Examination of the movement of spine

The spine is part of the axial skeleton of vertebrates, it consists of individual vertebrae, which are firmly but movably connected to each other.

Joints of the spine
there are three types of joints we can see in the spine :-


 * cartilaginous joints - synchondroses columnae vertebralis - intervertebral discs;
 * fibrous joints - syndesmoses columnae vertebralis - long and short ligaments;
 * synovial joints - articulationes columnae vertebralis - joints between the articular processes of neighboring vertebrae, craniovertebral joints - joints and ligaments connecting the occipital bone with the atlas and axis.

Spinal mobility
Mobility in the presacral region is given by the sum of mobility between the individual vertebrae. Its extent is affected by the height of the intervertebral discs (direct ratio), the shape and inclination of the vertebral spinous processes and the shape of the articular surfaces.

the movements of the spine are :-


 * 1) anteflexion (forward bend) and retroflexion (backward bend)
 * 2) lateroflexion (bow to side )
 * 3) rotation torque (rotation)
 * 4) circular movements - combination of flexion, extension and lateroflexion

The individual sections of the spine differ in mobility:

The orientation of the spine
During retroflexion of the cervical spine, we place 2 fingers on the adjacent spinous processes of the C-Th transition area: during this maneuver, the C6 moves forward so that it escapes under the palpating finger, while the C7 spinous process remains in place. C7 vertebra may not always be the most prominent! The palpation of the L5 vertebra is used to delimit the presacral part of the spine - the last spinous process that moves during anteflexion and retroflexion. We also find it by connecting the two aanterior superior iliac spines - where the line intersects the  vertebral column, lies the spinous process of L5.

Examination of spinal mobility
For most tests, we assume the starting position is an upright position, if otherwise, it is stated.

Schober's distance
The distance that shows the development of the lumbar spine. From the L5 spinous process we measure 10 cm cranially in adults and 5 cm cranially in children, both points can be marked with a dermograph. After the measurement, the examinee leans forward, with a healthy spine, the distance between the two points increase to 14 cm for adults and 7.5 cm for children. Some authors report measurements from the S1 vertebral spinous process, where upon extension the distance changes from 10 to 15 cm.

Stibor's distance
Stibor's distance shows us the mobility of the thoracic and lumbar spine. The starting point is again the spinous process of the vertebra L5 (S1), the second point is the spinous process of the vertebra C7 - we measure the distance between them and monitor its change after anteflexion. For a healthy spine, there should be an elongation of 7-10 cm.

Forestier fleche
Forestier's fleche ( or fleche test ) measures the the perpendicular distance of the external occipital protuberance from the wall. It can be measured while standing or lying down .The patient is instructed to stand with their back facing a wall and asked to keep their back and head as tightly to the wall as possible. In this position the distance between External occipital protuberance and the wall must be zero.

Chepoy's distance
Chepoy's distance evaluates the range of motion in the cervical spine in flexion. We will find the spinous process of the C7 vertebra and measure 8 cm cranially from it, at maximum forward inclination the measured distance will increase by at least 2.5–3 cm.

Otto's inclination distance
Otto's inclination distance measures the mobility of the thoracic spine in forward flexion. The starting point is again the spinous process of the C7 vertebra, from which we measure 30 cm caudally. The distance of the points shown increases with the forward flexion by at least 3.5 cm.

Otto's reclining distance
Otto's reclining distance measures the mobility of the thoracic spine in retroflexion. The second point is again 30 cm from the starting spinous process of the C7 vertebra, the distance decreases by 2.5 cm when tilted. The sum of both Otto distances gives the index of sagittal mobility of the thoracic spine.

Thomayer's distance
The Thomayer's distance, sometimes referred to as the simple forward bend test, displays and evaluates the non-specific mobility of the entire spine. It consists of an anteflexion made from a standing position, where the distance of the third finger from the floor is measured in the most extreme position. We consider fingers touching the floor or distance of up to 10 cm to be normal, above 30 cm it is already a clear pathology.

During the test, we must pay attention to certain distortions - the movement can be compensated by movement in the hips or, conversely, limited due to the shortening of the knee flexors (the patient shrinks his knees and feels pain in the hamstring). In addition to hypomobility, the test can also examine significant hypermobility, when the patient touches the pad with the whole palm or forearm (this is already considered a very significant ligament disorder). Increased laxity and thus positive testing for hypermobility is more common in women.

Lateroflexion
The bow test is for guidance only and provides information on the symmetry and range of the bows. The examinee stands with their back against the wall, with their arms along their  body with the palms facing the body. The examinee bows and marks the distance he reached with the longest finger.