PTA 2210 Manual Muscle Testing: Trunk

Lumbar and thoracic extension (grades 0, 1 and 2)

- Position/test/instruction: Identical to grade 3, except therapist must palpate lumbar and thoracic spine extensor mms (individual mms cannot be isolated.)

Lumbar and thoracic extension (grade 3)

- Position: Prone with arms at sides. - Test: Pt extends spine, raising body from the table so that umbilicus clears the table. - Instruction: "Raise your head, arms and chest from the table as high as you can."

Thoracic trunk extension (grades 4 and 5)

- Position: Prone with head and upper trunk extending off table from about the nipple line. Hands should be touching side of head, shldrs and elbows retracted. - Test: Pt extends thoracic spine to the horizontal. Is a small movement, should not go past horizontal (will cause movement in lumbar spine.) - Instruction: "Raise your head, shoulders and chest to table level."

Lumbar trunk extension (grades 4 and 5)

- Position: Prone, fingertips lightly touching side of head, shldrs in ER (weight of head and arms substitutes for manual resistance by PT/PTA.) - Test: Pt extends the lumbar spine until the entire trunk is raised from the table (clears umbilicus.) - Instruction: "Raise your head, shoulders and chest off the table. Come as high as you can."

Pelvis elevation (grades 2 and 3)

- Position: Supine (or prone), hip in ext, lumbar spine in neutral or ext. Therapist supports leg just above ankle with one hand, other hand under the knee so limb has slightly decreased friction. - Test: Pt hikes the pelvis on the test side to bring the rim of the pelvis closer to the inferior ribs. Grades 1 and 2 are typically not given to ensure clinical accuracy. - Instruction: "Bring your pelvis up to your ribs."

Pelvis elevation (grades 4 and 5)

- Position: Supine (or prone), pt grasps edges of the table to provide stabilization during resistance. - Test: Pt hikes the pelvis on one side, therby approximating the pelvic rim to the inferior margin of rib cage. Therapist provides resistance. - Instruction: "Hike your pelvis to bring it up to your ribs, hold it. Don't let me pull your leg down."

Trunk rotation (grade 0 and 1)

- Position: Supine with arms at sides, hips flexed with feet flat on table. - Test: Therapist will support pt's head as pt attempts to flex trunk and turn to either side. Palpate external oblique on one side, and the internal oblique on the other side. - Instruction: "Try to lift up and turn to your right." Repeat for left side.

Trunk flexion (grades 0, 1 and 2)

- Position: Supine with arms at sides. - Test: Therapist will stand at side of table, hand used for palpation at midline of thorax, four fingers of both hands to palpate rectus abdominis. - Sequence 1: Ask pt to raise head, if pt cannot lift head move on to next sequence. - Sequence 2: Therapist cradles upper trunk and head off table and asks pt to lean forward, if there is no depression of rib cage move to next sequence. - Sequence 3: Ask pt cough, if pt can cough, if pt cannot cough but there is palpable rectus abdominis activity is grade 1.

Trunk rotation (grade 4)

- Position: Supine with arms crossed over chest - Test/instruction: Same as grade 5, aside from pt arm position.

Trunk rotation (grade 3)

- Position: Supine with arms outstretched above plane of body. - Test/instruction: Same as grade 5, aside from pt arm position.

Trunk rotation (grade 2)

- Position: Supine with arms outstretched above plane of body. - Test: Therapist will palpate external oblique on one side, and the internal oblique on the other side. - Instruction: "Keep your chin pointed to the ceiling while you lift your head, reach toward your right knee.

Trunk flexion (grade 3)

- Position: Supine with arms outstretched in full ext above plane of body. - Test/instruction: Same as grade 5, except for pt arm position. Outstretched arms neutralizes resistance by bringing weight of arms closer to COG.

Trunk rotation (grade 5)

- Position: Supine with fingertips to the side of the head. - Test: Pt flexes trunk and rotates to one side, movement is then repeated on opposite side. - Instruction: "With your chin pointed to the ceiling, lift your head and shoulders from the table, taking your right elbow toward your left knee." Repeat for the other side.

Trunk flexion (grade 4)

- Position: Supine, arms crossed over chest. - Test/instruction: Same as grade 5, aside from pt arm position.

Trunk flexion (grade 5)

- Position: Supine, legs straight and fingertips lightly touching the back of head. - Test: Pt flexes trunk through ROM, lifting trunk until scapulae clear table, neck should not flex. - Instruction: "Keep your chin pointed toward the ceiling and lift your head, shoulders and back off the table."