MMT Thoracic And Lumbar Spine

Question 0

MMT: trunk extension- thoracic

Answer 0

Iliocoastalis thoracis, longissimus thoracis
Grades 5,4
Pt position: prone with head and upper trunk extending off table from about the nipple line, hands behind head
Therapist position: standing so as to stabilize LEs just above ankles
Test: extend thoracic spine to the horizontal
Command: “raise your head, shoulders, and chest to table level”

Question 1

MMT: trunk extension- lumbar

Answer 1

Iliocoastalis lumborum
Grades 5,4
Pt position: prone with hands clasped behind head
Therapist position: standing so as to stabilize LEs just above ankles if patient had normal hip strength (stabilize at pelvis if pt has weak hip extensors) no resistance given
Test: extend lumbar spine until entire thorax is raised from table (clears umbilicus)
Command: “raise your head, shoulders, and chest off table; come up as high as you can”

Question 2

MMT: trunk extension- lumbar and thoracic spine

Answer 2

Iliocoastalis thoracis, iliocoastalis lumborum, longissimus thoracis
Grades 3,2,1,0 (test used if pt unable to do thoracic or lumbar trunk extension at grades 5,4)
Pt position: prone with arms at sides
Therapist position: standing so as to stabilize LEs just above ankles
Test: extend lumbar spine until entire thorax is raised from table (clears umbilicus)
Command: “raise your head, arms, and chest off table as high as you can”

Question 3

MMT: elevation of the pelvis

Answer 3

Quadratus lumborum, external obliques, internal obliques
Grades 5,4,3,2,1,0
Pt position: supine with hip and lumbar spine in extension; grasps edge of mat to provide stabilization during resistance
Therapist position: standing at foot of mat facing pt; grasp test limb with both hands just above ankle and pull caudally
Test: pt hikes pelvis on one side
Command: “hike your pelvis to bring it up to your ribs. Hold it. Don’t let me pull your leg down.”

Question 4

MMT: trunk flexion

Answer 4

Rectus abdominus, external obliques, internal obliques
Grades 5,4,3
Pt position: supine, knees out straight
Therapist position: standing at side of table at level of patients chest to be able to determine whether scapulae clear table during test. May need to stabilize at pelvis for patients with weak flexors
Test: flex trunk through range of motion; trunk is curled until scapulae clear table
Command: “tuck your chin and bring your head, shoulders, and arms off table, as in a sit up”
Grade 5- hands clasped behind head
Grade 4- hands across chest
Grade 3- arms outstretched above plane of body
Grades 2,1,0
Pt position: pt in supine with arms at sides and knees flexed to prevent reverse action of hip flexors if abdominal muscles are weak
Therapist position: standing at side of table. Palpate at midline of thorax over linea alba, four fingers of both hands palpating rectus abdominus

Question 5

MMT: trunk rotation

Answer 5

External obliques, internal obliques
Pt position: supine
Therapist position: standing at pts waist level
Test: flexes trunk and rotates to one side and then repeated to the opposite side
-right elbow to left knee (left rotation): right external obliques and left internal obliques
-left elbow to right knee (right rotation): left external obliques and right internal obliques
Command: “lift your head and shoulders from the table, taking your right/left elbow toward your left/right knee.”
Grade 5- hands clasped behind the head
Grade 4- hands across chest
Grade 3- arms outstretched, scapula clears table
Grade 2- arms outstretched, unable to clear scapula
Grade 1,0
Pt position: supine with arms at sides, hips and knees flexed with feet flat on table
Therapist position: head supported as pt attempts to turn to one side. One hand palpates internal and external obliques while assisting pt to turn to one side

Question 6

Quiet inspiration

Answer 6

Diaphragm
Pt position: supine
Therapist position: standing next to pt at waist level, one hand placed at level of epigastric region just below the dip hood process (resistance given by this hand)
Test: inhales with maximal effort and holds maximal inspiration
Command: “take a deep breath….as much as you can….hold it. Push against my hand. Don’t let me push you down.”

Question 7

Forced expiration

Answer 7

The clinical test for forced expiration is coughing: effective coughing equites the use of all muscles of active expiration
Functional: normal or only slight impairment
-crisp/explosive expulsion of air
-volume sharp, able to clear airway
Weak functional: moderate impairment
-decreased volume, diminished air movement
-labored, several attempts to clear airway
Nonfunctional: severe impairment
-no airway clearance or expulsion of air
-cough may be nothing more than effort to clear throat
Zero: cough is absent