus; stationary arm along lateral midline of fibula toward fibular head; moving arm along lateral border of foot toward 5th metatarsal.

Ankle plantarflexion (PF)

Setup: Supine or seated.

Stabilization: Stabilize tibia; avoid inversion/eversion drift.

Substitutions: toe flexion, midfoot motion, inversion/eversion.

Inversion/Eversion

Setup: Seated with lower leg supported, foot off edge.

Stabilization: Stabilize distal tibia/fibula; minimize hip rotation and knee movement.

Substitutions: tibial rotation, forefoot motion instead of rearfoot, toe movement.

Goniometer landmarks (common approach): Axis anterior to ankle between malleoli; stationary arm aligned with tibial crest; moving arm aligned with 2nd metatarsal (note: methods vary—be consistent within your setting).

Ankle documentation checklist

• DF with knee straight and knee flexed (degrees)
• Heel behavior (stays down vs lifts), arch behavior (collapses vs stable)
• Pain location (anterior ankle pinch vs calf stretch vs medial/lateral)
• Quality/end-feel (firm vs springy vs guarded)

How to Document ROM Like a Clinician

Minimum required elements

• Motion + side: e.g., “R hip IR”
• Type: AROM and/or PROM
• Degrees: start–end (or end only if start is standardized at 0)
• Pain: intensity and location, and whether it limits motion
• Quality: smooth/jerky, apprehension, guarding, end-feel
• Substitutions: what you saw and what you did to control it

Examples

R knee extension PROM: -8° (firm end-feel, posterior knee tightness 2/10, no guarding)  AROM: -12° (quad lag, mild shaking)

L ankle DF PROM (knee flexed): 0–12° (firm, no pain, heel down; minimal midfoot pronation)  DF PROM (knee extended): 0–6° (calf stretch)

Practice Drills: Stabilization and Cue Selection

Read each scenario, then choose the best stabilization and best cue. After you answer, compare to the provided “best response.”

Drill 1: Shoulder flexion with trunk substitution

Scenario: During shoulder flexion AROM in standing, the patient reaches 150° but you notice rib flare and lumbar extension starting around 120°. They report “tightness” in the front of the shoulder at end range.

• Choose stabilization: A) Hold scapula down firmly B) Block rib cage/lower thorax to limit extension C) Hold elbow to keep it straight
• Choose cue: A) “Lean back to get higher” B) “Keep your ribs heavy; reach your arm up without arching” C) “Turn your palm down”

Best response: Stabilization B. Cue B. Then re-test in supine to reduce lumbar substitution and re-measure.

Drill 2: Hip flexion PROM with posterior pelvic tilt

Scenario: Supine hip flexion PROM: at ~95° the pelvis starts to posteriorly tilt and the lumbar spine flexes. The patient says it feels like a hamstring stretch, not hip pain.

• Choose stabilization: A) Stabilize ASIS to prevent pelvic tilt B) Hold the ankle only C) Stabilize the opposite knee into flexion
• Choose cue: A) “Let your low back round” B) “Keep your pelvis heavy; tell me when you first feel resistance in the hip” C) “Point your toes”

Best response: Stabilization A. Cue B. Consider testing hip flexion with knee flexed (if not already) to reduce hamstring limitation when the goal is hip joint ROM.

Drill 3: Knee extension PROM with avoidance

Scenario: Supine knee extension PROM: the patient lifts the heel slightly as you approach terminal extension and reports anterior knee discomfort.

• Choose stabilization: A) Support heel on a towel roll and keep it in contact B) Push down on the forefoot C) Hold the patella firmly
• Choose cue: A) “Keep your heel heavy and relaxed; I’ll do the movement” B) “Tighten your quad as hard as you can” C) “Hold your breath”

Best response: Stabilization A. Cue A. Measure the point where the heel begins to lift as a sign of pain/guarding and document pain location and behavior.

Drill 4: Ankle dorsiflexion AROM with midfoot collapse

Scenario: Seated ankle DF AROM appears “good,” but you see the arch collapse and the foot pronate while the tibia barely advances. The patient feels no pain.

• Choose stabilization: A) Stabilize distal tibia and maintain subtalar neutral/rearfoot position B) Hold toes into extension C) Stabilize the knee into valgus
• Choose cue: A) “Let your arch drop and bring your knee in” B) “Keep your heel down and your arch gently lifted; bring your shin forward” C) “Curl your toes”

Best response: Stabilization A. Cue B. Re-check DF with knee flexed and extended, and document whether motion came from talocrural DF versus midfoot pronation.