We received this email from a chiropractic colleague: “I recently attended a continuing education seminar accredited by a chiropractic college. The presenter was talking about outcome measures and highly recommended cervical and lumbar range of motion (ROM) as a good outcome measure for patients with spinal conditions. But I am hesitant to use ROM, because it seems to be inconsistent with a patient’s status.”

What does the current research demonstrate? Today we investigate the relationship between spinal manipulation and ROM. In 2012, a systematic review assessed whether spinal manipulation improves range of motion findings (Millan 2012). This study was published in Chiropractic & Manual Therapies. The research team consisted of 5 PhDs. Overall, this study had good methodological rigor. The research team performed a thorough search of the literature with multiple reviewers selecting and appraising the studies.

Review Findings

Nine studies examined cervical ROM. Overall, the studies did not show a clinically important effect of spinal manipulative therapy on cervical ROM. Three studies examined lumbar ROM. None of the three studies showed an effect of spinal manipulative therapy on lumbar ROM.

Additional Research

In another study, cervical motion was measured in 75 healthy subjects and 101 chronic whiplash patients. This research team could not distinguish between chronic neck pain and no neck pain based upon ROM (Prushansky 2006). Also, a prospective case-control study investigated 4,293 adults, assessing the association of chronic neck pain and ROM. The research team found no correlation between neck pain and cervical range of motion (Kauther 2012).


ROM should not be recommended as an outcome measure, because it cannot distinguish between patients with and without symptoms, and it is not responsive after spinal manipulation. Thus, it has validity and responsiveness shortfalls.

Exceptions to the Rule

As with many recommendations, there are exceptions. ROM would be a good outcome measure for patients with torticollis or antalgic posture, because it is likely to be responsive for these conditions.


ROM can still be used as an orthopedic test, and it can still be used to estimate disability within AMA guidelines. Just keep in mind the shortfalls when you use it.

The gold standard in healthcare for patients with spinal issues are patient self-reports. Patients and payers want practitioners to use “measures that matter to the patient.” Use outcome measures such as Oswestry, NDI, and Functional Rating Index for function and Numeric Rating Scale (0-10) and Visual Analog Scale (0-100) for pain. All of these patient self-report outcome measures are reliable, valid, and responsive.

“Why You Should Stop Using ROM as an Outcome Measure."


1. Millan M, Leboeuf-Yde C, Budgell B, Descarreaux M, Amorim MA. The effect of spinal manipulative therapy on spinal range of motion: a systematic literature review. Chiropr Man Therap 2012;20:23.
2. Prushansky T, Pevzner E, Gordon C, Dvir Z. Performance of cervical motion in chronic whiplash patients and healthy subjects: the case of atypical patients. Spine 2006;31:37-43.
3. 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;21:1522-7.


Disclaimer: This article represents the opinion of the author and is not a recommendation from ChiroCode. Be sure to follow individual payer policy requirements for outcome measure reporting.