Lecture 1 Flashcards
Lordosis and kyphosis in the back.
Cervical–> lordosis
throacic–> kyphosis
Lumbar–> lordosis
Thoracic–> kyphosis
What is 1 vertebral unit?
- 2 adjecent vertebrae
- Assx intervertebral disc
How do we name a dysfunction?
Name the disfunction based on where it likes to live.
For example: our our spine likes to rotate right–> Rotated R SD
What are the spinous processes?
attachments for ligaments and muscles.
Where are transverse processes ALWAYS located?
The location of the transverse processes will never change; they will always be at the level of the vertebral bodies.
As we move down the spine, why do vertebral bodies increase in size?
D/t an increase in weight.
What is the rules of 3?
The rule of 3 tells us where the spinous process is in relation to the transverse processes in the thoracic spine.
T1- T3
&
T12
Spinous process is located at the same level of the transverse process
T4-6
&
T-11
Spinous process is located 1/2 a segment below the corresponding transverse process
T7-9
&
T-10
Spinous process is located at the transverse process of 1 vertabra below.
What are the orientations of the superior facet with the vertebral bodies
in the
Cervical
Thoracic and
Lumbar
region?
BUM-BUL-BM
Cervical (BUM)- backwards, upwards and medial
Thoracic (BUL)- backwards, upwards and lateral
Lumbar- backwards and medial
How to identify segments in the thoracic spine
- how to find C7
- spine of scapula-
- inferior angle of the scapula
- iliac crest
- T1- find C7= 1 below
- T3 spinous process and transverse process–> located where the spine of the scapula is
- Inferior angle of the scapula–> spinous process of T7 and transverse process of T8.
L4 vertebra–> iliac crest
What is coupled motion?
When motion along one axis is consistent with motion about a 2nd axis. The main motion cannot occur without the associated motion occuring as well
What does linkage of joint do?
Linking multiple structures increases the range of motion
When joints are linked, how do we exam a specific joint?
Isolate it.
How do we look at the functional assessment of a joint?
Assess linkage.
Active range is motion describes what barrier?
Physiological barrier (involves active motion)
What barrier describes passive ROM?
Anatomic barrier
Name: the range between the physiologic and anatomic barrer of motion in which passive ligamentous stretching occurs before messing up our tissue
elastic barrier
What is our restrictive barrier?
Limit within the anatomic range of motion.
It will decrease our physiolgic range
Why do spinal SD matter?
When our spine is restricted in motion, it can reduce efficiecy, impair flow of fluids, alter nerve function and create a structural imbalance
How is motion referenced when we are talking about our vertebra?
Motion always refers to the movement of the [anterior/superior] surface of the vertebra.
Too much motion/or not enough motion is in reference to the top vertebra in our vertebral unit.
- For example, excessive motion of L2 is the movement of L2 on L3.
Fryette’s principles tell us what?
they describe the motion of the spine
Fryette has 3 principles: What are their names
Type 1 mechanics
Type 2 mechanics
Type 3 mechanics
Type 1
TONGO (type one; neutral; grouped; opposite)
In a neutral position (not flexed or extended), SB and R are oppsite and occurs in a group of vertebra.
Example of type 1
Rotated L; SB R.
- Rotation occurs towards the convexity of the spine
Type 2
TTØSS (type 2, not neutral (flexed or extended), single vertebra, same side)
In flexion or extension, SB and R will occur in the same direction for in ONE vertebra.
Type 2; rotation occurs towards ______.
Concavity.
What segments of the spine have type 1 and type 2 mechanics?
Thoracic
Lumbar
Name a Type 1 dysfunction for the thoracic spine
and what is this telling us?
T1-3NSRRL
- Pt has no change with flexion or extension
- They prefer SB to the R (restricted to L SB)
- They prefer R to the L (restricted to R R)
Name a Type 2 dysfunction for the thoracic spine
And what is this telling us?
T8FSRRR
symettry is restored in flexion
Pt is restricted to L SB and L R in flexion
Third Principle
Fryettes third principle says movement in any plane of motion will change the movement of that segment in other planes.
If motion is restricted in one plane, it will be restricted in others. When improved, it will improve in other.
Do Fryattes principles apply to all areas of the spine?
1 and 2 only apply to the thoracic and lumbar.
3 applies to all.
Pushing anterior on the RIGHT transverse process will rotate our vertebra _____.
LEFT
in the transverse plane
Pushing anterior on the left transverse processs will will rotate our vertebra _____
RIGHT
in the transverse plane
Rotation
Plane:
Axis:
Plane: Transverse/horizontal
Axis: Superior-inferior
Flexion/extension
Plane:
Axis:
Plane: sagittal
Axis: horizontal (R-L)
SB
Plane:
Axis:
Plane: Coronal/frontal plane
Axis: Anterior-posterior
How to do a SEGMENTAL EVALUATION
- Neutral
- R and L Rotation:
- Patient lies prone with the head in neutral, or in position of comfort.
- Examiner will stand at side of table
- Using the pads of the thumbs, examiner will apply firm pressure on the transverse processes (TP) of the vertebra being assessed (this is the LOAD).
- You may note a difference in position at this time with one TP being more posterior than the other. This is referred to as the posterior TP or “PTPs”.
- Apply anterior, SPRINGING force on one side (LEFT or RIGHT) and then assess other side.
- Springing on the right TP causes left rotation, and vice versa.
- Look for ease of motion and/or hard end-feel/resistance.
- The side of the resistance to anterior springing–> PTP side and the direction of rotation preference.
- •Ex: If the R-TP springs easier, that segment is rotating L more freely (aka “rotated left”)
- Repeat at each vertebral level (T1-12 and/or L1-5) or as indicated by screening exam on 3 adjacent vertebrae.
How to do a segmental exam for neutral
R and L SB
- Slide the transverse process medially without applying a force.
- Ease–> side it likes to translate
- Ex: If the R-TP moves translates easier towards the left, that segment is sidebending R more freely (aka “sidebent right”)
- Can also be inferred by spinal mechanics after Flexion & Extension assessment
You have a R transverse process that does not like to rotate.
How would you describe this.
Rotated to the R (lives in R rotation)
R-PTP (posterior transverse process) has a hard-end feel (does not like to rotate L)
Restricted to rotation to the L
What is scoliosis?
A lateral curvature of the spine named for the convexity that is mroe common n F and 2% of population.
Levo- Left
Dextro- right
what can we find during physical exam of scoliosis
- waist and shoulders are asymmetric
- rib cage prominance
- differences in lengths of L
- Cobb angle
- deformity when forward bending
- use scoliometer to test
How we go about into tx scoliosis is based on the Cobb angles. What are the angles we need to look at?
<25 degrees= conservative tx. just monitor
25-45–> brace
>45- surgy to prevent profression
- over 50–> fuck up respiratiory
- over 75- fuck up cardiac
T1-5 N RRSL
describe
PTP on right
Freedom of right rotation & left sidebending
Restricted to left rotation & right sidebending
Name dysufcion
L PTP
Improved with extension
-posterior L TP
ERLSBL