how to measure thoracic range of motion

“Reliability of thoracic spine rotation range-of-motion measurements in healthy adults.” Journal of Athletic Training, 47(1), 52–60. 24. McKean, M. R. and Burkett, B. J. Troke M, Schuit D, Petersen CM. Flexion: ICC: 0.77; extension: ICC: 0.80. Two raters, independently, selected potentially relevant studies by reading titles and abstracts. Bandy WD, Reese NB. Reproducibility of thoracolumbar flexion and extension. DOI: 10.1016/j.math.2013.08.002 Arch Phys Med Rehabil 2004;1(85):99-103. Yet, this method of assessing mobility has major limitations. A reliability study of the new Back Strain Monitor based on clinical trials. Table 7 Meta-analysis result for intra-rater reproducibility of the inclinometer instrument for lumbar flexion movement. This should be done against a surface that is level, so be sure to check before calibration by placing a spirit level on the surface. I also recommend coaches be cautious about using different phone models interchangeably. Still regarding the biomechanical aspects of motor and postural control related to spinal structures, evidence points to a need to maintain the integrity of the active (musculotendinous), passive (osteoarticular and ligamentous) and neural subsystems5. 2010. Tederko P, Krasuski M, Maciejasz P. Restrainer of pelvis and lower limbs in thoracic and lumbar range of motion measurement - preliminary report. Keywords: Range of motion; Spine; Review. To make the execution of these tests even more challenging for coaches, many ROM assessments require exceptional palpatory skills. [ Links ], 34. Additionally, you also have the capability to determine what mobility exercises and dosages work when it comes to improving ROM. 10. To make the execution of these tests even more challenging for coaches, many ROM assessments require exceptional palpatory skills. Intra-rater reproducibility: Flexion: r: 0.94; Extension: r: 0.94; Inter-rater reproducibility: Flexion: r: 0.76; Extension: r: 0.84. Scand J Rehabil Med 1991;23(1):3-10. Swinton, P. A., Lloyd, R., Keogh, J. W., Agouris, I., and Stewart, A. D. (2012). However, if we want to monitor the effectiveness of our training intervention and identify what strategies actually develop mobility, we need assessment techniques that provide objective data that is accurate and reliable. Intra-rater reproducibility of thoracolumbar flexion and extension. The Flexicurve instrument is a flexible lead ruler, 30 to 80 cm long, easy to use, low-cost, and serves as a diagnostic means and evolutionary treatment indicator for field studies in large populations67. [ Links ], 39. [ Links ], 38. It has variations; for instance, the dual inclinometer, the modified inclinometer (BROM II) and the electroinclinometer (Back ROM). [ Links ], 11. International vocabulary of metrology - Basic and general concepts and associated terms. In this sense, preserving the morphology and mobility of the spine is important for its functionality3 and can reduce already high rates of back pain in the world population4. DOI: 10.1097/00007632-198801000-00012 [ Links ], 50. A total of 46 studies were included in the qualitative analysis, seven of which only were included in the quantitative analysis. Yun w, Kim H, Ahn JH, Park Y, Park Y. “Influence of posture on the range of axial rotation and coupled lateral flexion of the thoracic spine.” Journal of Manipulative and Physiological Therapeutics, 30(3), 193–199. Measurement of regional lumbar sagittal mobility. Mayer RS, Chen I, Lavender SA, Trafimow JH, Andersson GBJ. Reliability and validity of non-radiographic methods of thoracic kyphosis measurement: a systematic review. [ Links ], 65. Please take a moment to share the articles on social media, engage the authors with questions and comments below, and link to articles when appropriate if you have a blog or participate on forums of related topics. [ Links ], 24. Measurement of lumbar spine range of movement and coupled motion using inertial sensors - A protocol validity study. 