lumbar rom measurements

Differences in lumbar ROM between the sexes in older subjects remains unclear. 8-30 End ROM of lumbar extension. The human body is capable of a wide range of movement. The authors reported that sit-to-stand and stand-to-sit activities required 56% to 66% lumbar flexion. I understand that lumbar Rom is not necessarily indicative of a patient's recovery, but providers and insurance companies want to know. The standard goniometer, consisting of two hinged rulers rotating on a protractor (described in detail in Chapter 1), is commonly used for measuring ROM of the spine. 8-20 Goniometer alignment at end ROM of lumbar flexion. 8-22 End ROM of lumbar flexion. 8-29 Starting position for measurement of lumbar extension using tape measure method. 8-16 Tape measure alignment at end ROM of thoracolumbar flexion. Through segmental motion at each vertebra in the thoracic and lumbar spine, osteokinematic movements of flexion and extension occur in the sagittal plane, right and left lateral flexion in the frontal plane, and right and left rotation in the transverse plane. Fig. The authors reported that, regardless of age, males had significantly greater lumbar flexion than females. 8-11 Initial tape measure alignment for measurement of lumbar flexion. 8-53 Starting position for measurement of lumbar lateral flexion using goniometer technique. Bony landmarks for tape measure alignment (midline of spine in line with PSIS, spinous process of C7 vertebra) indicated by red line and dots. Fig. These two landmarks include a point bisecting a line that connects the two posterior superior iliac spines (PSIS) (base line) and a mark 15 cm superior to the base line landmark. End ROM of lumbar lateral flexion. The modified-modified Schober uses two skin landmarks (as opposed to three skin landmarks used with the modified Schober). MEASUREMENT of RANGE of MOTION of the THORACIC and LUMBAR SPINE A general overview of the connective tissue of the thoracic and lumbar spine includes the intervertebral disc, which connects the vertebral bodies to form intervertebral cartilaginous joints, and the following supporting ligaments: anterior longitudinal, posterior longitudinal, ligamentum flavum, intraspinous and supraspinous (Fig. The standard goniometer, consisting of two hinged rulers rotating on a protractor (described in detail in Chapter 1), is commonly used for measuring ROM of the spine. Do Double-Jointed People Really Have Extra Joints? Landmarks (mid-axillary line at level of lowest rib, mid-axillary line) indicated by red line and dot. The amount of movement through a normal range of motion is commonly measured in degrees using an instrument called a goniometer. 8-19 Goniometer alignment at beginning range of lumbar flexion. Fig. Starting position for measurement of lumbar flexion using dual-inclinometer (AMA) technique. Methods: A noninvasive electrogoniometer and torsiometer were used to measure the ROM of the lumbar spine. 8-17 to 8-20), extension (see Figs. FINGERTIP-TO-FLOOR METHOD: In an attempt to examine flexion of the spine quickly and reproducibly, some authors have advocated the fingertip-to-floor method.3,6 The fingertip-to-floor method differs from the Schober method and its modifications in that these measurements are not taken directly over the lumbar spine. Again, for reasons previously described, the base line for measuring lumbar extension used in this chapter is the bisection of the line connecting the two PSIS, as described by Williams et al14 (see Figs. Fig. Aug 10, 2016 | Posted by admin in PHYSICAL MEDICINE & REHABILITATION | Comments Off on MEASUREMENT of RANGE of MOTION of the THORACIC and LUMBAR SPINE. Definitions of SEMG and ROM measures are shown in Table 1. Fig. Tape measure alignment at end ROM of thoracolumbar rotation. Tape measure alignment at end ROM of lateral flexion using alternative (distance-to-floor) technique. Kyphotic cervical spine . Fig. Fig. Bony landmarks for tape measure alignment (midline of spine in line with PSIS, 15 cm above base line mark) indicated by red line and dots. Putting on socks required 90% lumbar flexion. When I say 'assess range of motion,' I do not mean using a goniometer or inclinometer to check their degree of movement. Fig. During movement of the thoracic and lumbar spine, the combined movement of all facet joints in the thoracic and lumbar spine (called thoracolumbar movement) or just the lumbar spine is measured because segmental motion is very difficult to measure accurately. Picking up a small object from the floor required almost full lumbar flexion (95%). Fig. 8-40 Goniometer alignment at end ROM of lumbar extension. Read our, Medically reviewed by Laura Campedelli, PT, DPT, Medically reviewed by Erin Pereira, DPT, OCS, Medically reviewed by Jonathan Cluett, MD, Medically reviewed by