Spine (EXAM 3) Flashcards
1
Q
Vertebrae
A
- Neck –> 6 cervical
- Mid-Back –> 12 Thoracic
- Low Back –> 5 Lumbar, 1 Sacrum (made up of 4-5 fused segments), 1 coccyx
2
Q
Vertebral Body
A
Function:
- Transmits body weight
- Provides flexible structure upon which muscles can act
- Provides attachment
- Limits ROM
- Absorbs shock (this is the actual “cushion”, NOT THE DISC)
3
Q
Atlas
A
- C1
- Does not have a body or disc
4
Q
Axis
A
- Dens to articulate with the axis
- 50% of your neck rotation comes from the atlantoaxial joint
5
Q
Cervical Vertebrae
A
- C3-C7 have a more normal appearance
- All have a transverse foramen for the vertebral artery
- Bifid spinous process for the ligamentum nuchae and greater amount of neck muscles
6
Q
Movement in Cervical Area
A
- Articular processes in an oblique plane
- Allows the cervical spine to have more combined movement than thoracic or lumbar
- Allows movement in all direction
7
Q
Thoracic Vertebrae
A
All 12 thoracic vertebrae have a notch in their transverse processes and a facet on their bodies for rib attachment
8
Q
Movement in the Thoracic Area
A
- Facets in frontal plane in upper thoracic
- Move toward sagittal plane in lower thoracic
- More lateral bending and rotation
- Extension is limited
9
Q
Lumbar Vertebrae
A
- Thicker and larger to handle compressive loads and strong muscle forces
- Lordotic curve places sheer force on the discs at the lower levels
- B-angle & A-angle???
10
Q
Facet Joints in the Lumbar Area
A
- L1-L2 Angle –> 25 (15-47)
- L2-L3 Angle –> 28 (17-51)
- L3-L4 Angle –> 37 (15-57)
- L4-L5 Angle –> 48 (13-70)
- L5-S1 Angle –> 53 (36-70)
11
Q
3 General Types of Back Pain
A
- Rib dysfunctions in the thoracic spine
- Sacroiliac joint dysfunctions (SI joint)
- Generalized low back pain
12
Q
Acute, Subacute, and Chronic Pain
A
- Acute back pain can last 3-4 weeks
- Subacute back pain can last up to 12 weeks
- Chronic back pain is longer than 3 months
13
Q
Chronic Pain Cycle
A
- Pain –> Muscle Tension –> Reduced circulation –> Muscle Inflammation –> Reduced Movement –> Pain
- Includes a significan psychological component
- Anxiety, depression, poor sleep, etc can also increase pain perception and hamper physical performance
14
Q
Mechanical Back Pain
A
- Often acute or sudden onset
- Damage or irritation to:
Ligament
Muscle
Connective tissue
Facet joint (or bone)
Possible early annular damage to the disc - Usually gets worse over the course of the day
- Not directly nerve related, but can radiate down to the buttocks or hips
- Pain is usually cyclic
- Pain is aggravated by a specific direction or movement (positional)
- Pain is relieved by lying down or a specific movement or position
15
Q
Non-Mechanical Back Pain (Neurologic Pain)
A
- Often progressive and insidious onset, but can be acute
- Possible irritation to:
Intervertebral disc
Nerve root
Internal organ - Random pain patterns tend to worsen over time
- Sensory changes in the saddle area or problems with micturition should be checked asap
- Nerve related can radiate down to the lower leg and foot
- Pain is usually exacerbated by sitting and better when standing
- Internal organ problem creates vague achy deep pain that does not appear to have any position that alleviates pain
16
Q
When to see a doctor
A
- Athletes should be reported any and all back pain
- Serious issues for referring the athlete:
Radiating pain or numbness
Non-positional pain
Pain or numbness in the saddle area
Noticeable and explainable changes in micturition
17
Q
Rib Dysfunction
A
- Usually an acute onset of mechanical pain
- More commonly found between the scapulae
- Pain is usually localized in the back, but can radiate toward the sternum
- Can exist without “back pain” and be evident in respiratory restrictions
18
Q
Rib Movement in the Thoracic Spine
A
- A: Pump handle, ribs ELEVATE, expand rib cage in anterior direction (1-6)
- B: Bucket handle, LATERAL-SUPERIOR direction (7-10)
- C: Caliper, LATERAL direction (transverse plane), opening up anteriorly (8-12)
19
Q
Rib Motions
A
Primary Motions: Inhalation and Exhalation
- Pump handle motion (major movement in upper 6 ribs)
- Bucket handle motion (major movement in below rib 6)
