Post on 01-Jun-2015
Thoracic and Thoracic and Lumbar Spine Lumbar Spine
Clinical EvaluationClinical EvaluationOrthopedic Assessment III Orthopedic Assessment III – Head, Spine, and Trunk – Head, Spine, and Trunk
with Labwith Lab
PET 5609CPET 5609C
Clinical EvaluationClinical Evaluation
History:History: Location of Pain:Location of Pain:
Pain radiating into extremitiesPain radiating into extremities Peripheral paresthesia or numbness:Peripheral paresthesia or numbness:
Result of impingement or pressure on nerve Result of impingement or pressure on nerve root exiting intervertebral foramen or dural root exiting intervertebral foramen or dural irritation proximal to pain siteirritation proximal to pain site
Pain Locations:Pain Locations: Lumbar pain – possible ambiguous causeLumbar pain – possible ambiguous cause Sacroiliac pathology – pain around PSIS or Sacroiliac pathology – pain around PSIS or
radiating pain in hip/groinradiating pain in hip/groin Piriformis spasm – symptoms of sciatic nerve Piriformis spasm – symptoms of sciatic nerve
dysfunctiondysfunction
Clinical EvaluationClinical Evaluation
History:History: Onset of Pain:Onset of Pain:
AcuteAcute ChronicChronic Insidious pain onsetInsidious pain onset Note: Patient may Note: Patient may
describe a single describe a single incident that initiated incident that initiated pain, although pain, although trauma is probably an trauma is probably an accumulation or accumulation or repetitive repetitive stresses/microtraumastresses/microtrauma
Clinical EvaluationClinical Evaluation
Clinical EvaluationClinical Evaluation History:History:
Mechanism of Mechanism of Injury:Injury:
Movement: Flexion, Movement: Flexion, Extension, Lateral Extension, Lateral Bending, RotationBending, Rotation
Blunt Trauma: Blunt Trauma: Direct blow to Direct blow to lumbar/thoracic arealumbar/thoracic area
ContusionsContusions Compressive Stress:Compressive Stress:
Hyperextension of Hyperextension of spinespine
History:History: Pain Pain
Consistency:Consistency: Constant Pain: Constant Pain:
Unyielding (does Unyielding (does not improve with not improve with various position various position of patient’s of patient’s spine)spine)
Example Example pathology – pathology – Inflammation of Inflammation of dural sheathdural sheath
Clinical EvaluationClinical Evaluation
History:History: Pain Consistency:Pain Consistency:
Intermittent Pain: Intermittent Pain: Mechanical Origin – certain spinal positions Mechanical Origin – certain spinal positions
may ↑ or ↓ pain symptoms may ↑ or ↓ pain symptoms Compression/stretching of nerve root – Compression/stretching of nerve root –
Increase painIncrease pain Positioning (flexion, traction) – lessen the Positioning (flexion, traction) – lessen the
pressure on involved structurepressure on involved structure
Clinical EvaluationClinical Evaluation
History:History: Bowel or bladder signs:Bowel or bladder signs:
Does the patient have any bowel or Does the patient have any bowel or bladder problems?bladder problems?
