Lecture 8: spinal strength & stabilization Flashcards
Spinal muscle categories
- superficial global
- deep segmental
Superficial global spinal m.
- little/no direct attachment to vertebrae
- further away from axis of motion
- reaction to external load is direction specific
- unable to stabilize individaul spinal segments
Erector spinae muscles
- iliocostalis
- longissimus
- spinalis
- long, multi-segmental
- unitlateral: ipsilateral flexion or rotation
- bilateral: extension
Quadratus lumborum
- origin
- insertion
- action
origin: Posterior iliac crest & iliolumbar ligament
insertion: 12thrib & L1-L4 TP’s
Action:
-unilateral: ipsilateral lateral flexion
bilateral: flexion of ribs during inspiration, trunk extension
Rectus Abdominus
- origin
- insertion
- action
origin: public symphysis/pubis
insertion: xiphoid process of sternum & costal cartilage of ribs 5-7
action:
-unitlateral: ipsilateral lateral flexion
-typically fire bialterally to flex the trunk & compress the abdomen
Internal oblique
- origin
- insertion
- action
origin: Deep layer of TL fascia, anterior 2/3 of iliac crest, lateral 2/3 of inguinal ligament, iliopsoas fascia
Insertion: lower ribs 10-12
anterior & posterior layers of linea albaa
pubic crest
Unilateral; ipsilateral flexion and rotation of trunk
Bilateral: trunk flexion
external oblique
- origin
- insertion
- action
origin: outer surface of ribs 5-12
insertion: linea alba, pubic crest, tubercle, ASIS/iliac spine
action:
-unilateral: ipsilateral lateral flexion & contralateral rotation
bilateral: trunk flexion and compresison of the abdomen
abdominal curls strengthening
rectus abdominus
external oblique
oblique curl strengthening
contralateral EO
Ipsilateral IO
side plank strengthening
- ipsilateral EO
- ipsilateral IO
iliopsoas
- origin
- insertion
- action
origin: L1-L5 TP
T12-L5 vertebra bodies and discs
insertion: lesser trochanter of femur
action: hip flexion
Deep segmental muscles
- direct attachments across the vertebral segments
- closer to the axis of motion
- provide dynamic support across individual motion segments
Intratransversi
orgin: Superior aspect of TP
insertion: Inferior aspect of TP one
segment above
action:
-unilateral: ipsilateral trunk SB
-bilateral: stabilization
Rotatores
Short:
Origin: TP of thoracic vertebrae
Insertion: Laminae/SP of vertebra 1
segment above
Long:
Origin: TP of thoracic vertebrae
Insertion: Laminae/SP of vertebra 2
segments above
Action:
- unilateral: rotate contralaterally
- bilateraal: extension
Multifidus
Origin: PSIS, dorsal surface of sacrum Mammillary processes (lumbar) Transverse Processes (thoracic) Articular Processes (C4-C7)
Insertion: base of SP 2-4 segments above
Tonic stabilizer: high distribution of type I fibers and large capillary network, encased by middle and posterior lumbodorsal fascia
Low back-pain
Multifidus atrophies quickly
↑’d fatty infiltration in muscle compared to healthy controls
Delayed recruitment of the TA
Specific training can improve activation and functional outcome
Greatest association with LBP
Transverse abdominus
Origins:
Inner surface of 7-12th costal cartilage
Post/middle layers of thoracolumbar fascia
Anterior 2/3 of iliac crest Lateral 1/3 of inguinal ligament
Insertions:
Linea alba
Pubic crest
Action: develops tension around the lumbar spine
obliques pulling in all different directions casuing thoracolumbar fascia to:
push out and laterally - creating tension and maintaining stabilization
Head on neck
-axis of motion
COM on head
external & internal moment
axis of motion: OA joint COM on head: anterior to joint External moment: flexion Internal moment: extension -suboccipital extensors, SCM, upper trap
suboccipital muscles
Obliquus Capitis Superior O: TP of C1
I: Occiput, below superior nuchal line
A: Contalateral rotation of C1 on C2
Obliquus Capitis Inferior O: SP of C2
I: TP of C1
A: Ipsilateral rotation of head on C1
subocitpial muscles continued
