340 Canine Sports Medicine and Rehabilitation
of end‐feel; this is the case with glenohumeral
joint flexion stretching the supraspinatus, and
glenohumeral joint abduction stretching the
subscapularis. With the multi‐joint muscles on
slack, the joint is gently moved into the testing
range of motion and overpressure is applied to
assess for pain, restriction, or hypermobility.
Overpressure should not be applied to a joint
that is hypermobile or has an empty (painful)
end‐feel. When end range is determined, the
goniometer is placed over the joint with the sta-
tionary arm on the proximal bony landmark,
the point of rotation over the joint, and the
movable arm on the distal bony landmark
(Figure 13.5). The goniometric measurement is
recorded and the subjective end‐feel is noted.
An increase or decrease in PROM from the
nonaffected side to the affected side, and from
one session to the next, leads a therapist to fur-
ther assess the affected joint. For example, a limi-
tation in goniometric elbow flexion with a hard
capsular end‐feel may lead the therapist to care-
fully assess joint play to determine if the articu-
lar surfaces, joint capsule, or both are causing the
limitation. The treatment for hypomobile joints
generally includes joint mobilization manual
therapy. Once completed, the joint is remeasured
to determine whether the treatment improved
the joint range of motion. An absence of improve-
ment in range of motion in a session and from
one session to the next will lead a therapist to
reassess the cause of the restriction and change
their treatment plan accordingly. See Chapter 6 for
detailed information on PROM measurements.
Flexibility
Objective evaluation of flexibility allows the ther-
apist to determine baseline passive muscle exten-
sibility. To test flexibility, the patient assumes a
relaxed side lying position. Slowly, the therapist
guides the limb into the stretched position, stabi-
lizing the origin of the muscle and moving the
insertion of the muscle in the direction opposite
to the concentric action of the muscle. As the ther-
apist passively lengthens the muscle, they evalu-
ate the subjective quality and quantity of
extensibility throughout the available range of
motion. Careful consideration is given to multi‐
joint muscles, as they require precise hand place-
ment to stabilize the origin or insertion of the
(B)(C)(A)Figure 13.5 (A) When completing the goniometric
measurement for flexion of the glenohumeral joint,
the therapist must keep in mind that range of motion
limitations may be due to joint capsule involvement,
joint play restrictions, or, due to the origin and
insertion of the supraspinatus, musculotendinous
involvement. (B) When completing the goniometric
measurement for glenohumeral joint extension, the
therapist carefully stabilizes the scapula to ensure
assessment of joint end‐feel. Without stabilization,
the scapula glides on the thorax creating a false‐
positive hypermobility measurement. (C) When
completing the goniometric measurement for
glenohumeral joint abduction, the therapist carefully
stabilizes the scapula against the thorax to prevent a
false‐positive hypermobility measurement. The
therapist also is careful to prevent unintentional
external rotation of the joint, which may involve the
subscapularis tendon.