Lumbar Spine Range Of Motion

Original Editor - Lucinda hampton

Top Contributors - Lucinda hampton and Kim Jackson  

Introduction[edit | edit source]

Assessment of range of motion (ROM) of the lumbar spine is an important part lumbar spine examination. Aberrant spinal motion is associated with faulty spinal mechanics. Motion of the lumbar spine is assessed in all planes including flexion, extension, side bending, and rotation.[1]

Table: Average Healthy Ranges of Motion Measured from Anatomic Position: Lumbar spine[2]

Flexion 50 degrees
Extension 15 degrees
Right lateral flexion 20 degrees
Left lateral flexion 20 degrees
Right rotation 5 degrees
Left rotation 5 degrees

When assessing movement

  • With AROM looking for willingness to move, quality of movement, where movement occurs, range, pain, painful arc and deviations.
  • Overpressure (at the end of all AROM if they are pain-free), normal end-feel should be tissue stretch.

Methods[edit | edit source]

Testing Lx Flexion
Inclinometer

The most accurate method to measure the movement of the vertebrae is through radiography, but use of long-term radiography is not sensible due to risk of radiation and cost. [1] Other methods of measurement include:

  • Fingertip to floor test (uses tape measure)
  • Schober test and modified Schober test (uses tape measure)
  • Inclinometer: an expensive handheld, circular, fluid-filled disc that has a weighted gravity pendulum attached to it that is maintained in the vertical direction. It is graduated by 0.5 degree intervals over 360 degrees.
  • Goniometer
  • Tape measure: inexpensive instrument for measuring spinal motion, and possibly the easiest to use.
  • Visual observation

Variations ROM Norms[edit | edit source]

Variables affect lumbar range of motion: There are significant differences between the motion characteristics of the normal (see table above) and LBP populations. However, due to the diverse nature of these populations, there is great variability within the two groups. This limits the clinical usefulness of these measurements.[3]

  1. Flexion (73-40 degrees) declines noted with age.
  2. Lateral flexion (28-14 degrees, L&R) declined with age.
  3. Extension (29-6 degrees) declined the greatest at 79% with age.
  4. No decline in axial rotational (7%) way across the age spectrum. [4]

Researches in 2005 created a "comprehensive, gender-specific, broadly based and age-related indices for normative lumbar ranges of motion in all planes of movement. These are applicable to individuals throughout adult life, from adolescence through to old age". [4]

ADLs[edit | edit source]

Housework

Most individuals use a relatively small percentage of their full active ROM when performing activities of daily living (ADLs). The ROM and percentage of full active lumbar spinal ROM used during 15 ADLs was 3 to 49 degrees (in the study a 2010 study).[5]

  1. When looking at lifting an object from the ground requires: via squatting requires 42 degrees amount of sagittal motion; bending at the waist requires 48 degrees of sagittal motion.
  2. Ascending and descending stairs require equivalent amounts of total motion in all 3 motion planes, all being less than the above figures.
  3. Grouped together, personal hygiene ADLs (hand washing, washing hair, shaving, and make-up application) required a similar amount of motion compared with the walking and going up and down stairs.

Validity[edit | edit source]

The medical management of LBP patients is based upon clinical history and physical findings, and the measurement of motion forms a core component of assessment. The measurement of motion has the advantage of being more objective and quantifiable than the assessment of subjective measures such as pain. However systematic review concluded there is little evidence to support the use of current methods of range of movement measurement in the lumbar spine. They noted that if ROM is to continue to be to assess spinal function, degree of impairment and response to therapeutic input, scientific evidence on the validity of these procedures need be found.[6][3]

References[edit | edit source]

  1. 1.0 1.1 Musculoskeletal Key Physical Examination of the Lumbar Spine Available: https://musculoskeletalkey.com/physical-examination-of-the-lumbar-spine/ (acessed 20.11.2022)
  2. Learn muscles Motions of the Joints of the Lumbar Spine Available;https://learnmuscles.com/blog/2017/08/30/motions-lumbar-spine/ (accessed 21.11.2022)
  3. 3.0 3.1 McGregor AH, McCarthy D, Dore CJ, Hughes SP. Quantitative assessment of the motion of the lumbar spine in the low back pain population and the effect of different spinal pathologies on this motion. European Spine Journal. 1997 Sep;6(5):308-15.Available;https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3454599/pdf/586_2005_Article_BF01142676.pdf (accessed 20.11.2022)
  4. 4.0 4.1 Troke M, Moore AP, Maillardet FJ, Cheek E. A normative database of lumbar spine ranges of motion. Manual therapy. 2005 Aug 1;10(3):198-206.Available:https://pubmed.ncbi.nlm.nih.gov/16038855/ (accessed 20.11.2022)
  5. Bible JE, Biswas D, Miller CP, Whang PG, Grauer JN. Normal functional range of motion of the lumbar spine during 15 activities of daily living. Clinical Spine Surgery. 2010 Apr 1;23(2):106-12. Available:https://pubmed.ncbi.nlm.nih.gov/20065869/ (accessed 21.11.2022)
  6. Littlewood C, May S. Measurement of range of movement in the lumbar spine—what methods are valid? A systematic review. Physiotherapy. 2007 Sep 1;93(3):201-11. Available:https://www.csp.org.uk/journal/article/physiotherapy-september-2007/measurement-range-movement-lumbar-spine-what-methods (asccessed 20.11.2022)