How many moveable and unmoveable bones are in the spine? How many vertebrea are there and how many spinal nerves?
- 24 moveable bones
- 33 bones total
7 cervical – 12 thoracic– 5 lumbar – 5 sacral -4 cocegeal
- 31 pairs of spinal nerves coming out of
- the foramen of the spine
- 8 – cervical
- 12 – thorcic
- 5 - lumbar
- 5 – sacral
- 1 – coyxxis
Why do we shrink as we age?
height of vertebrea: 3/4 is bone, ¼ is vertebral disc – as you age the Intervertebral disk shrink and dry causing a person to get shorter and may cause pain.
What is the axial load on the muscles? In what motion is this worse?
- Axial load
- 20% load goes through the facets
- 80% of the load through the body
In extension you get more load on the facet joints then when you in spinal neutral.
What are the other name of facet joints and what are they?
zygapophysial joint (zygapophyseal, apophyseal, Z-joint, or facet joint) is a synovial joint between the superior articular process of one vertebra and the inferio articular process of the vertebra directly above it. There are two facet joints in each spinal motion segment. The biomechanical function of each pair of facet joints is to guide and limit movement of the spinal motion segment. In the lumbar spine, for example, the zygapophysial joints function to protect the motion segment from anterior shear forces, excessive rotation and flexion. Zygapophyseal joints appear to have little influence on the range of side bending (lateral flexion). These functions can be disrupted by degeneration, dislocation, fracture, injury, instability from trauma, osteoarthritis, and surgery. In the thoracic spine the zygapophysial joints function to restrain the amount of flexion and anterior translation of the corresponding vertebral segment and function to facilitate rotation.
Name the curves of the spine and explain which are secondary and primary and why?
Cervical curvature – lordosis
- thoracic curvature - kyphosis
- lumbar curvature – lordosis
- Sacral curvature - kyphosis
thoracic and sacral curves are considered the primary curves – due to the fact that they devolop in the womb and so are there first
- Cervical curvatures devolop when the baby lifts his head up
- Lumbar curvature - develops when a baby begins to walk and get his feet beneath him
cervical and lumbar curves are secondary curve because develops later
What is sclerosis?
sclerosis is a side ways curve of the spine – a common cause of this idiopathic , we don't know why this happens but it can be myoptathic or caused by a muscle imbalance moves the spine. Sometimes is due to hemivertebrae – which means the vertebrae are wedge shaped. Starts/devolopes in people in their teens.
What is Hemivertebrae?
Hemivertebrae - Among the congenital vertebral anomalies, hemivertebrae are the most likely to cause neurologic problems. They are wedge shaped vertebrae, and therefore can cause an angle in the spine (such as kyphosis, scoliosis, and lordosis). The most common location is the midthoracic vertebrae, especially the eighth (T8). Neurologic signs result from severe angulation of the spine, narrowing of the spinal canal, instability of the spine, and luxation or fracture of the vertebrae. Signs include rear limb weakness or paralysis, urine or fecal incontinence, and spinal pain. Most cases of hemivertebrae have no or mild symptoms, so treatment is usually conservative. Severe cases may respond to surgical spinal cord decompression and vertebral stabilization. The probable cause of hemivertebrae is a lack of blood supply causing part of the vertebrae to not form.
In what pt would we see alot of kyphosis and lordosis?
In older peoples we see a lot of kyphosis
in pregnancy we see a lot of lordosis or due to a beer belly or in wheel chair belly.
Why do wheelchair pt have issues with lordosis?
Can also have problems due to a tight psoas major , which increases lumbar lordosis – common in amputees or in pt in wheel chairs, who have sat for so long that the muscle tightenes so when you want them to learn to walk again if it hasn't been stretched, then they have a lot of pain trying to use the prostetic.
What is the test for sclerosis?
Test for sclerosis– have a person touch there toes and you can see a lump on the persons back
What vertebrea have tranverse facets?
Transverse facet were rib attaches are only on the thoracic All vertebrae have superior and inferior facets but the angles change.
What is Pars interarticularis?
Pars interarticularis – is the part between the superior and inferior articular process and facet on the pedicals – ( literally means the bit between the joints ) this is commonly broken or cracked and this can allow the whole disc to move and this is the spondolythesis or the scotty dog fracture.
What is Spinabifida and what are the two types we care about?
