{"id":660,"date":"2010-12-02T15:26:20","date_gmt":"2010-12-02T15:26:20","guid":{"rendered":"https:\/\/cloverock.info\/mockosce23\/new\/examination-of-active-range-of-motion\/"},"modified":"2023-01-11T21:25:22","modified_gmt":"2023-01-11T21:25:22","slug":"examination-of-active-range-of-motion","status":"publish","type":"post","link":"https:\/\/www.qpercom.com\/sim\/index.php\/the-examination-of-the-spine\/principles-techniques-a-procedure-for-the-exam\/examination-of-active-range-of-motion\/","title":{"rendered":"Examination of active range of motion"},"content":{"rendered":"<p>The \u2018neutral position\u2019 (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\u00b0 flexion, so that the pelvis is fixed during this movement.<\/p>\n<p><iframe loading=\"lazy\" src=\"https:\/\/player.vimeo.com\/video\/124535603?dnt=1&amp;app_id=122963\" width=\"640\" height=\"480\" frameborder=\"0\" allow=\"autoplay; fullscreen; picture-in-picture\" allowfullscreen><\/iframe><\/p>\n<h2>Procedure<\/h2>\n<ul>\n<li>If needed, demonstrate the movements (the rotation in particular) and \u2018guide\u2019 the movements with both your hands&nbsp; particularly with the backward motion&nbsp;(= extension) and when dealing with elderly patients.<\/li>\n<li>Fixate the torso or the pelvis if needed.<\/li>\n<li>Inspect the movements at the dorsal side and assess:\n<ul>\n<li>the course of the movement (fixations?, \u2018escape behaviour\u2019 in the painful section of the movement trajectory?, is the erector muscle of the spine tensed symmetrically?)<\/li>\n<li>the maximum movement trajectory<\/li>\n<li>the appearance of pain<\/li>\n<li>the appearance of crepitations<\/li>\n<li>observing contractures and\/or compensatory movements<\/li>\n<\/ul>\n<\/li>\n<li>Ask the patient to carry out the following movements:<\/li>\n<\/ul>\n<p><em><strong>Cervical spinal column<\/strong><\/em> (standing upright or seated)<\/p>\n<ul>\n<li>flexion (chin on chest) [Figure 18]<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-650\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Spine_18_MG_2462.jpg\" alt=\"18_MG_2462\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_18_MG_2462.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_18_MG_2462-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 18<\/span><\/span><\/p>\n<ul>\n<li>extension [Figure 19]<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-651\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Spine_19_MG_2463.jpg\" alt=\"19_MG_2463\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_19_MG_2463.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_19_MG_2463-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 19<\/span><\/span><\/p>\n<ul>\n<li>lateroflexion left\/right [Figure 20]<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-652\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Spine_20_MG_2464.jpg\" alt=\"20_MG_2464\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_20_MG_2464.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_20_MG_2464-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 20<\/span><\/span><\/p>\n<ul>\n<li>rotation left\/right [Figure 21]<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-653\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Spine_21_MG_2465.jpg\" alt=\"21_MG_2465\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_21_MG_2465.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_21_MG_2465-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 21<\/span><\/span><\/p>\n<ul>\n<li>nodding (test for C0 &#8211; C1 &#8211; C2) [Figure 22]<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-654\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Spine_22_MG_2466.jpg\" alt=\"22_MG_2466\" width=\"400\" height=\"293\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_22_MG_2466.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_22_MG_2466-300x220.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 22<\/span><\/span><\/p>\n<p><em><strong>Thoracic and lumbar spine<\/strong><\/em> (standing upright except for the rotations)<\/p>\n<ul>\n<li>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].<br \/>\n<em>N.B.<\/em> Pay attention to the appearance of a gibbus and also inspect laterally the size of the thoracic kyphosis (see also specific tests).<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-655\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Spine_23_MG_2468.jpg\" alt=\"23_MG_2468\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_23_MG_2468.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_23_MG_2468-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 23<\/span><\/span><\/p>\n<ul>\n<li>extension (pay attention to compensatory flexion of knees and hips) [Figure 24]<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-656\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Spine_24_MG_2469.jpg\" alt=\"24_MG_2469\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_24_MG_2469.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_24_MG_2469-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 24<\/span><\/span><\/p>\n<ul>\n<li>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&nbsp; or an increase or decrease during this movement) [Figure 25]<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-657\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Spine_25_MG_2471.jpg\" alt=\"25_MG_2471\" width=\"400\" height=\"295\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_25_MG_2471.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_25_MG_2471-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 25<\/span><\/span><\/p>\n<ul>\n<li>rotation right\/left (test with patient seated) [Figure 26]<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-658\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Spine_26_MG_2474.jpg\" alt=\"26_MG_2474\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_26_MG_2474.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_26_MG_2474-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 26<\/span><\/span><\/p>\n<p><em><strong>Sacro-iliac joints <\/strong><\/em>(with patient seated)<\/p>\n<ul>\n<li>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]<\/li>\n<\/ul>\n<p><span class=\"jce_caption\" style=\"display: inline-block;\"><img loading=\"lazy\" decoding=\"async\" class=\" size-full wp-image-659\" style=\"margin: auto;\" src=\"https:\/\/cloverock.info\/mockosce23\/new\/wp-content\/uploads\/2010\/12\/Spine_27_MG_2475.jpg\" alt=\"27_MG_2475\" width=\"400\" height=\"294\" srcset=\"https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_27_MG_2475.jpg 400w, https:\/\/www.qpercom.com\/sim\/wp-content\/uploads\/2010\/12\/Spine_27_MG_2475-300x221.jpg 300w\" sizes=\"auto, (max-width: 400px) 100vw, 400px\" \/><span style=\"width: 400px; display: block;\">Figure 27<\/span><\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>The \u2018neutral position\u2019 (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\u00b0 flexion, so that the pelvis is fixed during [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[66],"tags":[142],"class_list":["post-660","post","type-post","status-publish","format-standard","hentry","category-principles-techniques-a-procedure-for-the-exam","tag-the-examination-of-the-spine"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Examination of active range of motion - Qpercom | Skills in Medicine<\/title>\n<meta name=\"description\" content=\"Online Mock OSCEs with examiners, patient actors, instant results and personalised feedback. 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