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Musculoskeletal Conditions II > Review of Spinal Biomechanics > Flashcards

Review of Spinal Biomechanics Flashcards

1
Q

Which way do the superior and inferior facet joints of the lumbar spine face? And which joints do they articulate with?

A

Superior Facet Joints = medial facing and Inferior Facet Joints = lateral facing

The Superior Facet Joints articulate with the Inferior Facet Joints

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2
Q

Describe the facet joint orientation of L1-L4 and what movements they permit and limit.

A

L1-L4 are orientated in the sagittal plane

They permit flexion and extension, and limit axial rotation

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3
Q

Describe the facet joint orientation of L5-S1 and what movements it prevents and allows.

A

L5-S1 are orientated more in the frontal plane

They prevent anterior shear of L5 on S1, also affecting how much flexion/extension is available

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4
Q

What are the kinematics during lumbar spinal flexion?

A

Anterior roll and glide of superior vertebra

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5
Q

During lumbar flexion of the spine, what has tension and compression placed on it?

A

Tension = interspinous ligaments, supraspinous ligaments, facet capsules, posterior disc

Compression = anterior disc

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6
Q

During lumbar spine extension, what are the kinematics?

A

A posterior roll and glide of superior vertebra

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7
Q

During lumbar spinal extension, what has tension and compression on it?

A

Tension = anterior longitudinal ligament and anterior disc

Compression = facet joints

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8
Q

What kinematics occur during lumbar lateral flexion?

A

A lateral roll and glide of superior vertebral body

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9
Q

During lumbar spinal lateral flexion, what is placed on tension and compression?

A

Tension = contralateral intertransverse ligament and facet capsule

Compression = ipsilateral facet

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10
Q

What motion occurs during lumbar spinal rotation?

A

Very little motion, but (1) facet joint gapping at ipsilateral facet (2) facet joint compression at contralateral facet

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11
Q

What are Fryette’s Laws of Physiologic Spinal Motions for the lumbar spine coupled motions?

A
  1. When the lumbar spine is in a neutral position, sidebending of a vertebral segment will be opposite to the direction of rotation
  2. When the lumbar spine is flexed or extended (non-neutral), sidebending of a vertebral segment will be in the same direction of rotation
  3. If motion is introduced at a segment in any plane of motion, motion in the other planes will be reduced
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12
Q

Describe how the thoracic superior and inferior facets are orientated and in what plane.

A

The superior facet joint is in the posterior direction and the inferior facet joint is in the anterior direction. They are in the frontal plane.

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13
Q

How are the upper thoracic spinal facet joints orientated and what motions does it limit and promote?

A

They are orientated in the frontal plane.

They limit flexion and extension and promote axial rotation and lateral flexion.

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14
Q

How are the lower thoracic spinal facet joints orientated and what motions does it limit and promote?

A

They are more sagittally orientated.

They permit somewhat more flexion and extension.

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15
Q

What are the kinematics in the thoracic spine during flexion?

A

Anterior roll and glide of the superior vertebra

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16
Q

What is placed on tension and compression in the thoracic spine during flexion?

A

Tension = interspinous ligaments, supraspinous ligaments, facet capsule, posterior disc

Compression = anterior disc

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17
Q

What are the kinematics in the thoracic spine during extension?

A

Posterior roll and glide of superior vertebra

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18
Q

What is placed on tension and compression in the thoracic spine during extension?

A

Tension = anterior longitudinal ligament and anterior disc

Compression = facet joints

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19
Q

What are the kinematics in the thoracic spine during lateral flexion?

A

lateral roll and glide of superior vertebral body

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20
Q

What is placed on tension and compression in the thoracic spine during lateral flexion?

A

Tension = contralateral intertransverse ligament and facet capsule

Compression = ipsilateral facet

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21
Q

What are the kinematics in the thoracic spine during rotation?

A

Inferior articular facet of superior vertebra slides on superior articular facet of inferior vertebra

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22
Q

How is axial rotation affected in the thoracic spine?

A

Freedom of this motion decreases in a cranial-to-caudal direction

23
Q

What are the thoracic spine coupled motions?

A

Coupled motion patterns are variable in the thoracic spine

  • Lower thoracic spine motion takes on qualities of the lumbar spine
  • Upper thoracic spine motion takes on qualities of the cervical spine
24
Q

How are the facet joints orientated in the cervical spine and what does this provide for motion?

A

They are orientated approximately 45 degrees between frontal and transverse planes. Which provides freedom of motion in all three planes.

25
Q

What are the kinematics of the cervical spine during flexion for the AO, AA, and C2-C7 joints?

A

AO = anterior roll and posterior glide of O on A

AA = anterior tilt of atlas on axis

C2-C7 = anterior roll and glide of superior on inferior body and antero-superior glide at facet joints

26
Q

What are the kinematics of the cervical spine during extension for the AO, AA, and C2-C7 joints?

A

AO = posterior roll and anterior glide of O on A

AA = posterior tilt of atlas on axis

C2-C7 = posterior roll and glide of superior on inferior body and posterior inferior glide at facet joints

27
Q

What does flexion do to the diameter of the intervertebral foramen?

A

It decreases the diameter (which could lead to spinal stenosis)

28
Q

What is the coupled motion in the cervical spine during rotation? During rotation, what occurs at the AA and C2-C7 joints?

