Vertebral Column Flashcards
PT Evaluation 3 R’s
- Reproducible Sign
- Region of origin
- Reactivity level
Hypomobility syndrome want to promote…
Mobilization
Instability syndrome want to promote…
Stabilization
Symptoms get worse what do you do for application of joint mobilization?
- Hold/monitor
2. Decrease 1 variable, repeat 1-5 reps and reexamine
Symptoms get slightly better, what do you do for application of joint mobilization?
Repeat 1-5 Reps, reexamine
Symptoms dramatically better, what do you do for application of joint mobilization?
Hold, monitor
No change in symptoms, what do you do for application of joint mobilization?
Increase 1 variable, repeat 1-5 reps and reexamine
What are neurophysiological effects of joint mobilizations?
- Firing of articular mechanoreceptors, proprioceptors
- Firing of cutaneous and muscular receptors
- Altered nocioception
What are the mechanical effects of joint mobilizations
- Stretching of joint restrictions
- Breaking adhesions
- Altered positional relationships
- Diminished/eliminate barriers to normal motion
What are the psychological effects of joint mobilizations?
- Confidence gained through improvement
- Positive effects from manual contact
- Response to joint sounds
Evidence regarding manipulation effectiveness
acute low back pain.
- Spinal manipulation is safe, effective, and recommended intervention in management of LBP
Indication for joint mobilizations
- Improve loss of accessory or physiological movement
- Reduce closing/opening dysfunction of the spine
- Restore normal articular relationships
- provide symptom relief and pain control
- Enhance motor function through reduction of pain and restoring articular relationships
- Improve nutrition to intra-articular structures by promoting mobility
- Reduce muscle guarding
- Curtail a progressive loss of mobility associated with disease or injury
- Increase/maintain mobility when an individual is unable to do so independently
- Safely encourage early mobility following injury
- Develop patient confidence in respect of favorable outcome
- Provide preparation or support for other manual/nonmanual interventions
Contraindications for Grades I-IV joint mobilizations
- Hypermobility/instability
- Inflammation/effusion
- Hard end feel
- Medically unstable
- Presence of acute pain that increases with repeated attempts
- Acute radiculopathy
- Bone disease or fracture detectable on radiograph
- Spinal arthorpathy (DISH)
- Deteriorating CNS pathology
- Status post joint fusion
- Blood clotting disorder
Relative precautions for grades I-IV joint mobilizations
- Malignancy (> 50 y.o., failure to respond, unexplained weight loss)
- Total joint replacement
- Bone disease not detectable on radiograph (Osteoporosis, osteopenia, osteomalacia, chronic renal failure)
- systemic connective tissue disorder (rheumatoidarthritis, Down’s syndrome, Ehrlos-Danlos syndrome,Marfan’s syndrome, lupus erythematosus)
- Pregnancy or immediately postpartum, oral contraceptives, anticoagulant therapy
- Recent trauma, radiculopathy (distal to knee/elbow), cauda equina
- early healing phase with new developing CT
- Individuals unable to communicate
- Psychogenic patients
- Long term corticosteroid use
- Skin rash/open wounds in region being treated
- elevated pain levels that make palpation and stabilization unreasonable
How many total vertebrae
29
How many cervical vertebra
7
How many thoracic vertebra
12
How many lumbar vertebra
5
How many sacral verteba
5
How many coccygeal vertebra
4
What is a vertebral motion segment
two facets above and below
What are the three separate joints in vertebral motion segment
2 facets and the IV and the vertebral bodies
How many pairs of facet joints are in the spine
24
What type of joint are facet joints classified as
Planar
In UCS facets are oriented in what alignment
horizontal
In LCS facets change to what position
45 degrees
Z joints/uncovertebral joints are made up by what anatomical process?
Uncinate process. This process limits side-bending and posterior translation and glides
What are the two roles of meniscoidal of facet joints?
- fill space during joint displacement
2. actively assist in the dispersal of synovial fluid
Thoracic spine facet joint orientation
vertical direction. Facilitates rotation
What motion is resisted by facets in thoracic spine
resists anterior displacement
Lumbar spine facet joint orientation
Vertical with J shaped surface.
Motion restricted by facet joint in lumbar spine
restricts rotation and anterior shear
What contributes to lordosis in lumbar and cervical spine
IVD.
Three sub-systems that contribute to stability
- Passive system - anatomical structures contributing to stability
- Active system - muscles
- CNS - feedforward (anticipatory) feedback (reflex) control
Spinal stability - Neutral Zone (Panjabi)
region of laxity around neutral resting position of spinal segment
What happens in neutral zone
- Minimal loading is occurring in passive structures and active structures
- Spinal motion is produced w/ min internal resistance
Movement of vertebral column occurs in what manner
diagonal pattern as combinations of flex/ext with a coupled motion of SB/rotation
What produces movement in spine
agonist and synergistic muscles which initiate and supply power of movement
What muscles control and modify movements of the spine
antagonistic spinal muscles
Amount of motion available at each region of spine is affected by what variables?
- Disc-vertebral height ratio
- compliance of fibrocartilage
- Dimension/shape of adjacent vertebral end plates
- Age
- Disease
- Gender
Coupling of spinal motion in UCS
SB and rotation occur in opposite directions
Coupling of spinal motion in LCS
SB and rotation occur in same direction
Fryette’s First Law
When any part of lumbar/thoracic spine is in neutral position, SB of vertebra will be opposite to the side of rotation of that vertebra.
1. standing neutral SB right, you will ROTATE left
Fryette’s Second Law
When any part of spine is in position of flexion/hyperextension, SB of vertebra will be to same side as rotation
1. flex/hyperextend your spine and SB right.. you will rotate right
Fryette’s third law
If motion in one plate is introduced to spin any motion occurring in another direction is thereby restricted.
1. when perform forward flexion, won’t be as much motion in other planes
Restriction Ext/SB/Rot to same side as pain
Closing restriction - articular
Restriction Flex/SB/Rot to side opposite of pain
opening restriction - capsular
Level of spine: cervicobrachial
C3-C7
Level of spine: atlanto-axial
C1-C2
Level of spine: atlanto-occipital
C0-C1
Injury to cervicoencephalic region
- Cognitive dysfunction
- CN dysfunction
- Sympathetic system dysfunction (sweating abnormalities, pupillary dilation)
Principal motion of atlanto-occipital joint?
Flexion extension (15-20) degrees.
Also have Side flexion (10 deg)
Rotation negligible.
YES AND MAYBE JOINT
What is the most mobile articulation of the spine?
Atlanto-axial joint
Motion at atlanto-axial joint
Flex-ext = 10 deg
side flex = 5 deg
Rotation = 50 deg - primary movement
NO JOINT
Symptoms in Cervicobrachial region
- Neck and/or arm pain
- HA
- Restricted ROM
- Paresthesia
- Altered myotomes and dermatomes
- Radicular signs
What makes up about 25% of cervical spine height?
IVD
