Spine MMT Flashcards
what are the primary muscles that perform capital extension?
- rectus capitis Posterior Major/Minor
- Longissimus Capitis
- Obliquus Capitis Superior/Inferior
- Semispinalis Capitis
- Trapezius
- Spinalis Capitis
for grades 3 and up, how should the pt be positioned when assessing capital extension with MMT?
- Prone
- Head off table
- PT supports at chin with one hand
- Instruct pt to “look at where the wall meets the floor”
for grades 0,1,2 how should the pt be positioned when assessing capital extension with MMT?
- supine
- head supported on table
- place hands under base of skull to palpate muscles
- Instruct pt to “look back at me without lifting your head from the table”
where should the PT stabilize during capital extension MMT?
one hand under chin (grades 3 and up) just in case head drops
where should resistance be applied during capital extension MMT?
towards the ground at the base of the head
what muscles are primarily assessed during cervical extension?
- erector spinae cervical portion
- semispinalis cervicis
- splenius cervicis
- Upper traps
what muscles are assisting in cervical extension?
- Interspinalis cervicis
- Intertransversarii cervicis
- rotatores cervicis
- Multifidi
- levator scapulae
for grades 3 and up, how should the pt be positioned when assessing cervical extension with MMT?
- Prone
- head off the table (shoulders at the edge of table)
- Pt supports under the chin with one hand and places other hand on the back of head
- Instruct the pt to “push your head back into my hand without tilting your head”
- movement is like a chin tuck
what is the alterantive position for cervical extension grade 3?
in presence of trunk weakness, therapist holds upper trunk
for grades 0,1,2 how should the pt be positioned for cervical extension MMT?
- supine
- PT has hands under occiput
- Instruct the pt to “push your head down into my hands”
- similar to a chin tuck motion
where should the PT stabilize during cervical extension MMT?
one hand under the chin for grades 4 and 5
at the upper trunk for grade 3
where should force be applied during cervical extension MMT?
towards the ground at the back of head
make sure the pt doesn’t tilt the head back
what are the primary muscles tested during combined extension (cervical and capital)?
same muscles that performed cervical and capital extenstion
how should the pt be positioned for combined cervical and capital extension MMT?
- prone
- shoulders at the edge of table so head is off
- arms by the sides
- Instruct the pt to “lift your head and look at the wall/ceiling”
what is the alternative pt positioning for combined cervical and capital extension MMT?
for grade 3
involves stabilization of upper back if pt has trunk or hip extensor weakness?
how do you grade combined cervical and capital extension MMT?
No specific test/position for grades 0,1,2
check for full or partial ROM
Palpate
where should the PT stabilize during combined cervical and capital extension MMT?
PT has one hand under chin in case of head drop
upper trunk for alternative test
where should resistance be applied during combined cervical and capital extension MMT?
applied down and slightly out
what muscles are primarily assessed during capital flexion MMT?
- rectus capitis anterior
- rectus capitis lateralis
- longus capitis
what muscles assist in capital flexion?
suprahyoid muscles
how should the pt be positioned during captial flexion MMT?
- supine
- head supported on table
- Instruct the pt to “tuck your chin, don’t lift your head from the table, don’t let me lift your chin”
- same position for all grades
where should the PT stabilize and apply resistance during capital flexion MMT?
no stabilization
both hands are used to counter flexion at the chin
what muscles are primarily assessed with cervical flexion MMT?
- SCM
- longus colli
- anterior scalene
what muscles assist with cervical flexion?
suprahyoid muscles
middle and posterior scalene
for grades 3 and up, how should the pt be positioned during cervical flexion MMT?
- supine
- head supported on table
- Instruct pt to “lift your head from the table keeping your shoulders down, don’t let me push your head down”
for grades 0,1,2 how should the pt be positioned during cervical flexion MMT?
- supine
- head supported on table
- Instruct pt to “roll your head to the left and then right”
- palpate for contractility
where should the PT stabilize during cervical flexion MMT?
stabilize thorax to prevent lifting of shoulders
where should resistance be applied during cervical flexion MMT?
forehead with 2 fingers
what muscles are primarily assessed during combined capital and cervial flexion?
all capital and cervical flexors
how should the pt be positioned for combined capital and cervical flexion MMT?
- supine
- head supported on the table
- Instruct pt to “bring your head up until your chin is toward your chest, do not raise your shoulders off the table”
how should combined capital and cervical flexion MMT be graded?
- Grade 5: Pt completes ROM Against strong resistance.
- Grade 4: Pt Completes ROM w/mod resistance
- Grade 3: Pt completes ROM w/no resistance.
- Grade 2: Partial ROM
- Grade 1: Palpate muscle but no motion.
where should the PT stabilize during combined capital and cervical flexion MMT?
stabilize thorax to prevent lifting of shoulders
where should resistance be applied during combined cervical and capital flexion
applied to the forehead down and out
how can you isolate the SCM with MMT?
- same position as cervical flexion
- instruct pt to “turn head to one side and then lift your head keeping it turned
- for gravity minimized simply have them turn their head and palpate SCM
what muscles are primarily assessed with cervical rotation MMT?
