craniovertebral angle
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- evaluate amount of LCE/F
- draw a horizontal line at level of C7 spinous process, draw line from tragus to C7 to find angle, normal approx 50 deg, smaller angle indicates greater FHP/LCE
- greater LCE/F
- limited by palpation skills, is only measuring proxy for spine bc not actually on vertebra, may be influenced by body shape
tragus to wall distance
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- use positioning of the head to evaluate upper thoracic, lower/upper cervical flex/ext posture and function
- stand against the wall, feet 10 cm away, trunk flush with wall, measure in relaxed and chin tucked for insight into capacity, typically <10 cm in neutral neck
- lower cervical flexion, upper cervical extension, thoracic flexion
- palpation/landmarking error
deep neck flexor endurance test
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- endurance of longus capitis and coli (deep flexors near the cervical vertebrae)
- patient supine with hips and knees flexed comfortably, patient roll head into chin tuck 2 finger widths off surface and hold in pos, remove fingers, 30-40 seconds in healthy adults
- upper cervical extension
- look for compensation by SCM through head lift off
cervical extensor endurance test
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- endurance of upper cervical flexors, lower cervical extensors
- patient prone on table with neck and head off edge, arms at sides, hold cervical spine parallel to ground, UCF (chin tuck)
- upper cervical extension, lower cervical flexion, FHP
- look for compensation using arms to support, thoracic extension
prone press up
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- thoracolumbar extension mobility
- prone on ground, hands under shoulders, push up into extension, look for distribution of curve, greater curve lumbar, thoracic should be flat, may see hinge points/crease around vertebrae with limited motion
- greater thoracic kyphosis, shallow lumbar lordosis
- lack of strength to support body weight?
Wolfson modified schober test
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- amount of lumbar flexion, can use value to determine how to design intervention
- landmark S2 by palpating PSIS to midline, mark point 16 cm above S2, patient forward flexion, mark change in distance between the two points, approx 5-7 cm
- deep lumbar lordosis
- body size/proportion, palpation accuracy
finger to floor distance
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- evaluate the distance between tips of middle fingers relative to standing surface
- standing toes edge of elevated surface, bend forward and reach fingers as far down as possible with full knee extension, minus score below surface, plus score above surface, qualitative observation on flexion, approx +-15 cm
- req good balance, multi-chain movement thus limited by hamstring, glutes, and PF flexibility
Biering Sorenson test
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- thoracolumbar extensor endurance
- patient lies prone on table with pelvis and lower body supported, hold the patient’s ankles, hands crossed on shoulders, keep body parallel to ground
- deeper thoracic kyphosis, shallow lumbar lordosis
- assessor’s ability to look for compensation
60 degree incline test
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- evaluate flexion endurance
- patient sitting on ground with knees and hip bent, back straight forming 60 deg angle with ground with board supporting, remove board and patient needs to hold position, take qualitative observation
- deep lumbar lordosis, anterior pelvic tilt
- assessor’s ability to look for compensation
side plank endurance hold
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- lat flexion, pelvic tilt endurance
- test floor side with feet staggered in low side plank
- lateral trunk flexion or pelvic tilt to one side
- assessor’s ability to look for compensation
spinal lateral flexion
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- amount of lateral flexion as length
- standing feet apart, one side body against wall, standing neutral, mark tip of middle finger on thigh, model laterally flexes to end point while keeping pelvis against wall, mark tip of finger for length, looking for symmetry between sides
- lateral flexion to one side, scoliosis
- landmarking error, ability to look for compensation
modified thomas postition
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- hip flexor extensibility
- sitting on the edge of table, model holds one knee and lies back, pelvis in neutral, test leg hangs, contract abs to avoid deep lordosis, angle between greater trochanter to lateral epicondyle and horizontal, +-10 deg relative to horizontal
- anterior pelvic tilt
- assessor’s ability to look for compensations with ant tilted pelvis, landmarking error
popliteal angle
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- hamstring extensibility
- model supine, tester holds femur in 90 deg hip flexion, press back of heel to extend knee without moving femur until feel resistance or model feels discomfort, watch for pelvis, 140 +- 10 deg along the posterior knee
