By Zachary Boswell, SPT
Physical Therapists (PTs) are trained to be experts on movement throughout the human body. PTs will use a variety of tests, measures, and techniques to assess movement, in an effort to identify abnormal movement and to test for effectiveness of interventions. Some tools that may be used include goniometers, inclinometers, and tape measures. Koning et al found that these tools predominantly score as unreliable and invalid when used to measure cervical motion. The “best” tool reported in this study was an Electronic Digital Inclinometer (EDI-320). 2
In addition to these tools, PTs are trained to use their hands to assess mobility at a variety of different joints, not just at the spine. PT’s can look at motion of the hips, mid back, neck, and even foot/ankle when evaluating your spine!
This information is useful to consider when establishing a diagnosis and identifying a response to treatment. PTs will look at two different types of movement when addressing the spine: physiological and accessory. Physiological movement occurs when we move in flexion, extension, lateral flexion, and rotation. Accessory movement includes anterior to posterior mobilizations, vice versa, and side glides.
Current research presents mixed findings regarding validity and reliability of these manual assessments.3,4,5,6,8 Individuals trained in the techniques, and those who use them regularly, find them to be much more useful than those who do not.7 There is often agreement between therapists who have been trained in the techniques, however the validity of the assessment when compared to movement assessed with dynamic MRI imaging is inconsistent. 4
When evaluating low back pain, physical therapists will take a thorough subjective history, assess functional movement, and incorporate segmental motion assessment. PT’s use many tools, including how each segment moves, strength, and flexibility to guide diagnosis and treatment.
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- Fritz J, Cleland J, Childs J. Subgrouping patients with low back pain: evolution of a classification approach to physical therapy. J Orthop Sports Phys Ther. 2007;37(6):290-302.
- Koning CHPD, Heuvel SPVD, Staal JB, Smits-Engelsman BCM, Hendriks EJM. Clinimetric evaluation of active range of motion measures in patients with non-specific neck pain: a systematic review. European Spine Journal Eur Spine J. 2008;17(7):905-921. doi:10.1007/s00586-008-0656-3.
- Kulig, K, Powers C, Landel R, Chen, H, Fredericson M, Guillet M, Butts, K. Segmental lumbar mobility in individuals with low back pain: invivo assessment during manual and delf-imposed motion using dynamic MRI
- Landel R, Kulig K, Fredericson M, Li B, Powers CM. Intertester Reliability and Validity of Motion Assessments During Lumbar Spine Accessory Motion Testing. Physical Therapy. 2007;88(1):43-49. doi:10.2522/ptj.20060179.
- Piva SR, Erhard RE, Childs JD, Browder DA. Inter-tester reliability of passive intervertebral and active movements of the cervical spine. Manual Therapy. 2006;11(4):321-330. doi:10.1016/j.math.2005.09.001.
- Trijffel EV, Anderegg Q, Bossuyt P, Lucas C. Inter-examiner reliability of passive assessment of intervertebral motion in the cervical and lumbar spine: A systematic review. Manual Therapy. 2005;10(4):256-269. doi:10.1016/j.math.2005.04.008.
- Trijffel EV, Oostendorp RA, Lindeboom R, Bossuyt PM, Lucas C. Perceptions and use of passive intervertebral motion assessment of the spine: A survey among physiotherapists specializing in manual therapy. Manual Therapy. 2009;14(3):243-251. doi:10.1016/j.math.2008.02.005.
- Walker B, Koppenhaver S, Stomski N, Hebert J. Interrater Reliability of Motion Palpation in the Thoracic Spine. Evidenced-Based Complementary and Alternative Medicine. 2015. doi:10.1155/2015/815407