Axial Skeleton- "Intro, Function, and Sacral- WK13 ( Ch9+10)

Question 1

What are the primary and secondary curves of the spine ?

Answer 1

Primary: sacral and thoracic kyphoses
Secondary: Lumbar and Cervical Lordoses

Question 2

What happens to the spinal curves during sagittal plane movement: Cervical Flexion and Extension

Answer 2

Flexion: Decreased Lordosis
Extension: Increased Lordosis

Question 3

What happens to the spinal curves during sagittal plane movement: Thoracic Flexion and Extension

Answer 3

Flexion: Increased Kyphosis
Extension: Decreased Kyphosis

Question 4

What happens to the spinal curves during sagittal plane movement: Lumbar Flexion and Extension

Answer 4

Flexion: Decreased Lordosis
Extension: Increased Lordosis

Question 5

What happens to the spinal curves during sagittal plane movement: Sacral

Answer 5

sacrococcygeal curvature is fixed

Question 6

What is one negative of having spinal curves ( especially at transitions) ?

Answer 6

The spine becomes subject to shear forces

Question 7

Where does the line of gravity fall for each spinal curve and is this a good thing or a bad thing ?

Answer 7

Just in front of the curves concavity; This is a good thing (1) it allows for natural maintenance of normal curves (2) alternating flexion and extension torques minimizes NET torque; which minimizes muscle use and ligament stretch.

Question 8

For each ligament give its attachments, function, and special qualities: Ligamentum Flavum

Answer 8

attch.: superior laminae to inferior laminae
function: form posterior wall of the vertebrocanal, resist flexion
special qualities: highly elastic, “yellow ligament”

Question 9

For each ligament give its attachments, function, and special qualities: Supraspinous and Interspinous

Answer 9

attch.: between spinous processes
function: resist flexion
special qualities: superiorly becomes ligamentum nuchae, inferiorly becomes more sparsse and partially replaced by TL fascia and small musculotendinous fibers.

Question 10

For each ligament give its attachments, function, and special qualities:Intertransverse

Answer 10

attch.: extend between adjacent transverse processes
function: resists forward and lateral flexion
special qualities: thin and poorly defined

Question 11

For each ligament give its attachments, function, and special qualities:ALL

Answer 11

attch.: from basilar part of occipital bone to anterior sacrum
function: resists extension
special qualities: long, strong, straplike, widens caudally

Question 12

For each ligament give its attachments, function, and special qualities:PLL

Answer 12

attch.: posterior surface of C2 to the sacrum
function: resists flexion
special qualities: cranially broad, inferiorly narrow

Question 13

For each ligament give its attachments, function, and special qualities: Apophyseal joint capsules

Answer 13

attch.: along the rim of the facet surfaces
function: maintains physical integrity of the joint while guiding spinal kinematics
special qualities: lax in anatomic position; increasingly taut at movement extremes.

Question 14

What happens to the PLL as it descends through the lumbar spine and how does this affect the discs in the lumbar region ?

Answer 14

• It becomes more narrow as it ascends
• It does not inhibit posterior bulging of the discs.

Question 15

Describe a motion segment and it’s components:

Answer 15

Transverse and Spinous processes
Facet Joints
Interbody joint, disc

Question 16

Define the following terminology as it relates to movement at a spinal motion segment: Osteokinematics

Answer 16

movement or rotations within 3 cardinal planes

Question 17

Define the following terminology as it relates to movement at a spinal motion segment: Arthrokinematics

Answer 17

relative movement between articular surfaces, facet joint movement

Question 18

Define the following terminology as it relates to movement at a spinal motion segment: Axis of Rotation

Answer 18

using the anterior and superior surface of the vertebral segment

Question 19

C6 rotation means that the vertebral body rotates to the ____________ but the spinous process rotates to the ____________

Answer 19

right, left

Question 20

What are “ intra-articular inclusions” and how can they affect facet joints ?

Answer 20

Small and inconsistently formed accessory structures like subcapular fat pads or fibro-adipose meniscoids

• They may act as “ deformable spacers” ; provide protection at extremes of motion; may become impinged and lead to cervical pain; may “lock” or block joints by resisting arthrokinematics.

Question 21

Which part of the IVD has nerve and blood supply ?

Answer 21

the outer layers of the annulus fibrosus

Question 22

How does the annulus help dissipate loads ?

Answer 22

The annulus resists radial deformation adding rigidity to gel-like nucleus

Question 23

How does the disc get its nutrition ?

Answer 23

From vertebral bodies and blood vessels in superficial annulus, nutrients must diffuse to get deeper.

Question 24

Why are we taller in the morning than in the evening and why would a disc be more painful in the morning ?

Answer 24

• Due to increased disc volume as water re-enters the disc over night

Question 25

Explain the process of disc degeneration.

