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Upper Body Goniometric Assessment: Technique and potential restricting structures Audio

Goniometry of the upper body, including shoulder flexion, extension, internal rotation, external rotation, and cervical spine goniometry. A list of potential muscles, fascia, and neural structures that may restrict motion at the shoulder and spine.

Upper Body Goniometric Assessment: Technique and Potential Restricting Structures

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Brookbush Institute

I have almost completed my CPT certification and am half-way through the Human Movement certification to inform my massage practice. The different modalities of reading, watching audiovisual materials, and attending live or recorded webinars have been important to my learning style and for review.

Brookbush Institute has the most detailed, specific and effective tools for online learning for movement and/or bodywork professionals. I love the combination of the videos as well as the text available online.

I recently completed the CPT course. It was demanding yet practical. I would highly recommend it for anyone wanting an education about human movement.

I have my personal trainer certificate through here and am almost finished my human movement specialist certification. Overall, the education that Brookbush has packaged together for clinicians and trainers is invaluable. I am a physio assistant so coming from more of a rehab background I appreciate that this education has been beneficial both as a trainer and in a rehab setting. I love that I have been able to do all learning at my own pace and able to work around my schedule. Thank you for setting up this platform! Highly recommend :)

I have been a massage therapist for 10 yrs and I feel like all the “pieces” I’ve learned throughout the yrs have been put into place and can see the full picture. I am also a member to tons of great content since I love to learn! I plan to get my CPT through them as well.

I have been following Brent Brookbush for nearly a decade- back when I was a personal Trainer and now as a Physical Therapist. BBI is an incredible resource for any movement nerds and corrective exercise specialists! The information is thorough with multiple real world applications. I am looking forward to an in-person Manual Therapist course the second they do one a little bit closer to Virginia ;)

I have taken both the Human Movement Specialist and Certified Personal Trainer certificate programs and have found the value in understanding the how and ways the body moves and functions and from evidence, non-biased, outcome, conceptual, theoretical, and practical approach to helping my clients/patients look better, feel better, and move better.

Over the last years I've returned time and again to Brookbush Institute for stellar coursework as I've worked toward a Human Movement Specialist certification. (I'm currently ACE CPT, and in training with Anatomy Trains for Structural Integration Manual Therapy.) Every Brookbush Institute module is fantastic and each one includes detailed informational videos, written descriptions of how to-do, and, more importantly, why to-do!

I am a 70 yr old chiropractor and no other healthcare provider was able to come up with an exercise protocol particular to my structural and balances and muscle deficits and keep me in the game. And as for continuing education on human skeletal movement, the website is phenomenal full of great exercises for particular mechanical dysfunction.

The H.M.S. is the most valuable certificate I have earned and was a fraction of the the cost of my others. Define the best bang for your buck!

Brookbush is the most efficient Personal Training Certification I have ever come across. All the lessons are well thought out and very straight to the point.

I am getting my Master's degree in Kinesiology, and I would like to say that I have benefited greatly from the rich, comprehensive, well-documented scientific content of Brookbush Institute that links theory to practical applications. Proudly I've got my CPT certificate, and I am on my way to get my HMS certificate.

Having courses count towards different certifications makes it so users can transition seamlessly from one certification to another. In my case, going from earning the BI CPT to earning the BI HMS was an easy decision and I am proud to have earned both certifications. I have also had the pleasure of going to a Live HMS workshop that was well taught by Instructor Boettcher and that was excellent to see how the methods and techniques are implemented.



I have been a member of BBI for years and every course I have taken has been incredibly informative. I learn more from these courses than I do at local CEU courses for my PTA license. I also earned my CPT and HMS certifications through the platform. It was so convenient and the content was top notch! Forever member.

We learn principles in academia, we learn cool new modalities via whatever specialty certification, but BBI really concentrates on the nuances of passive treatment and they do a fantastic job. The format in which BBI instructs soft tissue specialists (DPTs, Chiros, ATs) like myself feels like almost like an apprenticeship. You get a thoroughly detailed explanation of the “why’s”, and a visual comprehension of how to apply. Personally, I believe application is where the good and the great are distinguished.

Brookbush has been incredibly helpful since I was in massage school and now as I’m in my career! I run my own practice and it gives me the resources I need to not only improve what I already know, but also help me navigate better, more efficient ways of treatment.

Totally loving the convenience and affordability of this program with my crazy lifestyle! I feel like I am getting a quality education without a massive cost! My favorite part is the videos I can watch in the courses. I learn so much better that way. Once I really spent more time on the site, I figured out how to maneuver around a lot better! I enjoy the sense of humor, as well as the easy explanation, and short tests. And if I am really tired, I can have the computer read me the lessons. 😁

Challenging concepts are explained in very understandable terms without dumbing down the material, and I find this program to be superior in quality to other personal training programs.

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Human Movement Specialist

Integrated Manual Therapist

 All fitness, performance, and rehabilitation programs should start with an assessment. The goal of assessment is to refine technique selection, with the intent of improving client and patient outcomes. This course describes the 

 goniometric assessments used to assess range of motion (ROM) of the upper extremity joints and cervical spine (Note, reliable = shoulder flexion goniometry is included, and shoulder abduction goniometry is not).