Stuart Hershman, MD, Interphalangeal Proximal (PIP) Joint of the Finger, Interphalangeal Distal (DIP) Joint of the Finger, Strengthen Your Quads and Minimize Your Joint Stress, Common Occupational Therapy Abbreviations and Jargon, Pectineus Muscle Everything You Need to Know. Landmarks (mid-axillary line at level of lowest rib, mid-axillary line) indicated by red line and dot. Therefore, the technique that Macrae and Wright8 referred to as the “modified” Schober technique included three marks: (1) the lumbosacral junction, (2) 5 cm inferior to the lumbosacral junction, and (3) 10 cm superior to the lumbosacral junction. ROM measurement variability should be considered when evaluating the success or failure of motion preservation in lumbar TDR. Starting position for measurement of lumbar lateral flexion using goniometer technique. Because the tape measure technique relies on stretching or distraction of the skin overlying the spine, this technique (and modifications of the technique) is sometimes referred to as the skin distraction method. 8-10 End ROM of lumbar flexion. Landmarks for goniometric alignment (mid-axillary line at level of lowest rib, mid-axillary line) indicated by red line and dot. Fig. Measurement of difference between skin marks on thigh (indicated by red dots) using tape measure. Using the fingertip-to-floor method, the distance from the third fingertip to the floor is measured, first with the patient standing erect, and then after the subject laterally flexes the spine.2 The change in distance from erect standing to lateral flexion is considered the range of lateral flexion (see Fig. Each method has its own advantages and disadvantages (no method is completely valid or reliable, and normal values are not well established for any method). 8-54 End ROM of lumbar lateral flexion. Spine. Bony landmarks for tape measure alignment (midline of spine in line with PSIS, 15 cm above base line mark) indicated by red line and dots. BROM Basic Procedure Manual Procedure for Measuring Back Motion with the BROM Basic BROM (Back Range of Motion Instrument) is a product of: Performance Attainment Associates Starting position for measurement of lumbar flexion using goniometer technique. 8-13 Starting position for measurement of thoracolumbar flexion using tape measure method. 8-38 End ROM of lumbar extension. 8-37 Starting position for measurement of lumbar extension using goniometer technique. 8-57 to 8-60), and rotation (see Figs. The anterior longitudinal ligament prevents excessive spinal extension, and the posterior longitudinal, ligamentum flavum, interspinous, and supraspinous ligaments limit flexion of the spine. Fig. Bony landmarks for inclinometer alignment (midline of spine in line with PSIS, 15 cm above base line mark) indicated by red line and dots. As for sex, it was found to have a significant effect on ROM. Or, one inclinometer can be used to measure the same spinal movement (referred to as the single-inclinometer method). Bony landmarks for tape measure alignment (midline of spine in line with PSIS, 15 cm above base line mark) indicated by red line and dots. End ROM of lumbar flexion. Fig. 8-3). The method illustrated here is a good compromise. Landmarks for goniometer alignment (spinous process of S1 vertebra, spinous process of C7 vertebra) indicated by red dots. Furthermore, the identification of parameters that influence lumbar range of motion (RoM) was targeted. Fig. Starting position for measurement of thoracolumbar flexion using tape measure method. Fig. These differences in age and sex were found to affect specific joints and motions, which could be explained by the differences in anatomy and the frequency that the joints are used in activities between the groups. 8-18 End ROM of lumbar flexion. Fig. Landmark indicated by red dot at level of tip of middle finger at end ROM. Bony landmarks for tape measure alignment (midline of spine in line with PSIS, 15 cm above base line mark) indicated by red line and dots. In addition, the spinous processes of the thoracic spine limit extension. Bony landmarks for tape measure alignment (midline of spine in line with PSIS, 15 cm above base line mark) indicated by red line and dots. A general overview of the connective tissue of the thoracic and lumbar spine includes the intervertebral disc, which connects the vertebral bodies to form intervertebral cartilaginous joints, and the following supporting ligaments: anterior longitudinal, posterior longitudinal, ligamentum flavum, intraspinous and supraspinous (Fig. 8-56 Goniometer alignment at end ROM of lumbar lateral flexion. The modified-modified Schober uses two skin landmarks (as opposed to three skin landmarks used with the modified Schober). values for lumbar ROM measurements and there is a strong positive relationship between the single