Spinal Regional Range of Motion

Question 1

Motion Testing

Answer 1

– evaluates the ability of the patient to move in various planes; helps determine dysfunctional or pathological areas disturbing the patient’s functional ability
 Possibly the most important measure of the somatic dysfunction components and the one objective measure which can be documented with relative certainty
- Regional vs. Segmental
- Active vs. passive
-quality of motion vs. quantitiy of motion vs. pattern of motion

Question 2

Active vs. Passive

Answer 2

 Active motion performed by patient; should be done prior to passive motion performed by physician
• SEVERE limitation in active motion should alert physician to more serious pathology and do NOT perform passive tests before X-ray
• Physiologic barrier – limits active motion from reaching the range of passive motion
 Passive motion testing is generally better for detection of somatic dysfunction
• Better for detecting true restriction (“end-feel”) as the patient is not actively involved
• MORE range of motion possible than active
• Anatomic barrier – limits passive motion
 Somatic dysfunction quickly reaches the restrictive barrier

Question 3

Regional vs. Segmental

Answer 3

 Regional – cervical vs. thoracic vs. lumbar

Question 4

quantity vs. quality vs. pattern

Answer 4

 Quantity – degrees of motion

 Quality – as patient moves actively, does it hurt? Where? Tentative? Accessory motion? Crepitus (noise)?

Question 5

Planes of Motion

Answer 5

o	Sagittal Plane Motion
	Around transverse (horizontal) axis
	Forward & backward bending = flexion and extension
o	Coronal Plane Motion
	Around anterior posterior (AP) axis
	Sidebending R or L (SR or SL)
o	Transverse (horizontal) Plane Motion
	Around vertical axis
	Rotation R or L (RR or RL)
o	Translational Motion – involves side bending and rotation simultaneously

Question 6

Why Perform Motion Testing

Answer 6

o Helps tell you there may be a mechanical problem
 Functional – spasm, articular dysfunction, etc.
 Pathological – fracture, arthritis, metastasis
o Helps tell you where a problem is located (region or tissue)
o Allows you to measure improvement post-treatment
o Most objective assessment tool for categorizing somatic dysfunction and related pain
 “gold standard” in osteopathic palpation
 Somatic dysfunction is “named” for the directions of free motion

Question 7

Spinal Anatomical Landmarks

Answer 7

o	C7 – vertebra prominens
o	T1 – below spinous process of C7
o	T3 – spine of scapula
o	T7 spinous process; T8 transverse process – inferior angle of scapula
o	L4 – level of iliac crests (Males)
o	L5 – level of iliac crests (Females)

Question 8

Cervical Region Vertebra

Answer 8

o C2-C7 articular facets
 Oblique plane
 Face backward, upward, and medial
 Facets permit freest movement in flexion and extension
 Facets limit motion in side bending and rotation

Question 9

Cervical Region Range of Motion Evaluation

Answer 9

 Forward bending (flexion) – 45-90 degrees
 Backward bending (extension) – 45-90 degrees
 Left/right side bending – 30-45 degrees
• Place fingers laterally so you can feel transverse process of C7/T1 moving
 Left/Right rotation – 70-90 degrees
• 50% of rotation comes from C1-C2 articulation
 Muscles Involved: trapezius, splenius capitis, semispinalis capitis, sternocleidomastoid

Question 10

Thoracic Region

Answer 10

o Motion is limited but not to the detriment of respiration
o Motion is limited in all directions by ribs
o Motion testing is broken down into subdivisions – T1-T4 (motion to T5), T5-T8 (motion to T9), T9-T12 (motion to L1)
 Monitor motion using one or two digits on spinous processes or transverse process
 Stop when monitored site starts to move

Question 11

Thoracic Region Range of Motion Evaluation

Answer 11

 Side bending
o Translate right = sidebend left
o Keep shoulders over pelvis
o Patient is relaxed!!! No tightened muscles
• T1-T4 – 5-25 degrees
• T5-T8 – 10-30 degrees
• T9-T12 – 20-40 degrees
 Rotation
• T9-T12 – 70-90 degrees
• Without ribs: coronal facets allow more rotation (especially at lower segments)
 Muscles Involved: trapezius, erector spinae group, semispinalis thoracis, rotatores and levatores

Question 12

Lumbar Region

Answer 12

o Flexion and extension – freest movements
o Side bending – moderate
o Rotation – minimal

Question 13

Lumbar Region Range of Motion Evaluation

Answer 13

 Flexion – 70-90 degrees
 Extension – 30-45 degrees
 Left/Right side bending – 25-30 degrees
• Hip Drop Test for Side Bending (may also use sacral base and pelvic declination)
o Ask subject to bend one knee
o Iliac crest should drop ~25 degrees
o Watch smoothness of lumbar curve and symmetry
 **local exam warranted at sites where curve not smooth
 Muscles involved: latissimus dorsi, erector spinae group, quadratus lumborum, iliopsoas

Question 14

Limiting Factors in Lumbar Range of Motion - Ligaments tensed during forward bending

Answer 14

• Supraspinous
• Interspinous
• Flavum
• Capsular
• Posterior longitudinal
• Annulus fibrosis

Question 15

Limiting Factors in Lumbar Range of Motion - Tissues tensed during backward bending

Answer 15

• Anterior longitudinal ligament
• Intervertebral disc
• Articular facets
• Spinous processes (inter-spinous ligament)
• Spinous processes (bony impingement)

Question 16

Muscular Involvement in Motion Restriction

Answer 16

o Hypertonicity (“spasm”), fibrous scarring, etc.
o Muscles affecting shoulder or scapular motion
 Trapezius
 Latissimus dorsi
 Rhomboid major and minor
 Levator scapula