FCS MMT - LE and Spine

Capital FLEX mm.

Rectus capitis anterior, rectus capitis lateralis, longus capitis

Capital EXT mm.

Rectus capitis posterior major and minor

Obliquus capitis superior and inferior

Longissimus capitis

Splenius capitis

Semispinalis capitis

Upper trapezius

Spinalis capitis

Posterior SCM

Cervical FLEX mm.

SCM

Longus colli

Anterior scalene

Cervical EXT mm.

Longissimus cervicis

Semispinalis cervicis

Iliocostalis cervicis

Splenius cervicis

Upper trapezius

Spinalis cervicis (often absent)

Quiet Inspiration mm.

Diaphragm

External and Internal Intercostals

Innermost Intercostals

Scalenes

Levator Costarum

Forced Expiration mm.

External and internal obliques

Transverse Abdominis

Rectus Abdominis

Internal Intercostals

Latissimus Dorsi

Trunk FLEX mm.

Rectus Abdominis

External and Internal Obliques

Trunk EXT mm.

Iliocostalis thoracis/lumborum

Longissimus thoracis

Spinalis thoracis

Semispinalis thoracis

Multifidi

Rotatores thoracis/lumborum

Interspinales thoracis/lumborum

Intertransversarii thoracis/lumborum

Quadratus lumborum

Trunk ROT mm.

External and internal obliques

Pelvis Elevation mm.

Quadratus lumborum

External and internal obliques

Hip FLEX mm

iliopsoas

Hip FLEX, ABD, and ER mm.

Sartorius

Hip EXT mm.

Gluteus maximus

Biceps femoris-long head

Semitendinosus

Semimembranosus

Hip ABD mm.

Gluteus medius

Gluteus minimis

Hip ABD and FLEX mm.

TFL

Hip ADD mm.

Adductor magnus

Adductor brevis

Adductor longus

Gracilis

Pectineus

Hip IR mm.

Gluteus minimis

Gluteus medius

TFL

Hip ER mm.

Obturator externus and internus

Quadratus femoris

Piriformis

Gemelli mm.

Gluteus maximus

Knee FLEX mm

Biceps femoris

Semitendinosus

Semimembranosus

Knee EXT mm.

Rectus femoris

Vastus intermedius

Vastus lateralis

Vastus medialis longus and obliquus

Ankle DF and Inversion mm.

Tibialis anterior

Ankle PF mm.

Gastrocnemius

Soleus

Ankle inversion mm.

Tibialis posterior

Ankle eversion mm.

Peroneus longus and brevis

Great toe MTP FLEX mm.

Flexor hallucis brevis

Great Toe MTP and IP EXT

Extensor hallucis longus

Great toe IP FLEX mm.

Flexor hallucis longus

Lesser toe MTP FLEX mm.

Lumbricals

Lesser Toe MTP EXT mm.

Extensor Digitorum brevis

Lesser Toe IP FLEX mm.

Flexor digitorum longus and brevis

Lesser Toe IP EXT mm.

Extensor digitorum longus

Capital FLEX position

supine w/ head supported on table; arms by side

Capital FLEX cue

Tuck your chin. Don’t lift your head from the table. Hold it. Now, don’t let me lift up your chin.

Capital FLEX Screening Palpation

Capital Flexor muscles

Capital FLEX stabilization

Head is stabilized by table

Capital FLEX Resistance

Hands cupped under mandible.

Upward and backward direction.

Capital EXT pt. positioning

Prone w/ head off table; arms at side

Capital EXT cue

Look at the wall in front of you

Capital EXT Screening Palpation

Suboccipitals on either side of C2

Capital EXT Stabilization

Hand under the head to guard

Capital EXT Resistance

over the occiput

Capital EXT 0-2 Grading

In Supine, look to the back wall w/o lifting head

Cervical FLEX pt. position

supine w/ head supported on table; arms at side

Cervical FLEX Cue

Bring your head off the table, keeping your eyes on the ceiling and shoulder on the table.

