3 Movements of the Trunk. Flexion Rotation Extension
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1 3 Movements of the Trunk Flexion Rotation Extension 1
2 TRUNK FLEXION 2
3 TRUNK FLEXION: Rectus Abdominalis O: Crest of Pubis & ligaments covering front of symphysis pubis. I: By «3 portions into cartilages of 5th, 6th & 7th ribs. N: Lower intercostal nerves. Accessory Ms.: Internal Obliques & external obliques (reverse action). 3
4 TRUNK FLEXION: ROM In backlying: flex. of thorax on pelvis is possible until scapulae are raised from the table. Motion is mainly at the thoracic spine. Fixation: 1) Reverse action of hip flexor muscles. 2) Weight of legs and pelvis. 4
5 TRUNK FLEXION: Rectus Abdominalis Limited ROM if: Tension of the posterior longitudinal ligament, ligamenta flava & interspinal & infraspinal ligaments. Tension of the spinal extensor muscles. Apposition of lower lips of vertebral bodies anteriorly with surfaces of subjacent vertebrae. Compression of intervertebral fibocartilages in front. Contact of lower ribs with abdomen. 5
6 TRUNK FLEXION: Testing Grade 5 Pt. Is backlying with hands behind neck. Th. stabilizes legs firmly. If hip flexors are weak stabilize pelvis. Pt. flexes thorax on pelvis through ROM. Command:» Flex your thorax on pelvis until scapulae are raised from table---relax» Weight of the pt. s arms serves as resistance 6
7 TRUNK FLEXION: Testing Grade 4 Pt. In backlying with arms at sides. Stabilize legs and pelvis if weak hip flexors. Movement is possible untill scapulae (all surface) are raised from the table. 7
8 TRUNK FLEXION: Testing Grade 3 Backlying with arms at sides. Stabilize legs and pelvis as above.* Pt. Flexes thorax through partial ROM: Head, tips of shoulders and upper borders of scapulae should clear table. Command:» Flex your thorax on pelvis until scapulae are raised from table ----relax». 8
9 TRUNK FLEXION: Testing Grade 2 Pt. In supine, backlying with arms at sides. Pt. Flexes cervical spine. Lower portion of thorax is depressed & pelvis is tilted untill the lumbar area of spine is flat on table. Palpation will help to determine smoothness of contraction. Command: Flex your cervical spine, depress the lower portion of thorax and tilt your pelvis until the lumbar spine is flat on the table. 9
10 TRUNK FLEXION: Testing Grade 1-0 Backlying. Palpation: over the anterior abdominal wall as patient attempts to cough (also during rapid exhalation or as patient attempts to lift head). Note: observe deviation of umbilicus. Upward movement indicates stronger contraction of upper section muscle, & downward movement, stronger contraction of lower section. Commands: Try to cough----relax Try to perform rapid exhalation. Try to lift your head up ---relax. 10
11 11
12 Trunk Rotation: Internal & External Oblique External Oblique: O: 8 digitations from external surfaces & inf. borders of lower 8 ribs. I: Ant. ½ of iliac crest & aponeurosis to pubic tubercle. N: Lower intercostals. 12
13 Trunk Rotation: Internal & External Oblique Internal Oblique O: lateral half of upper surface of inguinal ligament, anterior 2/3 of iliac crest. I: Crest of pubis, linea alba, inf. bordres of cartilages of 3 last ribs. N: Lower intercostals. 13
14 Trunk Rotation: Int. & Ext. Oblique: ROM ROM in backlying: until scapula on side of forward shoulder is raised from table. Limited by: Tension of annulus fibrosus between vertebrae. Tension of oblique abdominal muscles on side opposite to those being tested. In thoracic area, tension of the costovertebral ligaments. In Lumbar area, interlocking of articular facets. Fixation: Reverse action of hip flexors. Accessory muscles: Lattissimus Dorsi. Semispinalis. Multifidus. Rotatores Rectus abdominis (combined trunk rotation & flexion). 14
15 Trunk Rotation: Int. & Ext. Oblique: Gr. 5, 4 GR. 5: Backlying with hands behind neck. Stabilize legs firmly. Command: Rotate and flex thorax to one side. Repeat to opposite side. GR.4: Backlying with arms at sides. Stabilize legs firmly. Command: Rotate & flex thox to one side. Repeat the opposite side. Note: If hip flexors are weak; stabilize pelvis instead of legs. 15
16 Trunk Rotation: Int. & Ext. Oblique: Gr. 3 Gr. 3: with arms on opposite shoulders 16
17 Trunk Rotation: Int. & Ext. Oblique: Gr. 2 Sitting with arms relaxed at sides. Pelvis is stabilized. Command :»Rotate thorax. Repeat with rotation to opposite side.» Alternate: Backlying then rotate untill a definite approximation of thorax & pelvis is evident. 17
18 Trunk Rotation: Int. & Ext. Oblique: Gr. 1 & 0 Examiner palpates muscles as the patient attempts to approximate thorax on left & pelvis on right. Repeat with opposite side. Note: Observe deviation of umbilicus, which will move towards the strongest quadrant if there is a difference in strength of opposing oblique muscles. 18
19 Trunk Extension New Movement 19
20 Trunk Extension 5 muscles: Iliocostalis Dorsalis(thoracis) Longissimus dorsi Spinalis dorsi Iliocostalis lumborum Quadratus lumborum Sacrospinalis 20
21 Trunk Extension Iliocostalis Dorsi: O: upper borders of angels of lower 6 ribs. I: Upper borders of angels of upper 6 ribs. Transverse process of C7 vertebrae. N: adjacent spinal nerves. 21
22 Trunk Extension Longissimus Dorsi: O: common tendon of sacrospinalis, transverse processes of lumbar spine. I: tips of transvers processes of all thoracic vertebrae. Lower 9 or 10 ribs. Spinalis Dorsi: O: Spinous processes of first 2 lumbar & last 2 thoracic vertebrae. I: Insertion processes of upper 4 to 8 thoracic vertebrae. 22
23 Trunk Extension Iliocostalis Lumborum: O: common tendon on middle crest of sacrum, spinous processes of T&& T12, inner lip of iliac crest & lat. crest of sacrum. I: inf. borders of lower 6 or 7 ribs. Quadratus lumborum: O: Iliolumbar ligament & adjacent 5 cm of iliac crest. I: medial half border of lower border of last rib. Transverse processes of upper 4 lumbar vertebrae. N: T12, L1, L2 23
24 Accessory muscles: Semispinales Rotatores Multifidus. ROM: Trunk Extension Limitation of ROM: Thoracic spine extends only to approximately a straight line. Lumbar spine extends freely. Fixation: Contraction of gluteus max. & hamstring muscles. Weight of pelvis & legs. Tension of anterior Longitudinal ligament of spine. Tension of ant. Abdominal Muscles Contact of spinous processes. Contact of inf. articular margins with laminae. 24
25 Trunk Extension: Testing Gr. 5 & 4 & 3 Face lying ( prone) Stabilize the pelvis. Command: extend the lumbar spine untill lower part of thorax is raised from the table. is given on the lower thoracic area for gr. 4. is on the thoracic spine & upper thorax for gr. 5. Lumbar spine 25
26 Thoracic Spine 26
27 Trunk Extension: Gr. 3 & 2 &1 Position in prone with pelvis stabilized. C: gr. 3: «extend thoracic & lumbar spine through ROM». Gr. 2: prone, complete partial ROM. Gr. 1: palpate spinal extensor muscles to see the degree of contraction as patient attempts to raise the trunk. 27
28 28
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