CERVICAL AND THORACIC SPINE

Question 1

FACET ORIENTATION

Answer 1

Cervical - coronal 45
Thoracic - coronal 60

Question 2

PURPOSE OF THE CERVICAL SPINE

Answer 2

One of the main purposes of the cervical spine is to orientate the head in space, ensuring the eyes are always level to the horizon

Question 3

SEGMENTAL MOVEMENT

Answer 3

The Csp has the greatest ranges of movement across the whole spine
The occipital atlanto joint is all about flexion and extension and it has virtually no rotation or side bending available to it
C1-C2, it is all about rotation
C3-C4 has the greatest range of motion for the whole Csp
The Tsp has the least amount of movement available to it in all vectors

Question 4

MECHANISM OF FORCES (FORCES AFFECTING THE CSP)

Answer 4

• The types of forces that can impact the structures of the spine
  o Unloaded
  o Tension
  o Compression
  o Bending
  o Shear
  o Torsion
  o Combined loading

Question 5

LEVER MECHANISM

Answer 5

1st class lever – the fulcrum around the occipital-atlanto condyles

Question 6

ARTICULAR PILLAR AS STRENGTH AND STABILITY - TYPICAL FEATURES

Answer 6

• Body
  o Small, triangular
  o Also has joints of Von Luschka
• Spinous processes
  o C2-3 bifid
  o C4-7 long
• Vertebral foramen
  o Small
• Transverse processes
  o Has transverse foramen for the vertebral artery
• Facet orientation
  o Coronal 45
• Articular pillar
  o Extension of pedicle

Question 7

WHY IS RHEUMATOID ARTHRITIS A PROBLEM FOR THE CSP?

Answer 7

• Rheumatoid arthritis is a chronic autoimmune disease that can cause inflammation and damage to the joints
• In the cervical spine rheumatoid arthritis can cause
   Instability
   Bone erosion
   Deformity
• This can lead to spinal compression and nerve damage, which can result in symptoms such as
   Neck pain
   Stiffness
   Weakness
   Loss of sensation

Question 8

WHY IS THE HYPERMOBILITY SPECTRUM A PROBLEM FOR THE CSP?

Answer 8

• HSD is the condition characterised by joint hypermobility which can affect the Csp stability
• In individuals with hypermobility, the ligaments and muscles supporting the cervical spine may be weak or lax leading to:
   Subluxation
   Dislocation of the cervical vertebrae
• This can cause spinal called compression and nerve damage resulting in symptoms such as:
   Neck pain
   Headaches
   Muscle weakness
• Also, people with HSD may be more prone to developing other conditions that can affect the cervical spine, such as Chiari malformation, basilar invagination and atlantoaxial instability

Question 9

OCCIPITAL-ATLANTO JOINT - ROLL AND SLIDE MECHANISM

Answer 9

Concave bone
o Atlas facet slides
Convex bone
o Occipital facet rolls
Which is fixed/permissive moving structure and which is the moving structure?
o Active = occiput
o Passive = C1

Question 10

ROLL AND SLIDE MECHANISM - SIDE BENDING

Answer 10

There is always an element of rotation with side bending

Question 11

THORACIC SPINE AND BREATHING

Answer 11

The Tsp is the most mechanically stable part of the spine
This is to allow a secure attachment for the ribs to articulate from during breathing
The thorax and rib cage are a closed, sealed system which allows it to act as a bellows

Question 12

BREATHS PER MINUTE DEPENDING ON AGE

Answer 12

Birth – 6 weeks
o 30 – 40 breaths per minute
6 months
o 25 – 40 breaths per minute
3 years
o 20 – 30 breaths per minute
6 years
o 18 – 25 breaths per minute
10 years
o 17 – 23 breaths per minute
Adults
o 12 – 20 breaths per minute
Elderly > 65
o 12 – 28 breaths per minute
Elderly > 80
o 10 – 30 breaths per minute

Question 13

PATTERN OF BREATHING DEPENDING ON AGE

Answer 13

Child - belly
Adult (female) - chest
Adult (male) - lower chest/abdomen
Elderly - belly

Question 14

CHEST SHAPES

Answer 14

Pectus carinatum (pigeon chest)
Pectus excavatum (sunken chest)
Barrel chest

Question 15

MECHANICS OF RIBS

Answer 15

Ribs articulate with the TP’s of 2 vertebra and the body of 1 vertebra (apart from ribs 1 and ribs 11 and 12)

Question 16

BREATHING MECHANICS

Answer 16

Tsp provides secure attachments for ribs to articulate during breathing
T1-6 pump handle
T7-10 bucket handle
T11-12 calliper

Question 17

HOW DOES HYPERINFLATION DISRUPT BREATHING MECHANICS?

Answer 17

Can be caused by asthma
Asthma- can’t breathe in properly, therefore can’t breathe out
Develop barrel chest which hyper inflates lungs, leading to hyperextension of ribs, which stretches intercostal muscles
Stretching intercostals beyond their capacity will allow recoil back to previous state, causing ribs to relaxing and improving ability to breathe

Question 18

OTHER LIMITING FACTORS FOR BREATHING

Answer 18

• Age
• Scoliosis
• Schuerman’s kyphosis
• Rheumatoid arthritis
• Obesity

Question 19

CAN OSTEOPATHY CURE ASTHMA?

Answer 19

Osteopathy cannot cure asthma
It can be helpful in managing some of the symptoms associated with it
Osteopathic techniques, such as
o Rib raising
o Soft tissue massage
o Spinal manipulation
These can help improve
o Breathing mechanics
o Reduce muscular tension
o Improve overall lung function
Also, osteopathic treatment can help reduce stress and anxiety, both of which can exacerbate asthma symptoms