Lumbar & Hips ROM & MMT

thoracolumbar flexion

pt standing, feet shoulder width, spine neutral
stabilize pelvis ant (stop ant tilt)
pt bends forward (arms relaxed, knee straight)
stop when feel pelvis tilt forward
firm end-feel

thoracolumbar flexion tape measure

distance between T1 and S2
measure start & end
normal range = 4 inch difference

thoracolumbar flexion double inclinometers

over T1 spinous process & sacrum (S2)
zero at start, stabilize, do test motion, measure again
normal range = 60 degrees (difference between both)

fingertip to floor (flexion)

feet together, no stabilization
slowly bend forward, knees straight
measure distance from tip of 3rd finger to floor
normal range = 0.1 to 2.2 cm

thoracolumbar extension

pt standing, feet shoulder width, spine neutral
stabilize pelvis on back (stop post tilt)
pt leans back
stop when feel pelvis tilt back
firm maybe hard end-feel

thoracolumbar extension tape measure

distance between T1 & S2
measure start & end
no normal range
difference between start & end

thoracolumbar extension double inclinometers

over T1 spinous process & sacrum (S2)
zero at start, stabilize, test motion, measure again
normal range = 25 degrees (difference between both)

thoracolumbar lateral flexion

pt standing, feet shoulder width, spine neutral
stabilize pelvis on sides (stop lat tilt)
bend to one side (arms relaxed, knees straight)
feet stay flat on floor
firm maybe hard end-feel

thoracolumbar lateral flexion goniometer

fulcrum = S2 spinous process
prox arm = perpendicular to ground
dist arm = in line with T1
normal range = 35-38 degrees

thoracolumbar lateral flexion double inclinometers

over T1 spinous process & sacrum (S2)
zero at start, stabilize, test motion, measure again
normal range = 25 degrees (difference between both)

fingertip to floor (lateral flexion)

pt standing, back flat against wall
feet shoulder width, arms at sides
no stabilization
bend to side (keep back on wall & knees straight)
measure distance from 3rd finger to floor
no normal range

fingertip to thigh (lateral flexion)

same set-up as fingertip to floor
mark start & end position of middle finger on ant thigh
normal range = 21 cm

thoracolumbar rotation

pt seated, no back support, feet on floor, spine neutral
stabilize pelvis on back (stop rotation)
turn body to one side (keep trunk upright & feet on floor)
firm maybe hard end-feel

thoracolumbar rotation goniometer

fulcrum = over center of head
prox arm = parallel to imaginary line between ASIS or PSIS
dist arm = imaginary line between acromions
normal range = 45 degrees

thoracolumbar rotation double inclinometers

pt standing & flexed forward
rotate trunk w/o extending
over T1 & S2
zero at start, stabilize, test motion, measure again
no normal range

lumbar flexion

pt standing, neutral spine
stabilize pelvis on front (stop ant tilt)
bend forward
firm end-feel

lumbar flexion skin distraction

mark S2 & 15 cm above S2
line up tape between marks
test motion & measure again
normal range = 5.8 - 7.7 cm (measurement minus 15)

lumbar flexion double inclinometers

over T12 & S2
zero at start, stabilize, test motion, measure again
normal range = 60 degrees (difference between both)

lumbar flexion single inclinometer

over T12 & S2
zero at start, stabilize, test motion, measure again
measure each separately
no normal range (T12 minus S2)

lumbar extension

pt standing, feet shoulder width, spine neutral
stabilize pelvis on back (stop post tilt)
extend spine
firm maybe hard end-feel

lumbar extension skin distraction

mark S2 & 15cm above S2
line up tape between
test motion & measure again
no normal range (measurement minus 15)

lumbar extension double inclinometers

over T12 & S2
zero at start, stabilize, test motion, measure again
normal range = 20-42 degrees (difference between both)

lumbar extension single inclinometers

over T12 or S2
zero at start, stabilize, test motion & measure again
measure separately
no normal range (T12 minus S2)

lumbar lateral flexion

pt standing, feet shoulder width, spine neutral
stabilize pelvis on sides (stop lat tilt)
bend to one side
firm maybe hard end-feel

lumbar lateral flexion double inclinometers

over T12 & S2
zero at start, stabilize, test motion, measure again
normal range = 25-30 degrees (difference between)

lumbar lateral flexion single inclinometers

over T12 or S2
zero at start, stabilize, test motion, measure again
measure separately
no normal range (T12 minus S2)

trunk flexion MMT

rectus abdominis
supine, LE extended, flat lumbar spine, post pelvic tilt
no stabilization
palpate over ant abdomen (lat to midline)
pt flexes trunk (keep post tilt)
no resistance

