Normal values for neck flexion, extension, side bending and rotation, how to measure each one, and how to measure from a camera.
Neck range of motion is central to documenting whiplash, mechanical neck pain and recovery, and it is hard to measure consistently by hand. The landmarks sit on soft tissue and the trunk likes to join in.
Normal neck range of motion
AAOS reference values for healthy adults. Some later references list higher figures, especially for rotation, so state which reference you compare against.
| Motion | AAOS |
|---|---|
| Flexion | 0–45° |
| Extension | 0–45° |
| Lateral flexion | 0–45° |
| Rotation | 0–60° |
How to measure neck range of motion with a goniometer
Seat the patient with the back supported so the motion comes from the neck, not the thoracic spine.
Flexion and extension
- Position
- Seated, back supported, head in neutral
- Axis
- External auditory meatus
- Stationary arm
- Perpendicular to the floor
- Moving arm
- Along the base of the nostrils
- Watch for
- Thoracic flexion or extension and the chin poking forward
Lateral flexion
- Position
- Seated, back supported
- Axis
- Spinous process of C7
- Stationary arm
- Along the thoracic spinous processes
- Moving arm
- Dorsal midline of the head
- Watch for
- Shoulder elevation and trunk side bending
Rotation
- Position
- Seated, back supported
- Axis
- Center of the top of the head
- Stationary arm
- Parallel to a line between the two acromion processes
- Moving arm
- Tip of the nose
- Watch for
- Trunk rotation
Measuring neck range of motion with a camera
Flexion and extension read best side-on, with the camera at head height. Side bending reads best from in front. Rotation is easiest to see from above or by tracking the nose from in front.
- From a photo: the free online goniometer lets you tap the axis and both segments on a picture and read the angle. Nothing is uploaded.
- Live: MotionArc tracks the joints from any phone, tablet or laptop camera and measures the movement as it happens, in the clinic or on a video call.
Why two clinicians get different numbers
A goniometer reading depends on the person holding it. Finding the bony landmarks, lining up the arms and positioning the patient all add variation, and that variation is larger between two clinicians than for one clinician measuring twice.
- Small changes between two clinicians may not be real. At the shoulder, a true change measured by two different therapists needs about 15°, compared with 6° to 11° when the same therapist measures both times. Agreement between testers is weakest for shoulder extension and internal rotation.
- The instrument matters. At the knee, the smallest difference you can trust is about 6° with an inclinometer, 10° with a long-arm goniometer, 12° with a smartphone app and 14° with a short-arm goniometer or a visual estimate.
- Video can work. Shoulder angles measured over a video call with an on-screen protractor came within 0.2° to 5° of goniometer readings on average, and most smartphone apps studied show adequate reliability.
- What helps: a written protocol for patient position and landmarks, the same instrument each time, the same clinician where possible, and a note of how the measurement was taken.
Measuring from a camera takes out the hand-held step. Nobody has to line up the goniometer arms by hand, and the same view can be set up visit after visit.
Early access is limited, and we set up every account personally.
More reference values: normal range of motion chart for every joint. Other joints: Shoulder · Hip · Knee · Ankle · Low back.
Sources
- American Academy of Orthopaedic Surgeons. Joint Motion: Method of Measuring and Recording. Chicago: AAOS; 1965.
- AAOS values as tabulated in a Jones & Bartlett Learning clinical handbook, chapter 1 (sample chapter). Link
- Hendriks et al. Plastic and Reconstructive Surgery Global Open. 2020. Supplement: normal range of motion values according to the AAOS. Link
- Norkin CC, White DJ. Measurement of Joint Motion: A Guide to Goniometry. 5th ed. Philadelphia: F.A. Davis; 2016.
- University of West Alabama Athletic Training. Goniometry lab: joint measurement procedures. Link
- Youdas JW, Carey JR, Garrett TR. Reliability of measurements of cervical spine range of motion: comparison of three methods. Phys Ther. 1991. Link
- Mullaney MJ, et al. Physiother Theory Pract. 2010;26:327 (reliability of shoulder range of motion measurement). Link
- Riddle DL, Rothstein JM, Lamb RL. Goniometric reliability in a clinical setting: shoulder measurements. Phys Ther. 1987;67:668. Link
- Hancock GE, et al. J Exp Orthop. 2018 (reliability of knee range of motion measurement methods). Link
- Sahu et al. J Shoulder Elbow Surg. 2022;31:201 (shoulder range of motion by video conference versus goniometer). Link
- Keogh JWL, et al. Reliability and validity of clinically accessible smartphone applications to measure joint range of motion: a systematic review. PLOS ONE. 2019;14:e0215806. Link
Measure cervical range of motion from any camera.
No goniometer, no wearables. The same movement, measured the same way, every visit.
Straight answers. If yours is not here, request access and ask us anything.
AAOS reference values for healthy adults are about 45° of flexion, 45° of extension, 45° of lateral flexion and 60° of rotation to each side. Some later references list higher values, particularly for rotation.
With the patient seated, place the goniometer axis over the top of the head, align the stationary arm with the line between the acromion processes and the moving arm with the nose. Many clinicians use a CROM device instead, which agrees better between testers.
Yes. Cervical range of motion tends to decrease with age, so compare a patient with age-matched values or with their own baseline.
Yes. MotionArc measures range of motion, form and balance from any phone, tablet or laptop camera, in the clinic or live on a video call. Early access is open to a small group of professionals.
Clinicians sign a business associate agreement (BAA) with us before any real patient data is entered. The free goniometer on this site runs in your browser and never uploads photos.