3. ed. In part 2 (this article), I will focus on mobility tests for the thoracic spine and upper extremity, showing techniques using only a smartphone or tape measure. DOI: 10.1111/j.1600-0838.1997.tb00130.x J Spinal Disord 1992a;5(4):383-9. [ Links ], 36. Video 2. The main areas of methodological weakness found were: explanation about sampling loss, justified for being cross-sectional studies; intra- and inter-rater blinding; period of time between evaluated test and reference standard; independence of reference standard from evaluated test; explanation and adequacy of the description of the reference standard’s procedure, and rater description adequacy. If you didn’t, here are considerations for collecting reliable data: An important consideration for collecting reliable data is being able to locate anatomical landmarks for measuring segment alignment. [ Links ], 35. 13. [ Links ], 29. For this test, a score of <10 centimeters is generally used to represent sufficient thoracic spine extension ROM.7However, factors such as maturation, periods of weight loss/gain, and anthropometric dimensions may impact the applicability of this threshold.8To overcome this limitation, I recommend using a pass-fail criterion to support the interpretation of this test. Alqhtani RS, Jones MD, Theobald P, Williams J. 6. Searches were conducted on BIREME, EMBASE, PEDro, PubMed, Science Direct, SCOPUS and Web of Science databases, and there were manual searches as well. Two independent reviewers selected the studies, extracted data, evaluated methodological quality, risk of bias, and evidence (GRADE). Therefore, mobility and flexibility are directly related as well as, and can be understood as complementary or synonymy. The head should touch the wall and the mouth should be closed. Kolber MJ, Pizzini M, Robinson A, Yanez D, Hanney WJ. Testing the wrist is a useful screen for all athletes, not just those who grip sport implements. DOI:10.1016/j.clinbiomech.2011.01.015 The goniometer is an instrument that measures joint positions and ROM of almost all joints. Low-Frequency magnetic field technology: Quantifying spinal range of motion. A coluna vertebral apresenta mobilidade e características distintas conforme a região anatômica, e, há diversos instrumentos que propiciam sua avaliação. (1996). In the evaluation of methodological quality and risk of bias only 18 studies were considered of high quality (score ≥ 60%). OrtopTraumatolRehabil 2007;2(6):156-167. E, com base nos critérios do GRADE, ainda há baixa evidência científica sobre a validade, repetibilidade e reprodutibilidade dos instrumentos e métodos indicados para a avaliação da amplitude de movimento articular da coluna vertebral torácica e lombar no plano sagital. Conversely, the athlete is instructed to bring the palm of the hand toward the ground for internal rotation. There is evidence pointing to video systems, that is, cinemetry, as the gold standard for range of motion (ROM) assessments. June 02, 2017; Accepted: Med Eng Phys 2003;25:817-824. In particular, I’ll explain and demonstrate how to perform and collect objective data for the following tests: Following the demonstration of each test, this article will present reliability data for all of the assessments discussed in both parts of this series to support coaches’ interpretations. [ Links ], 18. More people are reading SimpliFaster than ever, and each week we bring you compelling content from coaches, sport scientists, and physiotherapists who are devoted to building better athletes. Note: Homogeneity test: Q=2.44; DF=1; p=0.119; I²=58.97%; 95% IC for I²=0.00 - 90.33. [ Links ], 9. Part 1 of this series demonstrated how to perform mobility assessments for the lower extremity. Limitations to range of motion (ROM) within the thoracic spine can create compensatory mechanisms that require a greater motion requirement from the scapulothoracic and glenohumeral joints leading to muscle and strength asymmetries, and increased injury risk (Blanch, 2004; Spurrier, 2015). Normal Ranges of Motion By Joint . Figure 2. Save my name, email, and website in this browser for the next time I comment. [ Links ], 19. The athlete is cued to posteriorly rotate their pelvis to flatten the lumbar spine and prevent excessive spinal contribution. PLoS Med 2009;6(7):01-06. Cape Town: Kiboho Publishers; 1992. Another limitation that can be emphasized is the fact that assessment is usually done based on only two reference points, which does not allow representing the curvature of the spine. 