The ‘neutral position’ (starting position) is the position in which the patient is standing upright with stretched knees (if possible) and the feet next to another. When testing the rotation capacity of the spine, the patient is seated on a stool with hips and knees in 90° flexion, so that the pelvis is fixed during this movement.
Procedure
- If needed, demonstrate the movements (the rotation in particular) and ‘guide’ the movements with both your hands particularly with the backward motion (= extension) and when dealing with elderly patients.
- Fixate the torso or the pelvis if needed.
- Inspect the movements at the dorsal side and assess:
- the course of the movement (fixations?, ‘escape behaviour’ in the painful section of the movement trajectory?, is the erector muscle of the spine tensed symmetrically?)
- the maximum movement trajectory
- the appearance of pain
- the appearance of crepitations
- observing contractures and/or compensatory movements
- Ask the patient to carry out the following movements:
Cervical spinal column (standing upright or seated)
- flexion (chin on chest) [Figure 18]
Figure 18
- extension [Figure 19]
Figure 19
- lateroflexion left/right [Figure 20]
Figure 20
- rotation left/right [Figure 21]
Figure 21
- nodding (test for C0 – C1 – C2) [Figure 22]
Figure 22
Thoracic and lumbar spine (standing upright except for the rotations)
- flexion (instruct the patient to first place the chin on the chest and then to bend further thoracolumbarly; the ultimate aim is to touch the floor with the fingers or hands whilst the knees are straight, thereby inhibiting compensation from the knees and hips) [Figure 23].
N.B. Pay attention to the appearance of a gibbus and also inspect laterally the size of the thoracic kyphosis (see also specific tests).
Figure 23
- extension (pay attention to compensatory flexion of knees and hips) [Figure 24]
Figure 24
- lateroflexion right/left (for this, ask the patient to let the right arm slide down along the right leg; repeat this for the left arm along the left leg) (pay attention to the presence of a scoliosis or an increase or decrease during this movement) [Figure 25]
Figure 25
- rotation right/left (test with patient seated) [Figure 26]
Figure 26
Sacro-iliac joints (with patient seated)
- Ask the patient to cross his/her legs in turn; whilst the patient does this, pay attention to any indications of pain at the level of the SI-joints. (In principle, movement in the sacro-iliac joint should be virtually impossible!) [Figure 27]
Figure 27