Basic diagnostics of locomotor apparatus
Evaluation of posture and functional stage of musculoskeletal system
- Determination of posture
- Traditional posture standards for male and female according to Klein, Thomas, and Mayer.
The methods recognize different criteria for the evaluation of posture in male and female according to silhouette images and classify postures into 4 different categories (excellent, good, weak, bad). Clinical examination is performed to independently evaluate the position of head, shoulders, and scapular bones; chest and abdominal profile; spine curvature; pelvic inclination; and position of lower extremities, including the foot arch.
Evaluation of spinal curve with plumb line
- The head should align directly over the sacrum, and any deviation from midline may reflect a spinal deformity. The examiner can detect deformity by dropping a plumb line from the spinous process of C7 or occipital bone down to the level of the gluteal cleft. The deviation of spine from plumb line and number of centimeters of the plumb line from the gluteal cleft is noted.
- We can measure the depth of spinal curve in cervical (normality= 2,5cm) and lumbar (normality= 4cm) region.
Fig. 1 Adam's forward bending test
Adam's forward bending test - deep forward bend - Evaluation of length of hamstrings, erector of spine, unwinding of spine. Normality=third finger touching floor
Muscle test – postural muscles
With qualitative scale we are measuring:
Muscles with tendency to be shorted (postural muscles)
Evaluation:
- without shortening,
- moderate shortening,
- pathological shortening
- Calf (m. gastrocnemius, m. soleus)
- Hamstrings (m. semitendinosus, m. semimembranosus, m. biceps femoris, m. gracilis)
- Adductor muscles
- Flexors of hip joint (m. iliopsoas, m. rectus femoris, m. tensor fascie latate)
- Extensor of spine (paravertebral muscels)
- Pectoral muscles
- Muscles in nape region (m. trapezius pars descendens, m. levator scapulae, sternocleidomastoid)
Muscle test – weakness
Muscles with tendency to be weak together with motion stereotypes
Evaluation:
- motion stereotype:
- good
- poor
- muscle weakness:
- good,
- moderate weakness,
- pathologically weak
- Motion stereotype of extension of lower extremity +power of gluteal muscles
- Motion stereotype of flexion of trunk + power of abdominal muscles
- Motion stereotype of abduction of arm + power of deltoid muscle
- Motion stereotype of flexors of neck + power of deep flexors of neck and head
Hypermobility
We can use some basic test for hypermobility diagnostics. There must be more than one test positive to state hypermobility.
- Adams forward bending test
- Hyperextension of knee joint
- Hyperextension of elbow joint
- Toe test
- Scarf test