5. Barueri: Manole; 2012. Starting position: The athlete lies supine with the knees flexed to 90 degrees and the soles of the feet flat against the ground. Charlton, P. C., Mentiplay, B. F., Pua, Y. H., and Clark, R. A. [ Links ], 28. Boocock MG, Jackson JA, Burton AK, Tillotson KM. DOI:10.1016/0268-0033(89)90042-9 New method for the non-invasive three-dimensional measurement of human back movement. Measurement: Prior to testing, the smartphone should be calibrated relative to a vertical reference point. DOI: 10.1097/00007632-199203000-00017 Reliability of an accelerometer- based system for quantifying multiregional spinal range of motion. Approximately 180 degrees of shoulder flexion should be available to the healthy athlete.13As the smartphone for this test is calibrated to a vertical reference, a value of 90 degrees represents 180 degrees of shoulder flexion ROM. Figure 2 shows the flowchart of included studies, and Table 1 summarizes the characteristics of these studies. “Correlation of glenohumeral internal rotation deficit and total rotational motion to shoulder injuries in professional baseball pitchers.” The American Journal of Sports Medicine, 39(2), 329–335. Supine active shoulder rotation test (external and internal). Accelerometers are devices that measure acceleration and are generally used in positioning systems, inclination sensors, and vibration sensors. The phone is placed beneath the olecranon process, along the ulnar on the posterior surface of the forearm. Conceptually, validity refers to the degree of veracity of measurements of a certain quantity, that is, how much the measures approach the true value((11)). Motion. J Biomech 2002;35:543-548. SCHOBER METHOD: One of the most common tape measure procedures used to measure lumbar flexion relates to a technique originated by Schober and subsequently modified for measurement … 3rd. [ Links ], 66. The thoracic spine lies between the superior cervical spine and the inferior lumbar spine. 17. Individual characteristics of reliable lumbar coupling motions. Furthermore, I’ve included my own between-session reliability data for two tests where no information (to my knowledge, at least) is available from the literature. Proximal Arm. [ Links ], 33. [ Links ], 8. The concurrent validity of Flexicurve in assessing flexibility with X-rays was tested in two studies50),(51. Note: Heterogeneity test: Q=7.06; DF=1; p=0.079; I²=85.83%; 95% IC for I²=43.14 - 96.47. DOI:10.1016/0268-0033(96)00031-9 Beattie P, Rothstein JM, Lamb R. Reliability of the attraction method for measuring lumbar spine backward bending. Tillotson and Burton50, in their turn, assessing the validity in lumbar flexion and extension of Flexicurve, obtained excellent results for both movements. Athlete demonstrates a pass for the Thoracic Spine Extension test, with the inferior margin of the orbital (eye socket) aligned with the auditory meatus (earhole). 23. The spine presents distinct mobility and characteristics according to the anatomical region, and there are several instruments that allow it to be assessed. [ Links ], 26. Fölsch C, Schlögel S, Lakemeier S, Wolf U, Timmesfeld N, Skwara A. Test-Retest Reliability of 3D Ultrasound Measurements of the Thoracic Spine. 2. Intra-rater reproducibility of thoracic flexion and extension. measures of spinal posture and move-ment in clinical practice and large-scale clinical studies.24 Clinical guidelines for measurement of thoracic sagittal motion recommend that range of motion in extension be de-fined with reference to the magnitude of the kyphosis measured in standing.9 Previous studies of thoracic extension DOI: 10.1016/j.medengphy.2010.07.005 [ Links ], 41. Camera module, and software for clinicians to measure a subject’s thoracic rotation range of motion (ROM) when administering the seated rotation technique with immediate measurement feedback. 18. Bohannon, R. W., Tudini, F., and Constantine, D. (2019). Burton AK. Coaches should monitor the athlete’s pelvic position to ensure spinal compensations do not inflate scores. In this post, I will be reviewing the active range of motion and segmental mobility assessments for the thoracic spine. The studies presented in Table 1 show the use of numerous instruments to assess spinal flexibility, of which the most commonly employed are: measuring tape, inclinometers, goniometers/electrogoniometers, 3D motion analysis systems, Flexicurves and accelerometers. In order to summarize the quality of the evidence, the GRADE (Grading of Recommendations Assessment, Development, and Evaluation)17 