Incontinence: Loss of bowel or bladder Incontinence: Loss of bowel or bladder controlcontrol
May indicate lower nerve root lesions (cauda May indicate lower nerve root lesions (cauda equina syndrome), or spinal cord injuryequina syndrome), or spinal cord injury
Description: urinary incontinence may range Description: urinary incontinence may range from occasionally leaking urine (during from occasionally leaking urine (during cough/sneeze) to having sudden episodes of cough/sneeze) to having sudden episodes of strong urinary urgencystrong urinary urgency
Clinical EvaluationClinical Evaluation
History:History: Bowel or Bladder Signs:Bowel or Bladder Signs:
Cauda Equina Syndrome: Cauda Equina Syndrome: Nerves within the spinal canal have been damagedNerves within the spinal canal have been damaged Result: nerves supplying the muscles of the legs, Result: nerves supplying the muscles of the legs,
bladder, bowel and genitals do not function properlybladder, bowel and genitals do not function properly Patients experience numbness, loss of sensation and Patients experience numbness, loss of sensation and
pain in the legs, buttocks and pelvic region (damage pain in the legs, buttocks and pelvic region (damage usually permanent)usually permanent)
Causes:Causes: Spina bifida (abnormality in closure of spinal canal) Spina bifida (abnormality in closure of spinal canal) TumorsTumors Injury (spinal fractures) Injury (spinal fractures) Intravertebral disc herniation Intravertebral disc herniation Vascular (blood vessel) problems or infections of the Vascular (blood vessel) problems or infections of the
cauda equinacauda equina
Clinical EvaluationClinical Evaluation
History:History: History of spinal History of spinal
injury:injury: Previous injuries:Previous injuries:
Structural Structural degenerationdegeneration
Predisposition to Predisposition to injuryinjury
Changes in activity:Changes in activity: Exercise habits Exercise habits
(intensity levels, (intensity levels, duration, frequency)duration, frequency)
Footwear, running Footwear, running surfacessurfaces
New bedNew bed
Clinical EvaluationClinical Evaluation
General Inspection:General Inspection: Frontal Curvature:Frontal Curvature:
Alignment of lumbar, Alignment of lumbar, thoracic, cervical thoracic, cervical vertebrae with patient vertebrae with patient lying prone or lying prone or standingstanding
Normal alignment – Normal alignment – straight straight
Abnormal alignment:Abnormal alignment: Scoliosis – lateral Scoliosis – lateral
curvature (lumbar curvature (lumbar and/or thoracic and/or thoracic spine)spine)
Clinical EvaluationClinical Evaluation
General Inspection: General Inspection: ScoliosisScoliosis Signs and symptoms:Signs and symptoms:
Uneven shoulders Uneven shoulders One shoulder blade appears One shoulder blade appears
more prominent more prominent Uneven waist / 1 hip higher Uneven waist / 1 hip higher
vs. othervs. other Leaning to one side Leaning to one side Back pain and difficulty Back pain and difficulty
breathing (severe scoliosis)breathing (severe scoliosis) Causes:Causes:
Idiopathic (85% of cases)Idiopathic (85% of cases) Underlying neuromuscular Underlying neuromuscular
disease, leg-length disease, leg-length discrepancy, birth defect, discrepancy, birth defect, fetal development fetal development (congenital)(congenital)
Not caused by poor posture, Not caused by poor posture, diet, exercise, or the use of diet, exercise, or the use of backpacks backpacks
Clinical EvaluationClinical Evaluation
Diagnosis:Diagnosis: Angle: X-rayAngle: X-ray
Normal Spine (0 Normal Spine (0 degrees)degrees)
Scoliosis: (> 10 Scoliosis: (> 10 degrees)degrees)
Complications: Complications: (severe (severe scoliosis)scoliosis)
Lung and heart Lung and heart damage: damage: compression of compression of rib cage against rib cage against heart, lungsheart, lungs
> 70 degrees> 70 degrees Back problemsBack problems
Clinical EvaluationClinical Evaluation
General Inspection:General Inspection: Scoliosis Test: Adam’s Forward Bend TestScoliosis Test: Adam’s Forward Bend Test