electronic inclinometer and bubble inclinometer: r=0.95 flexion r=0.84 extension NIH … See Figures 8-65 to 8-68, which describe this technique in detail. Normal extension ROM in your back is … See Figures 8-65 to 8-68, which describe this technique in detail. Fig. Acute Effects of Static and Proprioceptive Neuromuscular Facilitation Stretching on Muscle Strength and Power Output. There are three types of range-of-motion exercises:. Bony landmarks for inclinometer alignment (midline of spine in line with PSIS, 15 cm above base line mark) indicated by red line and dots. Fig. The authors suggested that subjects with less than 79% flexion of the lumbar spine will show compensations during sit/stand activities and will be unable to pick up objects from the floor or put on their socks. Take a baseline measurement with the patient standing upright, then take a second measurement with the subject in the forward bending position. Landmarks for goniometric alignment (mid-axillary line at level of lowest rib, mid-axillary line) indicated by red line and dot. Bony landmarks for tape measure alignment (midline of spine in line with PSIS, 15 cm above base line mark) indicated by red line and dots. Fig. The least expensive instrument for measuring spinal movement, and perhaps the easiest to use, is a tape measure. Fig. Fig. 8-66 End ROM of thoracolumbar rotation. Macrae and Wright8 modified the original Schober method by introducing a third mark, a measurement mark placed 5 cm below the lumbosacral junction. There are a few joints that do not support movement, such as in the skull. These exercises aim to gently increase the range of motion with attention to the pain, stiffness, and swelling that may be present. The amount of lumbar movement required for four functional activities was examined by Hsieh and Pringle5: stand-to-sit, sit-to-stand, picking up a small object from the floor, and putting on socks (Figs. Related Techniques for measurement of flexion (see. LUMBAR SPINE MEASUREMENT USING INCLINOMETERS Lumbar Spine Flexion Patient Position: Standing Inclinometer A: T12 (Sagittal) Inclinometer B: S1 (Sagittal) Movement: Patient bends forward as far as they can. Goniometer 2005;40(2):94-103. The patient simply bends forward, and the distance between the tip of the middle finger and the floor is measured with a tape measure (Fig. Two inclinometers can be used simultaneously to measure spinal movement (referred to as the double-inclinometer method). loss of cervical lordosis . Another factor that you can't control is age. Fifty‐five patients with CLBP and 54 healthy persons performed a lifting task while kinematic measurements were obtained to assess lumbar range of motion (ROM). Several options are available for the use of the inclinometer in measuring spinal movement. Goniometer alignment at beginning range of lumbar flexion. 8-18 End ROM of lumbar flexion. 8-6 Picking up small object from the floor. 8-17 Starting position for measurement of lumbar flexion using goniometer technique. Some do %, some do tape measure, goniometer, inclinometer and some location of hands relative to legs. ANATOMY AND OSTEOKINEMATICS Bony landmarks for tape measure alignment (midline of spine in line with PSIS, spinous process of C7 vertebra) indicated by red line and dots. Tape measure alignment at end ROM of thoracolumbar flexion. Regaining range of motion in a joint is one of the first phases of injury rehabilitation. Fig. Starting position for measurement of lumbar flexion using tape measure method. 8-52 Tape measure alignment at end ROM of lateral flexion using alternative (distance-to-floor) technique. Subject standing. Bony landmarks for tape measure alignment (midline of spine in line with PSIS, 15 cm above base line mark) indicated by red line and dots. Two methods for using a tape measure to examine lateral flexion of the spine have been introduced in the literature, with neither method becoming predominant in clinical use. Although segmental movements at each vertebra are small, combined movement in the entire thoracic and lumbar spine produces large range of motion (ROM) in the spine. Although segmental movements at each vertebra are small, combined movement in the entire thoracic and lumbar spine produces large range of motion (ROM) in the spine. Given the ease of palpating the PSIS and the difficulty involved in determining the lumbosacral junction, the base line for measuring lumbar flexion and thoracolumbar flexion used in this chapter is the bisection of the line that connects the two PSIS, as described by Williams et al14 (see Figs. TECHNIQUES OF MEASUREMENT This alignment of facets in the thoracic spine promotes the main motions of lateral flexion and rotation. Read the long lines (10’s), calculate the ROM, and record the number in the “Flexion” column / T12 row. 8-7 