Torso Region

Musculoskeletal Overview

Authors
Affiliations

Doctor of Physical Therapy

B.S. in Kinesiology

Doctor of Physical Therapy

B.A. in Neuroscience

Reading list
  • Examination
  • Manual tx
    • ch28 Orthopaedic Manual Physical Therapy of the Lumbopelvic Spine
    • ch29 Orthopaedic Manual Physical Therapy of the Thoracic Spine and Costal Cage

The torso can be defined as the combination of the pelvis and the trunk.

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 age.

In general, normal lateral flexion is 20-30°.

Table 1: Age related Lumbar Spine Lateral Flexion ROM changes
Baseline ROM is for the 2-13 years group. Down arrows (↓) indicate a decrease in ROM relative to this baseline.
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°
Table 2: Age related Lateral Flexion Segmental ROM Changes
2-13 (years) 35-49 (years) 50-64 (years) 65-77 (years)
L1-2 12°
L2-3 12°
L3-4 16°
L4-5 15°
L5-S1

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 age.

L3-L4 is one of the most mobile segments, and has 16° in adolescence and drops to 8° in adulthood.

Thoracic Spine

Torso Treatment Checklist

Note

It is important to note that even healthy joints with healthy supporting structures can perform compensatory or dysfunctional movements.

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 muscles. Only then can we create a “big picture” of the region’s overall function.

Alignment, Mobility, and Muscle activation can be used to guide our understanding of torso function.

The pelvis position should be considered when assessing the torso, since this is the platform that the torso sits on. Check the angle between the pelvis and one or both of the lower extremities.

Weight bearing

  • “Note how the client’s feet absorb and align to the floor”.
  • Follow each bony segment up the chain to the pelvis.
  • “Each segment of the trunk will attempt to absorb and couner the positioning of the pelvis in attempts to neutralize alignment”

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)
    • 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 present
  • Is there less tone at a segment unilaterally or bilateraly?
  • “Is there scarring or swelling along the muscle pathway, unilaterally or bilaterally?”

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?”
  • “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”
  • Note rigidity at joint level pressure
  • Note instability to endpoint pressure

Response

  • “Positive changes in segmental alignment”
  • “Normalizing segmental mobility into a position of alignment”
  • “Remaining limits to mobility with alignment deviations to address in future sessions”

Treatment

  • Gapping
    • Gapping spinous processes
    • Gliding superior segment antero-superiorly relative to lower segment

Pain

  • Clinical Considerations of Upper Back Shoulder and Arm Pain
  • Ch53 Clinical Considerations of Trunk and Pelvic Pain

References

1.
Heick J, Lazaro RT. Goodman and Snyder’s Differential Diagnosis for Physical Therapists: Screening for Referral. 7th edition. Elsevier; 2023.
2.
Wise CH, ed. Orthopaedic Manual Physical Therapy: From Art to Evidence. F.A. Davis Company; 2015.
3.
Jones B. B Project Foundations. b Project; 2025.
4.
Jones B. B Project Physical Therapy Curriculum. b Project; 2025.
5.
Donnelly JM, Simons DG, eds. Travell, Simons & Simons’ Myofascial Pain and Dysfunction: The Trigger Point Manual. Third edition. Wolters Kluwer Health; 2019.

Citation

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