Comparison of methods of measuring active cervical range of motion

Spine (Phila Pa 1976). 2010 Sep 1;35(19):E976-80. doi: 10.1097/BRS.0b013e3181cd6176.


Study design: Experimental study. Cervical range of motion (CROM) was measured using different clinical methods.

Objective: To compare the reliability and accuracy of visual estimation, tape measurement, and the universal goniometer (UG) with that of the CROM goniometer in measuring active CROM in healthy volunteers. The secondary objective was to identify the single neck movement that best represents overall range of motion.

Summary of background data: Neck movement is affected by pathology in the spine and shoulder. A reliable and accurate measurement of neck movement is required to quantify injury, recovery, and disability. Various methods of measuring neck movement have been described of which radiography remains the accepted reference standard. However, radiography is impractical for routine clinical assessment. Visual estimation, tape measurement, and the UG are convenient alternatives. To date, the accuracy and reliability of these methods have not been compared in healthy subjects, and the single neck movement that best reflects overall range has not yet been identified.

Methods: Active cervical flexion, extension, right and left lateral flexion and rotation were measured in 100 healthy volunteers. Visual estimation, tape measurement between fixed landmarks, and the UG aligned on fixed and anatomic landmarks were compared with the CROM goniometer, which was used as the reference standard.

Results: Compared with the CROM goniometer, the UG aligned on fixed landmarks was the most accurate method, followed by the UG on anatomic landmarks. The reliability of the UG was between substantial and perfect. Visual estimation was reproducible but measured range of movement inaccurately. Tape measurement was inaccurate. Extension best reflected overall range.

Conclusion: The UG aligned on a fixed landmark is most reliable method of measuring neck movement clinically. Where range must be quickly assessed, extension should be measured.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Anthropometry / instrumentation*
  • Arthrometry, Articular*
  • Biomechanical Phenomena
  • Cervical Vertebrae / physiology*
  • England
  • Female
  • Humans
  • Male
  • Middle Aged
  • Movement*
  • Neck Muscles / physiology*
  • Observer Variation
  • Physical Examination*
  • Range of Motion, Articular
  • Reference Values
  • Reproducibility of Results
  • Sex Factors
  • Young Adult