Patient Position: Standing with hands held in Patient Position: Standing with hands held in front (arms straight)front (arms straight)
Evaluation Procedure: Patient bends forward, Evaluation Procedure: Patient bends forward, sliding hands down the front of each legsliding hands down the front of each leg
Positive Test: Positive Test: Asymmetrical hump along lateral aspect of Asymmetrical hump along lateral aspect of
thoracolumbar spinethoracolumbar spine One shoulder blade appears more prominentOne shoulder blade appears more prominent Uneven hips Uneven hips
Implications:Implications: Functional scoliosis: scoliosis present when Functional scoliosis: scoliosis present when
patient stands straight, disappears during flexionpatient stands straight, disappears during flexion Structural scoliosis: present during both standing Structural scoliosis: present during both standing
and with flexionand with flexion
Clinical EvaluationClinical Evaluation
Clinical EvaluationClinical Evaluation
General General Inspection:Inspection: Sagital Curvature:Sagital Curvature:
Normal Normal Alignment:Alignment:
Lordotic cervicalLordotic cervical Kyphotic Kyphotic
thoracicthoracic Lordotic lumbarLordotic lumbar Kyphotic sacralKyphotic sacral
Clinical EvaluationClinical Evaluation
Clinical EvaluationClinical Evaluation
General General Inspection:Inspection: Observation of Observation of
GAIT:GAIT: Spinal pain – Spinal pain –
influence on influence on walking and walking and running gaitrunning gait
SlouchingSlouching ShufflingShuffling Shortened gaitShortened gait
Clinical EvaluationClinical Evaluation
General Inspection:General Inspection: Skin Markings:Skin Markings:
Café-au-lait spots: Café-au-lait spots: presence of presence of darkened areas of darkened areas of skin pigmentationskin pigmentation
Normal (benign)Normal (benign) Collagen diseaseCollagen disease Neurofibromatosis Neurofibromatosis
11 95% of patients 95% of patients
will display will display spotsspots
Clinical EvaluationClinical Evaluation
General Inspection:General Inspection: Skin Markings: Sign of Skin Markings: Sign of
Neurofibromatosis-1Neurofibromatosis-1 Neurofibromatosis-1:Neurofibromatosis-1:
Autosomal dominant diseaseAutosomal dominant disease Characterized by formation of Characterized by formation of
neurofibromas (tumors involving nerve neurofibromas (tumors involving nerve tissue) in the skin, subcutaneous tissue, tissue) in the skin, subcutaneous tissue, cranial nerves, and spinal root nervescranial nerves, and spinal root nerves
Implications: growth of tissue along the Implications: growth of tissue along the nerves – puts pressure on affected nerves nerves – puts pressure on affected nerves and cause pain and severe nerve damageand cause pain and severe nerve damage
Loss of nerve function (sensation, Loss of nerve function (sensation, movement)movement)
Clinical EvaluationClinical Evaluation
General Inspection:General Inspection: Breathing patterns:Breathing patterns:
Irregular breathing (i.e. shallow Irregular breathing (i.e. shallow respirations, pain)respirations, pain)
Injury to thoracic vertebraeInjury to thoracic vertebrae Pressure on thoracic nervesPressure on thoracic nerves Trauma to ribs, costal cartilageTrauma to ribs, costal cartilage
Bilateral comparison of skin folds:Bilateral comparison of skin folds: Asymmetry of natural foldsAsymmetry of natural folds
Causes: muscle imbalance, ↑ or ↓ Causes: muscle imbalance, ↑ or ↓ kyphosis, scoliosiskyphosis, scoliosis
Clinical EvaluationClinical Evaluation
General Inspection:General Inspection: Kyphosis:Kyphosis:
Abnormal forward Abnormal forward rounding of the upper rounding of the upper back (> 40 to 45 back (> 40 to 45 degrees)degrees)
Round back or Round back or hunchbackhunchback
Causes:Causes: Developmental Developmental
problems, degenerative problems, degenerative diseases (arthritis), diseases (arthritis), osteoporosis with osteoporosis with compression fractures, compression fractures, traumatrauma
Severe cases:Severe cases: Can affect lungs, Can affect lungs,
