NECK FLEXIONStarting & ending positionSitting 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 FLEXIONPrecautionPrevent trunk flexion. Prevent neck rotation and lateral flexion.Factors limiting ROMTension 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 ExtensionStarting & ending positionJust as for flexionAxis – external auditor

meatus Stationary arm – vertical Moving arm – aligned with

nostrils ROM From 45 – 0 for

extensionFrom o- 45 for hyper

extension

NECK ExtensionPrecautionJust as for flexionFactors limiting ROMTension of flexors muscles of neck ( ventral

neck muscles)Approximation of spinous process.

Starting & ending positionJust as for flexion& extensionAxis : 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.

ROMFrom 0 – 60-75 degrees in each

direction.The distance is approximately 5

in to each side as measured by tape.

CERVICAL ROTATION

CERVICAL ROTATION

precautionPrevent trunk rotationPrevent 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 positionSitting 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 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)PrecautionPrevent trunk lateral flexion to the test side.Tape measurementBetween mastoid process of the temporal

bone and the acromion process of the scapula..

Trunk FlexionStarting position: the tape is

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 HyperextensionThe tape alignment is just the

same as for trunk flexionROM 2 inchesPrecautionsPrevent hip extension.Prevent trunk rotation.Factors Limiting ROMTension of anterior abdominal

muscles ( muscles of trunk flexion)

Contact of spinous processes.Tension of longitudinal ligament

of spine.

Thoracic and lumbar lateral flexionPosition Standing erect.Axis - S1 spinous process Stationary arm - vertical Moving arm - C7 spinous

process Stabilization The pelvis is stabilized.

Thoracic and lumbar lateral flexionMeasuring tapeStarting position: place one end of measuring

tape on the 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 ROMContact 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.