Caliper motion of Rib 11 and 12
Torsional Movement
- When T5 rotates to the right in relation to T6, the posterior aspect of the right 6th rib turns externally and the posterior aspect of the left 6th rib turns internally
20
Q
Final Thoughts on Ribs
A
- 1st rib issues can cause significant neck pain
- 2nd rib issues can cause neck pain but can also cause pain down the arm b/c of its proximity to the brachial plexus
- Thoracic mobility is vitally important to normal rib function
- Repeated injuries in the same rib region point to musculoskeletal imbalance
21
Q
SI Joint Indicators
A
- “Low-back Dimples”
- PSIS
- PSIS can be used to determine if there is an SI joint dysfunction w/ a motion test
22
Q
Relationship b/t R-L sides and pain
A
Most SI joint problems cause discomfort on either the right or left side, no commonly both
23
Q
Mechanical or Neurological?
A
Mechanical in nature where movement into flexion or extension will hurt more
24
Q
Lumbar Spine vs Sacrum
A
- When the lumbar spine flexes, the sacrum posteriorly nutates (extends)
- When the lumbar spine extends, the sacrum anteriorly nutates (flexes)
- Abnormal mechanics in the lumbar spine can negatively affect sacral movement
- Abnormal sacral position directly affects the pelvis and proper pelvic motion
- A lumbar or sacral problem could produce SI joint pain and dysfunction. If so, simply fixing the innominate is not going to fix the problem. You need to be able to fix the lumbar and sacral problem
25
Q
Understanding Neutral Pelvis
A
- Important for low back stability
- Position should be maintained for core strengthening exercises
- Key position to teach back pain patients to hold
- Weak abs increases lordosis in the lumbar area
26
Q
Low Back Pain Epidemic
A
- Up to 80% of low back pain is considered idiopathic (actual cause or origin unknown)
- Most common form of back pain in general population
- Total costs associated w/ LBP exceeds $100 billion
27
Q
LBP in Athletes
A
- Still the most common form of back pain in college athletes
- More common forms:
Spondylolysis
Spondylolisthesis
Discogenic
Facet impingement
SI Joint
28
Q
Spondylolysis
A
- AKA “Scotty Dog Fracture”
- Younger patients have good potential to return to normal activity w/ proper rest, unloading and proper core work
- Progression leads to disc and degenerative problems
29
Q
Spondylolisthesis
A
- Forward slippage of a lumbar vertebrae on the vertebrae below it
- A secondary effect of spondylolysis due to fracture of the pars interarticularis
- Distance of slipping determines severity of disc, joint, and neural involvement
- Extension is more painful in this condition
30
Q
Facet Impingement
A
- One of the most common forms of acute back pain
- Can be temporarily debilitating and painful
- Acute BP is different from Facet Joint Syndrome which is more chronic and involves facet hypertrophy, inflammation and facet arthritis
- The facet joint has a capsule that can sometimes get “impinged” or pinched b/t the 2 articular surfaces
- When this happens it will get inflamed and painful it will also restrict motion at that joint and make it difficult to open or close the facet joint
31
Q
Facet Joints
A
- Help guide the proper motion for the spinal segment
- Important for helping carry the load on the spine and important in resisting shear loads in the lumbar spine
- Joint capsules have their own nerve innervation
- Acute and subacute pain seem related to capsule damage
- Chronic pain is probably related to osteoarthritis
- Disc degeneration and facet joint stress go hand in hand
32
Q
Tropsims
A
- Abnormalities that can occur in the shape of the facets
- Somewhat common to find at the L5-S1 level
- Can produce abnormal amounts of facet joint stress and degeneration w/ difficulty in particular movements for that segment
- Half-moon shape –> 12%
- Flat (normal) –> 57%
- Asymmetric Half-Moon, Half-Flat Shape –> 31%
33
Q
The Intervertebral Disc
A
- Discogenic pain means that the disc is the source or cause of the pain
- Early degeneration or disc damage results in annular tears and the disc gradually shifts and bulges
- Can eventually cause nerve pain
34
Q
What’s a slipped disc?