trunk flexion grading

grades 3+ to 5 —> scapula clears table
5 = hands behind head
4 = arms across chest
3+ = arms straight at side
3 = arms at side, only upper scapula clears
2 = arms at side, only head & neck clear
1 = trace, no motion
0 = no trace, no motion

trunk flexion leg lowering test

rectus abdominis & ext oblique
supine, arms across chest, hips 90 flex, knees straight
no stabilization, one hand under pt lower back
palpate ant trunk (lat to midline)
pt lowers legs to table (keep knees straight & back flat)
no resistance

leg lowering grading

based on leg angle when lose tilt
5 = lowers legs to table
4+ = legs to 15 degrees from table
4 = legs to 30 degrees
4- = legs to 45 degrees
3+ = legs to 60 degrees
3 = legs to 70 degrees
2 = legs >75 degrees
1 = trace, no motion
0 = no trace, no motion

trunk rotation MMT

external & internal obliques
supine, hands behind neck, LE extended
stabilize over LEs
palpate anterolateral abdomen (lat to rectus abdominis)
pt flexes & rotates trunk
no resistance

trunk rotation grading

grades 3-5 — scapulae clear table
5 = arms behind neck
4 = arms across chest
3 = arms straight at sides
2 = gravity-eliminated (full or partial)
1 = trace, no motion
0 = no trace, no motion

trunk rotation gravity-eliminated test

pt seated, arms at sides, hands cannot grip table
stabilize pelvis
palpate anterolateral abdomen (lat to rectus abdominis)
pt turns to side (away from stabilized pelvis)

trunk extension MMT

erector spinae (thoracic & lumbar), multifidus, semispinalis thoracis, quadratus lumborum
prone, hands behind neck, LE extended
stabilize over post thighs & pelvis
palpate lat to lumbar & thoracic spinous processes
pt extends trunk
no resistance

trunk extension grading

grades 3-5 — sternum clears table
5 = hands behind neck
4 = hands at low back
3 = hands straight at side
2 = partial ROM
1 = trace, no motion
0 = no trace, no motion

pelvic elevation MMT

quadratus lumborum, iliocostalis lumborum
supine or prone, test hip slightly ABD, feet off table
pt holds table
palpate above post iliac crest (lat & deep to erectors)
pt elevates pelvis

pelvic elevation grading

5 = hold against max
4 = hold against mod
3 = hold against min
2 = full AROM
1 = trace, no motion
0 = no trace, no motion

hip flexion

pt supine, neutral pelvis & hips, knees straight
stabilize IL pelvis
flex hip (let knee bend)
soft, maybe firm end-feel

hip flexion goniometer

fulcrum = lateral hip (GT)
prox arm = pelvis lateral midline
dist arm = femur lateral midline (lat epicondyle)
normal range = 120-140

hip extension

pt prone, pelvis & hip neutral
or, sidelying (test hip on top), lower limb slight hip & knee flex
stabilize IL pelvis
extend hip (knee straight)
firm end feel

hip extension goniometer

fulcrum = lateral hip (GT)
prox arm = pelvis lateral midline
dist arm = femur lateral midline (lat epicondyle)
normal range = 18-30

hip abduction

pt supine, neutral pelvis & hips, knees straight
stabilize over iliac crest (stop lat tilt & rotation)
pt hip ABD (no rotation or flex)
firm end feel

hip abduction goniometer

fulcrum = ASIS
prox arm = imaginary line between both ASIS
dist arm = femur anterior midline
normal range = 40-55

hip adduction

pt supine, neutral pelvis & hip, knees straight, CL leg ABD
stabilize IL pelvis
ADD hip (no rotation or flex)
firm end feel

hip adduction goniometer

fulcrum = ASIS
prox arm = imaginary line between both ASIS
dist arm = femur anterior midline
normal range = 20-25

hip internal rotation

pt seated, knees & hips 90 flex, knees dangling
stabilize distal femur (stop ABD, ADD, flex & pelvis motion)
move lower leg lateral
firm end feel

hip IR goniometer

fulcrum = anterior patella
prox arm = perpendicular to floor or parallel to support
dist arm = lower leg anterior midline
normal range = 30-45

hip external rotation

pt seated, knees & hips 90 flex, knees dangling
stabilize distal femur (stop ABD, ADD, flex or pelvis motion)
move lower leg medial
firm end feel

hip ER goniometer

fulcrum = anterior patella
prox arm = perpendicular to floor or parallel to support
dist arm = lower leg anterior midline
normal range = 32-50