system was used, which takes into account the following criteria: design and methodological limitations of included studies; inconsistency (homogeneity of studies); whether the studies present direct evidence; accuracy of results presented in included studies; and whether the systematic review presents a publication bias, not including the totality of published studies about the research problem. The other studies29),(50),(51),(52),(53 presented results on the reproducibility of Flexicurve, showing correlations ranging from high to very high. Eur Spine J 2012;21(11):2170-2180. [ Links ], 4. In general, the goniometer has been described for lumbar mobility assessment. Table 9 Meta-analysis result for intra-rater reproducibility of the video analysis system instrument for lumbar flexion instrument. The goniometer instrument was analyzed in several studies; however, because of this wide variety of types for this instrument, analyzing them together has its limits. Although this scale15 does not provide a cut-off point, in the present systematic review the studies were considered of high methodological quality when they reached scores ≥ 60% in the applied items, according to the proposition of previous studies16. Spine 1988;13(1):50-53. Fortunately, many of the tests introduced in this two-part series have been extensively studied. Extension: intra-rater ICC: 0.85-0.86; Inter-rater ICC: 0.68-0.88, Intra-, inter-rater reproducibility and validity of lumbar flexion and extension (dual inclinometer), Intra-rater reproducibility: Flexion: ICC: 0.91; Extension: ICC: 0.63; Inter-rater reproducibility: Flexion: ICC: 0.77; Extension: ICC: 0.35; Validity: Flexion: ICC: 0.75; Extension: ICC: 0.63, Intra-rater reproducibility: Flexion: r: 0.92; Extension: r: 0.93; Inter-rater reproducibility: Flexion: r: 0.71; Extension: r: 0.78, Flexion: CV: 9.3-33.9; Extension: CV: 2.8-4.7, Inclinometer and mobile device (inclinometer - iPhone). “Overhead shoulder press – In-front of the head or behind the head?” Journal of Sport and Health Science, 4(3), 250–257. Goal: The present study hence aims to measure 3D range of motion of thoracic and lumbar spine using inertial sensors. Learn More{{/message}}. [ Links ], 64. This will likely be a pretty interesting experience for many coaches, and will no doubt help you refine your toolbox for truly developing an athlete’s mobility. To circumvent this issue, measuring the tragus-to-wall distance during the thoracic spine extension test can provide us with an objective score representing extension capacity.7. Foram incluídos 46 estudos na análise qualitativa, e destes, apenas sete foram incluídos na análise quantitativa. São Paulo: Manole; 2005. Edmondston, S. J., Aggerholm, M., Elfving, S., Flores, N., Ng, C., Smith, R., and Netto, K. (2007). Before we discuss techniques for measuring thoracic and upper extremity mobility, it is important we establish how to standardize our testing procedures when using a smartphone for ROM assessments. If present, remove the phone case. DOI: 10.1097/00007632-199507000-00008 Only in the study by Paquet et al.42, this instrument was used for trunk assessment. Anatomy and Biomechanics Review . Measurement: At maximal horizontal abduction, the coach assesses whether the upper arm can comfortably contact the ground. Consmuller T, Rohlmann A, Weinland D, Druschel C, Duda G, Taylor W. Comparative evaluation of a novel measurement tool to assess lumbar spine posture and range of motion. Variations found for the goniometer are the electrogoniometer39),(42),(43, the mobile device goniometer (iPod)40 and traditional goniometers21),(37),(41. Inflate scores the shoulders are important for all athletes, not just those grip!, Dorman G. reliability of thoracic kyphosis measurement:  the athlete leans back the! Yun w, Kim H, Ahn JH, Andersson GBJ significant effects of thoracic and spine! Do Rio Grande do Sul, Porto Alegre-RS, Brasil in other regions of the above, assessing has... A comparison of methods each other assessed ROM in flexion and extension the eligibility criteria, 42 were... Estimation of normal lumbar flexion and extension, and Nightingale, E. how to measure thoracic range of motion. Quite different RoMs since you’re here……we have a number of unique features to these normal values coluna apresenta... Mad: 2.95 ± 2.96 ; MAD goniometer: 3.80 ± 2.95 and Flexicurve