A spinal assessment involves applying pressure at varying levels and angles to the spinal column in order to determine joint health and mobility. It plays a crucial role in the static assessment of any animal as it aids in the identification of underlying pathology. Prior to a spinal assessment, active ROM of the animal should be conducted if possible to identify autonomous areas of restrictions. Also, a visual assessment should be done in order to identify any lumps/cuts. Communication with the owner is also essential to discuss history and current concerns.
Cervical to Coccygeal — ensure to include the tail!
This blog post will outline 5 key points to ensure are incorporated into a spinal assessment for both small and large animal patients.
Prior to manipulation and assessment, joint palpation is essential. Feeling for muscle changes (hypertrophy, atrophy), bony changes (thickening) and oedema/heat that will indicate injury and the stage at which it is occurring ie. active inflammatory stage (heat, swelling) versus chronic pathology (joint thickening and effusion with localised muscular changes).
Correct Angulation and Level of Pressure
Ensure that adequate pressure is used to cause movement to the vertebrae, but not so much firm pressure that it could cause pain or so much displacement that an accurate analysis of the ROM cannot be achieved. Practice the pressure on your own fingers so that you can feel what is the right amount to cause movement but not firm displacement.
Bear in mind how this will differ between species and breeds.
Ensure that you have an awareness of joint angulation and therefore range of motion. This requires an awareness of the angulation of each intervertebral joint and the range of motion it is biomechanically able to achieve. An example would be the anticlinal vertebrae of the horse (T15) whereby the angle of the dorsal spinous processes changes.
Analyse the Restrictions
When assessing each IVJ, ensure to note the degree of restriction and what the restriction feels like… not only that it feels restricted! This can be graded from mild to moderate to severe, and restriction types can vary from muscular to bony. Determine asymmetrical movement by comparing the left to the right side. Consider whether the restriction is present in lateral mobilisation, flexion or extension.
Ensure to monitor this at each visit to determine progress or regression.
Even though a spinal assessment is being conducted, the surrounding muscles cannot be omitted. For example, in the case where the thoracic spine of a horse is being assessed, the epaxial muscles should also be assessed simultaneously for localised trigger points, tonicity, pain response, temperature and mass.
Specific Orthopaedic and Neurological Tests
Where an area of restriction has been noted, ensure to correlate findings with potential pathological processes and conditions. This can be achieved with the use of special tests in order to aid a more specific analysis of the compromised area. For example, the conduction of a sacral pinch to analyse SI mobility in a horse, or the cutaneous trunci reflex in a dog with neurological deficits. Essentially, ensure to link findings to other MSK pathologies that may not only be occurring within the spine but as a primary condition elsewhere in the body.
Overall, the conduction of a spinal assessment has a fundamental role in the assessment of any animal that is being treated by a veterinary physiotherapist. Whether it is used the first time an animal is seen in clinic or weekly to assess progress in an intensive physiotherapy programme, it is a skill that is essential to have. Its method of conduction is a rather in-depth and separate topic, but I hope this blog post provides a quick read in covering some key elements that should be incorporated into a spinal assessment.