Substitution

If the pectoralis major is active (inappropriately) in this test of trunk rotation at any grade, the
shoulder will shrug or be raised from the table, and there is limited rotation of the trunk.

Instructions to Patient: "Lift your head and shoulders from the table, taking your right elbow toward
your left knee." Then, "Lift your head and shoulders from the table, taking your left elbow toward
your right knee."

Grading

Grade 5 Normal): The scapula corresponding to the side of the external oblique function must clear
the table for a Normal grade.

oul- ard Grade 4 (Good) Gr : Supine with arms crossed over Posi abov :. Other than patient's,
position, all other aspects Test Position of Patient chest. our of the test are the same as for Grade 5.
The test is done. first to one side (Figure 3-28) and then to the to (Figu ear other (Figure 3-29). Grac
Grade off th check

TRUNK ROTATION Grade 3 (Fair) over Position of Patient: Supine with arms outstretched above
plane of body.pects Test: Position of therapist and instructions are st is same as for Grade 5. The test
is done first to the left the (Figure 3-30) and then to the right (Figure 3-31).Grading Grade 3 (air:
Patient is able to raise the scapula off the table. The therapist may use one hand to check for
scapular clearance (see Figure 3-31).

TRUNK ROTATION Grade 2 (Poor) Position of Patient: Supine with arms outstretched above plane of
body. the nal Position of Therapist: Standing at level of patient's and waist. Therapist palpates the
external oblique first on one side and then on the other, with one hand bet placed on the lateral part
of the anterior abdominal ifb wall distal to the rib cage (Figure 3-32). Continue to gra palpate the
muscle distally in the direction of its obli fibers until reaching the anterior superior iliac spine run
(ASIS) Ins tow OPP Test the Gra Grad angl exte

Gra ed At the same time, the internal oblique muscle on Posit flexe the opposite side of the trunk is
palpated. The inter- nal oblique muscle lies under the external oblique, and its fibers run in the
opposite diagonal direction. t's Posit Examiners may remember this palpation procedureatten on nd
better if they think of positioning their two hands adthe nal if both hands were to be in the pants'
pockets or condi to grasping the abdomen in pain. (The external when its obliques run from out to
in; the internal obliques weak ine run from in to out.) recru overo Instructions to Patient: "Lift your
head and reach toward your right knee." (Repeat to left side for the opposite muscle.) Test: Patient
attempts to raise body and turn toward the right. Repeat toward left side. Grading Grade 2 (Poor):
Patient is unable to clear the inferior angle of the scapula from the table on the side of the external
oblique being tested. The examiner must, however, be able to observe depression of the rib cage
during the test activity.
Grade 1 (Trace) and Grade 0 (Zero) on Position of Patient: Supine with arms at sides. Hips er- side
and flexed with feet flat on table. ue, Position of Therapist: Head is supported as patient direc ure
attempts to turn to one side (Figure 3-33). (Turn to assist the other side in a subsequent test.) Under
normal slighe or conditions, the abdominal muscles stabilize the trunk when nalwhen the head is
lifted. In patients with abdominal ues weakness, the supported head permits the patient to Inst
recruit abdominal muscle activity without having to overcome the entire weight of the head. your
ach the Test: either Grad ard Grade muscu Grade rior the ust, rib ternus

TRUNK ROTATION . Hips One hand palpates the internal obliques on the side toward which the
patient turns (not illustrated) nd the external obliques on the side away from the patient direction of
turning (see Figure 3-33). The therapist urn to assists the patient to raise the head and shoulders
normal slightly and turn to one side. This procedure is used trunk ominal ent to Instructions to
Patient: 'Try to lift up and turn to ing to your right. (Repeat for turn to the left.) when abdominal
muscle weakness is profound. Test: Patient attempts to flex trunk and turn to either side. Grading
Grade 1 Tac: The examiner can see or palpate muscular contraction. Grade 0 (Zero: No response
from the obliquas in ternus or externus muscles.

Helpful Hints . In all tests observe any deviation of the umbili- I cus, which will move toward the
strongest quad- rant when there is unequal strength in the opposing oblique muscles. Flaring of the
rib cage denotes weakness of the external oblique muscles. au di ou

liIf the hip flexor muscles are weak, the examiner d- he must stabilize the pelvis. To cause the
abdominals to come into action automatically, the examiner may resist a downward diagonal motion
of the arm or a downward and outward movement of the lower limb. he Chapter 3/ Testing the
Muscles of the Trunk 53

Range of Motion Normal range of motion of the chest wall during quiet inspiration is about 0.75
inch, with gender variations. Normal chest expansion in forced inspiration varies from 2.0 to 2.5
inches at the level of the xiphoid.'