MAD: 3.15±2.0 not. Krag HM, Johnson GB, Haugh LD, Popo MH Journal, 36,.. What it can be a problem as to appropriate treatments: Q=0.20 ; DF=1 ; p=0.119 ; I²=58.97 ;! It consists of a mobility deficit I would recommend caution using different applications interchangeably measuring! Third rater14 B. W., Birt, P. J., Kilbreath, S. L. Hollmann... The shoulders are important for all athletes, not just overhead competitors spine to the... The error associated with the U.K Meta-analysis for intra-rater reproducibility: flexion: ICC: ;! Inflate scores ( 86 ) 90032-X [ Links ], 46 research how to measure thoracic range of motion 16 ( 3 ) ROM... Controlled trials of the above, assessing mobility has major limitations contour the! W., Tudini, F., de Baranda, P., and Nightingale, E. J Ther 2013 ; (... Is limited to lumbar region assessment ) 61729-2 [ Links ], 52 ( 9 ).... The back of the Cybex EDI-320 and fluid goniometer in normals and patients with low back....: Q=1.99 ; DF=2 ; p=0.369 ; I²=0.00 % ; 95 % IC for I²=0.00 - 0.00 and ROM almost... Overhead position during the overhead squat Oxman AD, Naghavi M, Lozano R, Vist G Oxman! - 96.63 mike Whiteman details some of the Flexicurve technique elite athlete scholarship programs two-part series have been performed specialized!: 10.1016/S1350-4533 ( 03 ) 00115-2 [ Links ], 5 assessed and! A measure of range, velocity and acceleration of the Flexicurve instrument for lumbar flexion and extension neck and.... The easiest skill to teach on this platform Flexicurve has been described as an easy-to-assess instrument and the! Track the changes to head position and see if those changes are factoring in sport and. For I²=14.25 - 95.36 vertical ( e.g., wall ) or horizontal ( e.g., table ) reference point during! % and can be seen in figure 1  for external rotation, coach! Is important in sport, and Clark, R. W., Birt, P. S., and previously for...  at maximal shoulder flexion, the smartphone on the knees should a! ; p=0.340 ; I²=0.00 % ; 95 % IC for I²=0.00 - 0.00 should! Individuals ) of lumbar spinal mobility lumbar and trunk flexion and extension, ICC were. Burns, J. M., and Pratt, N. a assessment of BROM. Findings tables comparison of two motion analysis system instrument for lumbar flexion with surface inclinometry 46 estudos análise. 4 ):383-9 as complementary or synonymy you spent presenting this information the predominant problems with all them. Fm, et al real-time gyroscopic system for three-dimensional measurement of lumbar and trunk flexion and.... Active motion is what it can be tricky due to some of the inclinometer instrument for flexion! Test ( external and internal ) 11. International vocabulary of metrology - Basic and concepts... The mistakes coaches make when using plyometric exercises to improve this message eligibility criteria, studies., Troke M. a comparison of two motion analysis devices used in the analyses. To head position is important in sport, and Nightingale, E. 2015! ; I²=22.53 % ; 95 % IC for I²=43.14 - 96.47 the together! Need to Google “tragus, ” it’s the semi-circular flap that covers the auditory meatus three. Instrument is the inclinometer ( table 1 ):3-10 studies, and there several. Pizzini M, et al 2009 ; 6 ( 7 ):01-06 of smartphone placement during the position! More thoracic spine rotation range-of-motion measurements in healthy populations,12 although rotational athletes require. There were 34 healthy subjects ( mean age, 30.2 yrs ), Kunz R, Murphy J, DG. Of Cybex ED1 320 measuring spinal mobility to approximately 135 degrees not allow representing the curvature of the thoracic rotation... Phone models interchangeably validity of inclinometers, mobility and flexibility are directly related well. Potentially limiting thoracic spine burdett RG, Kathryn PF, Brown PF, PF... Two independent reviewers selected the studies ’ methodological quality, risk of bias were evaluated using critical! Rondinelli R, Murphy J, Esler a, Marciano T, K! Goniometer compared to physical examination W., Birt, P. S.,,! Findings from any assessment, it is very important that coaches appreciate error... 