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Spine Movements

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Spine Movements

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Spine Movements occur in the sagittal, coronal and horizontal plane. The movements include Forward Spine Flexion, Extension, Side Flexion and Rotation.

The plane of the facet joint is at an angle of 60° to the horizontal. The facets are more vertically oriented than the cervical region. Hence the forward flexion is limited. Extension is limited due to the inferior articular process touching the subsequent lamina and the spinous process coming into contact with each other. Rotation is the main plane of movement possible in the thoracic spine.

See Also: Adams Forward Bend Test

Spine Movements Tests

Forward Spinal Flexion

The amount of forward spinal flexion possible in thoracic spine is 20–45°.

Because the range of motion at each vertebra is difficult to measure, the examiner can use a tape measure to derive an indication of overall movement as following:

  • The examiner first measures the length of the spine from the C7 spinous process to the T12 spinous process with the patient in the normal standing posture.
  • The patient is then asked to bend forward, palpate the spinous process of T12 and L1.
  • Place one hand on the back of the patient to detect the point at which the spinal extension moves into the lumbar vertebrae and the spine is again measured.
  • A 2.7 cm (1.1 in.) difference in length is considered normal.
spine flexion
Forward bending with patient sitting to measure the flexion of spine

Note is made of the ease with which the patient is able to carry out the movement. While the patient is bending forward, the examiner observes the spine from the “skyline” view.

The prominence is measured by a scoliometer giving an angular reading, or by measuring the height of the prominence directly and recorded in centimeters. If the patient has a non-structural scoliosis, it disappears during flexion while a structural scoliosis persists.

spine skyline view
Patient is asked to bend forward. The prominence is viewed “skyline” from the caudad end. The difference in the height of the prominence on the either side of the spinous process is depicted directly in centimeters in the scoliometer or as a angular reading,

Spine Extension

As with spine flexion, the examiner can use a tape measure and obtain the distance between the same two points (the C7 andT12 spinous processes). Again a 2.5 cm difference in tape measure length between standing and extension is considered normal.

Palpate the spinous process of T12 and L1 and detect at which the spine extension moves into the lumbar vertebrae. McKenzie advocates the examiner to place the hands on the lumbosacral region to add stability while performing the backward movement or to do extension while sitting or prone lying (sphinx position)”.

spine extension
Evaluating extension of thoracic spine in the standing position
spine extension
Evaluation of extension of the thoracic spine in prone position

Spine Side Flexion

Side flexion (lateral flexion of spine) is approximately 20–40° to the right and left in the thoracic spine.

The patient is asked to run the hand down the side of the leg as far as possible without bending forward or backward. The examiner can then estimate the angle of side flexion or use a tape measure to determine the length from the fingertips to the floor and compare it with that of the other side. Normally, the distances should be equal.

If, on side flexion, the ipsilateral paraspinal muscles tighten or their contracture is evident (Forrestier’s bowstring sign), ankylosing spondylitis or pathology causing muscle spasm should be considered.

A wedge or block is placed under the patient’s buttock on the side being tested. The elevation of the buttock will lock the lumbar spine in contralateral side bending and ipsilateral rotation. Instruct the patient to rotate as far as possible toward the side where the block was placed.

Spine Side Flexion
Side or lateral flexion in thoracic spine

Spine Rotation

Rotation in the thoracic spine is approximately 35–50°.

The patient is asked to cross the arms in front or place the hands on opposite shoulders and then rotate to the right and left while the examiner looks at the amount of rotation, comparing both ways. Again, the examiner must remember that movement in the lumbar spine and hips as well as in the thoracic spine is occurring.

To eliminate or decrease the amount of hip movement, rotation may be done in sitting. To eliminate rotation of lumbar spine, a wedge is given under the ipsilateral buttock.

Spine Rotation
Thoracic rotation to be examined in sitting posture with wedge on one side under the ischial tuberosity to prevent rotation at the lumbar level

Chest Expansion

Costovertebral joint movement is usually determined by measuring chest expansion.

The examiner places the measuring tape around the chest at the level of the fourth intercostal space. The patient is asked to exhale as much as possible, and the examiner takes a measurement. The patient is then asked to inhale as much as possible and hold the breath while the second measurement is taken. The normal difference between inspiration and expiration is 3–7.5 cm (1–3 in.).

References

  • Sarvdeep S. Dhatt, Sharad Prabhakar – Handbook of Clinical Examination in Orthopedics. An Illustrated Guide-Springer Singapore.
  • Santolin SM. McKenzie diagnosis and therapy in the evaluation and management of a lumbar disc derangement syndrome: A case study. J Chiropr Med. 2003 Spring;2(2):60-5. doi: 10.1016/S0899-3467(07)60044-5. PMID: 19674597; PMCID: PMC2646960.
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