Spinabifida – when the lamina don't fuse
- Spinabifida occulta – the lamina join but they don't form a sphinous process – mildest form of spinabidia – usually occurs in one or two lumbar vertebrea – not a bid deal
- in most cases is the mildest form of spinabifida
- Spinabifida Cystica – is when the lamina don't joint together and there is a gap and this is when the spinal cord may come out in and in extreme cases the mengies and spinal cord will come out through and forms a cyst it has many problem associated with it. Varying degrees of severity.
What is Meningomyelocele?
is were the menigies comes out the spinal cord through a hole in the lamina caused by spinabifida. This is a serious condition which often leaves the child paralyized from the wiast down.
Name distinctive characteristics of each type of vertebrea?
2 distinct characteristics of cervical vertebrea
- transverse process
- bifid spinous process – the end of the spinous process forms a Y at the end
Thoracic vertebrea – distinguing characteristics
sphinous process sits above the body of the vertebrae below
costal facet are on the transverse process and the body of the vertebrae – are at the junction C3-4 so it touches onto both superior in C3 inferior on C4, this is were the 4 rib joins. - are on all but T12 for the ribs – there is a synovial capsule in these , these joints can dislocate
Spinous process is flat and blade like
What artery becomes the basila artery?
Vertebral artery pass through the transverse foramen of cervical vertebra but for some reason it often skips C7 and go into c6-1 and then come out on the top of c1 and take a right angled bend to join with the other vertebral artery and together they form the basila artery which goes up the front side of the brain stem.
What arteries supply the brain?
2 coratid and 2 vertebral arteries
How do you know which artery of the vertebral artery test is blocked?
Vertebral artery test - When using the vertebral artery test which ever way you bend stretches the heck out of that sides artery and closes it so the opposite artery is the one that supplies the brain and hence if you see the eye twitching of a positive test then it must have a blockage. So when you left bend you close the left and the right must supply the brain so if you have a positive artery test then in this case it the right that must be blocked.
What can be confused with a positive vertebral artery test?
Vertebral artery test can be confused with vestibular damage.
What are the joints of luschka?
Joints of Luschka , uncovertebral joints, uncinate joints – are process on the edges of the body of the cervical vertebra that form a cup on the vertebral bodies and prevent the cervical vertebra from sliding left or right, so to mobilize them you must rock the head in a c shaped motion to get the best motion. U nfortunatly in some disease they can begin to fuse.
Where does the fourth rib come off of?
The transverse facets of T3-4.
Explain Fryette's Laws?
Law 1 – while in a neutral position cervical and thoracic vertebrae act differently , in Cervical vertebrae side bending and rotation occur to the same side. So these motion are coupled together (except in the OA joint) Example: side bend you neck to the right and try and look left you can't rotate much but you can rotate a lot to the right.
In thoracic and lumbar vertebrae it is opposite because in these vertebrae side bending and rotation are opposite. So right side bending goes with left rotation and vica versa.
Law 2 - if you fully flex or extend first then side bending and rotation are to the same side in all the spine just like in the neck.
Law 3 – if you move the spine in any plane (side bend, flex , extend) first then the amount of other motions left is reduce. This is important when you wish to lock the spine down for mobilization.
What is Spondylolysis?
Spondylolysis - a bilateral defect in the par articularis , with no separation – so its a scotty dog with a collar – which means if x rayed it looks like the scotty dog is wearing a collar because he has a crack in both sides of his neck.
What is Spondylolithesis ?
Spondylolisthesis– Scotty dog is decapitated , so the head is seperated from the body of the scotty dog and this allows the vertebral body above to move forward – so this is a bilateral gap on both sides leaving the vertebra below free to push forward. There are degrees of this. This can bend the spinal cord if it happens at a lower vertebrae like L5.
They grade this based – on how much the superior body is sticking out over the lower vertebrae
- 25% slippage
- 25-50% slippage
- 50-70% slippage – can be function even at higher degrees of slippage
- 75& and greater – it can slip of completely
What is Spondyloptosis?
Spondyloptosis – is when the superior vertebrae slips off of the inferior completely due ta case of Spondylolysis that has gone past grade 4.
What is Spondylosis?
