Spinal Assessment ROM Flashcards
what are more reliable measurements in the neck? why?
full cycle versus half-cycle
neutral position for cervical spine is not well defined
what are full-cycle vs half-cycle measurements
full = one end range to another
half = from neutral to end range
what is the best position for cervical ROM testing
sitting is greater than standing
what is the proportion of distance
difference of at-rest and end-range values
÷
at-rest value
why is the proportion of distance important
when doing tape measure measurements, POD negates effects of different body sizes and measurements when comparing multiple patients
mean ROM value of cervical flexion/extension
flex - 40
ext - 50
testing position/motion for cervical flexion/extension
seated with spine supported and stabilized
cervical spine positioned in neutral rotation and lateral flexion
flex cervical spine forward while maintaining a tucked chin and guiding the head anteriorly
end feel for flexion/extension
firm
goniometer placement cervical flexion/extension
axis - over external auditory meatus
SA - perpendicular to the ground
MA - along the base of the nares
what can be used to better align the goniometer?
tongue depressor between teeth
moving arm parallel to depressor
mean cervical spine lateral flexion ROM
22° to each side
testing position for CS lateral flexion
patient seated with spine supported and stabilized with neutral cervical flex/ext and rotation
say were going to the right
lateral flex by grasping left side and pulling to the side
normal end feel of cervical lateral flexion
Firm
goniometer placement for cervical spine lateral flexion
axis - C7 spinous process
SA - perpendicular to the ground
MA - along dorsal midline of head with occipital protuberance being point of reference
how would a tongue depressor be used during lateral flexion ROM
between teeth
axis centered near one end of tongue depressors
stationary arm is perpendicular to the floor
moving arm is aligned with tongue depressor
cervical spine rotation average ROM
50-80°
CS rotation testing position/movement
seated with spine supported, cervical spine should be in neutral
pull chin and head toward the shoulder
cervical spine rotation goniometer position
axis - over center of cranium
SA - perpendicular to an imaginary line between acromion processes
MA - aimed at tip of nose
tape measure method for cervical spine flex/extend
distance between tip of chin and lower edge of sternal notch
mouth closed
tape measure method for cervical spine lateral flexion
measure distance between mastoid process and lateral tip of the acromion process
tape measure method for cervical spine rotation
measure distance between the tip of the chin and acromion process
cervical flexion/extension inclinometer placement
one inclinometer over C7 spinous process and adjusted to 0°
one inclinometer is on posterior aspect of head and adjusted to 0°
what is important to keep in mind when doing cervical measurements of inclinometry
might need to move the C7 inclinometer to the side to not impede extension
if there is a deviation from 0 at C7, subtract that from the one on dorsal aspect of head.
cervical spine lateral flexion inclinometer placement
one inclinometer placed over C7 spinous process
one inclinometer placed on top of subject’s head and adjusted to 0°
cervical spine rotation inclinometer placement
patient in supine position
one inclinometer on center of subject’s forehead and adjusted to 0°
asked to roll head into rotation
generally which portion of the spine is the most flexible?
why?
cervical > thoracic > lumbar
structural differences, specifically spinous processes found in thoracic spine
tighter joint capsule of thoracic spine/rib cage
the lumbar spine is oriented in a way to allow for ____&_____, rather than _____&_______
flexion and extension
lateral flexion and rotation
how is the lumbar spine oriented?
