For every doctor of chiropractic, a factor for consideration in patient care is spinal motion. Abnormal movement is one of the most frequent findings, whether in the form of, “Doc, I just can’t bend,” or “There is a lack of normal motion on examination.” Or perhaps, “There is a fixation of C4.” But, in whatever form it occurs, abnormal motion can be measured. The question is, how?
First, we need to break the discussion into parts: the assessment of motion between two adjacent vertebral segments (intersegmental motion) and movement of an entire area of the spine (global motion). Both of these areas are interesting; but, today, we are going to confine ourselves to the global motion in the spine. We’ll look at four easy methods to use for assessing these motions and, just like most things in life, each has its good and bad points. For the sake of ease of explanation, we’re going to use the cervical area for all our examples.
#1 Visual Examination
The simplest method is to observe the patient as he or she moves the neck through the various planes of motion and, then, record the results, including a special note of any abnormal movement, such as motions that were less than normal. This method is easy and quick, but it doesn’t give us quantification. In other words, you can’t say that the patient has 25 degrees of cervical extension. Well, unless your eyes are calibrated a little differently than ours.
#2 Hardware Store Method
You take a trip to your local hardware store and buy a couple of circular levels. Then follow the directions in the Guides to the Evaluation of Permanent Impairment, Fifth Edition. You can use these devices to measure the amount of motion in a particular plane and also to determine the amount it varies from the normal range of motion for that area and movement. The good part is that these levels are inexpensive and durable, but they do take more time than the first method, and you may have to keep tapping these levels to keep the internal part of the levels swinging freely.
#3 Fluid Filled Inclinometers
You’ll probably have to order these. You use them the same way as the hardware store variety, but they tend to move smoothly, and you shouldn’t have to keep tapping them to get an accurate reading. Nice method, but more costly than the hardware variety.
#4 Wireless, Electronic Inclinometer
So, there you have four methods to determine global range of motion. A purist would insist that we include electronic inclinometers that do not interact with your computer. These would fall between numbers 3 and 4, and some of you might like them; so take a look. But, this will give you a place to start. Remember, no matter what methods you use, range of motion is a concern in spinal problems. So, give it some thought and see how it fits into your office.
Note: This information in not intended as healthcare advice. The determination of the risk and usability of information rests entirely with the attending doctor of chiropractic.
Roger R. Coleman, DC, is a 1974 graduate of Palmer College of Chiropractic, member of the Adjunct Research Faculty of Life Chiropractic College West, charter member of Washington State Chiropractic Association and author/co-author of eight scientific journal articles. He is heard on Coleman and Fairbanks Talk Science on the radio and is the author of the book Coleman’s Fables. A lecturer and inventor of several rehabilitation devices, he can be reached at 509-488-9679.
Dr. Stephan J. Troyanovich is a 1987 graduate of Palmer College of Chiropractic, practicing in Normal, IL, and a member of the Adjunct Research Faculty, Dept. of Research, at Life Chiropractic College West. He may be reached at 309-454-5556.