Range of the Motion (ROM) of the Cervical, Thoracic and Lumbar Spine Along the Traditional Anatomical Planes
PhD, MD Janis Savlovskis
This section demonstrates the evidence behind the choice of the specific value of rotatory motion for different parts of the spine in the traditional anatomical planes. The evidence comes from the
in vivo studies of healthy young males.
The literature meta-analysis is presented in the form of graphs that were composed following the uniform logic:
The range of motion implemented in the Anatomy Standard spine model in all traditional planes generally lies within limits between the weighted mean and upper double pooled standard deviation limit (2SD) derived from the
in vivo studies. This range approximately corresponds to the part of the population with the average and above the spine's average flexibility, without exceeding the 95 percentile borderline.
ROM of the Cervical Part of the Spine
Flexion of the Cervical Spine
The lateral view of the neutral and fully flexed cervical spine (64° of C0-C7 flexion)
Scientific evidence for 64° of cervical flexion based on
in-vivo non-invasive studies.
Extension of the Cervical Spine
The lateral view of the neutral and fully extended cervical spine (63° of C0-C7 extension)
Scientific evidence for 63° of cervical extension
Flexion + Extension of the Cervical Spine
Side-by-side lateral view of the cervical spine motion in sagittal plane – from the full extension to the full flexion (127° of C0-C7 motion)
Scientific evidence for 127° of cervical flexion–extension motion range.
Lateral Bending of the Cervical Spine
Side-by-side anterior view of the cervical spine motion in the frontal plane – from the neutral spine to the right and to the left (C0-C7 one side lateral bending 49°). Note the remarkable axial rotation motioin coupled with the lateral bending of the cervical spine.
Scientific evidence for the 49° of cervical lateral flexion motion range.
Axial Rotation of the Cervical Spine
Side-by-side anterior view of the cervical spine motion in the horizontal plane – from the neutral spine to the right and to the left (C0-C7 one side axial rotation 85°). Note the substantial lateral bending coupled with the axial rotation of the cervical spine.
Scientific evidence for the 85° of cervical axial rotation range.
ROM of the Thoracic Part of the Spine
Flexion of the Thoracic Spine
Side-by-side lateral view of the thoracic spine motion in the sagittal plane – from the neutral spine to the full flexion by (26° for Th1–Th12 flexion).
Scientific evidence for the 26° of the thoracic flexion range.
Extension of the Thoracic Spine
Side-by-side lateral view of the neutral and fully extended thoracic spine (22° for Th1–Th12 extension).
Scientific evidence for the 22° of the thoracic extension range.
Flexion – Extension ROM of the thoracic spine
Side-by-side lateral view of the thoracic spine motion in the sagittal plane – from the neutral spine to the full flexion by (48° for Th1–Th12 flexion-extension range).
Scientific evidence for the 48° of the thoracic flexion-extension ROM.
Lateral Bending of the Thoracic Spine
Side-by-side view of the neutral thoracic spine and left / right lateral bending by 30°.
Scientific evidence for the 30° of lateral bending of the thoracic spine.
Axial Rotation of the Thoracic Spine
Side-by-side view of the neutral thoracic spine and left / right axial rotation by 47°.
Scientific evidence for the 47° of axial rotation of the thoracic spine.
ROM of the Lumbar Part of the Spine
Flexion of the Lumbar Spine
The neutral spine and full flexion of the lumbar spine by 65°.
Scientific evidence for the flexion of lumbar spine for 65°.
Extension of the Lumbar Spine
The neutral spine and full extension of the lumbar spine by 31°.
Scientific evidence for the extension of lumbar spine for 31°.
Flexion + Extension of the Lumbar Spine
The ROM of lumbar spine from the full extension to the full flexion by 96°.
Scientific evidence for the flexion + extension range of lumbar spine by 96°.
Lateral bending of the Lumbar Spine
Side-by-side frontal view of the lumbar spine in the neutral position and in the maximum lateral bending by 30° to the right and 30° to the left.
Scientific evidence for the lateral bending of the lumbar spine by 30°.
Axial Rotation of the Lumbar Spine
Side-by-side frontal view of the lumbar spine in the neutral position and in the maximum right and left rotation by 15.3°.