 - "refers to the measurement of angles, in particular, the measurement of angles created at human joints by the bones of the body (1)"

 Most often, goniometric assessment highlights osteokinematic hypomobility (loss of joint ROM), aiding in the selection of release, mobilization, and stretching techniques. Less often, goniometry will highlight hypermobility (excessive joint ROM) and imply a need for activation, stabilization, and conditioning techniques. For an introduction to specific terminology, defining "good assessments," defining what goniometry measures, and best use, please check out:

Why Add Goniometry to Movement Assessment?

 Goniometry adds an assessment with continuous interval measures to movement assessments that only provide binary or discrete values. Assessments that only provide binary values include the 

, the Functional Movement Screen, static postural assessments, the L.E.F.T. Test, and shoulder mobility-dependent special tests such as 

, and your intervention improves but does not completely resolve 

 will appear the same on paper. With the OHSA you either have 

 or you do not, there is no reliable method for tracking "some improvement" using the 

 you can reliably track improvements in shoulder flexion range of motion (ROM) of just 5 degrees. Note, you could also use 

 to aid in deducing which structures are most likely to be contributing to dysfunction (e.g. if shoulder internal rotation is limited this may imply 

 recommends that these assessments are added to the repertoire of all sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.).

Goniometric Assessments Covered in this Course

Each goniometric assessment in this course includes a list of potentially affected structures, and those structures are hyperlinked to courses that cover specific interventions for those structures. 

Predictive Models of Postural Dysfunction

 were used to aid in considering all muscular, articular, fascial, and neural structures that may restrict each motion.

Printable PDF of the Movement Assessment Template:

Course Description: Goniometry: Upper Body

 Introduction to upper body goniometric movement assessment.

Course Study Guide: Upper Body Goniometric Assessment

For an introduction to goniometric assessment including definitions of specific terminology, defining a "good assessment," discussion on what goniometry measures and best use, check out: 

A list of potential restricting structures and links to articles on techniques specific to those structures is included below. The lists were compiled using various texts (1 - 8), clinical outcomes, and predictive models of postural dysfunction in an attempt to consider all of the muscular, articular, fascial, and neural structures that may restrict each motion.

Introduction

Shoulder External Rotation

Dr. Brent Brookbush performing shoulder internal rotation goniometry

Shoulder Internal Rotation 

Shoulder Flexion Goniometry

Shoulder Extension Goniometry

Cervical Lateral Flexion

Measurement of Joint Motion: A Guide to Goniometry 3rd Edition.

NASM Essentials of Corrective Exercise Training

Kinesiology of the Musculoskeletal System: Foundations of Rehabilitation – 2nd Edition

Joint Structure and Function: A Comprehensive Analysis: Fifth Edition

David G. Simons, Janet Travell, Lois S. Simons, 

Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition

Clinical Neurodynamics: A New System of Musculoskeletal Treatment

Moore, Margaret L. "Clinical assessment of joint motion." 

Miller, P. J. (1985). Assessment of joint motion. 

Lea, R. D., & Gerhardt, J. J. (1995). Range-of-motion measurements. 

Gajdosik, R. L., & Bohannon, R. W. (1987). Clinical measurement of range of motion. 

Bovens, A. M., van Baak, M. A., Vrencken, J. G., Wijnen, J. A., & Verstappen, F. T. (1990). Variability and reliability of joint measurements. 

Boone, D. C., Azen, S. P., Lin, C. M., Spence, C., Baron, C., & Lee, L. (1978). Reliability of goniometric measurements. 

Rothstein, J. M., Miller, P. J., & Roettger, R. F. (1983). Goniometric reliability in a clinical setting. 

Cools AM, De Wilde L, Van Tongel A, et al. (2014). Measuring shoulder external and internal rotation strength and range of motion: comprehensive intra-rater and inter-rater reliability study of several testing protocols. 

Dougherty J, Walmsley S, and Osmotherly PG. (2014). Passive range of movement of the shoulder: a standardized method for measurement and assessment of intrarater reliability. 

Journal of Manipulative and Phsyiological Therapeutics.

MacDermid JC, Chesworth BM, Patterson S, and Roth JH. Intratester and intertester reliability of goniometric measurement of passive lateral shoulder rotation. 

Awan R, Smith J, Boon AJ. (2002). Measuring shoulder internal rotation range of motion: a comparison of 3 techniques. 

Mullaney MJ, McHugh MP, Johnson CP, Tyler TF. (2010). Reliability of shoulder range of motion comparing goniometer to a digital level. 

Riddle DL, Rothstein JM, Lamb RL. (1987). Goniometric reliability in a clinical setting. 

Youdas JW, Carey JR, Garrett TR. (1991). Reliability of measurements of cervical spine range of motion- comparison of three methods. 

Bibliography

Questions, comments and critiques are welcome and encouraged.