Posterior-Anterior Segmental Mobility
Purpose: To assess for segmental motion and the effect it has on the patient’s symptoms.
Test Position: Prone.
Performing the Test: Stand at the head of the patient, facing the patient’s feet. Place thumbs on the spinous process to be tested. Keep your elbows straight and directly over the segment to be tested. Apply anteriorly directed force through thumbs using your trunk until pain or end range is acquired. Determine the amount of motion achieved (hypomobile, normal, hypermobile) or contributions of pain. Repeat on other segments. Test can also be performed while kneeling on table at side of patient facing patient’s head. Again place thumbs or thumb and 2nd digit (to cup the spinous process) over spinous process and apply anteriorly directed force through torso. Use whichever hand-hold is most comfortable and stresses your joints, as the examiner, the least.
Diagnostic Accuracy: Sensitivity: .82; Specificity: .79; -LR: .23; +LR: 3.9 (“Validity of five common manual neck pain producing tests”).
Importance of the Test: As you apply an anteriorly directed force on the spinous process of a vertebra, you induce a flexion motion of that vertebra relative to the inferior vertebra, and an extension motion of that vertebra relative to the superior vertebra. This test can be used to determine how much motion is available at each segment. If a joint is restricted throughout or just unilaterally, that can aid in determining the pathology and treatment plan. A thorough understanding of the spine’s osteology, arthrology, and arthrokinematics can help in understanding the results of your segmental testing. For example, in the fully flexed cervical spine, if a vertebra appears rotated to the left, that means there is a capsular restriction on that left facet. In a fully extended cervical spine, if the vertebra appears rotated to the left, that means there is a capsular restriction on the right facet.
Note: tests should only be performed by a properly trained health care practitioner.
Test Position: Prone.
Performing the Test: Stand at the head of the patient, facing the patient’s feet. Place thumbs on the spinous process to be tested. Keep your elbows straight and directly over the segment to be tested. Apply anteriorly directed force through thumbs using your trunk until pain or end range is acquired. Determine the amount of motion achieved (hypomobile, normal, hypermobile) or contributions of pain. Repeat on other segments. Test can also be performed while kneeling on table at side of patient facing patient’s head. Again place thumbs or thumb and 2nd digit (to cup the spinous process) over spinous process and apply anteriorly directed force through torso. Use whichever hand-hold is most comfortable and stresses your joints, as the examiner, the least.
Diagnostic Accuracy: Sensitivity: .82; Specificity: .79; -LR: .23; +LR: 3.9 (“Validity of five common manual neck pain producing tests”).
Importance of the Test: As you apply an anteriorly directed force on the spinous process of a vertebra, you induce a flexion motion of that vertebra relative to the inferior vertebra, and an extension motion of that vertebra relative to the superior vertebra. This test can be used to determine how much motion is available at each segment. If a joint is restricted throughout or just unilaterally, that can aid in determining the pathology and treatment plan. A thorough understanding of the spine’s osteology, arthrology, and arthrokinematics can help in understanding the results of your segmental testing. For example, in the fully flexed cervical spine, if a vertebra appears rotated to the left, that means there is a capsular restriction on that left facet. In a fully extended cervical spine, if the vertebra appears rotated to the left, that means there is a capsular restriction on the right facet.
Note: tests should only be performed by a properly trained health care practitioner.
References:
Sandmark H, Nisell R. "Validity of five common manual neck pain producing tests." Scand J Rehabil Med. 1995 Sep. Web. 08/18/2012.
Sandmark H, Nisell R. "Validity of five common manual neck pain producing tests." Scand J Rehabil Med. 1995 Sep. Web. 08/18/2012.