Spondylosis – is DJD degenerative joint disease , as you get older your joints in the spine degenerate and you can get joint deterioration of the spine and spinal osteoarthritis. With this degeneration the disk collapse and osteocyetes (bone spurs) grow into the intervertebral foramen causing a narrowing of this hole which is called stenosis (lateral or medial stenosis of the spine) and impinging the spinal nerves.
Traction can help this condition, but in extreme cases they may go in and surgical remove the bone spurs.
What is Ankylosing spondylitis?
Ankylosing spondylitis – ankylosing means bent – these people end up with bamboo spine – 13 in a hundred thousand people get this - more common in males 15-30 years old. Men get this 3/1 ration compared to females. It is a rheumatic disorder which can arthritis of the spine, sacrum and the SI joint – were there is inflammation and the spine begin to fuse together. When the spine fuses there not much that can be done about it so PT try to make it fuse in a function position such as upright instead of in a kyphoitic posture.. This is a systemic disorder which can also effect the eyes (see effects in eyes), heart valves and other parts of the body. Treated with anti-inflammations and with pool therapy. In the end the Spine becomes like a solid bamboo rod (has knots along it) and it can bend or flex at all and it can become weak and this can cause it to become broken and have to be fused if this happens.
What is the ILA and why does it matter?
ILA – inferior lateral angle of sacrum – this is important in palpation , forwe use these bottom corners to access if the sacrum is moved, nutation, counter nutation or left or right.
What is a hernia and in which direction do they occur and why?
Hernia –in a hernia the nucleus pulposis pushes through the annulus fibrosis and pushes on a nerve root.
Most herniations occur in a posterior lateral directionbecause that is were the posterior longitudinal ligament is weakest and because we spend out life in flexion , so were are always bending which squeezes the pulpolsis backwards. This pushes onto were the spinal nerves comes out and causes nerve pain and nerve root issue.
What is the McKenzie method?
McKenzie method – is used to treat hernias by PT – we try to push pulposi off the nerve and relieve the back pain. Can be done with variation of methods including using back bends while the pt is propped up on their elbows(various positions are used as well). Idea is to push the disk of the nerve, so we want to centralize the pain into the but, so if the pain spreads down into the legs your making it worse. If pain goes into just the but then it working even if the pain there is worse because it getting the bulge of the nerve and so centralizing the pain.
What are 2 signs ofherniation and what does each mean about the position of the impingement.
Lateral Shift – is when a pt stands with a slight kink or side bend in there back while standing, in these case the protrusion is on the nerve so this relieves the pressure of the disk on the nerve by side bending away form the lesion.
Nerve may be outside of the protrusion in which case the pt will side bend to the side of the lesion to take the pressure of the disk of the nerve.
Why do some lumbar herniations effect nerve roots other then the nerve root of that vertebrea?
L4-5 disk herniation doesn't always cause l4 problem because in the Claudia equina all these nerve roots run close together. OS L4 can impinge S1.
spine ends at L2 but nerve roots keep going down the vertebral foramon as the claudia equina.
Name the generic Ligaments of the spine – posterior to
Supraspinous ligament – goes across all the spinous processes
Interspinous ligament – between all the spinal processes
Ligament flavum – means yellow – in the vertebral foramen where the spinal cord is we find this ligament on the front side of the vertebral arch
posterior longitudinal ligament – is weaker and thinner and this is were most disc come out
anterior longitudinal ligament – on the very front
What ligament can be damaged in s whiplash injury?
Whip lash injuries damage – anterior longitudianl ligament may be ripped , of course if the head snap backs then may cause issue with posterior ligament to.
Name the Special ligaments at the OA and AA joints? What the test for the tow ligaments we care about?
Cruciate ligament – cross shaped ligament - holds the dens in place – connects the axis with the occiput
Superior longitudinal band
transverse ligament - holds dens to atlas , this is what dens rotates around – prevent dens from going into spinal cord. So if this lax or torn pt can have sever issues. So always test this before doing spinal mobilization.
Inferior longitudinal band
People with down syndrome have very weak or lax ligaments so always check the integrity of the cruciate ligament before working on the spine.
Test: palpate grab C2 and lift the head up and C2 should come instantly with it if the transverse ligament is intact if there is a delay or a boggy feeling this ligament may be damaged.
Alar ligament – goes from the dens out to the oxiput so links dens to the head so when there movement of the head C2 moves– important in side bending – to test put thumb on one side of C2 and side bend the head and feel C2 push into the thumb.
