Kines Final PracticalSpine

Cervical Flexion• Axis of Rotation : “Earhole” , External Auditory Meatus• Moving Arm : Align with base of nose• Stationary Arm : Perpendicular to ceiling or floor• pt position : Sitting, PT to the side

• Cues: “can you look down for me?” “Bring chin to chest”• Normal Values : 0- 40 Deg• Documentation : CSpine AROM Flexion 0-58Deg

• NotesAvoid awkard bends, look for consistent/even flexion. No protrusions / retractions.

Cervical Extension• Axis of Rotation : “Earhole” , External Auditory Meatus• Moving Arm : Align with base of nose• Stationary Arm : Parallel to ceiling or floor• pt position : Sitting, PT to the side

• Cues: “Let your head drop back and look at the ceiling for me”• Normal Values : 0 -50• Documentation : CSpine AROM Extension 0-68Deg

• NotesMay be painful, be quick. Be mindful for Vertebral artery test. Look for pure sagital motion, pure bend of CERVICAL not T/L.

Cervical Lateral Flexion• Axis of Rotation : C7 Spinous Process/ Protuberance • Moving Arm : Bisect the head• Stationary Arm : Perpendicular to the ground• pt position : sitting

• Cues: “can you bring your right ear to your right shoulder”• Normal Values : 0 – 20 Deg• Documentation : Cspine AROM R/L Lat Flexion 0-38Deg

• Notesconfirm you are on C7, look for pure cervical motion in frontal plane, mirror can help

Cervical Rotation• Axis of Rotation : Center of Cranium• Moving Arm : Line that aligns with base of nose• Stationary Arm : Line that connects acomions• pt position : sitting, PT above head

• Cues: “can you turn and look over R/L shoulder?”• Normal Values : 0- 90deg• Documentation : Cspine AROM R/L Rotation 0-77Deg

• NotesLook for pure rotation, avoid flexion, extension.

ThoracoLumbar Rotation• Axis of Rotation : Straight through cranium superior to inferior• Moving Arm : line between acromions• Stationary Arm : line between iliac crests• pt position : sitting in pelvic neutral, “good posture” for “zero”

• Cues: “place arms across chest, turn body to R/L”• “Normal” Values : 0 – 40degrees • Documentation : AROM R/L ThoracoLumbar Rotation 0-35deg

• Notes:Make sure it’s a transverse motion, avoid flexion, shoulder pulling in place of rotation, “pure twist”

ThoracoLumbar Flexion• Axis of Rotation : Line across T12• Inclinometer Position : Base right above T12 line• pt position : Standing, Pelvis Blocked

• Cues: “lean down and try to touch your toes”• Normal Values : 0-100 Deg• Documentation : AROM T/L Flexion 0-84deg iPhone App

• Notesmay need someone to help block or take inclinometer readingZERO inclinometer

ThoracoLumbar Extension• Axis of Rotation : Line across T12• Inclinometer Position : Base right above T12 line• pt position : Standing, Pelvis Blocked

• Cues: “Try and lean back for me, as far as you can go”• Normal Values : 0-25 Deg• Documentation : AROM T/L Flexion 0-90deg iPhone App

• Notesmay need someone to help block or take inclinometer readingZERO inclinometer

Lumbar Flexion• Axis of Rotation : Line across S2• Inclinometer Position : Base right above PSIS line• pt position : Standing, Pelvis Blocked

• Cues: “lean down and try to touch your toes”• Normal Values : 0-50 Deg• Documentation : AROM L Flexion 0-14deg iPhone App• Take T/L measurement and subtract what you get for L Flexion

• Notesmay need someone to help block or take inclinometer readingZERO inclinometer

Lumbar Extension• Axis of Rotation : Line across S2• Inclinometer Position : Base right above PSIS line• pt position : Standing, Pelvis Blocked

• Cues: “Lean back all the way for me as far as you can”• Normal Values : 0-20 Deg• Documentation : AROM L Extension 0-14deg iPhone App• Take T/L measurement and subtract what you get for L extension

• Notesmay need someone to help block or take inclinometer readingZERO inclinometer

ThoracoLumbar Lateral Flexion• Axis of Rotation : Line across T12• Inclinometer Position : Flat against pt spine, base T12• pt position : Standing, Pelvis Blocked

• Cues: “slide your R/L arm down R/L leg as far as you can”• Normal Values : 0-30 Deg• Documentation : AROM T/L SideBend R/L 0-14deg iPhone App

• NotesPure side-bending, avoid tri-planar motion. Look for symmetrical movements and angulations. Differences bi-laterally. Avoid pelvis shifting/hip hiking.