- post tilt, small tibia to femur angle
- landmarking error
manual muscle test: hip lateral rotators
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- strength of hip ext rotators
- patient seated with foot off ground or supine with hip and knee held at 90 deg flexion, tester in front of seated or to side of supine, one hand on lateral femur, other proximal to medial malleolus to push leg into internal rotation as model isometrically resists for 5-10 seconds, comparing both sides
- patella facing inwards, tibial external rotation when standing
- assessor’s ability to look for compensations with pelvic motion
manual muscle test: hip abductors
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- hip abductor strength
- model side lying with head on arm, other arm supporting, bottom leg bent, testing leg fully extended in neutral hip pos, slight abduction position, tester stabilizes pelvis at iliac crest with one hand and other above lateral knee (check first in case of unstable knee) or lateral malleolus (need more leverage), isometric resistance 5-10 seconds
- pelvic lateral tilt, valgus knee
- check for compensation with hip flexion or lateral pelvic tilt
medial longitudinal arch angle
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- pronation/supination of the foot
- single leg stand with light touch for balance, landmark centre lateral malleolus, tubercle of navicular, and 1st MTP joint and take angle between, neutral 130-150 deg, smaller angle more pronation, bigger more supination
- landmarking errors
acromion to table distance
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- pectoralis minor length for ant tilt and protraction
- mark the acromion, SOS, and the angle between, model supine on table, arms along trunk, measure vertical height from table to acromial angle and compare between shoulders
- ant tilt, protracted scapula
- proxy measure, landmarking error
lateral rotators ROM in GH joint
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- humeral lateral rotator ROM
- model supine, shoulder abduct and elbow flex to 90 degrees, lateral rotate to end range without scapular motion, take angle as humerus to trunk and length of forearm, normally 90 deg
- cubital fossas facing inwards
- not for those with unstable GH joint, assessor’s ability to look for compensation with scapular motion or spine extenison
manual muscle test: lower traps
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- lower traps strength
- model prone, shoulder abducted 120 deg, thumb up in ER, tester hand on distal forearm/humerus and pelvis to stabilize, model attempt to post tilt and retract against tester isometrically for 5-10 seconds
- ant tilt, protraction
- assessor ability to look for compensations with spinal extension or shoulder shrug/positioning
manual muscle test: mid traps and rhomboids
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- mid traps strength
- model prone, shoulder abducted 90 deg for mid traps, 45 deg for rhomboids, thumb up in ER, tester hand on distal forearm/humerus and pelvis to stabilize, model attempts to retract against tester isometrically for 5-10 seconds
- protraction
- assessor’s ability to look for compensations through spinal rotation or GH crossext
manual muscle test: serratus anterior
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- serratus anterior strength
- model supine with shoulder abducted 90, elbow flexed, shoulder in POS, test palpates post scapula and applies pressure through elbow along length of humerus to retract scapula, model resists isometrically for 5-10 seconds
- winging
- assessor’s ability to look for compensation through trunk rotation
manual muscle test: hip extensors
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- hip extensor strength
- model prone on table, flex knee to 90 deg and extend hip to lift off table, tester stabilize post pelvis and apply downward pressure to posterior thigh above knee, model resist isometrically 5-10 seconds
- ant tilt pelvis
- tester ability to look for compensations through trunk rotation or extension
manual muscle test: hip flexors
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- hip flexor strength
- model seated on table with thighs supported, hands over shoulders, lift test leg off table without pelvic motion, tester hand on iliac crest for stability and other apply downward resistance anterior thigh near knee, or supine with hip flexed 70-80, knee flexed, tester hand stabilize ASIS, other pull knee into hip extension while supporting knee from below, model resists for 5-10 seconds
- posterior pelvic tilt
- tester ability to look for compensation through spine movement or lateral tilt in seated and pelvic rotation or spine ext in supine
manual muscle test: tibialis posterior
1. what to evaluate
2. how to perform
3. postural observations to do test
4. limitations
- tibialis posterior strength
- model side lying with test leg bottom, foot over table in PF pos, tester hand stabilizing prox-med tibia and other on medial midfoot to press into eversion, model resist with inversion 5-10s isometric hold
- eversion/pronation
- tester ability to look for compensation/positioning