Cervical FLEX Screening Palpation

SCM (BE CAREFUL OF CAROTID)

Cervical FLEX Stabilization

Table provides stabilization

Cervical FLEX Resistance

Two fingers on pt’s forehead

Cervical FLEX Substitutions to watch for

Corners of mouth pulling down; skin wrinkling on anterior surface of neck

Cervical EXT pt. position

Prone w/ head off table; arms at side

Cervical EXT Cue

lift your forehead from my hand and keep looking at the floor

Cervical EXT Screening Palpation

Paraspinals on either side of mid-cervical vertebrae

Cervical EXT Stabilization

Hand under head to guard

Cervical EXT Resistance

2 fingers over the parieto-occipital area

Cervical EXT 0-2 Grading

Supine w/ head fully supported by table, pushing head down into clinician’s hands

Cervical ROT pt. positioning

Supine w/ cervical spine in neutral. Face turned as far to one side as possible

Cervical ROT cue

Turn your head and face to the ceiling. Hold it. Do not let me turn your head back.

Cervical ROT Screening Palpation

SCM or scalenes on contralateral side

Cervical ROT stabilization

head supported by talbe

Cervical ROT Resistance

Hand is placed over the side of head above the ear.

Cervical ROT Grade 0-2

In sitting, trunk and head supported by high-back chair. Head posture in neutral.

Quiet Inspiration pt. positioning

supine

Quiet inspiration cue

Take a full breath and hold it

Quiet inspiration screening

Observe normal respiration in sitting w/ contraction of the neck and abdominal muscles

Quiet inspiration stabilization

epigastric area below xiphoid process

Quiet inspiration resistance

One hand just below the xiphoid process.

Resistance in a downward direction.

Grade 5 quiet inspiration

high resistance = 100 pounds

Grade 4 quiet inspiration

Maximal inspiration occurs, but they can’t hold against heavy resistance

Grade 3 Quiet Inspiration

Completes inspiration, but can’t tolerate manual resistance

Grade 2 Quiet Inspiration

Epigastric rise w/o full inspiration expansion

Grade 1 Quiet Inspiration

Palpate contraction as pt sniffs with mouth closed

Things to look for during quiet inspiration (substitutions)

Hyperextension of lumbar spine or contraction of abdominal mm.

Forced expiration pt. positioning

sitting

Forced expiration cue

Give me a hard cough

Forced expiration Functional Grade

Normal or only slight impairment

Forced expiration Weak Functional Grade

Moderate impairment that affects the degree of active motion or endurance

Forced expiration Nonfunctional grade

Severe impairment

Forced Expiration Zero Grade

No cough

Trunk FLEX pt. positioning

Supine w/ hands clasped behind head

Trunk FLEX cue

Keep legs on the mat and try to get your entire scapula off the mat

Trunk FLEX screening palpation

Midline of thorax over line alba, 4 fingers of both hands for palpation

Trunk FLEX stabilization

Body weight stabilizes

Trunk FLEX Grade 5

Hands on head, inferior angle of scapula clears

Trunk FLEX Grade 4

Hands across chest, inferior angle of scapula clears

Trunk FLEX Grade 3

Hands outstretched in front, inferior angle of scapula clears

Trunk FLEX Grade 2

Arms outstretched and no scapular clearance

If the pt. can’t lift their head during Trunk FLEX, what movement can you do?

An assisted forward lean

What grade does a pt. get during an assisted forward lean during Trunk FLEX MMT if there is depression of the ribcage?

Grade 2

What grade does a pt. get during an assisted forward lean for Trunk FLEX MMT if there is a visible or palpable contraction?

Grade 1

What grade does a pt. get during an assisted forward lean during Trunk FLEX MMT if there is no activity?

Grade 0

If the grade for an assisted forward lean during Trunk FLEX MMT is 0, what movement do you assess next?

PT uses coughing

What grade does a pt. get if they can cough and there is a depression of a ribcage during Trunk FLEX MMT?

Grade 2

What grade does a pt. get if they can’t cough, but there is a palpable contraction during Trunk FLEX MMT?

Grade 1

Trunk EXT Lumbar pt. positioning

Prone with head and upper trunk supported by the table

Thoracic and Lumbar Trunk EXT Cue

Lift your trunk up as much as you can

Lumbar Trunk EXT Screening Palpation

Lumbar region

Thoracic and Lumbar Trunk EXT Stabilization

Strap on pelvis, and therapist stabilizes legs

Grade 5 for Lumbar Trunk EXT MMT

Hands behind the head, umbilicus clears, muscle holds like a lock

Grade 4 for Lumbar Trunk EXT MMT

Hands behind back, umbilicus clears, slight elasticity at the end point

Grade 3 for Lumbar and Thoracic EXT MMT

arms at side, umbilicus clears the table

Grade 2 for Lumbar and Thoracic EXT MMT

arms at side, head and upper portion of sternum clear table