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Thoraco-Lumbar Range of Motion Tutorial (Thoracic and Lumbar ROM)

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The following is a tutorial on thoraco-lumbar range of motion testing. Please note like all range of motion testing, you need to have the patient warm up accordingly through their ranges of motion prior to testing their range of motion. In this tutorial we are only walking through an initial one repetition testing. Like that of cervical you can do 3 repetitions for averaged results and validation should you wish to perform this additional detail of the study.

Please make sure to not extend hands above head nor out to side. Please follow as shown in this tutorial. The animation in the application is only to keep your place in the examination and is not a substitute for watching these tutorials.

CLOTHING REQUIREMENT: To perform this study appropriately, please make sure men have their shirt off, and women have shirt off and in sports top bra in order for the lateral view posterior tangent trace contour to trace their body. If you do not do this, it will trace their clothing and give you incorrect results. Please do not perform thoraco-lumbar ROM studies if you do not dress them accordingly. Please note in this first tutorial, he is in a t-shirt only because this is a demo for the world to see via the internet, and didn’t feel comfortable removing his shirt in this situation. Please watch the second tutorial below as well.

Tutorial Video: https://youtu.be/cXd2MK-AA74

Tutorial for sagittal thoraco-lumbar point placement: https://youtu.be/xjHNs-sUYV4?si=98FbAYGvBWIzd_aJ

Thoraco-Lumbar Range of Motion Module

One-Repetition Examination Walkthrough

📝 Preparation & Best Practices

  1. Review Mandatory Tutorials First
    • Before using this module, watch prior tutorials (clothing protocols, positioning, posture assessments).
    • Do not skip the clothing tutorial. Clothing must not obstruct back contours (no jackets, loose tops, etc.).
  2. Camera & Setup Guidelines
    • Ensure the camera is perpendicular to the patient.
    • Avoid obstructed views – arms should not block the posterior spine on lateral views nor the sides of the body in the AP view.
    • Ideal positioning: arms at sides if contours are visible.
    • Warm-up the patient prior to testing as per general Range of Motion testing guidelines.
  3. Optional Settings
    • Choose 1 or 3 repetitions. Three reps will average the values.
    • You may optionally mark the point of initial pain during active motion in any motion.
    • Enable or disable voice narration in settings as needed.

📸 Performing the Exam – Image Capture Sequence

Step 1: Add Range of Motion

  • Open an existing exam list..
  • Tap the ➕ Plus icon, select Range of Motion, then choose Thoraco-Lumbar ROM.

Step 2: Background Preference

  • Choose whether to remove the background or keep it.  This can also be changed to your preference default in settings.
  • If clothing blends into the background, turn the original background back on after image capture.  You can always turn on or off the background based on your preferences after the assessment is performed.

Step 3: Side Bending (Coronal Plane)

  1. Client faces forward in neutral standing posture, then capture their neutral position.
  2. Capture:
    • Laterally bend torso to right
    • Laterally bend torso to left

Step 4: Flexion/Extension (Sagittal Plane)

  1. Turn the patient 90 degrees left, with their right side facing the camera.
  2. Confirm visibility of spinal contours, making sure their arm doesn’t obscure their back..
  3. Capture:
    • Bend forward (flexion)
    • Bend backward (extension)

🔄 Axial Rotation Using Gyroscope

⚠️ Computer vision does not track rotation accurately, so this uses device gyroscope in a seated exam.

Step 1: Seated Axial Rotation – Lumbar

  1. Seat the patient in a non-rotating chair.
  2. Place device at approximate L1 level, tap capture (volume rocker) to zero (neutral position).
  3. Capture:
    • Twist to the left
    • Twist to the right

Step 2: Seated Axial Rotation – Thoracic

  1. Move device to T1 level, zero it again.
  2. Repeat twist sequence after initial neutral capture:
    • Twist to the left
    • Twist to the right

🎯 Avoid exaggerated values for the Lumbar spine. Normal lumbar rotation is limited; high values (e.g., 20°+) likely reflect pelvic movement or your device was not flush against the correct anatomical area and off the patient..

🖱️ Post-Exam: Editing & Digitization (Optional)

  • You can edit now or later during downtime.
  • Tap Edit to adjust point placements:
    • Drag the anatomical markers to correct when needed (e.g., T1, PSIS, ASIS, belt line).
    • Use zoom controls to fine-tune placement.
    • Adjust lateral body margins, tangents, and angle lines.

📌 These adjustments improve accuracy and are useful for research data and legal/clinical documentation.

📤 Reports & Exporting

Two Report Types:

  1. Thoraco-Lumbar ROM Client PDF Report
    • Simplified, omits neutral position.
    • Educational format for patients.
  2. Thoraco-Lumbar ROM Professional PDF Report
    • More detailed for documentation purposes. 
    • Designed for the Doctor or Clinician

Export Options:

  • Export to EHR / SOAP note system.
  • Email via Apple Mail App directly from device.

✅ Summary Points

  • Follow clothing and camera protocols for accurate results.
  • Ensure arms don’t block contours on the side views.
  • Use gyroscope only for seated axial rotation (T1 and L1).
  • Optionally digitize and edit image points after the exam.
  • Reports can be generated for both doctors and patients, with customizable formats.
  • Pain point, multiple reps, and volume button capture are all supported for efficiency.
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