nerves, causing pain nerves, causing pain and other problemsand other problems
Clinical EvaluationClinical Evaluation
General Inspection: Kyphosis Test:
Forward bend test Patient bends
forward from the waist while ATC views the spine from the side
With kyphosis, the rounding of the upper back may become more obvious in this position
Postural kyphosis – the deformity corrects itself when patient lies on their back
Clinical EvaluationClinical Evaluation
Postural kyphosis: May improve on its own
Exercises to strengthen back muscles, correct posture, and sleeping on a firm bed
Structural kyphosis: Caused by spinal abnormalities Scheuermann's disease:
Developmental disorder that causes a stooped forward or bent-over posture
Affects between 0.5% and 8% of the general population
Osteoporosis-related kyphosis: Multiple compression fractures
Low bone density
Clinical EvaluationClinical Evaluation
Clinical EvaluationClinical Evaluation
General Inspection:General Inspection: Movement and Movement and
Posture:Posture: Poor posture Poor posture
(standing, sitting, (standing, sitting, bending)bending)
Lordotic Curve:Lordotic Curve: Reduction:Reduction:
Muscle spasmMuscle spasm Hamstring tightnessHamstring tightness
Increased:Increased: Hip flexor tightnessHip flexor tightness Abdominal weaknessAbdominal weakness
Clinical EvaluationClinical Evaluation
Clinical EvaluationClinical Evaluation
General Inspection:General Inspection: Standing Posture:Standing Posture:
Lateral shift in trunk and pelvisLateral shift in trunk and pelvis Nerve root impingement (lateral shift ↓ Nerve root impingement (lateral shift ↓
pressure)pressure)
Erector Spinae Muscle Tone:Erector Spinae Muscle Tone: Unilateral hypertrophy or atrophyUnilateral hypertrophy or atrophy
Faun’s Beard:Faun’s Beard: Spina bifida occultaSpina bifida occulta
Clinical EvaluationClinical Evaluation
General Inspection: Spina BifidaGeneral Inspection: Spina Bifida Birth defect that occurs when the tissue surrounding Birth defect that occurs when the tissue surrounding
the developing spinal cord doesn't close properly the developing spinal cord doesn't close properly Spina Bifida Occulta:Spina Bifida Occulta:
Mildest form, results in a small separation in one or Mildest form, results in a small separation in one or more of the vertebrae of the spine (spinal nerves usually more of the vertebrae of the spine (spinal nerves usually not involved – most patients have no signs/symptoms or not involved – most patients have no signs/symptoms or neurological problems) neurological problems)
Inspection: Faun’s Beard, a collection of fat, a small Inspection: Faun’s Beard, a collection of fat, a small dimple or a birthmark on the newborn's skin above the dimple or a birthmark on the newborn's skin above the spinal defect spinal defect
Complications:Complications: Minor physical disabilitiesMinor physical disabilities Mental strainMental strain Severity:Severity:
Size and location of the neural tube defectSize and location of the neural tube defect Does skin cover the area?Does skin cover the area? Do the spinal nerves come out of the affected area of the Do the spinal nerves come out of the affected area of the
spinal cord?spinal cord?
Clinical EvaluationClinical Evaluation
Clinical EvaluationClinical Evaluation
Palpation: Thoracic SpinePalpation: Thoracic Spine Spinous ProcessesSpinous Processes Supraspinous Ligaments:Supraspinous Ligaments:
Fills space between the spinous processesFills space between the spinous processes Costovertebral Junction:Costovertebral Junction:
Articulation between ribs and thoracic Articulation between ribs and thoracic vertebraevertebrae
Only palpable on slender individualsOnly palpable on slender individuals Trapezius:Trapezius:
Origin to insertionOrigin to insertion Rhomboids and levator scapulae lie deep to Rhomboids and levator scapulae lie deep to
middle/upper traps middle/upper traps Paravertebral MusclesParavertebral Muscles Scapular MusclesScapular Muscles
Clinical EvaluationClinical Evaluation
11 – Spinous – Spinous ProcessesProcesses