Scientific evidence for the axial rotation of the lumbar spine by 15.3°.
First published: 19/Aug/2020
Last update: 22/Dec/2020
List of references
Alqhtani, R.S., Jones, M.D., Theobald, P.S., Williams, J.M., 2015. Reliability of an accelerometer-based system for quantifying multiregional spinal range of motion. J. Manipulative Physiol. Ther. 38, 275–281.
Anderst WJ, Donaldson WF, Lee JY, Kang JD. Three-dimensional intervertebral kinematics in the healthy young adult cervical spine during dynamic functional loading. Journal of Biomechanics. 2015;48(7):1286-1293.
Bergman GJD, Knoester B, Assink N, Dijkstra PU, Winters JC. Variation in the cervical range of motion over time measured by the “flock of birds” electromagnetic tracking system. Spine. 2005;30(6):650-654.
Dreischarf M, Albiol L, Rohlmann A, et al. Age-Related Loss of Lumbar Spinal Lordosis and Mobility – A Study of 323 Asymptomatic Volunteers. Shi X-M, ed. PLoS ONE. 2014;9(12):e116186–19.
Dvorak J, Antinnes JA, Panjabi M, Loustalot D, Bonomo M. Age and gender related normal motion of the cervical spine. Spine. 1992;17(10 Suppl):S393-S398.
Edmondston S, Waller R, Vallin P, Holthe A, Noebauer A, King E. Thoracic spine extension mobility in young adults: influence of subject position and spinal curvature. J Orthop Sports Phys Ther. 2011;41(4):266-273.
Edmondston SJ, Aggerholm M, Elfving S, et al. Influence of posture on the range of axial rotation and coupled lateral flexion of the thoracic spine. Journal of Manipulative and Physiological Therapeutics. 2007;30(3):193-199.
Edmondston SJ, Ferguson A, Ippersiel P, Ronningen L, Sodeland S, Barclay L. Clinical and radiological investigation of thoracic spine extension motion during bilateral arm elevation. J Orthop Sports Phys Ther. 2012;42(10):861-869.
Edmondston SJ, Henne S-E, Loh W, Ostvold E. Influence of cranio-cervical posture on three-dimensional motion of the cervical spine. Man Ther. 2005;10(1):44-51.
Feipel V, Rondelet B, Le Pallec J, Rooze M. Normal global motion of the cervical spine: an electrogoniometric study. Clin Biomech (Bristol, Avon). 1999;14(7):462-470.
Fujimori T, Iwasaki M, Nagamoto Y, et al. Kinematics of the thoracic spine in trunk lateral bending: in vivo three-dimensional analysis. Spine J. 2014;14(9):1991-1999.
Furness J, Climstein M, Sheppard JM, Abbott A, Hing W. Clinical methods to quantify trunk mobility in an elite male surfing population. Phys Ther Sport. 2016;19:28-35.
Ha T-H, Saber-Sheikh K, Moore AP, Jones MP. Measurement of lumbar spine range of movement and coupled motion using inertial sensors - a protocol validity study. Man Ther. 2013;18(1):87-91.
Hajibozorgi M, Arjmand N. Sagittal range of motion of the thoracic spine using inertial tracking device and effect of measurement errors on model predictions. Journal of Biomechanics. 2016;49(6):913-918.
Hsu, C.J., Chang, Y.W., Chou, W.Y., Chiou, C.P., Chang, W.N., Wong, C.Y., 2008. Measurement of spinal range of motion in healthy individuals using an electromagnetic tracking device. J. Neurosurg. Spine 8, 135–142.
Johnson KD, Kim K-M, Yu B-K, Saliba SA, Grindstaff TL. Reliability of thoracic spine rotation range-of-motion measurements in healthy adults. J Athl Train. 2012;47(1):52-60.
Kapandji A. The Physiology of the Joints. Vol 3. The Trunk and the Vertebral Column. 2nd ed. (Livingstone C, ed.). 1974.
Kauther MD, Piotrowski M, Hussmann B, Lendemans S, Wedemeyer C. Cervical range of motion and strength in 4,293 young male adults with chronic neck pain. Eur Spine J. 2012;21(8):1522-1527.
