spinal examination and assessment

The spine is a complex part of the body, with the very important role of protection and support. Without the spine, we would literally be a pile of bones.

There are 34 vertebrae in the spine, split into 5 sections. 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 5 sacral bones and 5 Coccygeal bones.

There are ligaments attaching to the spine. Anterior longitudinal ligament, posterior longitudinal ligament, inter spinous ligaments, inter transverse ligaments, ligamentum flavum, and ligamentum nuchae.

Several muscles attach directly to the spine, including, rhomboid major and minor, splenius capitus and cervices and trapezius.

During examination of the spine, it is important to start with subjective questioning. This is arguably the most important part of the examination. Questioning the patient about everything to understand what they have done that has caused the injury. It is essential that referred pain is questioned as that indicates a neural problem.

Next comes objective which includes observation, superficial touch and palpation. Observation is used to determine if there is any muscular bulk or spasm involved. Important features, for example, the spinal bones that protrude like c7, can be determined as they can be seen to have scars, bruising or an abnormal skin texture or colour.

Superficial touch is used to decide if there are any inflammatory processes going on. The heat from the skin distinguishes the inflammatory process is occurring. If there is heat, then it indicated an underlying problem.

Palpation is used to determine if there is a difference in feel for the therapist on specific land marks. If there is pain on palpation, it may indicate a problem under the skin in either muscle or bone.

Active range of movement tests contractile tissues like muscles and tendons. It allows the therapist to see whether there is a limitation involved in the movement. Measurements are essential to compare between the normal and their uninjured side.

Active range of movement with overpressure tests non-contractile tissue like ligaments, bones, bursae, etc. A limitation in the movement can indicate an injury in the non-contractile tissues.

Resisted range of movement is next to determine muscular strength within the range of movement. Mid-range should be the strongest of all the movements, then outer and inner ranges will be weaker, however, should still not have any muscular weakness if the muscles are healthy. A full range should be tested with resistance and marked with the oxford scale.

Neuromuscular tests are needed for testing the neurology connected to the muscles. Myotomes are used to determine if there is problem with the nerve that innovates a specific muscle group.

Dermatomes are an area of skin that is supplied by that specific nerve.

Reflexes are needed to ensure that the body can react to an external stimulus. There are lots of reflexes in the body, like the Achilles, Babinski and knee.

Special tests are performed to ensure that all aspects that could be wrong are being assessed. Special tests are specific to an injury to rule out that injury. If there is a positive special test, then it is possible that the patient has that specific injury. There are specific tests for the median, radial and ulna nerves, the brachial plexus and pain provocation.

All these tests give a range of indications as to what the injury is. Using differential diagnosis can help the therapist understand what the problem is and how it can be treated.