22 – Supraspinous – Supraspinous LigamentsLigaments
33 – Costovertebral – Costovertebral JunctionJunction
44 – Trapezius – Trapezius 55 – Paravertebral – Paravertebral
MusclesMuscles 66 – Scapular – Scapular
MusclesMuscles
StructureStructure LandmarkLandmark
Cervical vertebral Cervical vertebral bodiesbodies
Same level as spinous processesSame level as spinous processes
C1 transverse C1 transverse processprocess
One finger’s breadth inferior to mastoid One finger’s breadth inferior to mastoid processprocess
C3-C4 vertebraeC3-C4 vertebrae Posterior to hyoid bonePosterior to hyoid bone
C4-C5 vertebraeC4-C5 vertebrae Posterior to thyroid cartilagePosterior to thyroid cartilage
C6 vertebraeC6 vertebrae Posterior to cricoid cartilage; moves Posterior to cricoid cartilage; moves during flexion and extension of cervical during flexion and extension of cervical spinespine
C7 vertebraeC7 vertebrae Prominent posterior spinous processProminent posterior spinous process
T1 vertebraeT1 vertebrae Prominent protrusion inferior to cervical Prominent protrusion inferior to cervical spinespine
T2 vertebraeT2 vertebrae Posterior from jugular notch of the Posterior from jugular notch of the sternumsternum
T3 vertebraeT3 vertebrae Even with the medial border of the Even with the medial border of the scapular spinescapular spine
T7 vertebraeT7 vertebrae Even with the inferior angle of the Even with the inferior angle of the scapulascapula
L3 vertebraeL3 vertebrae Posterior from the umbilicusPosterior from the umbilicus
L4 vertebraeL4 vertebrae Level with the iliac crestLevel with the iliac crest
L5 vertebraeL5 vertebrae Typically demarcated by bilateral Typically demarcated by bilateral dimples, but variable from person to dimples, but variable from person to personperson
S2S2 At level of the posterior superior iliac At level of the posterior superior iliac spinespine
Clinical EvaluationClinical Evaluation
C7
T1
T2
T3
T4
T5
1 1 – Spinous Processes– Spinous Processes 22 – Step-off Deformity – Step-off Deformity 33 – Paravertebral Muscles – Paravertebral Muscles
Clinical EvaluationClinical Evaluation Spondylolisthesis:Spondylolisthesis:
Forward slippage of a vertebrae on the one Forward slippage of a vertebrae on the one below itbelow it
L4 and L5 / L5 and S1L4 and L5 / L5 and S1 Affects 5-6% of males, 2-3% of femalesAffects 5-6% of males, 2-3% of females Causes:Causes:
Strenuous physical activity (weightlifting, Strenuous physical activity (weightlifting, gymnastics, football)gymnastics, football)
Types:Types: Developmental:Developmental:
May exist at birth, or may develop during childhood May exist at birth, or may develop during childhood (generally not noticed until later in childhood/adult (generally not noticed until later in childhood/adult life)life)
Acquired:Acquired: Degeneration: caused by the daily stresses that are Degeneration: caused by the daily stresses that are
put on spine (i.e. carrying heavy items, physical sports)put on spine (i.e. carrying heavy items, physical sports) Connections between the vertebrae weakenConnections between the vertebrae weaken
Single or repeated forceSingle or repeated force
Clinical EvaluationClinical Evaluation Spondylolisthesis:Spondylolisthesis:
Grade 1:Grade 1: 25% of vertebral 25% of vertebral
body has slipped body has slipped forward forward
Grade 2:Grade 2: 50%50%
Grade 3:Grade 3: 75%75%
Grade 4:Grade 4: 100%100%
Grade 5:Grade 5: Vertebral body Vertebral body
completely fallen off completely fallen off (i.e.,spondyloptosis)(i.e.,spondyloptosis)
Clinical EvaluationClinical Evaluation Symptoms:Symptoms:
May be asymptomaticMay be asymptomatic Low back pain Low back pain
(especially after (especially after exercise)exercise)
↑ ↑ lordosis lordosis Pain/weakness in one or Pain/weakness in one or
both legs both legs ↓ ↓ ability to control ability to control
bowel/ bladder functions bowel/ bladder functions Tight hamstrings Tight hamstrings Advanced Advanced
spondylolisthesis: spondylolisthesis: changes may occur in changes may occur in the way patient the way patient stands/walksstands/walks