hip rotation alternative position

pt prone, test knee 90 flex, CL knee straight
move lower leg lateral for IR
move lower leg medial for ER

hip flexion MMT

iliacus & psoas major
pt seated, legs off table, hold table edge
stabilize IL iliac crest
hard to palpate
pt flexes hip
push over anterior distal thigh into hip extension

hip flexion gravity-eliminated

pt sidelying, test limb on bottom, hip extended, hip flexed
stand behind pt, stabilize pelvis & top leg
pt flexes hip w/ flexed knee
standard grading

hip flexion/ABD/ER MMT

sartorius
pt seated, legs off table, hold table edge
stabilize over IL iliac crest
palpate ant thigh
pt slides heel up CL shin
on distal thigh into hip ext & ADD, and on medial ankle into hip IR

hip flexion/ABD/ER gravity-eliminated

pt supine, test leg heel on CL ankle, CL leg straight
same stabilization, palpation & action
standard grading

hip flexion/ABD/ER common substitution

hip flexion only

prone hip extension MMT

glute max, semitendinosus, semimembranosus, biceps femoris
pt prone, legs extended
stabilize over post/sup pelvis
palpate post/inf pelvis & post/sup thigh
pt extends hip (knee straight)
push over post distal thigh into hip flexion

prone hip extension gravity-eliminated

pt sidelying, test leg on bottom (slight flex)
stand in front of pt & support upper leg
stabilize top pelvis
pt extends hip (knee straight)
standard grading

hip extension glute max II MMT

pt prone, hip extended, knee 90 flexion
stabilize over post/sup pelvis
palpate post/inf pelvis
pt extends hip (keep knee at 90)
push over distal thigh into hip flexion

hip extension glute max II gravity-eliminated

pt sidelying, test limb on bottom in slight hip flex, knee 90
stand in front, support upper leg, stabilize pelvis
palpate post/inf pelvis
pt extends hip (keep knee at 90)
standard grading

hip abduction MMT

gluteus medius & minimus
pt sidelying, test limb on top, hip slight ext, no rotation
stabilize pelvis from behind
palpate glute med (above GT)
pt abducts hip (no hip/pelvis rotation)
push over lateral distal thigh into hip ADD

hip abduction gravity-eliminated

pt supine, hip full ADD, knee straight
stabilize ant/lat IL pelvis
standard grading

hip abduction common substitutions

gravity resisted —> pelvis post rotation (allows TFL)
gravity eliminated —> hip ER (allows hip flexors)

hip abduction with flexion TFL I

tensor fascia lata
pt sidelying, test limb on top, hip 45 flexion
stabilize lateral pelvis from behind
palpate ant to GT & distal to ASIS
pt lifts leg w/o hip rotating
push over distal thigh into hip ADD

hip abduction with flexion gravity-eliminated

pt long sitting, hip 45 flexion, knee straight
stabilize ant/lat pelvis
standard grading

hip ABD & flexion common substitution

in gravity eliminated
hip ER allows hip flexor substitution

hip adduction MMT

adductor magnus, longus & brevis, pectineus, gracilis
pt sidelying, test limb on bottom, hip neutral
support top leg in 25-30 ABD & pelvis from behind
palpate medial thigh
pt lifts lower leg
push over medial distal thigh into hip ABD

hip adduction gravity eliminated

pt supine, non-test limb full ABD, test limb 0 ADD & knee straight
stabilize IL pelvis
standard grading

hip adduction common substitutions

in gravity-resisted
pelvis post rotation — allows hip flexors
pelvis ant rotation — allows hip extensors

hip medial rotation MMT

TFL, gluteus medius & minimus
pt seated, legs hanging
stabilize via pt BW
palpate ant/lat pelvis lateral to sartorius (ant glute med & TFL
pt IR hip — moves foot lateral
push medially over ant/med distal thigh & lat distal thigh

hip medial rotation gravity-eliminated

pt supine, test limb full hip ER & ext, knee straight
stabilize anterior IL pelvis
standard grading

hip IR common substitution

gravity-resisted
test side pelvis elevation, CL wt shift

hip lateral rotation MMT

piriformis, gemellus superior & inferior, obturator internus & externus, quadrates femoris
pt seated, legs hanging
pt BW stabilizes
palpate between sacrum & GT
pt ER hip (move foot medial)
push lateral over ant/lat distal thigh & medial distal leg

hip lateral rotation gravity eliminated

pt supine, test limb full IR & extension, knee straight
stabilize anterior IL pelvis
standard grading

hip ER common substitution

gravity-resisted
trunk lean toward test limb