What four muscles important in small movements of the head form the suboccipital traingle?
- Obliquus Capitis inferior - dooesn't go to head
- Obliquus Capitis superior
- Rectus capitis posterior major
- Rectus capitis posterior mainor
What muscle named capitis doesn't go to the head?
Obliques capitis inferior
What happens in head forward posture?
Head forward posture is a flexion of the lower neck and an extension of the upper cervical area. Which leads to shortened and tight muscles of the sub-occipital triangle.When this press on the suboccipital nerves you can get head aches.
What two structure are the main propriceptors of the body?
Muscle spindles – detect length – there are two types of neurons coming out of them the 1A and the type 2 afferents neurons. They signal different type of info 1A signals how fast the muscle is stretched and the type 2 signals the amount of stretch.
Golgi tendon organ – tells the force going through the muscle tendoninus junction.
What are the common features of the tranverses spinalis group?
tranverses spinalis group they all sit in trough between the tranverse and the spinous process and all go from the transverse to a spinous process above. They are the superfical to deep ; semispinalis, ,multifidis, rotatores.
Explain the two most likely sources of bacl pain?
Back pain – thought to be from 1of 2 sources slipped disk and this causes radiating or refered pain – treatment is the meckensy approach
Facet joints issues or orientation – hyper and hypo mobility of the facet joints – the theory is that if one segment locks up then the segments below become hyper mobile to compensate and the result is pain, thought that this hypomobility tends to be caused by the multifidia locking up.
What is the austrailian method?
Is a Treatment used to fix back pain when the cause is due to facet orientation – austrailian method - some of these chronic back pain pt are thought to have hyper mobility in this area (spinal segments) so you use proper activation of transverse abdominus and lumbar multifidisit to stabilize these hypermoblized section and sense the mutlidifi is very specific to certain levels the activation of set multifidi and the transverse abdominus can stabilize the spine.
What is the mammillary process, what is it purpose?
mammillary process –Of the three tubercles noticed in connection with the transverse processes of the lumbar vertebrae, the superior one is connected in the lumbar region with the back part of the superior articular process, and is named the mammillary process. Attachments of mammillary process: The multifidi muscle attaches to the mammillary process and helps to stabilize the vertebral joints. It spans from the sacrum to the cervical, endowing stability to each segmental level.
How many pairs of ribs are there and name each type?
- 12 Pairs of ribs
- top 7 are called true ribs or vertebrosterno ribs – connect from vertebrea to the sternium and have it own strip of costal cartilage (hyaline cartilage) to the sternum.
8-10 false ribs – vertebralchondro ribs - 8—10 ribs there cartilage merges into the cartilage of ribs seven before linking to the sternum
11-12 are floating or vertebral ribs because they have no link to the sternum – usually don't break because float out of the way.
Explain what and were fibro andf hyaline carilage are?
fibrocartilage is used for shock absorbtion – two most common location – pubic symphasis and the vertebral disc and the SI joint
hyaline cartilage is articular cartilage found in joints and also found in the plates in the chest, that attach to the ribs.
Which ribs usually break and why?
11-12 are floating or vertebral ribs because they have no link to the sternum – usually don't break because float out of the way.
Top two pairs of ribs are usually protected by the clavicle so if your going to break a rib it will usually be one of the ribs between the 4-7.
How do you determine which vertebrea a rib belongs to?
Each vertebrae has a superior and inferior costal facets and a transverse costal facet – you name a rib based on the the rib that comes of the superior transverse costal facet of a vertebra goes with that vertebrae. However each rib actually connects with the inferior facet of the vetebra above as well but is not considered to be off that vertebrae.
Name the two ligaments of the ribs that we care about? and what they do?
Radiate ligament – comes off the end of the rib and glues it to the body of the vertebrae.
- Costotransverse ligament – is the ligament that holds a rib to the transverse process of its associated
Why can costvertebral joint issues effetc blood flow in the hands?
The costovertebral joint can sublux quite easy – can be treated and mobilized
If you have a costovertebral issue this can effect the sympathetic chain ganglion that run right beside the spine.
paravertebral ganglion – sympathetic chain – problems in the spine such as costovertrbral lesion can effect the sympathetic nervous system.
