Week 10: Spine and Trunk Flashcards
An abnormal curvature of the cervical vertebrae?
Lordosis
An abnormal curvature of the thoracic vertebrae?
Kyphosis
Abnormal curving of the spine
Scoliosis
This protects the SC, organs, breathing, transmits loads, stabilizes and mobilizes?
Spine
This portion of the spine functions to absorb shock, bear weight, and mobilize the trunk?
Anterior portion
The anterior portion of the spine includes what 2 structures?
body
intervertebral disc
This portion of the spine functions to protect the SC, bear weight, and stabilize?
Posterior portion
The posterior portion of the spine includes what structure?
spinous process
These joints within the spine allow for flexion, extension, and torsion; likewise, they interlock for stability
Facet joints
The point where 1 vertebrae touches the next?
facet joints
Two structures within the intervertebral discs
Nucleus pulposus (middle) annulus fibrosus (surrounding)
Describe the axis of rotation in the intervertebral disc
Anterior with flexion
Posterior with extension
In the intervertebral disc, how does rotation impact the flexion and extension on the NP?
it decreases it
What 2 areas of the back are common for herniations?
- Cervical
2. Lumbar
With a herniation in the back, which structure is being pushed out?
Nucleus pulposus
What are the main differences between the structure of the lumbar, thoracic, and cervical vertebrae?
lumbar: body is larger for more support
thoracic: more facets for greater articulation with the spine
cervical: transverse foramen for sympathetic nervous system
All motion in the spine is limited by what 3 structures?
- capsule
- facet joints
- portions of the annulus fibrosis
What limits spinal extension?
vertebrae
What is the closed pack position of the spine?
spinal extension
What ligament limits cervical rotation and extension?
Alar Ligament
What 2 structures limit cervical extension?
trachea
esophagus
What angle are the facets of the cervical spine at?
45*
What portion of the skull does C1 meet? What about C2?
C1- Occipital condyles
C2- Dens of C1
What is the atlas? What is the axis?
atlas is C1
axis is C2
Most prominent spinous process of the cervical vertebrae?
C7
This motion extends the upper cervical and flexes the mid to lower cervical vertebrae?
Protraction of the jaw
This motion flexes the upper cervical and extends the mid to lower cervical vertebrae?
Retraction of the jaw
When measuring the cervical vertebrae, where do we measure from?
external auditory (acoustic) meatus
What is the closed pack position for cervical spinal motion?
70* extension
Attachment sites for STERNOCLEIDOMASTOID?
O: sternum and clavicle
I: mastoid process of temporal bone
What is the innervation for STERNOCLEIDOMASTOID?
spinal accessory N
With a protracted forward position, what is overactive?
sternocleidomastoid
Actions (4) of STERNOCLEIDOMASTOID?
- ipsilateral flex neck
- contralateral rotation of neck
- flex lower neck
- extend upper neck/head
Attachment sites for SCALENE group?
O: TP of cervical vertebrae
I: anterior 1st rib; posterior 2nd rib
Actions (3) for SCALENE group
- lateral flex neck
- elevates the 1 and 2 rib
- flex neck
What does the SCALENE group stabilize?
C spine
Upper ribs
What is the scalene group an accessory to?
respiration
Innervation of SCALENE group
cervical spinal nerves
This group is also known as the “posterior triangle”
Scalene Group
What angle are the facets of the thoracic spine at?
60*
What makes the thoracic vertebrae unique?
they have costal facets which allow for articulation with the ribs
Why are the thoracic vertebrae more oriented in the frontal plane?
so more lateral flexion can occur
The rib cage is connected to which part of the spine?
thoracic (T1-T12)
How many ribs are there?
24 ribs total
- pairs 1-7: true (articulate with the sternum)
- pairs 8-10: false (articulate with cartilage)
- pairs 11&12: floating (no articulation)
2 main functions of the rib cage
breathing
protections
5 muscles that make up the rib cage musculature? Which 2 articulate directly on the ribcage?
- intercostals
- diaphragm
- abdominals
- sternocleidomastoid***
- scalene group***
* **articulate directly on ribcage
Action of the external intercostals vs. the internal intercostals?
External- elevate ribs and contralaterally rotate trunk
Internal- depress ribs and ipsilaterally rotate the trunk
Functions for respiration
Attachment of the INTERCOSTALS
Ribs to ribs
Innervation of the INTERCOSTALS?
Intercostal N.
Action of the DIAPHRAGM?
Depresses during inspiration allowing for more lung expansion
Innervation of the DIAPHRAGM?
Phrenic N. (3,4,5 keep you alive)
Attachments (3) of the DIAPHRAGM?
- L1-L3
- lower 6 ribs
- xiphoid process
True or false? Inspiration and expiration are both active movements only?
False, Expiration is passive and active
What 4 muscles help with inspiration?
- Diaphragm
- external intercostals
- scalenes
- SCM
What 2 muscles help with expiration?
- internal intercostals
2. abdominals
Is the thoracic or lumbar spine more stable? More mobile?
stable- thoracic
mobile- lumbar
What is the function of the lumbar spine?
flexion
also helps translate load into pelvis and lower extremity (“gate keeper”)
What is the function of the thoracic spine?
rotation
What angle are the facets of the lumbar spine at?
90*
Where is the greatest motion of flexion/extension in lumbar spine?
