Lecture 8: spinal strength & stabilization Flashcards by Jessica Kaufman

Spinal muscle categories

superficial global

- deep segmental

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

Erector spinae muscles

iliocostalis
longissimus
spinalis
long, multi-segmental
unitlateral: ipsilateral flexion or rotation
bilateral: extension

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

abdominal curls strengthening

rectus abdominus

external oblique

How well did you know this?

Not at all

Perfectly

oblique curl strengthening

contralateral EO

Ipsilateral IO

How well did you know this?

Not at all

Perfectly

side plank strengthening

ipsilateral EO

- ipsilateral IO

How well did you know this?

Not at all

Perfectly

iliopsoas

origin
insertion
action

origin: L1-L5 TP
T12-L5 vertebra bodies and discs
insertion: lesser trochanter of femur
action: hip flexion

How well did you know this?

Not at all

Perfectly

Deep segmental muscles

direct attachments across the vertebral segments
closer to the axis of motion
provide dynamic support across individual motion segments

How well did you know this?

Not at all

Perfectly

Intratransversi

orgin: Superior aspect of TP
insertion: Inferior aspect of TP one
segment above
action:
-unilateral: ipsilateral trunk SB
-bilateral: stabilization

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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

How well did you know this?

Not at all

Perfectly

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 ```