All objective assessments should contain observations (static and dynamic), active movements, passive movements, resisted movements, functional movements, special tests, palpations, neurological involvement and an upper motor neuron lesion assessment. A spinal assessment also includes accessory movements where we perform central and unilateral posterior anterior (PA) to assess the stiffness and pain of the joints around the processes (spinous and transverse). For me the hardest part of the assessment is considering what functional movements are specific to areas of the spine, as we have never touched on this area in lectures. It was interesting to hear the other ideas that people had about this as it gives a different perspective on things.

With observations it is important to look at posture. This is because different positions can affect the tightness of certain muscles. If someone has rounded shoulders it is likely that they have tight pectorals which we can assess during palpations. If the muscles are tight we are then able to treat the to see if this improves the objective measures.

Areas for further improvement

My first area for improvement would be to improve my knowledge on the functional movements associated with each part of the spine. These are important to assess as it can help you to understand what positions the client get pain, stiffness, decreased range of movement in. This will then help to compartmentalise treatment.

Another area I struggle with is linking special tests for certain joints such as the shoulder or hip to the spine. For example, you may want to perform special tests for the sacroiliac joint (SIJ) if there is a problem with the lumbar spine. This can help to rule the SIJ in or out of the problem so can help you get closer to finding the cause of the pain etc.

Things to Remember:

1. A PA is not a palpation
2. An accessory movement is a movement that the patient cannot perform themselves
3. A leg length discrepancy is considered when there is a difference of over 2cm of true leg length which is from the anterior superior iliac crest (ASIS) to the medial malleous
4. Scoliosis is indicated if the shoulders, scapula, iliac crest or posterior superior iliac spine (PSIS) are not level
5. Posterior pelvic tilt (PPT) = ASIS is higher than PSIS (increased flexion, decreased lordosis)
6. Anterior pelvic tilt (APT) = PSIS is higher than ASIS (increased extension, increased lordosis)