primarily in sagittal plane
_____ is more limited than _____ in the lumbar spine
flexion
extension
where does the greatest mobility of flexion and extension occur between
L4-L5
where does the greatest amount of flexion occur
L5-S1
what portion of the lumbar spine allows for more lateral flexion / rotation
upper lumbar
in general, what plane/axis does flexion and extension occur in (for all spinal sections)
sagittal
medial-lateral
in general, what plane/axis does lateral flexion occur in (for all spinal sections)
frontal
anterior-posterior axis
what is the mean lateral flexion range for thoracic/lumbar spine
35°
testing position/motion of lateral flexion in lumbar/thoracic spine
standing with spine in neutral
asked to bend trunk to one side
both feet flat with knees extended
do not allow for any flexion/ext/rotation of spine
end feel for thoracic/lumbar lateral flexion
firm
goniometer placement for thoracic/lumbar spine lateral flexion
axis - posterior aspect of S1
SA - perpendicular to ground
MA - aligned with posterior aspect of C7 spinous process
in general, what axis/plane does rotation occur on (for all segments of the spine)
transverse
vertical axis
what is the mean ROM for thoracic/lumbar spine rotation
45°
testing position for thoracic/lumbar rotation
patient is sitting
spine in neutral
asked to twist their body to one side keeping trunk erect and feel flat on the supporting surface
end feel for thoracic/lumbar spine rotation
firm
goniometer placement for T/L spine rotation
axis - center of cranial aspect of subjects head
SA - perpendicular to an imaginary line between two tubercles on the iliac crests
MA - perpendicular to an imaginary line between the two acromion processes
tape measure method for T/L Spine flexion ROM
Spinous process of C7 and S1 are marked
distance between the two are measured in starting position (neutral spine, erect posture)
patient is asked to flex forward and distance between points is measured
difference between two is the final measurement
average T/L spine flexion using tape measure method
4 inches
tape measure method for Lumbar Flexion ROM
Modified-Modified Schober Test
mark made over spine midway between two PSIS with a second mark made 15cm above
patient asked to bend forward while keeping feet flat and knees extended.
distance between 15cm and second measurement is range of motion for lumbar flexion.
how does the original Schober test differ from the modified?
OG - made at lumbrosacral junction and second mark is made 10 cm above first mark
T/L spine extension ROM tape measure method
same as flexion, but just extend
go until pelvis tilts posteriorly
difference between two second and first measurements is range of extension
Lumbar Spine extension ROM tape measure method
same as flexion but in extension
what is the fingertip to floor ROM measurement (T/L Spine Flexion)
standing position
patient is asked to bend forward as far as possible while keeping feet flat on floor and knees extended
difference between middle finger tip and ground is measured
is the fingertip-to-floor measurement recommended? what is it good for?
no, because hip flexion is included and spinal flexion cannot be isolated.
overall flexibility testing
Fingertip-to-Floor method for T/L spine lateral flexion
standing position
asked to bend to the side as far as possible with feet flat and knees extended
be sure patient maintains neutral spine
at end range, mark where tip of middle finger reaches to
difference between this point and floor is the range of motion
what is the alternative measuring process for a fingertip to floor measurement of T/L spine lateral flexion
difference between finger tip positions
marking where tip of middle finger is during starting position (erect, neutral posture)
doing normal test, then taking difference between fingertip positioning at the start and end on the leg.
inclinometer test for flexion (T/L spine)
inclinometer placed on spinous process of C7, adjusted to 0°
second inclinometer placed on midsacrum, adjusted to 0°
end range is recorded and difference between two is taken from the measurement
inclinometer placement for lumbar spine flexion
one inclinometer over spinous process of T12 and adjusted to 0°
another inclinometer placed over midsacrum, adjusted to 0°
patient is to flex to end range of motion, measurement is taken
midsacrum inclinometer subtracted from that on T12
for inclinometry measurement of lumbar flexion, what do numbers on the midsacral inclinometer represent
hip flexion range of motion
T/L Spine lateral flexion inclinometer measurements
standing position
one inclinometer on spinous process of T1, adjusted to 0°
one inclinometer placed on spinous process of S1, adjusted to 0°
asked to laterally flex
subtract reading on sacral inclinometer from that of the thoracic at end range
T/L spine rotation inclinometer measurement
standing position, patient asked to flex forward so that back is parallel to ground
one inclinometer on C7 spinous process, adjusted to 0°
one inclinometer on spinous process of S1, adjusted to 0°
sacral # - cervical = rotation ROM