Kim H, Shin S-H, Kim J-K, Park Y-J, Oh H-S, Park Y-B. Cervical coupling motion characteristics in healthy people using a wireless inertial measurement unit. Evid Based Complement Alternat Med. 2013;2013:570428.
Lewandowski J. Kształtowanie Się Krzywizn Fizjologicznych I Zakresów Ruchomości Odcinkowej Kręgosłupa Człowieka W Wieku 3-25 Lat W Obrazie Elektrogoniometrycznym. Poznan; 2006. ISBN: 8388923633, 9788388923630
Madinei SS, Arjmand N. Sagittal range of motion of the thoracic spine using standing digital radiography: a throughout comparison with non-radiographic data reviewed from the literature. Scientia Iranica. 2019;26(3):1307-1315.
Mannion AF, Knecht K, Balaban G, Dvorak J, Grob D. A new skin-surface device for measuring the curvature and global and segmental ranges of motion of the spine: reliability of measurements and comparison with data reviewed from the literature. Eur Spine J. 2004;13(2):122-136.
McGregor AH, McCarthy ID, Hughes SP. Motion characteristics of the lumbar spine in the normal population. Spine. 1995;20(22):2421-2428.
Morita D, Yukawa Y, Nakashima H, et al. Range of motion of thoracic spine in sagittal plane. Eur Spine J. 2014;23(3):673-678.
Nairn BC, Drake JDM. Impact of lumbar spine posture on thoracic spine motion and muscle activation patterns. Hum Mov Sci. 2014;37:1-11.
Narimani M, Arjmand N. Three-dimensional primary and coupled range of motions and movement coordination of the pelvis, lumbar and thoracic spine in standing posture using inertial tracking device. Journal of Biomechanics. 2018;69:169-174.
Neumann DA. Kinesiology of the Musculoskeletal System. 2nd ed. Mosby; 2010. eBook ISBN: 9780323527996
Ng JKF, Richardson CA, Kippers V, Parnianpour M. Comparison of lumbar range of movement and lumbar lordosis in back pain patients and matched controls. J Rehabil Med. 2002;34(3):109-113.
Niewiadomski C, Bianco R-J, Afquir S, Evin M, Arnoux P-J. Experimental assessment of cervical ranges of motion and compensatory strategies. Chiropr Man Therap. 2019;27(1):9-9.
O’Gorman, H., Jull, G. Thoracic kyphosis and mobility: the effect of age. Physiotherapy Practice. 1987;3:154–162.
Russell P, Pearcy MJ, Unsworth A. Measurement of the range and coupled movements observed in the lumbar spine. Br J Rheumatol. 1993;32(6):490-497.
Salem W, Lenders C, Mathieu J, Hermanus N, Klein P. In vivo three-dimensional kinematics of the cervical spine during maximal axial rotation. Man Ther. 2013;18(4):339-344.
Shin J-H, Wang S, Yao Q, Wood KB, Li G. Investigation of coupled bending of the lumbar spine during dynamic axial rotation of the body. Eur Spine J. 2013;22(12):2671-2677
Troke M, Moore AP, Cheek E. Reliability of the OSI CA 6000 Spine Motion Analyzer with a new skin fixation system when used on the thoracic spine. Man Ther. 1998;3(1):27-33.
Van Herp G, Rowe P, Salter P, Paul JP. Three-dimensional lumbar spinal kinematics: a study of range of movement in 100 healthy subjects aged 20 to 60+ years. Rheumatology (Oxford). 2000;39(12):1337-1340.
White AA, Panjabi MM. Clinical Biomechanics of the Spine. Lippincott Williams & Wilkins; 1990. ISBN-13: 978-0397507207
Willems JM, Jull GA, J K-FN. An in vivo study of the primary and coupled rotations of the thoracic spine. Clin Biomech (Bristol, Avon). 1996;11(6):311-316.
Zhou Y, Loh E, Dickey JP, Walton DM, Trejos AL. Development of the circumduction metric for identification of cervical motion impairment. J Rehabil Assist Technol Eng. 2018;5.