lecture 5- spine Flashcards
curves of the spine
-2 Lordotic curves
-Kyphotic curves
We are just one big kyphotic curve when we are born.
As we weight bear we develop kyphotic curves.
Vertebrae types
7 cervical
12 thoracic
5 lumbar
5 sacral (fused)
coccyx
Features of the spine
- body (anterior mass)
- spinous process
- lateral (transverse) process
–> articulations w ribs (thoracic spine)
–> facet joints
facet joints=
“little face”
-2 inferior, 2 posterior?
C1 pivots/rotates on
C2
cervical spine vertebral bodies are
small (not a lot of weight pushing down on them)
lumbar bodies are
large (weight bearing)
thoracic facet joints are oriented in which plane?
frontal plane
cervical spine, thoracic, lumbar: rotation
cervical and thoracic= a lot of rotation
lumbar= flexion and extension
Intervertebral discs: where are they, 2 components
lie between vertebral bodies
-annulus fibrosis (fibrocartilage)
-nucleus pulposus (gel)
Intervertebral disks functions
shock absorbers
(stability and cushioning)
Annulus fibres
15-25 concentric layers (born with them! don’t get more as you age “annually”!)
angled fibres
opposite direction of layers= good tensile strength
Nucleus pulposus
high concentration of proteoglycan (protein fibres)= hydrophillic
draws fluid in to the nucleus pulposus
that is why you are taller when you wake up–> fluid accumutates in the nucleus pulposus overnight
Joints: 2 types
Fibrocartilaginous
–> between vertebral discs and vertebral bodies
Synovial
–> facet joints (4 per vertebrae)
liquids are incompressible, so when there is force down on your spine,
forces are radial in all directions
forward bend: what load
axial load increased
axial load greater: sitting or standing
sitting bc spine is tilted
the further you lean forward,
the greater load on discs
-COM out of BOS= muscles in the back have to work harder to stabilize
ligamenta flava has more
elastin (more stretchy)
ligaments of the spine restrict
certain movements and stabilize the spine
4 ligaments of the spine
- Anterior and posterior longitudinal
= connect vertebral bodies - Ligamenta flava
= connect laminae - Intertransverse ligaments
= connect transverse processes - Interspinous and supraspinous ligaments
= connect spinous processes
Muscles of the spine
Erector spinae- superficial
Transversospinalis- deep
many others…
disc bulge/herniation come with
nerve related symptoms
transversospinalis muscles tighten when we
have low back pain
–> tightness doesn’t go away when pain goes away= address tightness in treatment
nerves are between each
vertebrae (nerve roots come off each side)
except cervical: 7 cervical vertibrae and 8 cervical nerves
spine: dermatomes
sensory nerves at the skin correspond with a specific nerve root
spine injuries: 4 causes
congenital predispositions
previous trauma
mechanical factors (poor posture, obesity)
acute or repetitive trauma
spine injuries: effects
pain, tenderness, spasm, restricted ROM
neurologic symptoms
(sciatica, weakness, numbness…)
Spine (sprain and strains) SSx
pain, tenderness
muscle spasm
restricted ROM
increased warmth
neurological Ssx= HOSPITAL!!!!
Spine (sprain and strain) treatment (8)
-rest (supine), no more than 2 days
-NSAID/pain meds
-cold therapy at first
-heat therapy later
-physio/massage
-rehab program (flexibility strengthening, task-specific)
-correct predisposing factors
-gradual RTP
explain lumbar disc herniation
- what
- where
- who is most vulnerable
nucleus pulposus breaks through annulus fibrosis
often at L4L5 and L5S1 levels
vulnerable between ages 30 to 50 bc elasticity and water in the nucleus pulposus decreased with age!!!!!
4 stages of lumbar disc herniation
protrusion
prolapsed
extrusion
sequestered
Disc protrusion (disc bulge)
cracks in annulus fibrosus appear
Prolapsed disc
nucleus pulposus moves completely through the annulus fibrosis
Extruded disc
nucleus pulposus moves into spinal canal, contacts the nerve root
Sequestered disc
portion of nucleus pulposus separates from disc and migrates into spinal canal
—% of disc herniations can reabsorb within a year
75
Intervertebral disc disease: 3 mechanisms
same as sprains and strains.
herniation of nucleus pulposus.
compression of nerve root(s) or spinal cord
What are the effects of intervertebral disc disease?
SSx same as sprains and strains, plus neurologic (sciatica etc.)
instability
osteoarthritis, osteophytes, steosis
Intervertebral disc disease treatment
conservative if possible
surgical (discectomy, laminectomy, fusion)
when we have a disc herniation
disc height decreases.
we lose disc material (nucleus pulposus), ligament stays the same length, therefore there is excess movement at the disc
–> increased stress at those areas, body will lay done more bone to try to stabilize
(intervertebral disc disease)
discography contributes to
more rapid degeneration of the disc
(don’t really use this as an imaging method anymore)
Brachial plexus neuropraxia “stinger or burner” Hx
stretching or compression of the brachial plexus
neck forced laterally
Brachial plexus neuropraxia SSx
pain and numbness in fingers, tingling from shoulder to hand
lasts for several minutes
Brachial plexus neuropraxia Tx
rest
if symptoms don’t go away, hospital
Spine fractures: 2 causes
- Axial load
- cervical spine (head into boards in hockey, helmet to helmet in football)
- 4th, 5th, 6th cervical vertebrae most common - Hyperextension
Spine fractures: 3 SSx
point tenderness, decreased ROM
pain in neck, chest, extremities
numbness/weakness in trunk or limbs
Spine fractures Tx
stabilize, c-spine collar, spine board
If unconscious, assume c-spine injury
Management of back (spine) injuries
- key is balance
- demands w functional capacity, -realistic expectations/goals - mainstays
- time!!
- cold, heat, NSAIDs, braces
-physio, massage, chiro
-correct predisposing factors
-may need to change job or sport
McGill Big 3
= to build endurance in spinal stabilizers
–> bird dog, trunk raise, side plank
–> 10 sec activity, 2 sec rest
–> reps descend: 8-6-4 for example
why should we not wear back braces?
increased muscle activity to support the spine bc muscles are trying to overcome the resistance of the brace
no decreased risk of back injuries
actually increased risk, esp if you have never had a back injury
if you have CVD, back braces increase bp
when is the only time a back brace would be beneficial?
powerlifting, and only for the time period that they are performing the lift for!