- SCM
- semispinalis
- longissimus capitis and cervicis
- trapezius
- scalenes
- levator scapulae
- obliquus capitis
- rectus capitis
for grades 3 and up, how should the pt be positioned for cervical rotation MMT?
- supine
- head supported on table
- start off facing L/R
- Instruct pt to “turn your head and face the ceiling, don’t let me push it back down
for grades 0,1,2 how should the pt be positioned for cervical rotation MMT?
- sitting
- head posture neutral
- instruct pt to “turn your head as far R/L as you can”
where should the PT stabilize and apply resistance for cervical rotation MMT?
- no specific stabilization
- resistance applied to side of head above ear
T/F: for trunk extension, thoracic and lumbar extension can be separated for all grades?
FALSE
only for grades 5 and 4
what muscles will be involved in trunk extension? (both thoracic and lumbar)
- Iliocostalis thoracis and lumborum
- Longissimus thoracis
- Spinalis thoracis
- Semispinalis thoracis
- Multifidus (multifidi)
- Thoracic and lumbar rotatores
- Intertransversarii Thoracis & Lumborum
- Quadratus lumborum
for grades 4 and 5, how should the pt be positioned for lumbar extension MMT?
- prone
- hands behind head
- Instruct pt to “raise your head, shoulders, and chest as high as you can”
- observe for pt to clear umbilicus
where should the PT stabilize during lumbar extension grades 4 and 5 MMT?
at the ankles
OR
pelvis if they have hip extnesion weakness
where should the PT apply resistance for grades 5 and 4 lumbar extension MMT?
no resistance applied
pts own weight is used as resistance
T/F: test for hip and neck extension prior to trunk
TRUE
for grades 4 and 5, how should a pt be positioned for thoracic extension MMT?
- prone
- mid chest (nipple line) off table with hands behind head
- Instruct pt to “raise your head, shoulders, and chest to table level
where should the PT apply resistance and stabilize during thoracic extension grades 4 and 5 MMT?
no resistance
stabilize at ankles
T/F: for grades 3, 2, 1, 0 thoracic and lumbar extension are tested together?
TRUE
for grades 3 and down, how should the pt be positioned for combined trunk extension MMT?
- Prone
- mid chest (nipple line) off table
- arms by side
- Instruct pt to “raise your head, and chest as high as you can”
- full ROM is grade 3
where should the PT stabilize and apply resistance during combined trunk extension MMT?
no resistance applied
stabilize at ankles
where should the PT palpate for grades 0 during combined trunk extension?
thoracic or lumbar adjacent to specific segement of spine
what are some common subsitutions that may be observed during combined trunk extension MMT?
- if spine extensors are weak and hip extensors are strong, pt will no be able to raise upper trunk from table. Instead pelvis will tilt posteriorly while L spine moves into flexion
- When back extensors are strong and hip extensors are weak, pt can hyperextend the low back and won’t be able to raise trunk without stabilization from PT
what muscles are primarily tested during trunk flexion?
- Rectus abdominis
- obliquus externus
- obliquus internus
what musles assist with trunk flexion?
Psoas major/minor
how should the pt be positioned for grades 3 and up during trunk flexion MMT?
- supine
- hands behind head for grade 5
- hands across chest for grde 4
- hands out for grade 3
- Instruct pt to “keep your chin pointed at ceiling and lift your head, shoulder, and back off the table”
- check for scapular clearance
how should a pt be positioned for grade 2 trunk flexion MMT?
- hook lying
- instruct pt to lift head from table
- if scapula does not lift its a grade 2
how should pt be positioned for grade 1 trunk flexion MMT?
- hook lying
- ask pt to lift their head off table
- if they cannot lift head off table then cradles head and ask them to lean forward
- if rib depression is observed = grade 2
- no rib depression but muscle activation = grade 1
if a pt coughs and you observe rib depression what grade should be given for trunk flexion?
grade 2
cough with no palpable contraction is a grade 1
what muscle is primarily tested during trunk rotation?
internal and external obliques
Instructions and positioning for trunk rotation grade 5
- supine
- hands behind head
- Instruct pt to “keep your chin pointed at the ceiling and lift your head, shoulders, and back off the table and to the side”
- look for scapular clearance
Instructions and positioning for trunk rotation grade 4
- supine
- hands across chest
- instruct pt to “keep your chin pointed at the ceiling and lift your head, shoulders, and back off the table and to the side”
- check for scapular clearance
Instructions and positioning for trunk rotation grade 3
- supine
- hands out
- Instruct pt to “keep your chin pointed to the ceiling and lift your head, shoulders, and back off the table and to the side”
- check for scapular clearance
Instructions and positioning for grade 2 trunk rotation
- supine
- hands by side
- pt is unable to raise scapula off the table, but therapist can observe depression of rib cage
Instructions and positioning for grade 1 trunk rotation
- hook lying
- PT supports pts with arm under upper trunk/shoulders
- palpate for internal oblique contraction
T/F: bringing your left elbow to your right knee during trunk rotation testing is testing the left external and internal oblique?
FALSE
tests the left external and right internal oblique
what is a common substitution that may be observed during trunk rotation testing?
if the pt has overactive pectoralis muscles, you will observe shoulder shrug/elevation with trunk flexion