MANUAL MUSCLE TESTING

For All :Grade 0 = No contraction or Motion

Capital Extension• Muscles used : Rectus Capitus Posterior Min/Maj, Sup/Inf

Oblique• Position: Prone for 3,4,5 Supine for 1,2 *Use towel on

forehead for comfort or pop out face piece

• Grade 5: Prone, Can you tilt your head back? Max resist• Grade 4:Prone, Can you tilt your head back? Mod resist• Grade 3:Prone, Can you tilt your head back? No Resist, Full

ROM• Grade 2: Supine, Can you tilt your head back ? Movement• Grade 1: Supine, Can you tilt your head back ? Contraction of

sub-occipitals

Cervical Extension• Muscles used : Splenius cervicis & capitis, Semispinalis cervicis• Position: Prone for 3,4,5 Supine for 1,2

• Grade 5: Prone, Can you move your whole head towards the ceiling without looking up ? Max Resist

• Grade 4:Prone, Can you move your whole head towards the ceiling without looking up ? Mod Resist

• Grade 3:Prone, Can you move your whole head towards the ceiling without looking up ? Full ROM, no resist

• Grade 2: Supine, Push head into table, any motion• Grade 1: Supine, Push head into table, any contraction

Capital Flexion• Muscles used : Rectus Capitus Ant/Lat ,Longus Capitus• Position: Supine

• Grade 5: Supine, “Nod”, Head on neck, max resist on side of head

• Grade 4: Supine, “Nod”, Head on neck, min resist on side of head

• Grade 3:Supine, “Nod”, Head on neck, full ROM• Grade 2: Supine, “Nod”, Partial ROM• Grade 1: Supine, “Nod”, Contraction

Cervical Flexion• Muscles used : SCM, Longus Colli, Ant Scalene• Position: Supine

• Grade 5: Supine, Bring head straight up, keep looking straight, Max Resist

• Grade 4:Supine, Bring head straight up, keep looking straight, Mod Resist

• Grade 3:Supine, Bring head straight up, keep looking straight, Full ROM

• Grade 2: Supine, Ask for cervical rotation side to side• Grade 1: Trace, Ask for cervical rotation, Check Opp. SCM

Cervical Rotation• Muscles used : SCM, Levator Scap, Upper Trap, Scalenes• Position: Supine; PT should guard against gravity rotating

• Grade 5: Supine, Max Resist against rotation to left and right• Grade 4: Supine, Mod Resist against rotation to left and right• Grade 3: Supine rotated to one side, Rotate head all the way

to the other side, keep looking straight, Full ROM• Grade 2: Supine, Rotation, Partial ROM or Gravity Rotating

Grade 2: Sitting, Rotation, Full ROM • Grade 1: Trace; Contralateral SCM, scalenes,

Lumbar Extension• Muscles used : Erector Spinae• Position: Prone; Ankles stabilized

• Grade 5: Prone, Lift trunk off table, Belly button clears table with no difficulty

• Grade 4:Prone, Lift trunk off table, Belly button clears table with little time or difficulty

• Grade 3:Prone, Lift trunk off table, Belly button clears table but can’t hold

• Grade 2: Prone, Lift trunk off table, Belly button doesn’t clear• Grade 1: Trace

Thoracic Extension• Muscles used : Erector Spinae• Position: Prone; Nipple line to base of table, Ankle Stabilized

• Grade 5: Prone, Comes to horizontal immediately • Grade 4:Prone, Comes to horizontal with little difficulty• Grade 3:Prone, Comes to horizontal but can’t hold• Grade 2: Prone, Come to horizontal, partial ROM• Grade 1: Trace

Trunk Flexion• Muscles used : Rectus Abdomis, Ext Oblique, Int Oblique• Position: Supine; Arm placement varies

• Grade 5: Arms behind head, Lift up, Clears Inf. Angle of Scap• Grade 4: Arms across chest, Lift up, Clears Inf. Angle of Scap• Grade 3: Arms on side, Lift up, Clears Inf. Angle of Scap• Grade 2: Sequence (Arms to side)• Head Raise : Lift head off table, Scap comes off = Grade 2• Assisted Fwd Lean : PT cradle head & shoulder, “can you lean

forward” depression of rib cage = Grade 2• No depression but contraction of Rectus Abdominis = Grade 1

• Cough : Head and Shoulder cradled, “cough” = Grade 2• Can’t cough but contracts Rectus = Grade 1

Trunk Rotation• Muscles used : Contralateral External Oblique, Internal

Oblique• Position: Supine, Looking for Scapula to clear

• Grade 5: Supine, Arms behind head, Try to bring elbow to opposite hip, Smooth motion

• Grade 4: Supine, Arms across chest, Try to bring elbow to opposite hip, Smooth motion

• Grade 3: Supine, Arms on side, Try to bring elbow to opposite hip, Smooth motion

• Grade 2: Supine, Arms on side, Try to bring elbow to head, Partial ROM

• Grade 1: Assist and ask for movement, Trace