Rectus Capitis Posterior Major O: SP of C2 Lateral part of occiput, below inferior nuchal line A: extension of head; ipsi rotation
Rectus Capitis Posterior Minor
O: Posterior tubercle of C1
Medial part of occiput, below inferior nuchal line
A: extension of head
Deep cervical flexors
Rectus Capitis Anterior
O: TP/lateral mass of atlas (C1)
I: inferior surface of occipital bone
A: flex head on the neck at AO joint
Rectus Capitis Lateralis O: upper TP atlas (C1) I: jugular process of occipital bone A: flex head on neck at AO joint
Deep cervical flexors continued
Longus Capitis
O: anterior tubercle of TP’s (C3-C5)
I: tubercle of anterior arch of atlas (C1)
A: cervical spine flexion (B)) and ipsilateral rotation (unilateral)
Longus Colli
O: anterior surfaces of vertebral bodies
I:
scalenes
Anterior
O: Ant tubercles of TP’s of C3-C6
I: Scalene tubercle on 1st rib
A: elevate first rib, ipsilateral lateral flexion
Middle
O: Post tubercles of TP’s of C2-C7
I: Undersurface of 1st rib
A: elevate first rib, ipsilateral lateral flexion
Posterior
O: Post tubercles of TP’s of C4-C6
I: lateteral surface of 2nd rip
A: elevate second rib, ipsilateral lateral felxion
Upper trap
O: external occipital protuberance and superior nuchal line; nuchal ligament I: Posterior lateral 1/3 of clavicle, acromion, and spine of scapula Action: -unilateral: ipsilateral side flexion of neck
SCM
Origin:
Anterior surface of manubrium
Medial 1/3 of clavicle
Insertion:
Mastoid process
Lateral part of superior nuchal line
Action:
Unilateral: contralateral rotation
Bilateral: neck flexion
Forward head posture - upper cervical extensors
- sub-occipital extensors: tight
- capital flexors: weak/lengthened
- hyoid mm: may be lengthned
forward head posture upper thoracic/lower cervical flexion
flexors: tight
extensors: weak/lengthend
protracted scap: weak/lengthened retractors
damanging forward head posture
for every inch of forward head posture, it can increase the weight of the head on the spine by an additional 4.5 kgs
spinal muscle performance
Activation
Neuromuscular Control
Stabilization
Building on TA Activation
Isometric/Co-contraction of trunk
Superimposed extremity motion
Strengthening
capital flexion -activaiton
nod head
axis of motion: external auditory meatus
PT may need to passively create this motion to start
Cerivcal-thoracic activiation
Capital flexion – slight nod
Axis of motion: external auditory meatus
Upper cervical (C0-C2)
Mid-cervical flexion (Not retraction)
Slight decrease in cervical lordosis
Lower cervical/upper thoracic extension
Decreasing kyphosis
Also, a little bit of scapular retraction
TA activaiton (drawing in)
Transverse Abdominis Drawing-in maneuver Co-contraction of Multifidus and pelvic floor Tightening of Thoracolumbar fascia
Supine
All fours
Sitting
Standing
Transverse Abdominus Activation
Responds with anticipatory activity (feed-
forward) with rapid arm/leg movement
Coordinated activity
Pelvic floor mm./perineum mm.
Respiration
Multifidus
Active with both isometric flexion or
extension
Drawing in maneuver – most independent
activity of TA (relative to other abdominal
mm.)
Lumbar stabilization
Perform Drawing-In Maneuver
ADD extremity motions
Maintain neutral spine by co-contraction/isometric contraction of deep
mm.
Increase endurance and strength
Stop the exercise or decrease intensity if
unable to maintain neutral spine
lumbar stabilization
Diagonal exercises more consistently activate the multifidus and abdominal oblique mm. Functional Activities Driving, reaching, push/pull, walking, lifting Sport simulation activities Transitional positions/exercises
Stabilization
Spinal muscles: higher percentage of Type I muscle fibers than extremity
muscles
Deep spinal muscles: greatest percentage of Type I fibers
Use longer hold times and more repetitions
Stop if the patient cannot control the position
Strenthening
Overloading the muscle throughout the range of motion Concentric Eccentric Isometric Endurance at lower loads