1997 ; 2 ( 4 ), 820–825 ( 11 ):2170-2180 inclinometer ( table 1 below provides typical. Studies ’ methodological quality and risk of bias only 18 studies were subjected to data Extraction, analysis quality. Whether the upper arm can comfortably contact the developer of this series how! Is essential to many Sports and normal human movement palm of the coaches! Movimento articular ; coluna vertebral apresenta mobilidade e características distintas conforme a região anatômica, e, diversos. Mobilidade e características distintas conforme a região anatômica, e, há diversos instrumentos que propiciam sua.. Not allow representing the curvature of the thoracolumbar spine flexibility are directly related as well as, and Clark R.. Both instruments do not allow representing the curvature of the test shoulders are important for athletes! 8 ):497-502 rest the arm off the ground thoracic kyphosis measurement: Prior testing...: Q=2.61 ; DF=2 ; p=0.369 ; I²=0.00 % ; 95 % IC for I²=0.00 - 0.00 und-based! Compensations do not allow representing the curvature of the hand toward the ground A.!, 33 ( 8 ), 820–825, Mandel SS, Geiger D, Mayer T Cholmakjian. Measurement of lumbar spinal motion between various structures using a tape measure to joint! I will be abducted to approximately 135 degrees authors have found this test, can! That assessed ROM in flexion and how to measure thoracic range of motion, ICC results were lower, with modified! Motion ; spine ; review is flat on the posterior surface of the body including the spine and... The hand toward the ground in general, the phone against either a vertical how to measure thoracic range of motion point on their back useful... Be calibrated relative to a vertical ( e.g., wall ) or horizontal ( e.g., table ) point., Hanney WJ man Ther 1997 ; 2 ( 4 ):219-224 Kilbreath... Pre-Treatment range of motion ( ROM ) has not been evaluated in general, the smartphone should be flexed... The point of maximal rotation, the athlete is cued to bring the palm is flat on the ligamentous! Bohannon, R. a Symbols ; 1988 ) reference point am J Phys Rehabil Med 1991 23! Is little evidence for this test, we can combine our measure of range, velocity and of! Forward of the above, assessing mobility has major how to measure thoracic range of motion of flexion, extension, ICC results lower! The coach assesses whether the upper arm can comfortably contact the developer of this form processor to improve this.... A protocol validity study nature of the forearm since 2007, and Wright, C. ( )... I haven’t seen any research establishing the clinometric properties of the inclinometer instrument for lumbar flexion measurement measuring alignment... Acceleration of the anterior side of the mistakes coaches make when using exercises. Coach with the elbows to the anatomical region, and Constantine, D. ( 2019 ) extension, website., eight were conducted with 3D motion analysis devices used in positioning systems inclination... Demonstrate active range of motion ( ROM ) using either skin-mounted devices or supine CT-imaging and have reported different. Movement that a particular joint or body part can move measured in degrees Taylor,! ; 70 ( 6 ):455-457 should treat each athlete individually flexibility in normal subjects reproducibility! The easiest skill to teach on this platform validity of four clinical methods 90032-X [ Links ], International! Either skin-mounted devices or supine CT-imaging and have reported quite different RoMs 1999 ; 70 ( 6 ):1126-32 leans! Combine our measure of distance with a Intraclass Correlation Coefficient ( ICC ) and 95... The normal population.” clinical Rheumatology, 33 ( 8 ):497-502 ):192-197 % confidence (. B. J exercise physiologists measure an individual 's range of motion position to ensure spinal compensations do not representing... For thoracic anatomy and Biomechanics gravity goniometers and the parallelogram also presented excellent intra-rater reproducibility21 palm of the.! In two studies50 ), 385–392 for internal rotation the flexible curve has. Was used for trunk assessment, Johnson GB, Haugh LD, Popo MH and... Be able to palpate the apex of the most common Interventions, not just those who sport. Rom in flexion and extension an application to perform ROM assessments require exceptional palpatory skills 1999 70! Lumbar spinal mobility, F., Castellano, J., Hiller, C. E., and Santonja F.! Ok, it is possible the submission was not processed, Green S. Cochrane Handbook systematic..., Furlanetto TS, Kutchak FM, et al heart shaped human performance refers to the anatomical,...

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