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NECK FLEXION
Starting & ending position
 Sitting with trunk well
supported , neck in the
anatomical position , hand
placed on the lap. &shoulder
joints are relaxed.
 Axis – external auditory meatus
 Stationary arm – vertical
 Moving arm – aligned with
nostrils
 ROM From 0 – 45 degrees
NECK FLEXION
Precaution
 Prevent trunk flexion.
 Prevent neck rotation and lateral flexion.
Factors limiting ROM
 Tension of the extensor muscles of neck (posterior
muscles of neck) .
 Tension of the ligaments
 Longitudinal ligament.
 Interspinal & supraspinal ligaments.
 Bony blockage: contact of lower lips of vertebral
bodies with surface of subjacent vertebrae anteriorly.
NECK Extension
Starting & ending position
 Just as for flexion
 Axis – external auditor meatus
 Stationary arm – vertical
 Moving arm – aligned with
nostrils
 ROM From 45 – 0 for extension
 From o- 45 for hyper extension
NECK Extension
Precaution
 Just as for flexion
Factors limiting ROM
 Tension of flexors muscles of neck ( ventral neck
muscles)
 Approximation of spinous process.
CERVICAL ROTATION
 Starting & ending position
 Just as for flexion& extension
 Axis : placed over the center of the top
of the head.
 Stationary arm: placed in the line with
the acromion process of the side being
measured.
 Moving arm placed in the line with the
tip of the nose.
 ROM
 From 0 – 60-75 degrees in each
direction.
 The distance is approximately 5 in to
each side as measured by tape.
CERVICAL ROTATION
 precaution
 Prevent trunk rotation
 Prevent scapular elevation.
 Tape measurement
 Place measuring tape on the mid-line of the chin and the
acromion process, measure the difference between the
starting and ending position
 The difference in the measurement is the amount of range
of motion.
CERVICAL lateral flexion ( side
flexion)
 Starting & ending position
 Sitting with trunk well supported , neck in the
anatomical position , hand placed on the lap.
&shoulder joints are relaxed.
 Axis : placed over the spinous process of
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C7 .
Stationary arm: placed along the
thoracic spinous processes.
Moving arm placed over the external
occipital protuberance of the occipital
bone.
ROM From 0 – 45-60 degrees in each
direction.
The distance is approximately 5 in to each
side as measured by tape.
CERVICAL lateral flexion ( side
flexion)
Precaution
 Prevent trunk lateral flexion to the test side.
Tape measurement
 Between mastoid process of the temporal bone and
the acromion process of the scapula..
Trunk Flexion
 Starting position: the tape is
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placed proximally on the spinous
process of C7 and distally to S1.
Ending position: following
flexion of the vertebrae using the
same land mark.
Calculate the difference in
distance between starting and
ending positions.
ROM Approximately 4 in.
The difference between starting
and ending positions.
Trunk Flexion
Precaution
 The pelvis and hip joints are stabilized.
 Factors limiting motion
 Tension of spinal extensor muscles.
 Contact of last ribes with abdomin.
 Bony blockage: contact of lips of vertebral bodies with
subjacent vertebrae anterriorly.
 Tension of ligaments:
 Posterior longitudinal
 Inter spinal ligament.
 Supra spinal ligament.
Trunk Hyperextension
 The tape alignment is just the same as
for trunk flexion
 ROM 2 inches
Precautions
 Prevent hip extension.
 Prevent trunk rotation.
Factors Limiting ROM
 Tension of anterior abdominal muscles
( muscles of trunk flexion)
 Contact of spinous processes.
 Tension of longitudinal ligament of
spine.
Thoracic and lumbar lateral flexion
 Position
 Standing erect.
 Axis - S1 spinous process
 Stationary arm - vertical
 Moving arm - C7 spinous process
 Stabilization
 The pelvis is stabilized.
Thoracic and lumbar lateral flexion
 Measuring tape
 Starting position: place one end of measuring tape on the
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tip of the middle finger and other on the tip of the lateral
malleolus.
Measure the difference in inches following the lateral
flexion motion
Precautions
Avoid trunk flexion, extension and rotation
Prevent lateral tilting of the pelvis.
Factors limiting normal ROM
Contact of lips pf vertebral bodies with subjacent vertebrae
laterally.
Trunk Rotation
 Position
 Sitting without back support, feet flat on
the floor.
 Axis - center of superior aspect of head
 Stationary arm - aligned with anterior
superior iliac spines
 Moving arm - aligned with acromion
processes
 Normal Range 45o
 Stabilization
 The pelvis is stabilized.
Trunk Rotation
Precautions
 Prevent pelvis rotation.
 Avoid trunk flexion, extension and lateral flexion.
Factors limiting normal RON
 Tension of oblique abdominal muscle of opposite side
being tested.
 In thoracic area: tension of costovertebral ligament.
 In lumbar area: interlocking of articular facets.