A

Rotation occurs with side-bending to the same side.

AA = atlas spins about dens of axis

C2-C7 = infero-medial glide at ipsilateral facets and supero-lateral glide at contralateral facets

29
Q

What is the coupled motion in the cervical spine during lateral flexion? What occurs at the AO and C2-C7 joints?

A

Lateral flexion occurs with rotation to the same direction.

AO = ipsilateral roll and contralateral glide of O on A

C2-C7 = infero-medial glide at ipsilateral facets and supero-lateral glide at contralateral facets

30
Q

What are the coupled motions in C2-C3 through C6-C7 and OA and AA?

A

C2/C3-C6/C7 = axial rotation coupled with side bending in the same direction

OA and AA = axial rotation coupled with side bending in opposite direction

31
Q

What happens with lumbar flexion as it compresses the anterior annulus?

A

The nucleus is forced posteriorly…prolonged or repeated flexion can weaken the posterior annulus resulting in herniation

32
Q

What are the 4 levels of severity of disc lesions? Describe them.

A

(1) Protrusion = may be without symptoms as nociceptors may not be present on the inner side of the disc
(2) Prolapse = will have radiculopathy symptoms
(3) Extrusion
(4) Sequestration = the nucleus pulposus has left the margins

33
Q

What is increasing severity of disc lesions correlated with?

A

Reduced torsional stiffness

34
Q

What two severities of disc lesions could respond to mechanical interventions?

A

Protrusion and Prolapse

35
Q

What are the two consequences of a disc lesion?

A

(1) axis of rotation shifts from vertebral body to facet joint
(2) loss of disc stiffness can increase compression forces at facet joint surfaces

36
Q

What can be the 3 different descriptions of spinal instability?

A

(1) mechanical structure becomes unstable when a “critical point” is reached
(2) abnormal joint motion patterns (typically too much motion)
(3) abnormal motor coordination patterns (typically not recruiting the muscles required for stability)

37
Q

What occurs as a result of mechanical instability in the spine?

A
  1. decrease in Young’s modulus (stiffness)
  2. decrease in load to yield point
  3. decrease in ultimate strength
  4. decrease in load to rupture
    1. disruption to passive restraints
38
Q

What can cause mechanical disruption to passive restraints to motion?

A

ligament disruption, loss of disc height, disc herniation, vertebral endplate fractures, laminectomy, reduced pars interarticularis integrity

39
Q

Describe normal motor coordination vs. abnormal motor coordination in the spine.

A

Normal motor coordination = the transverse abdominus is contracted before the anterior deltoid

Abnormal motor coordination = the anterior deltoid is contracted before the transversus abdominus

40
Q

Describe and name the short segmental muscles.

A

They are the deepest level of deep layer of back muscles, and include the interspinales and intertransversarii.

They have a small cross-sectional area, are rich in muscle spindles, and most likely act as position transducers

41
Q

Describe and name the transversospinales.

A

They are intermediate level of deep layer of back muscles, and include semispinalis thoracis, multifidi, and rotatores.

They are extensors, position transducers, and vertical stabilizers

42
Q

What are the actions of the quadratus lumborum?

A

unilateral contraction = lateral flexion of spine and unilateral pelvis elevation

bilateral contraction = lateral stabilizer of lumbar spine

43
Q

Describe and name the erector spinae muscles.

A

They are the most superficial of the deep layer of back muscles, and include iliocostalis lumborum, longissimus thoracis, and spinalis thoracis.

They do spinal extension.

44
Q

Describe the location and action of the latissimus dorsi muscle.

A

It is in the superficial layer and contributes to spinal extension (in addition to UE action).

45
Q

What are the actions of the psoas major?

A

hip flexion, lateral flexion of lumbar spine, flexion of lumbar spine, and vertical stabilizer

46
Q

What are the 2 roles of the transversus abdominis?

A

(1) compress the abdominal cavity
(2) increases tension in the thoracolumbar fascia

47
Q

What are the actions of the internal oblique?

A

Unilateral = lateral flexion and ipsilateral rotation

Bilateral = trunk flexion, posterior pelvic tilt, and increases tension in thoracolumbar fascia

48
Q

What are the actions of the external oblique?

A

Unilateral = lateral flexion and contralateral rotation

Bilateral = trunk flexion and posterior pelvic tilt

49
Q

What is the action of the rectus abdominis?

A

Trunk flexion

50
Q

What are the 2 things that the muscle contributes to spinal stability?

A

(1) increases intra-abdominal pressure which increases spine stiffness and reduces motion during sudden loads
(2) increases in all the “guy wire” muscle activity produces increases in intra-abdominal pressure

51
Q

Can a single muscle be identified as most important for lumbar spine stability?

A

No! Spine stability is dependent on relative activation of all trunk muscles and other loading variables.

52
Q

What are the “Big Three” stabilization exercises for the sipne?

A

(1) curl ups for rectus abdominis (anterior side)
(2) side bridge for obliques, transverus abdominis, quadratus lumborum (lateral side)
(3) progressions of “bird dog” for back extensors (posterior side)

53
Q

Why is it recommended to begin stabilization exercises with ROM exercises such as Cat/Camel?

A

They are thought to reduce spine viscosity or viscous stress.

Musculoskeletal Conditions II (20 decks)

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