Primarily, during the examination of the back the strength of the muscles is tested, since weak muscles can have a direct influence on posture.
Procedure
- The position of the patient depends on the muscle(group)(s) tested.
- Always ask about pain (and its location) when muscles are tensed by a patient.
- If required, palpate during the tension of the muscles:
- the maximum point of the pain
- the tone, for which the fingers are placed transverse to the course of the muscle fibres to gain an impression of the degree of contractility (hypo- or hypertonia)
- to differentiate between a lipoma and muscle hernia
- when an avulsion or muscle rupture is suspected
- Testing the musculature of the back
A. With patient standing upright [Figure 28]
- First determine the tone of the erector muscle of spine (higher lumbar) and multifidus muscle (lower lumbar) in the starting position. Then allow the patient to walk in place and again palpate bilaterally the lumbar paravertebral musculature.
Pay attention to the presence of hypertonia.
Figure 28
B. With the patient lying in a prone position [Figure 29]
- Fixate the legs of the patient just proximally from both ankles.
- Ask the patient to place his/her hands on top of the head and to subsequently lift the torso from the examination couch.
- Normally a patient should be capable of lifting the complete upper body (at least past the xiphoideus process of the sternum) from the examination couch.
Figure 29
Interpretation
In this position the hip extensors also contribute. In the case of weak hip extensors and normal back muscles, the patient will not be able to lift the torso from the examination table but still carry out a hyperextension of the back. If this happens, further examinations are indicated to exclude or identify a muscular imbalance (see section 3: ‘Special examination techniques’) or a neurological cause.
Testing the musculature of the abdomen
A. The rectus abdominis muscle
- The patient is in a supine position with the legs stretched
- Ask the patient to place the arms behind the head and to subsequently lift the torso upwards [Figure 30]
Figure 30
B. The left internal oblique muscle and the right external oblique muscle
- The patient is in a supine position with the legs stretched andboth arms behind the head
- Ask the patient to point both elbows to the left and from this position lift the torso diagonally to the left and upwards [Figure 31]
Figure 31
C. The right internal oblique muscle and the left external oblique muscle
- The patient is in a supine position with the legs stretched and both arms behind the head
- Ask the patient to point both elbows to the right and from this position lift the torso diagonally to the right and upwards.
Interpretation
Normally, if the abdominal muscles are strong enough, these movements should take place with a convex back; weak abdominal muscles result in a hyperextension (= concavity) of the back.
In these positions the hip flexors also contribute. In case of weak hip flexors, the torso can only be partially lifted and cannot be moved towards the legs.
If this happens, further examinations are indicated to exclude or identify a muscular imbalance (see section 3: ‘Special examination techniques’) or a neurological cause.