A
NOTHING, discs cannot “slip”
35
Q
Parts of an Intervertebral Discs
A
3 parts: - Annulus fibrosus - Nucleus pulposus - Vertebral endplate A 1 mm thick plate of hyaline cartilage that helps attach the disc to the body of the vertebrae above and below
36
Q
Nucleus Pulposus
A
- Central portion of the disc (more posterior in the L-spine)
- Loose collagen fibril network contained w/in an extensive gelatinous matrix (primarily Type II collagen)
- Contains high portion of proteoglycans at birth
- Decreases w/ age, and is replaced by collagen (occurs after age 20)
37
Q
Nucleus Pulposus Functions
A
- Imbibition: taking up and holding fluid
- Transmission of force: its incompressibility is responsible for transmitting much weight across the spinal segment
- Equalization of stress: hydrostatic property of transmitting forces equally in all directions
- Movement: provides “rocking” action to movement
- Nutrition: only the periphery of the disc is vascularized, receives nutrients via diffusion
38
Q
Nucleus Pulposus Degeneration
A
Includes a loss of disc height which then causes more load to be placed on the facets
39
Q
Annulus Fibrosus
A
- Made up of about 20 concentric rings
- Fiber pattern in each ring is offset
- Handles compression, shear, and torsional forces
- Outer layers are well innervated and contribute to discogenic pain when it bulges
40
Q
Forward Bending in the Spinal Segment
A
- Vertebra rocks over nucleus
- Facets slide up –> 40% displacement
- Anterior disc loaded and annulus bulges anteriorly
- Posterior disc is drawn taut and may become concave
- Nucleus deforms posteriorly
41
Q
Backward Bending in the Spinal Segment
A
- Vertebra rocks over nucleus
- Facets slide down and contact the lamina below
- Posterior disc is loaded and annulus bulges posteriorly
- Anterior disc is drawn taut
- Nucleus distorts anteriorly
- W/ continued backward bending facets become a fulcrum, the disc space undergoes distraction
42
Q
What is the most detrimental movement for the disc?
A
- Bend down
- Lift a heavy object and twist
43
Q
What “feature” makes the nucleus incompressible?
A
Its high water content
44
Q
What pathology could be associated w/ a fracture of the vertebral endplate
A
- HNP
- Scheuermann’s disease –> a form of kyphosis that typically starts in teen years can also increase risk of schmorl’s nodes
45
Q
Lumbar Pain
A
- Presents in the bulk of the paraspinal or low back musculature
- Often unilateral but can be bilateral under certain circumstances
- A decent amount of flexion and extension available as well as rotation
- Sidebending better at top portion and limited in lower
46
Q
Intervertebral Discs
A
- Compressive loads on the disc are about 1.5 time the externally applied load
- As the disc is compressed, the disc bulges laterally (placing stress on the annulus)
- Stress on the posterior part of the annulus in the lumbar spine is estimated to be 4 or 5x greater than the external compressive load when moving into some flexion
- Overall, standing w/ flexion increases pressure and further increased w/ rotation
47
Q
Spinal Stability- Core Training
A
- Abs are important, can’t be the main focus
- Core training is everything b/t the lower chest and pelvis
- Includes the erector spinae and lots of stabilization
