Fiu thoracic and lumbar spine clinical evaluation

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

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 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


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


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


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


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


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)


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


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


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


General General Inspection:Inspection: Sagital Curvature:Sagital Curvature:

Normal Normal Alignment:Alignment:

Lordotic cervicalLordotic cervical Kyphotic Kyphotic

thoracicthoracic Lordotic lumbarLordotic lumbar Kyphotic sacralKyphotic sacral


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


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


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)


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


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


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


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


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


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


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?


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


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


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 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


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


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)


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


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


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

Fiu thoracic and lumbar spine clinical evaluation

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