The role of a physical therapist is to help you regain your function and allow you to return to your life of work, recreation, and other daily activities. A key element of this role is determining whether you have the appropriate range of motion (ROM) available to accomplish your daily activities without pain. Until recently, physical therapists used a device known as a goniometer to measure this range of motion at a joint. Now, physical therapists measure ROM in a different way. This change was brought about by studies showing ROM measurements made using a new tool, known as an inclinometer, are more accurate, precise, and reproducible than measurements made using goniometers. According to the American Medical Association’s Guides to the Evaluation of Permanent Impairment (Third Edition), the inclinometer has been adopted to measure spinal ROM. Physical therapists have also found that inclinometers are easier to use, and provide new and more useful information.

Old School
A goniometer looks a bit like a protractor you may have used to measure angles in geometry class, but with arms, like the type of compass used for drawing circles. The arms of a goniometer intersect at a single axis or pin:

To measure the ROM at a joint with a goniometer, the patient moves his or her body part to the position directed by the therapist (i.e bend your knee). The therapist aligns the arms of the goniometer with the bones surrounding the joint and aligns the pin with the joint axis. Because the therapist cannot hold the goniometer directly against the bones, bone and joint axis positions must be estimated. The angle indicated by the goniometer is recorded. Goniometer measurements typically require the joint to be moved from the beginning of its range to the end of its range of motion. For example in the knee, a measurement is taken when the joint is fully bent and then again when it is fully straightened . Because the positions of the bones and axis points must be estimated, each reading made with a goniometer introduces error into the measurement. Normal joint mechanics introduce another source of error into goniometer measurements: unlike a door hinge rotating around a cylindrical pin, a joint rotates around the ends of the bones, which are not perfectly round. Therefore the joint axis itself moves, making the estimation of the axis position more difficult.

New School
No such estimates or alignments are necessary with an inclinometer. Inclinometers have dials or digital readouts that display the angle at which the inclinometer is situated relative to the line of gravity.



To use an inclinometer, the therapist holds the instrument on the patient, who begins in a standard starting position. The therapist zeroes-out the inclinometer and then instructs the patient to bend the joint through its ROM. The inclinometer’s final reading is the ROM measurement. The inclinometer never leaves contact with the patient and the axis does not need to be identified.

The accuracy of ROM measurements taken using inclinometers can be estimated by comparing their measurements with those taken from X-rays, which allow very direct joint angle measurements. Mayer et al. showed ROM measurements of the spine made using inclinometers are statistically similar to readings determined using X-rays. Keeley et al. showed repeated ROM measurements made using inclinometers yield very reliable values.

Unlike goniometers, inclinometers can be used in pairs to gain even more diagnostic information during patient evaluations. For instance, bending forward to touch the toes is a “composite” motion, that is, some of the motion comes from the hips and some comes from the lower back. When a patient has pain upon bending forward, the physical therapist can use two inclinometers at once to determine whether the lower back and hips are each contributing the proper amount of flexibility to support the movement. The inclinometer readings may indicate that the painful lower back is compensating for the inflexible hips. The therapist can then begin an effective course of physical therapy to relieve the lower back pain by restoring the patient’s hip function and flexibility.

To learn more about inclinometers or see how your spinal range of motion measures up, contact Physical Therapy of Los Gatos at (408) 358-6505.

You may have just had a bad fall, a misstep while running, or a sports collision. Or perhaps you’ve simply overused a muscle, tendon or ligament. These types of injuries are often called sprains, strains, and tears. Should you apply heat or ice?

The short and definitive answer is: ice.

You’re certainly forgiven if you didn’t know that. After all, many people use heating pads, hot whirlpools, and hot gel packs for their injuries, and some even apply sprays, creams or liquids to their skin to make it feel hot. But in the aftermath of an injury, you don’t want to apply heat to the affected area. You want to cool it with ice or an ice substitute. Here’s why:

Any injury severe enough to damage muscles, tendons, or ligaments will also damage the small blood and lymph vessels around those tissues. When this happens, the normally well-regulated system of blood delivery and lymphatic drainage of tissues is disrupted, and blood and lymphatic fluids are released in an uncontrolled manner. This causes inflammation, swelling, and pain.

Applying ice to an injured area relieves pain by slowing the conduction of nerve impulses from the area. Ice therapy also takes advantage of the body’s natural, adaptive response to cold, which is to maintain normal body temperature by cutting back on the blood supply to the cold area. This has the effect of allowing fluids to drain away from the injury, taking away injured cells, cell fragments, and inflammation-causing molecules. The result is reduced swelling and pain, and faster repair of damaged tissues.

The application of heat has the opposite effect. The body’s response is to send extra blood through the heated area so that the heat can be carried off before the tissues get too warm. Extra blood delivery to the injured area increases swelling, inflammation, and pain.

The best type of ice or ice substitute to use is whatever type you have at hand! Chemical cold packs, which chill rapidly when you break a capsule inside the pack, are expensive but work well. Cold gel-packs right from the freezer will also do the job. A zip-loc plastic bag filled with crushed ice is inexpensive and very effective. You can even use a bag of frozen peas and carrots!

Place the ice pack on the injured area and leave it there for 20 minutes. Remove it for 20 minutes, then put it back on. The best ice-on, ice-off intervals and the number of times you should use ice each day depend on the type, severity, and site of your injury. Please call our office for advice.

Should heat ever be applied to injuries? Yes, but only under limited, specific circumstances. For instance, several days after an injury, your physical therapist may instruct you to contrast your injury treatment with heat between ice applications. This has the effect of restoring normal blood circulation to the cold area quickly and accelerates the removal of injured cells, cell fragments, and by-products of the healing process from the injured site. We do not advise the use of heat to warm up a recovering joint or muscle prior to exercise. A slow and progressive active exercise warm-up, such as walking prior to jogging, is much more effective.

If you have sustained a soft tissue injury, the correct application of ice or ice substitutes will help control swelling, reduce pain, and speed your recovery. If you are unable to return to your day-to-day routine after a week of treatment with ice, or if you are in training for athletic competition, please call our office for additional advice and assistance.