Movement and measurement

Measurement of mobility of the spine involves several steps:

• get the patient to stand on their toes, thus checking plantarflexion of the foot and the S1 nerve root. If necessary, test each foot separately, giving them some support with an outstretched arm. Ask them to rock onto their heels - test of L4/L5

Next test the movements of the back:

• test flexion and dosiflexion, whilst measuring the change in length of a vertical line drawn on the lumbar region of the back, ie a line drawn from the lumbosacral junction to 10cm above and 5cm below should expand by at least 5cm. Look to see how much movement is due to back flexion and how much is due to movement at the hips.
  
  
• lateral flexion may be quantified by the level to which the patient may slide their hand down the side of each thigh.
  
  
• next with the patient sitting to prevent twisting of the hip, rotation of the thoracic spine may be assessed by asking the patient to twist around with their arms crossed.
  
  
• costovertebral movements are gauged by asking the patient to breathe in and out: the distance between maximal inspiration and expiration is normally 5cm.
  
  
• the neck should be examined if necessary.
  
  
• the patient is then asked to lie supine and the straight leg raise test is performed.
  
  
• carry out neurological testing of power; sensation - test Saddle area; reflexes - knee, ankle, Babinski; do a rectal examination - check tone, power, sensation