Low Back Pain: Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health from the Orthopaedic Section of the American Physical Therapy Association

. Author manuscript; available in PMC: 2016 Jun 6.

Published in final edited form as: J Orthop Sports Phys Ther. 2012 Mar 30;42(4):A1–57. doi: 10.2519/jospt.2012.42.4.A1

SEGMENTAL MOBILITY ASSESSMENT
ICF category	Measurement of impairment of body function – mobility of joint functions, specified as mobility in a vertebral segment
Description	With the patient prone, lower thoracic and lumbar spine segmental movement and pain response are assessed
Measurement method	The patient is positioned in prone. The examiner contacts each lower thoracic and lumbar spinous process with the thumbs. The examiner should be directly over the contact area keeping elbows extended, utilizing the upper trunk to impart a posterior to anterior force in a progressive oscillatory fashion over the spinous process. This is repeated for each lower thoracic and lumbar segment. The pressures can be also be directed lateral to the spinous process, in the region of the zygapophyseal joints, multifidi muscles, or transverse processes. The examiner can also change his/her contact position and places the hypothenar eminence (just distal to the pisiform) of one hand over the spinous process of each lower thoracic or lumbar spinous process and repeat the same posterior to anterior forces in a progressive oscillatory fashion. The mobility of the segment is judged to be normal, hypermobile, or hypomobile. Interpretation of mobility is based on the examiner’s perception of the mobility at each spinal segment relative to those above and below the tested segment, and based on the examiner’s experience and perception of normal mobility.
Nature of variable	Categorical with various grades depending on the study
Units of measurement	Ordered or categorical
Measurement properties	Measures for determining mobility reported low reliability for ordered scales with intraclass correlation coefficients (ICC) of 0.25 in patient studies²⁵ and kappas show poor to minimal agreement (k= −0.2 to 0.26).¹⁴⁶
Instrument variations	Segmental motion is also be tested with the subject in sidelying, facing clinician with hips and knees flexed and the clinician grasping the knee and flexing and extending, rotating, and laterally flexing the hip, pelvis and lumbar spine while palpating intersegmental motion.