No PSN supply to the limbs
In extremities there is only sympathetic which comes from chain ganglion – so they regulate your blood vessels to , make sweat to make your hair stand up on your arms are all caused by the sympathetic system so you can have blood supply issue in the hand do to problems with the costalveterbral joints because of it proximity to the chain ganglions.
Name the abdimal wall muscles and what they collectively do?
Abdominal wall is made of four walls of muscle that form a corset around the abdomen – these rotate the spin , flex the spine and holding stuff inside, they also raise interabdominal pressure which is usual from your expelling things out of orifices.
- 4 layers of muscle
- rectus abdominis – down front
- external oblique
- internal oblique
- transverse abdominus
What is the Valsalva maneuver?
Valsalva maneuver or Valsalva manoeuvre is performed by moderately forceful attempted exhalation against a closed airway, usually done by closing one's mouth and pinching one's nose shut. Variations of the maneuver can be used either in medical examination as a test of cardiac function and autonomic nervous control of the heart, or to "clear" the ears and sinuses (that is, to equalize pressure between them) when ambient pressure changes, as in diving, hyperbaric oxygen therapy, or aviation. – is used to lift heavy things or in sports in the long jump, because you want a firm rigid core to drive off the ground from.
Explain Diastasis recti?
Diastasis recti – is when the linea alba splits. Can be permanent or can reseal it varies. IF it is permenant you may see it when a women does sit up for it will pop out slightly.
- Diastasis recti (also known as abdominal separation)
- is a disorder defined as a separation of the rectus abdominis muscle into right and left halves. Normally, the two sides of the muscle are joined at the linea alba at the body midline. It is essentially a cosmetic condition, with no associated morbidity or mortality. Diastasis of this muscle occurs principally in two populations: newborns and pregnant women. In the newborn, the rectus abdominis is not fully developed and may not be sealed together at midline. Diastasis recti is more common in premature and African American newborns.
In pregnant or postpartum women, the defect is caused by the stretching of the rectus abdominis by the growing uterus. It is more common in multiparous women due to repeated episodes of stretching. When the defect occurs during pregnancy, the uterus can sometimes be seen bulging through the abdominal wall beneath the skin.
What are 4 comon sites of hernia?
- Umbilical hernia – a weakness in the belly button can let thing come out – so in males part of the small intestine may come out there – in women the round ligament
- of the uterus may come out
Femoral – femoral sheath creates femoral canal which can be a weak point.
inguinal –inguinal ligament keeps everything in the abdomen but in men intestines can come down the spermicord because it is weak point in the intestinal wall, this is less common in women they tend have a weak point at the round ligament were uterus attaches.
What is at the level of the umbilicus?
Umbilicus is usually level with L3-4 vertebral disk – though if there a lot of belly fat may be lower.
Tendonius inscription starts art L3-4 disc an cross belly button.
What is the pyramidalis?
pyramidalis is a small triangular muscle, anterior to the Rectus abdominis, and contained in the rectus sheath.
Inferiorly, it attaches to the pubic symphysis and pubic crest, arising by tendinous fibers from the anterior part of the pubis and the anterior pubic ligament. Superiorly, the fleshy portion of the muscle passes upward, diminishing in size as it ascends, and ends by a pointed extremity which is inserted into the linea alba, midway between the umbilicus and pubis. Therefore, when contracting, it has the function of tensing the linea alba.
80% of people have pryamidalis, 20% don't have one
Why is transverse abdominis important? How and what is it used to treat?
Transverse abdominus – may be important in lumbar stabilization – because the spin has a fascial sheath around it and when you tense the transverse abdominis it creates pressure around the spine and this makes it more rigid and hence stabilizes the spine/core. Most important muscle in the core.
Reaching forward activates erector spinea (something in the back comes on) and if reach back then the abdominals (something in the front comes on) come on. The transverse abdominis comes on no matter which direction you reach.
In chronic low back pain due to segmental instability the transverse abdominis will not activate in the right order we don't know this is the symptom or the cause. We will learn to palpate it and activate this muscle. We wish to avoid rectus abdominis contraction because this wont set the spine it will flex it.
Bio feed back is now used to relearn how to set the transverse abdominis before you move. There is a device like a blood pressure cuff under the back and when they contract transverse abdominis they lift off the table and this teaches them to activate it in supine and in time this can let them learn to use it in walking to.
This is called the Australian approach.