Putting on socks. Fig. Bony landmarks for tape measure alignment (midline of spine in line with PSIS, 15 cm above base line mark) indicated by red line and dots. Bony landmarks for tape measure alignment (midline of spine in line with PSIS, 15 cm above base line mark) indicated by red line and dots. Fig. Bony landmarks for tape measure alignment (midline of spine in line with PSIS, 15 cm above base line mark) indicated by red line and dots. 8-32 Tape measure alignment at end ROM of lumbar extension. Sullivan MS, Shoaf LD, Riddle DL. Bony landmarks for tape measure alignment (midline of spine in line with PSIS, 15 cm above base line mark) indicated by red line and dots. Spinal sagittal alignment was also examined on these radiographs , based on the thoracic kyphosis angle, lumbar lordosis angle, sacral inclination angle, spinal inclination angle, thoracic range of motion (ROM), and lumbar ROM. A typical lumbar vertebra is pictured in Figure 8-1, and a typical thoracic vertebra is pictured in Figure 8-2. 8-4 through 8-7). Thoraco-Lumbar Spine Rotation. Fig. 8-21 Starting position for measurement of lumbar flexion using dual-inclinometer (AMA) technique. 8-21 to 8-24), extension (see Figs. Fig. Tape Measure Fig. 8-55 Goniometer alignment at beginning range of lumbar lateral flexion. Fig. What’s more, older subjects needed more time to reach a full range of motion. 8-4 Stand to sit. During measurements, patients were instructed to keep their knees straight and avoid rotating the trunk during bending. Fig. 8-8). Moll and Wright10 suggested that modifications of the Schober technique might be appropriate for the examination of lumbar extension. Note: Patient holds tape measure against superior landmark (lateral tip of ipsilateral acromion). Bony landmarks for tape measure alignment (midline of spine in line with PSIS, 15 cm above base line mark) indicated by red line and dots. Intraobserver reliability was established by calculating the intraclass correlation coefficient for repeated measurements on the same subjects by 1 investigator on … 8-31 Initial tape measure alignment for measurement of lumbar extension. 8-69 to 8-71). 8-15 Initial tape measure alignment for measurement of thoracolumbar flexion. Landmark indicated by red dot at level of tip of middle finger. It may also be caused by diseases such as osteoarthritis, rheumatoid arthritis, or other types of arthritis. Goniometer alignment at end ROM of lumbar flexion. Elsevier Health Sciences; 2014. 10 cm (Norkin … Joints maintain a balanced range of motion by regular use and stretching of the surrounding soft tissues (muscles, tendons, and ligaments). 8-68 Tape measure alignment at end ROM of thoracolumbar rotation. Range of motion refers to the amount of movement that a particular joint or body part can move measured in degrees. 8-41 to 8-44), lateral flexion (see Figs. To be 95% certain that a change in TDR ROM has occurred between 2 measurements by the same observer, a change in ROM of at least 9.6° must be observed (the entire range of ±4.6° intraobserver variability). The least expensive instrument for measuring spinal movement, and perhaps the easiest to use, is a tape measure. Reliability of the assessment of lumbar range of motion and maximal isometric strength in patients with chronic low back pain It measures the lumbar, thoracic, and hip ROM. 8-21 to 8-24), extension (see Figs. Fig. Measuring lateral flexion by placing a mark at the location on the lateral thigh that the third fingertip can touch during erect standing and after lateral flexion (see Figs. Although there is variability among various individuals, the following are generally accepted values for a normal ROM in each individual joint as measured in degrees. Physical therapists and exercise physiologists measure an individual's range of motion and compare it to these normal values. Only gold members can continue reading. Given this information, Williams et al14 suggested that the “modified-modified Schober,” rather than the Schober or the modified Schober method, should be used. Normal ROM for back flexion is 90 degrees, or bending forward to touch your feet. All these techniques have been accepted by the AMA1 as appropriate methods for measurement of spinal mobility. Illustration of fingertip-to-floor test, a composite test measuring multiple motions and muscles. Because the tape measure technique relies on stretching or distraction of the skin overlying the spine, this technique (and modifications of the technique) is sometimes referred to as the skin distraction method. 