Single Inclinometer ROM Chart – Lumbar Flexion/Extension
Patient______
Instructions: Using a single mechanical inclinometer, place the middle of the base at/near T12. Have the patient flex forward keeping the knees straight/locked and at the end-point, bobb up and down several times to remove the slack, then take the measurement. Repeat 2-3x to make sure the inclinometer did not move &/or some other error did not occur. Place your finger/thumb nail on the dial where the pendulum stops, remove the inclinometer from the patient and have the patient stand up. Read the long lines (10’s), calculate the ROM, and record the number in the “Flexion” column / T12 row.
Replace the inclinometer at T12 and repeat this process in extension and record the measurement under the “Extension” column in the T12 row.
Repeat the flexion and extension measurements at S1 (upper gluteal fold) and place in the S1 row. Subtract the S1 from the T12 number and place the difference in the “True Lumbar FL / EXT” cell, below the 2 numbers. Record the “true lumbar flexion & extension” on the 2 page, QFCE/Exercise screen exam form and on the 1 page “Exercise Screen Results” form.
Use 2 inclinometers for all other spinal ROM’s (the “normative data” are in parentheses):
Lumbar ROM:
DATE: ____ /____/ ____ / Flexion / ExtensionT12
S1True Lumbar FL / EXT / ______(65º) / ______(30º)
Right lumbar lateral flexion (25º): ______
Left lumbar lateral flexion (25º):______
DATE: ____ /____/ ____ / Flexion / ExtensionT12
S1True Lumbar FL / EXT / ______(65º) / ______(30º)
Right lumbar lateral flexion (25º): ______
Left lumbar lateral flexion (25º):______
Cervical ROM:
DATE: / ___ /___/ ___ / ___ /___/ ___ / ___ /___/ ___ / ___ /___/ ___Flexion (50º)
Extension (63º)
Rt Lat. Flex (45º)
Lt. Lat. Flex (45º)
Rt Rotation (85º)
Lt Rotation (85º)