Spine Kinesiology

Normal curves

• cervical ( lordotic)

• thoracic (kyphotic)

• lumbar (lordotic)

• sacral (Kyphotic)

Lordotic curves

Cervical and lumbar

Kyphotic curves

Thoracic and sacral

Primary curve

Kyphosis

Secondary curve

Lordosis

Ligaments that bind the vertebrae together

• anterior and posterior longitudinal ligaments, extending the entire length of the column

• ligamentum flavum (L., flavus, yellow) between the laminae of adjacent vertebrae

• ligamentum intertransversarium, interspinale, and supraspinale

• ligamentum nuchae

What type of joint is the intervertebral disc and vertebra

Cartilaginous joint

Facets are what type of joint

Synovial joints

Motion segments consist of

• two adjacent vertebrae

• three intervertebral joints

• the soft tissues of the intervertebral disc

• longitudinal and intersegmental ligaments

• the capsules of the facet joints

Osteokinematic motions

Flexion (and lateral flexion), extension and L&R rot

Arthrokinematic motions

• anteroposterior shear or slide

• distraction-compression

Vertebral body

resistance to the compressive forces of superincumbent weight; muscle contractions; and external loads that occur in lifting, pulling, or pushing

Intervetebral disc

protect the facet joints from compression injury and permit—as well as limit—motions of the vertebrae

Anterior vertebral joint components

intertebral discs, and the longitudinal ligaments form the anterior vertebral structures.

Biomechanical functions of the vertebral bodies

include resistance to the compressive forces of superincumbent weight; muscle contractions; and external loads that occur in lifting, pulling, or pushing.

Components of intervertebral disc

annulus fibrosus, nucleus pulposus. end plate

Annulus fibrosus

a series of fibroelastic cartilaginous rings that enclose the nucleus pulposus

Sharpey’s fibers

• plastic cover

• outmost layer of the annulus fibrosus

• protect the annulus fibrosus and nucleus pulposus

Function of vertebral body

• restrain rotatory movement

• prevent excessive torsional movement

• allow slight motion

• bear weight

nucleus pulposus

Central mass, a gel with an 80% to 90% water content and two cartilaginous plates

Annulus pulposus

Changes shape, releases and absorbs water. And is naturally thicker in Ant than Post

Annulus Fibrosus

Shock absorber

Where does compression of nucleus pulposus comes from

Compression forces produced by standing and walking throughout the day cause the nucleus to lose small quantities of water

Two hyaline cartilaginous plates

Vertebral end plates

End plates function

separate the nucleus and the annulus from the vertebral bodies and merge with the annulus fibrosus collagen fibers

FLEXION of IV disc

• compression in the anterior part

• accommodation posteriorly

• posterolateral herniation

Extension of IV disc

• compressive force - posterior

• accommodation on ant IV disc

• ant displacement

• anterior herniation

Increase distraction forces

Force where nucleus pulposus is translated inward

Compress or less distraction

nucleus pulposus have superior or mediolateral translation

Angle of the hip in effective traction

90 degrees (usual) ; position - lvl of vertebra

nerve root problem

flex pt in traction

other forms of nerve problem

extended pt in traction

MCNAB’s Classification

Classification/stages of herniation

PT manageable hernia

stage 1 & 2

Not manageable by pure PT, involves laminectomy

stage 3 & 4

Buldging

• Protrusion of discs Annulus Fibrosus rupture

• Disc sags and looks like it is bulging outward

• C a herniated disc, the outer covering of the disc which is the annulus fibrosus’ inner layer has a hole or tear

Prolapse

• outermost layer of annulus fibrosus contain the nucleus

• Occurs when the outer fibres of the intervertebral disc are injured, and the soft material known as the nucleus pulposus, ruptures out of its enclosed space

Extrusion

Annulus fibrosus perforated and discal material moved in discal space

Sequestration

• Sharpey’s fiber is torn

• Formation of discal fragments from AF to NP to the disc

• Migration of the herniated disc fragment into the epidural space, completely separating it from the parent disc

Shmorl’s nodes

superior or inferior displacement of the nucleus pulposus

ALL - Anterior Longitudinal Ligament

limits backward bending; excessive extension

PLL - Posterior Longitudinal Ligament

Limit forward flexion (makes it taut)

Superior hernia to the nerve root

When pt leans on opposite side to be pain free

Herina is Inferior to the Nerve root

If the pt leans on the same side to be pain free

Vascular Claudication

result from blood supply problem

Neurogenic Claudication

Nerve root compression

Posterolateral HNP

Unilateral pain

pt position of comfort is prone

the pt is in supine with hip flexed and complains because of pain, he/she have HNP

pt position of comfort is supine

the pt is in prone position with hip extended and complains because of pain, he/she have spinal stenosis

Clinical manifestation: Increased CSF

Indicates inflammation

Hyporeflexia

reflex decreases because of nerve root compression (typical PNI) (LMNL)

Spondylosis

degeneration of IV disc and its adjacent structure

Spondylolysis

• a defect in pars interarticularis

• this defect is non displaced fracture

Spondylolisthesis

subluxation of one vertebral body on another, most often 2° to spondylosis

Posterior vertebral structures

• Arch

• Transverse and spinous processes

• Bilateral facet jts

Ligamentum flavum

Limits forward flexion, particularly in the lumbar area, where it resists separation of the laminae.

