Normal joint range of motion chart
Normal joint range of motion is how far a healthy joint moves, measured in degrees. This chart gives reference values for the shoulder, elbow, forearm, wrist, hip, knee, ankle, foot, neck and back, with the source of every value. Filter by joint, then compare a patient's measurement with the reference.
What is range of motion?
Range of motion (ROM) is how far a joint moves in one direction, measured in degrees from a start position. Physios measure it to see how much a joint is limited and to follow change over time.
The start position is usually the anatomical position, counted as 0 degrees. The US Department of Veterans Affairs (VA) rating schedule uses this rule with two exceptions. Shoulder rotation starts with the arm out to the side at 90 degrees and the elbow bent to 90 degrees. Forearm rotation starts with the arm by the side, the elbow bent to 90 degrees and the forearm halfway between palm up and palm down.
Active and passive range of motion
Active range is how far the person moves the joint with their own muscles. Passive range is how far it goes when you move it for them and they relax.
It helps to test both. In her Human Kinetics book on soft tissue therapy, Jane Johnson notes that pain or weakness can limit active movement, so a passive test can show range that the active test hides.
Most figures on this page are passive or do not say. The CDC study and Roaas and Andersson measured passive motion. The VA plates and the AMA spine values do not state which kind they are. If you measure active range, write that down, and do not expect it to match a passive value exactly.
How is range of motion measured with a goniometer?
A universal goniometer is a protractor with two arms. You place the fixed arm along one body segment and the moving arm along the other, lined up with set bony landmarks on either side of the joint, and read the angle in degrees.
- Put the patient in the standard test position for that movement and find the landmarks.
- Line up the goniometer at the start position and note the reading.
- Ask the patient to move as far as they can (active), or move the joint for them (passive). Do not force the joint past the point where pain or firm resistance stops it. After surgery or a recent injury, stay within any movement limits the surgeon or treating team has set.
- Line up the arms again at the end of the movement and read the angle.
- Measure the other side the same way.
Roaas and Andersson recorded angles to the nearest 5 degrees, which they describe as usual in clinical practice. In their healthy men the left and right sides were very similar. They suggest the patient's healthy side is a good comparison when only one side is affected.
The spine values in the chart come from the 1984 edition of the AMA Guides, which the VA describes as the last edition to measure spine motion with a goniometer. Later editions switched to an inclinometer, and the VA reports the reason the Guides give: in part, the small joints of the spine are hard to measure with a goniometer.
Average range of motion by age and sex
The CDC normal joint range of motion study (Soucie and colleagues, 2011) measured 674 healthy people aged 2 to 69, of whom 53.6% were female. Nine licensed physical therapists used universal goniometers to measure passive motion on both sides. Women had more motion than men in nearly all joints and all age groups, and averages were generally lower in the older age groups.
| Movement | Women: average (degrees) | Men: average (degrees) |
|---|---|---|
| Shoulder flexion | 172.0 | 168.8 |
| Elbow flexion | 150.0 | 144.6 |
| Elbow extension | 4.7 | 0.8 |
| Forearm pronation | 82.0 | 76.9 |
| Forearm supination | 90.6 | 85.0 |
| Hip flexion | 133.8 | 130.4 |
| Hip extension | 18.1 | 17.4 |
| Knee flexion | 141.9 | 137.7 |
| Knee extension | 1.6 | 1.0 |
| Ankle dorsiflexion | 13.8 | 12.7 |
| Ankle plantar flexion | 62.1 | 54.6 |
Values are the averages in degrees exactly as the CDC reference table gives them. The CDC page also lists a 95% confidence interval for each one. The table calls the forearm movements elbow pronation and elbow supination.
Elbow and knee extension are small numbers close to 0, and one is negative (elbow extension of -0.7 degrees in men aged 45 to 69). The CDC page does not say which direction a positive number means, so the compare helper does not use these two.
Why do sources give different normal values?
Sources measure different people in different ways. Roaas and Andersson give three reasons their results differed from earlier studies: the measurement procedure, the difficulty of measuring accurately and the differences between people. In their healthy men aged 30 to 40, knee flexion ranged from 115 to 160 degrees. They also compared their results with the 1965 handbook of the American Academy of Orthopaedic Surgeons (AAOS), which lists hip external rotation as 48 degrees. Their men averaged 33.6 degrees.
Soucie and colleagues found that their averages were, in most cases, significantly different from the most commonly used normative values. You can see this in the chart. The VA plate shows hip flexion to 125 degrees, while the CDC average was 140.8 degrees in females aged 2 to 8 and 127.2 degrees in males aged 45 to 69.
The VA and AMA figures are standard values used to record and rate motion. The CDC and Roaas figures are averages measured in healthy volunteers. That is why the chart names a source for every row.
Limits of these values
- The CDC averages cover ages 2 to 69 only, and the Roaas and Andersson figures come from men aged 30 to 40.
- Roaas and Andersson measured hip rotation lying face down with the knee bent, and foot inversion and eversion as whole foot movements with the knee slightly bent. A different position can give a different result.
- An average sits in the middle of healthy values, so many healthy people measure below it. The CDC confidence intervals show how precise each average is, not how far healthy people vary.
- A value above the reference can be normal. Some CDC averages are higher than the VA standard values.
- In exceptional cases, the VA schedule allows an examiner to call a patient's spine motion normal for them, with an explanation, when age, body build, a neurological condition or other factors that are not due to disease or injury of the spine explain the difference.
- We left out movements we could not check against a source we could open and read, such as shoulder extension.
The best comparison is often the patient's other side, or their own earlier measurement taken the same way.
References
- Soucie JM, Wang C, Forsyth A, Funk S, Denny M, Roach KE, Boone D; Hemophilia Treatment Center Network. Range of motion measurements: reference values and a database for comparison studies. Haemophilia. 2011;17(3):500-507. doi:10.1111/j.1365-2516.2010.02399.x
- Centers for Disease Control and Prevention. Normal Joint Range of Motion Study: reference values for normal joint range of motion. archive.cdc.gov
- US Department of Veterans Affairs. 38 CFR 4.71, Measurement of ankylosis and joint motion, Plates I and II. ecfr.gov
- US Department of Veterans Affairs. 38 CFR 4.71a, General Rating Formula for Diseases and Injuries of the Spine, Notes (2) and (3). ecfr.gov. The proposed rule states that these spine values are based on the American Medical Association Guides to the Evaluation of Permanent Impairment, 2nd ed. (1984): Schedule for Rating Disabilities; The Spine. Federal Register. 2002;67(171):56509-56516. govinfo.gov
- Roaas A, Andersson GB. Normal range of motion of the hip, knee and ankle joints in male subjects, 30-40 years of age. Acta Orthopaedica Scandinavica. 1982;53(2):205-208. doi:10.3109/17453678208992202
- Johnson J. Measuring joint range of motion. Excerpt from Soft Tissue Therapy for the Lower Limb. Human Kinetics. humankinetics.com
This chart compares range of motion measurements with published values for education. It is not a medical assessment.