Answer 25

age, high loads —> decreased disc permeability and increased calcfication of end plates —> less nutrients to disc and dehydrated and thin discs increased compressive loads and affects facet kinematics

Question 26

How does the disc help transmit loads through the spine at each motion segment ?

Answer 26

compression of disc leads to even distribution of forces in spine as nuceleus disperses forces radially and the annulus resists this deformation

Question 27

How does the disc respond to the following motion: sagittal plane flexion and extension

Answer 27

flexion: anterior compression, posterior stretching
extension: posterior compression and anterior stretch

Question 28

How does the disc respond to the following motion: Frontal plane lateral flexion

Answer 28

lateral flexion: ipsilateral compression; contralateral stretch

Question 29

How does the disc respond to axial compression, bending, torsion, shear

Answer 29

axial compression: force transmitted through disc –> end plates —> vertebral bodies

bending: 1 side compressed: tension on other side; nucleus migrates

torsion: resisted mainly by structures other than disc; annular fibers rupture with: torsion, axial compression and forward bending

shear: disc creep leaves facets only to resist motion

Question 30

Name the plane of motion that each region of the spine moves the best in: cervical, thoracic, lumbar

Answer 30

cervical: sagittal and horizontal plane
thoracic: sagittal plane
lumbar: sagittal plane

Question 31

Explain proper posture as if educating a patient

Answer 31

low back and neck curved naturally back, ears over shoulders, mid back neutral

Question 32

What happens to the rest of the spine with a posterior pelvic tilt in sitting ?

Answer 32

the rest of the spine flexes forward ( forward head posture). Upper cervical must extend slightly to remain with the eyes forward.

Question 33

What are the consequences on cervical structures of a chronic forward head posture ?

Answer 33

adaptive shortening of posterior suboccipitals, posterior ligaments and membranes associated with A-O and A-A joints. Pain and headache.

Question 34

What muscles belong to the extrinsic ( global) and intrinsic ( local) stabilizers of the spine ?

Answer 34

Extrinsic ( long muscles attaching to structures outside vertebral column): abdominals, erector spinae, QL, Psoas

Intrinsic ( short attaching to structures within vertebral column): transversospinal and short segmental muscles

TS: semispinals, multifidi, rotatores
SM: interspinales, intertransversarius

Question 35

What differences exist between the sit-up and the curl-up ?

Answer 35

sit-up: more hip flexor action, more emphasis on oblique muscles
curl-up: more rectus abdominis, modest lumbar flexion, better for patients with disc pathology

Question 36

What are 4 ways to improve lumbopelvic stability and what are some exercises that could be prescribed for the same purpose.

Answer 36

1. activate deeper stabilizers
2. challenges wide range of muscles
3. endurance
4. postural control, equilibrium, positional awareness

• drawing-in maneuver, supine bridge, prone plank, balance boards

Question 37

Which functional activities place the greatest pressures on the lumbar discs ?

Answer 37

holding load in front of body and bending forward; straight knees when lifting, sitting in forward slouched posture

Question 38

What is difference between squat and stoop lifting ?

Answer 38

squat lift places more stress on the knees whereas and stoop lift places more stress on back.

Question 39

Which is better squat or stoop lifting ?

Answer 39

both have their pros and cons, likely a mixture of both is best

Question 40

What is the valsalva maneuver and how does it affect lumbar discs ?

Answer 40

Voluntary increasing intra-abdominal pressure by contraction of abdominal muscles. unloads intervertebral junctions.

Question 41

How can you teach your patient to safely lift an object from the ground ?

Answer 41

1. lift slowly
2. reduce weight
3. decrease the EMA: lift things between your knees if possible
4. increase the IMA: maintain neutral spine.

Question 42

What are some causes of SIJ pain ?

Answer 42

may be secondary to injury to the joint or surrounding connective tissue. May result from obvious trauma; unilateral or unidirectional torsions at the hip. May be due to excessive stress caused by postural or structural abnormalities.

Question 43

What is one of the best diagnostic tool to determine if the SIJ is the source of pain ?

Answer 43

assessing reduction of pain level after administration of anesthetic

Question 44

Describe nutation and counternutation.

Answer 44

nutation: SI forward nod
counternutation: SI backward nod

either by tilting of sacrum or tilting of ilium

Question 45

What are some stabilizers of the SIJ ?

Answer 45

passive: gravity, sacrotuberous, sacrospinous, and interosseus ligament
active: erector spinae, lumbar multifidi, diaphragm and pelvic floor muscles; abdominals, hip extensors, lats, iliacus and piriformis

Question 46

What are the ROM norms for cervical flexion, extension, and lateral flexion?

Answer 46

45

Question 47

What are the ROM norms for cervical rotation ?

Answer 47

60

Question 48

What are the ROM norms for thoracolumbar flexion and extension

Answer 48

flx.: 80
extension: 25

Question 49

what are the ROM norms for thoracolumbar lateral flexion and rotation ?

Answer 49

lateral flexion: 35
rotation: 45