1. Neck & Trunk ROM Measurement

2. 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

3. 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.

4. NECK Extension Axis – external auditor meatus
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

5. NECK Extension Precaution Just as for flexion Factors limiting ROM
Tension of flexors muscles of neck ( ventral neck muscles)
Approximation of spinous process.

6. CERVICAL ROTATION Just as for flexion& extension
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 – degrees in each direction.
The distance is approximately 5 in to each side as measured by tape.

7. 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.

8. 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 C7 .
Stationary arm: placed along the thoracic spinous processes.
Moving arm placed over the external occipital protuberance of the occipital bone.
ROM From 0 – degrees in each direction.
The distance is approximately 5 in to each side as measured by tape.

9. 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..

10. Trunk Flexion
Starting 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.

11. 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.

12. 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.

13. 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.

14. Thoracic and lumbar lateral flexion
Measuring tape
Starting 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 ROM
Contact of lips pf vertebral bodies with subjacent vertebrae laterally.

15. 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.

16. 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.