Cervical Flexion
- Muscles: SCM, longus capitis, longus colli, rectus capitis anterior, anterior scalene
- Position: supine, shoulders 90 deg abd, elbow 90 deg flex, forearms resting on table
- Motion: tuck chin toward chest, lift into flexion
- Stabilize: abdominals help fixate thorax; may stabilize anterior aspect of thorax
- Palpation: SCM: proximal to medial aspect of clavicle or sternum; Long Cap/Colli: anterolateral surface vertebrae deep to SCM; RCA: too deep; Ant Scalene: above clavicle & posterior to SCM
- Resistance: on forehead, in direction of neck extension
- **No gravity-lessened
Cervical Extension
- Muscles: neck extensors
- Position: prone, neck neutral rotation, shoulders 90 deg abd, elbows flexed, forearms on table
- Motion: cervical extension
- Stabilize: upper thorax
- Palpation: posterior aspect of C-spine
- Resistance: occiput in the direction of neck flexion
- **No gravity-lessened
Cervical Rotation (Anterolateral Neck Flexion)
- Muscles: (unilateral) sternocleidomastoid
- Position: supine, head opposite side, shoulders 90 deg abd, elbows flex 90 deg, forearms rest on table
- Motion: rotate away, lift off surface
- Stabilize: abdominals help fixate thorax; may stabilize anterior aspect of thorax
- Palpation: from mastoid process to sternum or clavicle
- Resistance: lateral aspect of the skull toward table
- **No gravity-lessened
Cervical Lateral Flexion
- Primary muscle(s): upper trap
- Position: sitting
- Stabilize: none, bilateral test
- Palpation: lateral to cervical spinous processes
- Resistance: superior aspect shoulder, towards depression
Lumbar Flexion 1
- Muscles: rectus abdominus
- Position: supine, hands behind head, lower extremities extended, lumbar spine flat against surface (posterior pelvic tilt)
- PROM: assist pt to flex trunk to clear scapula
- Stabilize: none
- Palpation: anterior aspect of the trunk lateral to midline
- Resistance: graded
Lumbar Flexion 1 MMT Scale
5: hands behind head
4: arms folded across chest, all scapula off surface
3+: arms at sides + all scapula off surface
3: arms at sides + inferior scapula remain in contact with surface
2: raises head and cervical spine, all scapula in contact with surface
1: palpable contraction
Lumbar Flexion 2
- Muscles: rectus, EO
- Position: supine, arms across chest, hips flex 90 deg, knees extended
- Action: place hand behind low back, slowly lower legs toward table instruct pt to keep back pressed into surface
- Stabilize: none
- Palpation: anterior aspect of the trunk lateral to midline
- Patient action: lower legs while keep back flat – end where no longer maintain pelvic tilt
Lumbar Flexion 2 MMT Scale
5: able lower legs completely
4+: 15 deg b/t table and LE
4: 30 deg
4-: 45 deg
3+: 60 deg
3: 70 deg
2: > 75 deg
1: palpable contraction
Lumbar Extension
- Muscles: erector spinae (iliocostalis, longissimus, spinalis), transversospinalis, multifidus, rotatores, interspinales, intertransversali, quadratus lumborum
- Position: prone, hands behind head, pillow under abdomen, lower extremities extended
- PROM: assist motion in lumbar extension, entire sternum including xiphoid clears table
- Stabilize: posterior aspect of thighs and pelvis
- Palpation: lateral to spinous process of lumbar and thoracic vertebrae
- Resistance: graded
Lumbar Extension MMT Scale
5: hands behind head
4: arms folded behind back, all sternum off surface
3: arms at sides + all sternum off surface
2: arms at sides, partial ROM
1: palpable contraction
Lumbar Rotation – Gravity Resisted
- Muscles: external and internal obliques
- Position: supine, hands behind head, legs extended
- Motion: trunk rotation and flexion and clear scapula from surface (ipsilateral IO and contralateral EO)
- Stabilize: anterior aspect of lower extremity
- Palpation: external: lower edge of rib cage; internal: medial to & above ASIS
- Resistance: graded
Lumbar Rotation MMT Scale
5: hands behind head
4: arms folded across chest, all scapula off surface
3: arms at sides, all scapula off surface
Lumbar Rotation – Gravity Lessend
- Muscles: external and internal obliques
- Position: sitting, arms at sides
- Motion: trunk rotation
- Stabilize: anterior pelvis
- Palpation: side standing on - external: lower edge of rib cage
Pelvic Elevation
- Muscles: quadratus lumborum, iliocostalis lumborum
- Position: supine or prone, hip slight abduction and feet off end table
- PROM: elevate patient’s pelvis
- Stabilize: pt holds edge of table
- Palpation: typically too deep to palpate
- Resistance: proximal to ankle, pull caudally
Pelvic Elevation MMT Scale
5: max resistance
4: mod resistance
3: min resistance
2: elevates pelvis thru full ROM
1: palpable contraction