Supraspinous

Spinous process to spinous process tip to tip

Lim flex

C7 to sacrum

cervical area > ligamentum nuchae

Ligamentum nuchae

In the cervical area, the supraspinous ligament becomes the ligamentum nuchae. The interspinous and supraspinous ligaments resist forward bending.

Why does Coupling motions occur

because of the orientation of the planes of the left and right facet joints and limitation of motion provided by the disc, vertebral ligaments, fascia, and muscles

Coupling motions

Side bending w/ rot > rot w/ side bending

Coupling motions: Spine in N pos. in sagittal plane

rotation and side bending occur contralaterally

Coupling motions: Spine is flex/ Extend. in sagittal plane

rotation and side bending occur in an ipsilateral fashion

Atlanto-occipital jt

• Yes jt ; flex & extend

• note: execssive f&e - damage medulla oblongata

Atlanto-axial jt

• no jt

• 50% rot

antlanto-axial stabilizers

atlantal lig. And Alar Lig.

Alar lig - subluxation = hypermobile odontoid process (pt c. downsyndrome “trisomy21)

cervical region

upper and lower

Crainiovertebral angle

• determinant if pt have forward head posture

• C1, C2, C7

Forward bending of superior facet

Slide - Anterior , superior

backward bending of superior facet

Slide- posterior, inferior

side bending right

• left superior facet moves superiorly and anterior

• while the right superior facet moves inferior and posterior

• rotation of the vertebral body to the right and the spinous process to the left

Transitional vertebra

• T1 & T12

• T1 = limits the shape of cervical body

• T12 = its facet is mostly the same c lumbar vertebra

Function of Transitional vertebra

Support to head and trunk

Protect mediastinal organs

Pt of A of mm of respi (cont. rate of respi)

Facet jt of thoracic r.

• 20° of frontal plane

• Leans towards side bending

• Lateral flexion in left & right(limits by the ribs)

• move toward the vertical or frontal plane. • Limits flexion and extension

• ribs and the sternum, however, limit potential motions of the thoracic vertebrae

Costotransverse jt

not mobile articulation of Rib 1-10, same lvl of transverse process

Lumbar r.

common derangement, common sit of prob

line of problem is not straight

greater ROM

strong mm influence (ant and post)

Ant pelvic tilt

lumbar extension

lumbar lordosis

Post pelvic tilt

lumbar flexion

lumbar kyphosis

Lumbosacral junction

Articulation of L5 and S1

Lumbarization

Function of lumbar vertebra mimics by the sacral vertebra

Sacralization

Function of sacral vertebra mimics by the lumbar vertebra

Lumbosacral Angle

• Measure via x ray

• To know if decreased or increased angle is by the position of the pelvis.

• Pars interarticularis

Lumbosacral junction are reinforced by

Iliolumbar lig and sacrolumbar lig

increase ant pelvic tilt

lumbar Lordosis, inc LSA

increase post pelvic tilt

lumbar kyphosis

spondylolisthesis

Anatomic variations that weaken the joint may permit the lumbar vertebra to slide forward on the sacrum

Thoracolumbar Fascia

Thoracodorsal fascia; a strong , complex structure that acts like huge ligament to connect the ribs, vertebrae and sacrum, ; the posterior IV ligamentous system; and trunk muscles

Thoracolumbar Fascia components

• Anterior layer

  • Deepest and covers the Quad Lumborum

• Middle layer

• Posterior layer

  • Superficial and deep lamina

Sacrum

link between the axial skeleton and the lower extremities

Sacroiliac jt motions

anteroposterior, abd and add, ER and IR

Rectus Capitis lateralis

RCL mm is important for co-contraction (it produces upright posi. of the head)

Longus Colli

contracts and stabilizes the head during 3 circumstances: talking, coughing, and swallowing

PAM Scalenes mm

• lat flex head

• elevate ribs when contracting

• poor leverage in rot

Thoracic Outlet Syndrome

Impingement of the subclavian artery

RCL and LC

ipsilateral

SCM & scalene

contralateral

SCM - bilat

neck stabilizer

SCM - unilat

ipsilat - side bend

contralat - rot

Erector spinae

extend trunk

Sacrospinalis

core mm at the back - intersegmental mm (composed of - ILoveSpine in LaMe)

Rectus Capitis

post maj & minor