Torso Region
Musculoskeletal Overview
The torso can be defined as the combination of the pelvis and the trunk3.
Foundations
Torso inventory
- Glute origins
- A→P Joint mobility
- SP Depth
- SP spacing
- Curvature of spinal column
- Bilateral TPs
- Bilateral superficial paraspinals
- Deep paraspinals
- QL (pelvic, vertebral TP, and 12th rib outline)
Glute origins
The origins (proximal attachment) of the glutes can be found by palpating the rim of the pelvis along the iliac crest.
A→P Joint mobility
It is difficult to decipher what is “normal” vs “abnormal” joint mobility for the spine.
Each segment behaves slightly different from the next. When considering mobility we can use a few concepts to determine if a segment is behaving dysfunctionally.
Is the segment significantly less mobile than the segment above and below?
Even if you would expect the spine to be less mobile towards a certain area, if a segment is less mobile than its immediate neighbors than this breaks a pattern and should be noted.
Spinous processes
Torso
Lumbar Spine
ROM
Lateral flexion
The lateral flexion range of motion varies by individual and age3.
In general, normal lateral flexion is 20-30°3.
| Age Range (years) | Lateral Spine Flexion ROM (°) | Change from Baseline (°) |
|---|---|---|
| 2-13 | 62° | Baseline |
| 35-49 | 31° ↓ | -31° |
| 50-64 | 29° ↓ | -33° |
| 65-77 | 22° ↓ | -40° |
| 2-13 (years) | 35-49 (years) | 50-64 (years) | 65-77 (years) | |
|---|---|---|---|---|
| L1-2 | 12° | 5° | 6° | 4° |
| L2-3 | 12° | 8° | 7° | 7° |
| L3-4 | 16° | 8° | 8° | 6° |
| L4-5 | 15° | 8° | 7° | 5° |
| L5-S1 | 7° | 2° | 1° | 0° |
Segmentally, each joint has slightly different ranges of motion. The lateral flexion available at L5-S1 segment is limited and rapidly drops during into old age3.
L3-L4 is one of the most mobile segments, and has 16° in adolescence and drops to 8° in adulthood3.
Thoracic Spine
Torso Treatment Checklist
It is important to note that even healthy joints with healthy supporting structures can perform compensatory or dysfunctional movements4.
Functionally, we can evaluate joints by its respective limits of movement.
To comprehensively and successfully assess the torso, we need to perform an analysis on the joints, ligaments, and muscles4. Only then can we create a “big picture” of the region’s overall function4.
Alignment, Mobility, and Muscle activation can be used to guide our understanding of torso function4.
The pelvis position should be considered when assessing the torso, since this is the platform that the torso sits on4. Check the angle between the pelvis and one or both of the lower extremities4.
Weight bearing
Alignment
- Overall curvature
Palpation
Spinous Processes
- Depth
- Spacing between Spinous processes
- Tissue quality on either side of SP (guarding, swelling, atrophy, etc)
Transverse process
- Compare depth bilaterally
Vertebral column
- Overall curvature (with hips and ankles supported)4
- You should expect the curvature in the lumbar spine to peak at L3, this indicates that L3 is the most mobile
Patient positioning
- Start prone for general assessment
- Add pillow under hips/lower abdomen and foam roll under ankles when assessing spinal curvature
Muscle Pathways
Describe assessment
- Is muscle guarding present4
- Is there less tone at a segment unilaterally or bilateraly?4
- “Is there scarring or swelling along the muscle pathway, unilaterally or bilaterally?”4
Response to treatment
- “Muscle guarding reduces”
- “Segmental alignment improves”
- “Muscle tone normalizes regionally”
Segmental Joint mobility
To assess joint mobility, we must consider both alignment between segments and the freedom/mobility of each segment.
- Alignment: Aligned vs malaligned
- Freedom/mobility: Hypomobile vs normal vs hypermobile
Description
- “are there central SP spacing and depth changes?”4
- “Any segmental alignment changes present on the unilateral or bilateral surfaces of posterior articular pillars. Use a pressure dpeth beyond soft tissue depth tot compare above and below segments and left to right at each segment”4
- Note rigidity at joint level pressure4
- Note instability to endpoint pressure4
Response
Treatment
- Gapping
- Gapping spinous processes
- Gliding superior segment antero-superiorly relative to lower segment