Sanjeevni Sawale1*, Richa Bisen2 and Senthil Kumar E3
1Intern, Sinhgad Society’s SKN College of Physiotherapy, Pune, India
2Assistant Professor, Sinhgad Society’s SKN College of Physiotherapy, Pune, India
3Assistant Professor, Sinhgad Society’s SKN College of Physiotherapy, Pune, India
Received: 30 September, 2015; Accepted: 01 December, 2015;Published: 03 December, 2015
Sanjeevni Sawale, Intern, Sinhgad Society’s SKN College of Physiotherapy, Pune, India, E-mail:
Sawale S, Bisen R, Senthil Kumar E (2015) Normative Values for Active Lumbar Range of Motion in Children and Confounding Factors that Affects the Active Lumbar Range of Motion. J Nov Physiother Phys Rehabil 2(2): 062-068. DOI: 10.17352/2455-5487.000027
© 2015 Sawale S, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Normative value; Lumbar ranges; Children
Purpose: The purpose of this study was to establish normative values for active lumbar movement in children five, seven, nine, and 11 years of age and to find the confounding factors that affect the lumbar range.
Methods: End range active flexion, extension, and right- and left-side bending of the lumbar spine were measured for 400 normally developing children (200 girls, 200 boys) using dual inclinometric technique. Means were determined for each motion by age and sex. Group relationships were explored.
Results: Normative values for lumbar spine cardinal plane movements were identified. Reduced lumbar movement was found in the 11-year-old group compared with the 5-year-old group in both girls and boys. Flexibility levels were defined using percentiles as poor (<25th), moderate (between 25th and 75th), good (between 75th and 95th), and very good (>95th) respectively. The mean value for forward flexion, extension right and left lateral flexion for all participants was 55.9+17, 21.8+6, 15.2+5.1 and 14.9+5.
Conclusion: Normative data for cardinal plane movements of the lumbar spine provide therapists with a baseline for assessing spinal mobility of children of these ages.
Adequate range of motion(ROM) is necessary for maintenance of normal spinal movement patterns in the developing child . During the growth and maturation process, there are forces that contribute to the shape of the individual vertebra, which leads to changes in the posture and mobility of the mature spine . Patterns of change across the adult life span [3,4]. and the proposed reasons for these changes provide a valuable perspective for beginning exploration of spinal mobility in children[3-6]. Quantifying spinal mobility is a important component of the physical therapy examination process for both adults and children who experience limited spinal mobility as the result of spinal disorders or injury [3,4-11].
Two important developmental milestones in the lumbar vertebrae are achieved between seven and 11 years of age. First, the lumbar spine completes primary ossification between approximately seven and nine years [12,13]. As the percentage of bone increases relative to the percentage of cartilage, the bone becomes less malleable in response to both external and internal forces. Second, the lumbar facet joints change from a relatively frontal to a sagittal plane, and the shape changes from relatively flat at birth to curved by approximately 11 years of age . This change in lumbar facet orientation is thought to play a role in the quantity and direction of lumbar movement.
The confounding factors that affects the spinal mobility involve not only the ROM of a joint or series of joints but it is also affected by internal influences such as the type of joints, the elasticity of muscle tissues, tendon, ligaments, and length of musculature as well as by external influences such as age, gender, height, weight [3,9].
Lumbar range in children is important because spinal mobility in the developing child may be affected by diseases, disorders and/or injuries of the neuromuscular or musculoskeletal systems .
Numerous techniques have been developed to assess spinal flexibility such as visual estimation [11,12], finger-to floor distance , sit-and-reach measurements [14,15], standard or modified Schober’s methods , subjective reports through questionnaires  and the use of devices such as flexicurves , protractors and goniometers and inclinometers [18,19]. The preference of technique of spinal ROM evaluation in routine clinical practice is often based on its reliability, validity, simplicity, cost, level of invasiveness and technicality [11,12]. Establishment of reference norms for spinal flexibility requires assessment techniques with high level of validity and reliability. In light of this, the inclinometric technique has been found to be valid and reliable  and has been recommended as a valuable tool in routine clinical for assessment of spinal ROM. It is believed that the inclinometric technique could measure and differentiate movements of the hip from those of the lumbar spine  and could be learned quickly within a short period of time .
Normative values of spine range of motion (ROM) are essential for proper diagnosis of spinal impairments and in the monitoring of effect of treatment and patient’s recovery [21,22]. Normative values are also useful for physical therapists to estimate the active end-range spinal position achieved in each cardinal plane motion as they do not have direct access to radiographs as physicians quantify spinal mobility using radiographs .
They are also essential for proper diagnosis of spinal impairments. Early identification and management of abnormal lumbar spinal mobility is essential to prevent further deformity. Normative data and confounding factors that affects lumbar range is a valuable component in prevention of deformities . Adult lumbar spine mobility is frequently addressed in the literature and normative values for adult spinal mobility have been established using a variety of measurement devices  little information is available regarding normal lumbar spine mobility for children five to 11 years of age. The purposes of this study were to establish normative values for active lumbar flexion, extension, side bending in children five, seven, nine, and 11 years of age; to find the confounding factors that affect the lumbar range.
Materials and Methods
Four hundred healthy children participated in this study. Children who were 5, 7, 9 and 11 years of age were included in this study. Exclusion criteria included a history of disorders or activities that may affect spinal posture and mobility, such as back pain or injury, scoliosis, musculoskeletal disease, neuromuscular disease.11 Samples were selected randomly. Parental assent was filled and need of the study was well explained to parents and children. Permission from Institutional Ethical Committee (IEC) was taken (Ref: SKNCOPT Academic/2014/IEC/205).
Two bubble inclinometer- US baseline company, measuring tape, weighing scale, stadiometer, sit and reach box, pen and paper
Anthropometric measurements included height, weight, body mass index (BMI), limb length (LL), trunk length (TL) and hamstring flexibility.
1. Height was measured using a stadiometer. The subject stood barefooted on the platform of the scale looking straight ahead while the horizontal bar attached to the height meter was adjusted to touch the vertex of the head.
2. Weight was measured on weighing scale standing in an erect posture looking straight ahead.
3. LL was measured by taking the distance between the anterior superior iliac spine and the sole of the foot with the participant in a supine position (Figure 1).
4. TL was measured by taking the distance from the anterior superior iliac spine to the acromion process with the participant in an erect position sitting on stool (Figure 2).