Lumbosacral joint (L5-S1)
Attachments (3) of the RECTUS ABDOMINIS?
- xiphoid
- pubis
- costal cartilage of ribs 5-7
What 2 structures does the RECTUS ABDOMINIS stabilize?
Rib cage
Pelvis
Actions (3) of RECTUS ABDOMINIS?
- Flex trunk
- PPT
- Lateral flexion
Innervation of all the abdominal muscles?
Intercostal N.
Attachments (5) of the TRANSVERSE ABDOMINIS?
- Inguinal L.
- Iliac Crest
- Thoracodorsal Fascia
- Lower Ribs
- Abdominal Aponeurosis
Action of the TRANSVERSE ABDOMINIS?
Compression of the abdominal cavity
Actions (4) of the EXTERNAL abdominals?
- lateral flexion
- contralateral rotation
- flex trunk
- PTT
Attachments of the EXTERNAL Abdominal ?
Illiac Crest
abdominal aponeurosis
ribs 5-12
Actions (4) of INTERNAL INTERCOSTALS?
- lateral flexion
- IPSILATERAL rotation
- flex trunk
- PTT
Attachments of ERECTOR SPINAE GROUP?
Pelvis and ribcage
spine and mastoid process
Actions (3) of ERECTOR SPINAE GROUP?
- Extend neck and trunk
- APT
- Lateral flexion of neck and trunk
Innervation of ERECTOR SPINAE GROUP?
Spinal N.
Actions (4) of MULTIFIDUS?
- extend trunk
- APT
- lateral flex
- contralateral rotation
Where is the MULTIFIDUS located?
lower back
What 4 bones make up the pelvic girdle?
- ilium
- ischium
- sacrum
- pubis
What is nutation? Counternutation?
Nutation: anterior tilt of sacrum to ilium
Counter: posterior tilt of sacrum
Counter is closed pack
Nutation is open packed
What is the SI joint?
Where the sacrum meets the ilium
What happens from sit to stand in regard to your pelvic position?
sitting (posterior pelvic) to standing (neutral/anterior)
What happens in the lumbar spine with an anterior vs. posterior pelvic tilt?
Anterior: spine flexion
Posterior: spine extension
Proximal stability is need for?
distal mobility
T/F: pelvic stability and posture effects the LE and UE but not the jaw?
False
5 factors that can influence posture
- Patient factors
- psychological
- sensory systems
- musculoskeletal systems
- methods and measurements
How does trunk co-contraction occur? What muscles are working anteriorly? Posteriorly?
isometric co-contraction of agonist and antagonist
posteriorly: erector spinae and multifidus
anteriorly: transverse and oblique abdominals
What is the term for the downward directional force of gravity through the body towards the earth?
Center of Gravity
What is the term for the area on the earth between ones feet?
base of support
What is the term for the movement of the body in static position in order to maintain static standing balance?
postural sway
6 things that make up the “line of gravity” in proper standing posture?
- mastoid process
- anterior shoulder
- Through COG (S2)
- posterior to hip
- anterior knee
- 5-6 inches anterior to the ankle
In standing posture, what is happening to the abs, hip, and back?
abs pull up
hip flexors pull down
hip extensors pull down
back muscles pull up
What is torticollis and wry neck?
unilateral SCM tightness resulting in ipsilateral extension, ipsilateral lateral flexion and contralateral rotation
What is the cervical impact if there is increase capital extension ?
suboccipital extensors shorten resulting in pain and tension headaches
What is the cervical impact if there is an exaggerated lordosis?
tightening of spinal extensors, scalenes, upper trap, and levator scapulae
What is a TMJ dysfunction?
dysfunction of the synovial articulation between the mandible and temporal bone
- can be caused by poor posture
- can effect: headache, pain, decreased ROM, decreased ability to chew
What is thoracic outlet syndrome?
When the scalene group compress the neurovascular bundle that pass between the anterior and middle fibers
- commonly caused by forward head postures
- effect: UE weakness, pain, tingling, numbness
What are the shoulder and thoracic impacts of the protracted or forward jaw posture?
- tight chest muscles
- overlengthening of middle back muscles
- Thoracic: kyphosis
- Shoulder: protracted and elevated
- scapular: abducted, upward, winging
What is diaphragmatic breathing?
deep breathing that expands the abdomen instead of the chest
What is shoulder impingement?
pinching of muscles/tendons supraspinatus/biceps) or the subacromial bursa in the coracoacromial arch during shoulder elevation
What happens in the kinematic chain as a result of “flat back”
PPT
hip extension
knee flexion
foot pronation
What happens in the kinematic chain as a result of “hyper lordosis”
APT
Increase thoracic kyphosis
increase cervical extension
knee hyper extension
This vertebrae is parallel with the spine of the scapula?
T3
This vertebrae is in line with dimples?
S2
This vertebrae is in line with the iliac crest?
L4
This vertebrae is in line with the nipples?
T4
This vertebrae is in line with the inferior angle of the scapula
T7
This vertebrae is in line with where the last rib articulates
T12
What 4 movements do we test for in a hip muscle test?
flexion
extension
abduction
ER
What 2 movements do we test for in a scapula muscle test?
adduction
downward rotation
What 3 movements do we test for in shoulder muscle tests?
ER
IR
Horizontal abduction