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Shaw Chiropractic
A Medical-Legal Newsletter for Personal Injury Attorneys
by Dr. Steven W. Shaw

Ranges of Motion: What are Normal Values?

Recently, I have been receiving questions from adjustors and attorneys regarding normal values of ranges of motion (ROM) of the cervical and lumbar spinal regions. This is such a common component of the orthopedic examination that I assumed that everyone was familiar with the values and their significance. Apparently I was wrong, so this newsletter will address the topic spinal ROM, normal values and their importance. I have also included some data for extremity ranges of motion.

Interestingly, the “normal”ranges of motion are not universally accepted. They are dependent upon the method of determination and the author you reference (see page 2 of the attachment). Some authors will discuss the measurements based upon goniometric examination while others will use inclinometric measurements. Obviously, everyone rounds off the normal number to the nearest 5% which means that there is some margin of error in the normative data.

Since most physicians will be using the AMA Guides as their reference text, this newsletter will focus on the values published in the 5th edition. Additionally, since the guides recommend using inclinometric values for spine measurements I will limit the normal values to those presented in the text. It should be noted that many joints are not given normal values in the guides

The charts included on the front side of the attachment to this newsletter are taken from the values in the AMA Guides. You should note that the values represent the minimum normal values. The guides go on to show how these values relate to impairment when performing a functional (ROM) method impairment evaluation. For example, Cervical flexion should be 500 or greater. A 490 measurement would put it in the range of 300-490 which translates to 2% impairment. At 290 the impairment would be in the 150-290 degree range and be associated with a 4% impairment. Less than 150 of cervical flexion would be the maximum impairment range for cervical flexion and would be associated with a 5% impairment.

You will note that I have left blank some values for the lower extremities since the AMA Guides do not list the normal values (ex Dorsiflexion of the foot). For some extremity values the numbers seem unreasonably low (ex. Plantar flexion of the foot). I can only speculate for the reasons for this and therefore will not make an opinion. Some figures for lower extremity measurements are representative of the range of motion after which and impairment exists rather than what the normal ranges of motion should be.

All that being said, it should obvious that the ranges of motion as listed in the AMA Guides are not universally accepted or well defined when it relates to extremity involvement. I believe that the spine ranges of motion listed in the guides are realistic and usable when performing a Range of Motion method impairment rating.

From a clinical point of view, ranges of motion are valuable to determine patient response or lack thereof. However, the objectification of range of motion is most valuable when performing an impairment rating, and specifically a ROM method rating. Most patients will be evaluated for impairment using the Diagnostic Related Estimates method (DRE). The DRE has asymmetrical ranges of motion as one of it’s criteria but does not necessarily require inclinometric measurement and validity testing. Rather, it takes ROM asymmetry with a variety of other clinical findings and considerations and applies an impairment according to injury categories.

Unlike the DRE method, the ROM method requires accurate inclinometric assessment of joint ranges of motion. It also requires that the findings fall within validity parameters. The ranges of motion must be performed for a minimum of three trials and no more than 6 trials. Three of the trials must fall within 10% or 5 degrees of each other to meet the validity parameters.

Doing ROM method impairment also involves other components unrelated to ROM. One must consider other clinical findings such as sensory loss, motor loss and findings identified on the Specific Spinal Disorders table (Table 15-7 Pg 404). ROM Impairment determinations that do not consider these other factors are incomplete. Unfortunately, many computer programs which exist in the medical communities only consider ROM impairment based upon loss of ROM. This certainly is an injustice to an injured patient. It is also an error in procedure on the part of the examining doctor who may apply an impairment based upon inadequate clinical consideration of the other essential components.

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Ranges of Motion Values

Normal Cervical ROM Values
Flexion 50
Extension 60
Right Rotation 80
Left Rotation 80
Right Lateral Bending 45
Left Lateral Bending 45

Normal Thoracic ROM Values
Minimal Kyphosis 00 (-29- +59)
Flexion angle 60
Right Rotation 30
Left Rotation 30

Normal Lumbar ROM Values
True Lumbar Flexion 60
Sacral (Hip) Flexion (A)25
Extension (B) 25
Right Lateral Bending 25
Left Lateral Bending 25
Straight Leg raise <(A+B)+15%

Normal Wrist ROM Values
Flexion 60
Extension 60
Radial Deviation 20
Ulnar Deviation 30

Normal Elbow ROM Values
Flexion 140
Extension 0
Supination 80
Pronation 80

Normal Shoulder ROM Values
Flexion 180
Extension 50
Internal Rotation 90
External Rotation 90
Abduction 180
Adduction 50

Normal Hip ROM Values
Flexion >100
Extension 10-15
Abduction >25
Adduction >15
Internal Rotation >20
External Rotation >30

Normal Knee ROM Values
Flexion >110
Extension 0

Normal Ankle ROM Values
Dorsiflexion
Plantar Flexion >20
Inversion >20
Eversion >10

References for the normal values are: 1.American Academy of Orthopedic Surgeons, Joint Motion: Method Measuring and Recording, AAOS, Chicago, 1965; 2.Boone,DC Azen, SP Normal range of motion in male subjects. J Bone Joint Surg 61A:756, 1979; 3. Clark WA: A System of Joint Measurement J Orthop Surg 2:687, 1920; 4. Commission of California Medical Associationand The Industrial Accident Commission of the State of California: 5. Evaluation of Industrial Disability. Oxford University Pree, New York, 1960; Daniels, L and Worthington, C: 6 Muscle Testing: Techniques of Manual Examination, ed 3 WB Saunders Philadelphia 1972; Dorinson, SM and Wagner, ML,: 7 exact technique for clinically measuring and recording joint motion. Arch Phys Med 29:468, 1948;Esch, D and Lepley, M: Evaluation of Joint Motion:Methods of Measurement and Recording. University of Minnisota Press, Minneapolis 1974; Gerhardt, JJ and Russe, OA: 8International SFTR Method of Measuring and Recording Joint Motion. Huber Bern, 1975; Hoppenfeld, S: Physical Examination of the Spine and Extremities. Appleton Century Crofts, New York 1976;9 Journal of the American Medical Asociation: A Guide to the Evaluation of Permanent Impairment of the Extremities and Back. JAMA (special edition) 1, 1958;10 Kapandji, IA: Physiology of the Joints, Vols 1 and 2, ed 2. Churchill Livingstone, 1970; Kendall, FP and McCreary, EK Muscles, Testing and Functoin, ed 3. Williams and Wilkens, Baltimore, 1983; and 11 Wieche, FJ and Krusen FH: A New Method of Joint Measurement and a Review of the Literature. Am J Surg 43:659, 1939