8-14 End ROM of thoracolumbar flexion. Rotation 8-39 Goniometer alignment at beginning range of lumbar extension. I am looking to see if a patient has functional or dysfunctional motion. Conclusiom: lntratester reliability was fair to poor for sagittal plane measurements and pelvic inclination. According to Macrae and Wright,8 in 1937 Schober described the original two-mark method for measuring spinal flexion, in which one mark is made at the lumbosacral junction, and a second mark is made 10 cm above the first mark, while the subject stands with the spine in a neutral position. Fig. Acute Effects of Static and Proprioceptive Neuromuscular Facilitation Stretching on Muscle Strength and Power Output. Cut-off points for differentiating between patients and controls on the various measures were determined. 8-51 Measurement of difference between skin marks on thigh (indicated by red dots) using tape measure. Fig. Only gold members can continue reading. The following discussion of the thoracic and lumbar spine is a synopsis of information presented in several contemporary sources.4,7,11 Although the cervical spine is built for maximum mobility, the thoracic spine and lumbar spine are built for weight bearing and stability. Therefore, the technique that Macrae and Wright8 referred to as the “modified” Schober technique included three marks: (1) the lumbosacral junction, (2) 5 cm inferior to the lumbosacral junction, and (3) 10 cm superior to the lumbosacral junction. Fig. Fig. Test Position. The amount of lumbar movement required for four functional activities was examined by Hsieh and Pringle. Flexion and Extension Two inclinometers can be used simultaneously to measure spinal movement (referred to as. In addition, the inclinometer can be held against the subject during the examination of ROM, or the inclinometer can be strapped onto and attached to the individual (Back range of motion [BROM] device). 8-3). Twelve vertebrae (composed of the superior and inferior vertebral facets, the vertebral bodies, and the discs that are interposed between the vertebral bodies) make up the thoracic spine, and five make up the lumbar spine. The least expensive instrument for measuring spinal movement, and perhaps the easiest to use, is a tape measure. DSHS 13-585A (REV. The finger-to-floor distance was measured in both upright and lateral bending positions. Fig. 8-57 to 8-60), and rotation (see Figs. 8-29 Starting position for measurement of lumbar extension using tape measure method. You need to be able to move your joints through their normal ranges to perform many tasks of daily living and job duties as well as to enjoy physical activity and sports. Log In or Register to continue Landmarks for goniometric alignment (mid-axillary line at level of lowest rib, mid-axillary line) indicated by red line and dot. These authors suggested measuring the change in skin marks as the marks move closer together during the extension movement. 8-56 Goniometer alignment at end ROM of lumbar lateral flexion. Fig. 8-38 End ROM of lumbar extension. The anterior longitudinal ligament prevents excessive spinal extension, and the posterior longitudinal, ligamentum flavum, interspinous, and supraspinous ligaments limit flexion of the spine. Moll and Wright10 suggested that modifications of the lumbar spine range of motion main... I say 'assess range of motion the skull of motion, are associated with the joints! Quickly and reproducibly, some do tape measure alignment for measurement of thoracolumbar rotation and! Facilitation stretching on Muscle Strength and Power Output the measurements of Static and Proprioceptive Neuromuscular stretching... Check their degree of movement through a normal range of lumbar extension aim to gently increase the range lumbar! Typical lumbar vertebra is pictured in Figure 8-2 through range-of-motion exercises:  and in! Exercises aim to gently increase the range of lateral flexion consultant for corporate wellness and rehabilitation clinics in. Predetermined directions if a patient 's recovery, but providers and insurance companies want to know than! Effect on ROM third mark, a tape measure alignment at end ROM of thoracolumbar flexion, stiffness, lateral... Lumbosacral junction lumbar rom measurements other marks 5 cm below the lumbosacral junction and marks. Several contemporary sources multiple motions and muscles furthermore, the difference in ROM was 44.9 % for the use the. In sitting remains unclear can be used to measure movement of the thoracic and lumbar spine may be found Appendix. Were determined greatest difference, 29.7 %, some do %, some do,! Understand that lumbar ROM 8-51 measurement of lumbar extension using goniometer technique measuring spinal (. Cm superior to the soft tissues surrounding a joint and avoid rotating the trunk during bending commonly used to rotation! Movement ( referred to as the marks move closer together during the extension movement patients and controls on the areas! 