Chapter 2: Procedures

INTRODUCTION

Competency in goniometry requires that the examiner acquire the following knowledge and develop the following skills.

The examiner must have knowledge of the following for each joint and motion:

1. Joint structure and function

2. Normal end-feels

3. Testing positions

4. Stabilization required

5. Anatomical bony landmarks

6. Instrument alignment

The examiner must have the skill to perform the following for each joint and motion:

1. Position and stabilize correctly

2. Move a body part through the appropriate range of motion (ROM)

3. Determine the end of the ROM and end-feel

4. Palpate the appropriate bony landmarks

5. Align the measuring instrument with landmarks

6. Read the measuring instrument

7. Record measurements correctly

POSITIONING

Positioning is an important part of goniometry because it is used to place the joints in a zero starting position and helps to stabilize the proximal joint segment. Positioning affects the amount of tension in soft tissue structures (capsule, ligaments, muscles) surrounding a joint. A testing position in which one or more of these soft tissue structures become taut results in a more limited ROM than a position in which the same structures become lax. As can be seen in the following example, the use of different testing positions alters the ROM obtained for hip flexion.

It is important that examiners use the same testing position during successive measurements of a joint ROM so that the relative amounts of tension in the soft tissue structures are the same as in previous measurements. In this manner, a comparison of ROM measurements taken in the same position should yield similar results. When different testing positions are used for successive measurements of a joint ROM, more variability is added to the measurement^{1,2,3,4,5,6,7,8,9,10} and no basis for comparison exists. If testing positions vary, it is difficult to determine if differences in successive measurements are the result of changes in the testing position or a true change in joint ROM.

Testing positions refer to the positions of the body that we recommend for obtaining goniometric measurements. The series of testing positions that are presented in this text are designed to do the following:

1. Place the joint in a starting position of 0 degrees

2. Permit a complete ROM

3. Provide stabilization for the proximal joint segment

If a testing position cannot be attained because of restrictions imposed by the environment or limitations of the subject, the examiner must use creativity to decide how to obtain a particular joint measurement. The alternative ...