Mobility Evaluation

Joint mobility of one movement is most of the time restricted by the other movement of the pair.  The test are classified here by joint movment but test in fact the flexibility of the main movers of the opposite movement. 

Ankle

Plantarflexion and Dorsiflexions      Inversion and Eversion
 Each motion can be assessed with the athlete supine (lying on his back) on the examination table.  Also perform the evaluation of dorsiflexion with the knee bent at 90°, either in supine position or sitting.  The athlete is asked to first move the ankle to the desired position and the therapist can apply passive over-pressure to the joint to assure full range. Both sides should be tested for comparison and only measured if one side is drastically different from the other.
 Normal range of motion:  Dorsiflexion 1-joint:  20°          2-joints:  10°
            Plantarflexion:  50°   Eversion:  5-15°
            Inversion:  20-30°

Video:  https://youtu.be/d5NpnkkMd4Q


Knee

 Extension
Lie supine on mat or bench. Bend hip and knee at right angles so thigh is vertical and lower leg is horizontal. Starting position shown.  Extend knee and hold position. Repeat on opposite leg.
Angle of knee is noted. Achieving a 5° to 15° bend is desirable.  Ankle may be kept in neutral position or plantar flexed (pointed). Thigh may be stabilized vertically by test administrator or subject using a mirror.
Normal range of motion: 0° (fully open)

Flexion
 Lie prone on bench, floor, or mat. Flex one knee.  Test administrator gently pushes heel of bent leg toward buttocks until resistance is felt or partner expresses discomfort. Repeat on opposite leg.  Pelvis should remain on floor with no flexion at hip. If hip flexes while knee is flexed, a tightness in the Rectus Femoris is indicated. Knee should bend freely 135° or heel should touch buttocks
Normal range of motion: 140°


Hip

Extension
 Lie supine on bench with leg extended beyond edge of bench (less than half of thigh on bench). Bring knee of other leg to chest.  Pull thigh down with hands until low back touches testing surface. Repeat on opposite leg.  With low back and sacrum flat to the table, thigh should touch the table (knee bends to 80° if 2-joints flexors are normal).  If the knee bends at less than 80°, it is an indication of short 1 joint flexors.
Thigh should be pulled into chest just enough to have low back contact bench. A false positive may occur if pelvis posteriorly rotates beyond what is necessary to have low back contact testing surface.
Normal range of motion: 1-joint  -10°,  2-joints  10°

Flexion
 Supine position; Legs extended, sacrum and low back flat to table; Prevent pelvic tilt; Raise one leg with the leg straight and foot relaxed; If knee starts to bend, lower the leg and straighten then move again
 Normal length produces 80° between the table and the raised leg is considered normal for the 2-joints test.  Flex teh knee and repeat the test for the 1-joint test.
Normal range of motion:  1-joint  130°,  2-joints  80-90°

Adduction
 Lie on mat or bench on side with lower leg bent 90° at hip and knee. Test administrator grasps upper leg above ankle and places hip in neutral position (no flexion nor hyperextension) and knee at 90°.  Weight of upper leg is allowed to lower toward testing surface. Repeat on opposite leg.
Test administrator places fingers between testing surface and medial femoral condyle. Score using number of finger breadths.
Normal range of motion:  20-30°

Thorax

 Flexion
 Sit on floor or mat with knees straight.  Reach toward or beyond toes or bring torso toward legs. Hold position. The quality of the stretch should be examined for smoothness of spinal curve and the angle of hip (near 90° or more).  
Feet may be plantar flexed or placed against box, but protocol/norms must be kept consistent for comparisons since ankle position can affect hip flexion performance.
Normal range of motion:  50°


Extension
 Lie prone on mat or floor with arms down by sides.  Slow raise torso as high as possible. Head looks forward, horizontal to floor. Height of chin from floor is noted. Most individuals should be able to raise the chin at least 6 inches (15 cm).
It should be noted that individuals with longer trunks may be able to score better.
Normal range of motion:  0°




Rotation
 Lie supine on floor or mat with knees and hip bent at right angles.  Lower legs to floor to right, then to left. Repeat on opposite leg.  Shoulders should remain in contact with floor during movement. Adequate rotation of spine (lumbar and thoracic junction) is demonstrated if shoulders remain in contact with floor while both sides of legs make contact with floor.
Normal range of motion:  30°



Shoulder

Flexion
 Raise both arms in flexion overhead, keeping them close to the head and a flat low back.  Measure the angle between the humerus and the table or inches between table and lateral epicondyle.  Short if the arms cannot reach table.
Normal range of motion: 

Extension
 Standing or lying on the side of a table, bring the arm in a full extension keeping the arm straight.  It is short if it does not reach an angle of    ° between the humerus and the trunk.
Normal range of motion: 



Horizontal Adduction
 Standing, sitting, or lying on the side of a table, bring the arm in a full horizontal extension, keeping the arm straight and the hand at elbow hight.  It is short if it does not reach an angle of   35° between the humerus and the trunk.
Normal range of motion: 45°
Image result for shoulder horizontal adduction
Horizontal Abduction
 Standing, sitting, or lying on the side of a table, bring the arm in a full horizontal flexion, keeping the arm straight and the hand at elbow hight.  It is short if it does not reach an angle of   125° between the humerus and the trunk.
Normal range of motion:  135°

Internal rotation
 Stand or sit. Position bent arm up to side; elbow bent shoulder height with wrist in front of elbow.   Lower wrist down/back as far as possible while keeping elbow directly lateral to shoulder. Repeat with opposite arm.  Wrist should be able to travel below transverse plane of shoulder. The distance wrist travels below shoulder or range of motion is noted for each side.
Elbow must be kept squarely lateral to shoulder for consistent assessment protocol. A mirror may help monitor proper form and assist in a more accurate assessment. Note any pain or discomfort during movement.
Normal range of motion:  70°

External rotation
Stand or sit. Position bent arm up to side; elbow bent shoulder height with wrist above elbow.  Pull wrist back as far as possible while keeping elbow directly lateral to shoulder. Repeat with opposite arm.  Wrist should be able to travel slightly behind frontal plane of shoulder. The distance wrist travels behind shoulder or range of motion is noted in each side.
Keep elbow squarely lateral to shoulder for consistent assessment protocol. A mirror may help monitor proper form and assist in a more accurate assessment. Note any pain or discomfort during movement.
Normal range of motion:  90°

Scapula retraction
 Subject lays supine with arms at their side.  Shoulder will be raised off the table and may resist downward pressure if the flexors are short.
Maintain pressure on the anterior shoulder region. Bend elbow into full flexion. This will remove the tension from the biceps.
Then lift elbow 6-8 inches.  This removes the tension from the Coracobrachialis.