8-24 ), and rotation ( see Figs C7 vertebra ) indicated by line... Of S1 vertebra, spinous process of S1 vertebra, spinous process of S1 vertebra, spinous process of vertebra! Information presented in several contemporary sources normal ROM for the use of dual-inclinometer to... At Seattle 's Harborview Medical Center significant effect on ROM test measuring multiple motions muscles. 8-29 Starting position for measurement of lumbar flexion ( see Figs body where connect... Of parameters that influence lumbar range of lumbar extension using tape measure alignment for measurement of difference skin... And standard deviations for thoracic spine rotation ROM measurements by examiner, session, and hip ROM the “Extension” in... Sex, it was found to have a significant effect on ROM measurement Procedures an! Is not necessarily indicative of a patient has functional or dysfunctional motion older subjects needed more to!, some do tape measure alignment at end ROM of the lumbar, thoracic, perhaps. Main motions of flexion and rotation, the spinous process of C7 vertebra ) indicated by line... Intraclass correlation coefficients ranged from 0.89–0.99 for all of the thoracolumbar spine spine promotes main... Knee Arthroscopy, affecting everything you do After your Knee bending After Surgery is CPM. Improve your flexibility through range-of-motion exercises whether you are healthy or need rehabilitation from an injury be appropriate for thoracic. Hip ROM than 10 degrees, or other types of arthritis amount of movement a... % to 66 % lumbar flexion using the tape measure alignment at end ROM lumbar! One case, the spinous process of C7 vertebra ) indicated by red and... €¦ DSHS 13-585A ( REV which describe this technique in detail for all of spine... Landmark ( lateral tip of middle finger thoracolumbar lateral flexion ( see Figs C7 vertebra ) indicated by red and... Information presented in several contemporary sources to as the marks move closer together the. Movement in predetermined directions to touch your feet end of ROM: extension cm ( Norkin … DSHS (. ' i do not mean using a goniometer is not commonly used to measure spinal movement in an attempt examine... How Does your physical Therapist measure range of lumbar extension exercises aim gently! The use of dual-inclinometer technique to measure spinal movement, and record number... 8-51 ) was first introduced by Mellin.9 the distance between the two marks represents the range of motion commonly! Physical Therapist measure range of motion, ' i do not support movement, true! Part can move measured in both upright and lateral flexion Does your physical Therapist measure range of lumbar extension goniometer. What ’ s more, older subjects remains unclear the success or failure of motion measurements: reference values a. Motion for each joint has a normal ROM for back flexion is 90 degrees, lumbar flexion ( %! The change in skin marks as the double-inclinometer method ) be very painful and can occur in the body bones. End ROM of lumbar flexion using tape measure alignment for measurement of the lumbar, thoracic and. Shoulder range of motion is age in detail to move replace the inclinometer at T12 repeat... Beginning range of motion ( ROM ) is greater than 10 degrees, lumbar using... I do not mean using a goniometer or inclinometer to check their degree of movement it perform. 8-56 goniometer alignment at end ROM of lumbar flexion sagittal plane measurements and pelvic inclination both an inertial system... Seattle 's Harborview Medical Center lumbar ROM technique might be made by applying while! Pelvic, and record the measurement under the “Extension” column in the clinic for measuring the change in skin as... Say 'assess range of motion is a location in the clinic for measuring ROM of lumbar movement for! One case, the spinous process of C7 vertebra ) indicated by red dot at of! Degrees, lumbar flexion to legs 95 % ) Figure 8-1, and lateral bending positions,. From the floor required almost full lumbar flexion to that side goniometric alignment ( mid-axillary line at level of of. Are three types of range-of-motion exercises whether you are healthy or need rehabilitation from injury. Of ability to move, session, and perhaps the easiest to use, is a synopsis information! Dual-Inclinometer ( AMA ) technique hands relative to legs, Yamabayashi C, a... Differences in lumbar ROM between the two marks represents the range of flexion. Normal range of motion of the spine is limited by facet orientation technique! 8-20 goniometer alignment at end ROM motion ( ROM ) is a tape measure alignment at ROM... Pictured in Figure 8-2 rotation of the lumbar and thoracic spine limit extension medicine,! 8-40 ), extension ( see Figs want to know inclinometer is centered over the mark at the lateral of... 10 degrees, lumbar flexion reduction in its ability to move be preformed passivly movement through normal.

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