Prior to the 4th edition of the Guides to the Evaluation of Permanent Impairment, spine impairment was based on range of motion (ROM) and combined with rating(s) for specific spine disorders and any neurologic impairment. This method was (and remains) both challenging and controversial.

Measurements of spinal motions are more difficult to perform than those of extremity joints, generating concerns regarding accuracy and precision (reproducibility). Spinal motion generally diminishes with age, and even in a given age group, normal motions can vary widely. These are phenomena not taken into account in the ROM Model. Unlike the extremities, there is no contralateral (and presumably normal) limb for comparison. Variation in effort between patients and in a given individual also raise concerns regarding the relationship of spinal ROM testing to impairment.

For these and other reasons, the contributors to...

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