Clinical EvaluationClinical Evaluation Palpation: Sacrum and PelvisPalpation: Sacrum and Pelvis
Median sacral crestsMedian sacral crests Iliac crests:Iliac crests:
Palpate laterally from PSIS to find iliac crests and Palpate laterally from PSIS to find iliac crests and anteriorly to locate ASIS (level of symmetry)anteriorly to locate ASIS (level of symmetry)
Posterior superior iliac spinePosterior superior iliac spine GlutealsGluteals Ischial tuberosityIschial tuberosity Greater trochanterGreater trochanter Sciatic nerve:Sciatic nerve:
Place thumb on ischial tuberosity and 3Place thumb on ischial tuberosity and 3rdrd finger on finger on the PSIS. 2the PSIS. 2ndnd finger will fall into sciatic notch (nerve finger will fall into sciatic notch (nerve most superficial as it passes by ischial tuberosity)most superficial as it passes by ischial tuberosity)
Pubic symphysisPubic symphysis
11 – Median sacral – Median sacral crestscrests
22 – Iliac crests – Iliac crests3 3 – PSIS– PSIS44 – Gluteal muscles – Gluteal muscles5 5 – Ischial tuberosity– Ischial tuberosity6 6 – Greater – Greater
trochantertrochanter77 – Sciatic nerve – Sciatic nerve88 – Pubic symphysis – Pubic symphysis
1 1 – Iliac crest– Iliac crest
22 – Tensor fascia – Tensor fascia lataelatae
33 – Gluteus medius – Gluteus medius
44 – Iliotibial band – Iliotibial band
55 – Greater – Greater trochantertrochanter
66 – Trochanteric – Trochanteric bursabursa
1 1 – Pubis– Pubis
2 2 – ASIS– ASIS
33 – AIIS – AIIS
44 – Sartorius – Sartorius
5 5 – Rectus – Rectus femorisfemoris
Clinical EvaluationClinical Evaluation
Active Range of Motion:Active Range of Motion: Flexion and Extension:Flexion and Extension:
Measured with patient standingMeasured with patient standing Distance from the fingertips to the floor Distance from the fingertips to the floor
can be measured (accuracy affected by can be measured (accuracy affected by tightness of hamstrings and calf tightness of hamstrings and calf muscles and scapular protraction)muscles and scapular protraction)
Gravity assists with movementGravity assists with movement More accurate than hook-lying positionMore accurate than hook-lying position
Abdominal muscles have to overcome Abdominal muscles have to overcome weight of the trunkweight of the trunk
Clinical EvaluationClinical Evaluation Active Range of Motion:Active Range of Motion:
Lateral Bending:Lateral Bending: Patient standing (feet shoulder width apart and the Patient standing (feet shoulder width apart and the
hand opposite the direction of the movement resting on hand opposite the direction of the movement resting on the ilium)the ilium)
Patient bends trunk laterally (attempt to tough Patient bends trunk laterally (attempt to tough fingertips to the ground)fingertips to the ground)
Distance between the ground and fingertips is measuredDistance between the ground and fingertips is measured Rotation:Rotation:
Patient is sitting position (stabilizes pelvis and lower Patient is sitting position (stabilizes pelvis and lower extremity)extremity)
Patient rotates shoulder girdles and spinal column Patient rotates shoulder girdles and spinal column (attempt to look behind one’s back)(attempt to look behind one’s back)
Movement primarily occurs in thoracic spineMovement primarily occurs in thoracic spine
Clinical EvaluationClinical Evaluation Passive Range of Motion:Passive Range of Motion:
Flexion:Flexion: Patient in hook-lying positionPatient in hook-lying position Examiner brings the knees to the chest by lifting Examiner brings the knees to the chest by lifting
under the knees and thighs and flexing the hip under the knees and thighs and flexing the hip and thoracic spineand thoracic spine
Extension:Extension: Patient prone (hands flat on table at shoulder Patient prone (hands flat on table at shoulder
level – push-up position)level – push-up position) Patient extends arms, lifting the torso (hips and Patient extends arms, lifting the torso (hips and
legs remain of table)legs remain of table) Rotation:Rotation:
Patient in hook-lying positionPatient in hook-lying position Patient’s pelvis and legs are rotated to bring Patient’s pelvis and legs are rotated to bring
lateral portion of the knee towards the table lateral portion of the knee towards the table (shoulders remain flat)(shoulders remain flat)
MotionMotion Ligaments StressedLigaments Stressed
FlexionFlexion Posterior Longitudinal Posterior Longitudinal Ligament, Supraspinous Ligament, Supraspinous Ligament, Interspinous Ligament, Interspinous Ligament, Ligamentum FlavumLigament, Ligamentum Flavum
ExtensionExtension Anterior Longitudinal LigamentAnterior Longitudinal Ligament
RotationRotation Interspinous Ligament, Interspinous Ligament, Ligamentum FlavumLigamentum Flavum
Lateral Lateral BendingBending
Interspinous Ligament, Interspinous Ligament, Ligamentum FlavumLigamentum Flavum
Spinal Ligaments Stressed During Spinal Ligaments Stressed During Passive Range of Motion TestingPassive Range of Motion Testing
Clinical EvaluationClinical Evaluation
Beevor’s Sign:Beevor’s Sign: Test for thoracic nerve inhibitionTest for thoracic nerve inhibition
Patient performs an abdominal curl-up from hook-Patient performs an abdominal curl-up from hook-lying positionlying position
Normal Findings: abdominal muscles receive Normal Findings: abdominal muscles receive concurrent innervation from T5-T12 nerve roots concurrent innervation from T5-T12 nerve roots (umbilicus does not move)(umbilicus does not move)
Positive Test: umbilicus is pulled toward the headPositive Test: umbilicus is pulled toward the head Characteristic of spinal cord injury between T6 and Characteristic of spinal cord injury between T6 and
T10 levelsT10 levels Upper abdominal muscles (rectus abdominis) are Upper abdominal muscles (rectus abdominis) are
intact at the top of the abdomen but weak at the intact at the top of the abdomen but weak at the lower portion, patient is asked to do a sit up – only lower portion, patient is asked to do a sit up – only the upper muscles contract (umbilicus pulled the upper muscles contract (umbilicus pulled toward the head)toward the head)
Clinical EvaluationClinical Evaluation
Resistive Range of Motion:Resistive Range of Motion: Flexion:Flexion:
Patient position – supine with knees Patient position – supine with knees flexed and feet flat on tableflexed and feet flat on table
Stabilization – pelvisStabilization – pelvis Resistance – applied to the superior Resistance – applied to the superior
sternum as patient lifts the scapulae off sternum as patient lifts the scapulae off the tablethe table
Muscles tested – rectus abdominis, Muscles tested – rectus abdominis, internal oblique, external obliqueinternal oblique, external oblique
Clinical EvaluationClinical Evaluation
Resisted Range of Motion:Resisted Range of Motion: Extension:Extension:
Patient position – prone with arms Patient position – prone with arms interlocked behind the headinterlocked behind the head
Stabilization – lower lumbar regionStabilization – lower lumbar region Resistance – applied to upper thoracic spine Resistance – applied to upper thoracic spine
as patient lifts head, chest, and arms off as patient lifts head, chest, and arms off tabletable
Muscles tested – iliocostalis lumborum, Muscles tested – iliocostalis lumborum, iliocostalis thoracis, longissimus thoracis, iliocostalis thoracis, longissimus thoracis, spinalis thoracis, semispinalis thoracis, spinalis thoracis, semispinalis thoracis, rotators, latissimus dorsirotators, latissimus dorsi
Clinical EvaluationClinical Evaluation
Resisted Range of Motion:Resisted Range of Motion: Rotation:Rotation:
Patient position – supine (hands Patient position – supine (hands interlocked behind head)interlocked behind head)
Stabilization – opposite ASISStabilization – opposite ASIS Resistance – anterior aspect of shoulder Resistance – anterior aspect of shoulder
as it is rotated off the tableas it is rotated off the table Muscles tested – internal oblique, Muscles tested – internal oblique,
external oblique (opposite side), external oblique (opposite side), rotators, multifidirotators, multifidi