Factors influencing Thoracic Spine movement
- thoracic spine mobility is less than other areas of the spine - ribs - limit rotation and lateral flexion - have larger and spinous processes - joint surfaces approximating on each other a lot sooner (extension) - ligamentous network and joint capsules tend to be broader, more developed (joint capsules are tighter) - orientation of zygapophyseal joints (facets that articulate on each other) - sliding and gliding that occurs is a lot less
Thoracic Movement
- flexion/extension - X-axis, sagittal plane - rotation right and rotation left - Y-axis, transverse plane - lateral flexion right and lateral flexion left - Z-axis, frontal plane
Rib Articulations with vertebrae
costovertebral and costotransverse joints: - 2 points the ribs meet the thoracic vertebrae - head - articulates with the sides of the vertebral bodies (the facet is called a demi/hemi facet) Exercises - lateral costal expansion - therapists hands on sides of ribs, deep breath in, let ribs expand out (maintain mobility)
Costovertebral Joint
- tubercle of rib articulates with costal facet on the transverse process - allows rib to move on its long axis (bucket handle up)
Costotransverse Joint
- diarthrodial - when our ribs elevate, it increases medial to lateral diameter as well as up and down - uniaxial - allow rib to rotate on long axis
Costosternal articulations
- anterior - 2 parts - Costochondral - rib to cartilage - chondrosternal - cartilage to sternum - amphiarthrodial - some movement in cartilages. as we get older, cartilages get more calcified which is why its important to do exercises - 8, 9, 10 have shared cartilage - palpate them at the mid axillary line
Thoracic Kinematics
- 2 planes of movement - most flexion and extension occurs from T9-T12 - more rotation in the upper thoracic spine - lateral flexion linked with rotation (coupled motion) - Variable depending on where it occurs in the thoracic spine - one of the reasons people have scoliosis (deformity in frontal plane), you’ll see some rotation in the vertebrae which causes a rotation of the ribs - ribs are more prominent anteriorly or posteriorly (right or left depending on where the scoliosis is) - see it throughout, but maybe a little more in the upper spine - upper thoracic spine - if you laterally bend to the right, the vertebrae will also rotate to the right, spinous processes will move to the left, ribs will be prominent on the right - posterior; ribs will be prominent on the left - anterior - coupled rotation occurs because the spine is not straight (kyphosis, lordosis)
Lumbar Kinematics
- vertebrae get larger - tend to be wider medial to lateral, as opposed to anterior and posterior - flexion and extension predominates - because of the way the zygapophyseal joints are oriented - L4-S1 is where most of the flexion and extension take place - lateral flexion or rotation will take place in the upper lumbar spine - linked with the lower thoracic spine - linked mechanical motion - lateral flexion linked with flexion (very subtle) - rotation linked with contralateral flexion
Trunk
Thoracic and Lumbar together
Sacral Angle
- L5-S1 - sacral promontory - S1 isn’t straight across, it slopes down - angle is formed by a line from the top of S1 and a line that is parallel to the floor - the angle is usually 30 degrees - people that congenitally have a much larger angle (if S1 has a greater slope) can develop spondylolisthesis where vertebrae sheer each other; vertebrae is displaced
Pelvic Tilting
- ASIS’s are the point of reference - Anterior Pelvic Tilt - brings the ASIS’s forward - PSIS’s go up - pubic symphysis goes back - increases the angle - Posterior Pelvic Tilt - S1 slope will be more horizontal - decreases sacral angle - tight hip flexors result in anterior pelvic tilting
Connection between the spine and pelvis
Posterior - posterior portion of illium connection to S1, S2, S3 SI Joint - common area of pathology - nutation (sacral flexion) ; S1 moves forward and S5 moves backward ; in anatomical standing position we are in nutation - counter-nutation (sacral extension) - S1 moves backward and S5 moves forward - subtle movement will depend on where you’re upper body is and pelvic position - ligaments can contribute to movement depending on their looseness - diarthrodial, however not a lot of movement - uniaxial - motion being nutation and counter-nutation Sacral vertebrae are fused, synarthrodial, transfer weight bearing from lower extremity and spine
Ligaments at junction of pelvis and spine
- anterior and posterior sacral iliac ligament - sacrospinous ligament - between the sacrum and the iscial spine - above the sacrospinous ligament - greater sciatic foramen (sciatic nerve and blood vessels go through there) - sacrotuberous ligament - binds the sacrum to the pelvis - creates lesser sciatic foramen (sacrospinous above and sacrotuberous below) - illiolumbar ligament - comes off lumbar vertebrae and inserts on the back of the illium - lumbar spine is connected to the sacral spine = stability from this ligament
Spinal Ligaments
Anterior Longitudinal Ligament (ALL) - C2 to sacrum - runs continually on an anterior portion of the vertebral body - flexion will shorten it, extension will lengthen it - prevents hyper extension of the spine Posterior Longitudinal Ligament (PLL) - C2 to Sacrum - more posteriorly situated, runs continually - flexion will lengthen it, extension will shorten it - prevents hyper flexion - doesn’t cover as much as ALL (herniations are usually posterior and lateral because of this) Ligamentum Flavum - runs continuously inside the lamina on the left side and the right side - lengthens with flexion, checking hyper flexion Interspinous ligament - C, T, L - interrupted ligament, not continuous - segmentally through each level of spinous processes - lengthen in flexion, shorten in extension Supraspinous ligament - C7-sacrum - nuchal ligament is the extension of the supraspinous ligament cephaly - runs continuously down the spinous processes - lengthen in flexion, shorten in extension - prevent hyperflexion Intertransverse Ligaments - don’t run continuously (interrupted) - more laterally situated, posterior - lengthened by lateral flexion - main function is to add stability between vertebrae - most developed in lumbar spine - all ligaments working together may see some variation in the layout of ligaments among individuals Radial Ligament - stabilizes costovertebral joint
Cervical ligaments
Atlanto Cruciform Ligament - runs between C2 and C1 vertebrae from odontoid process and inserts into the arch of the atlas - stabilizes AA joint Alar Ligament - runs between odontoid process and the occiput - Stabilizes AA and AO joints
Function of Abdominals
Spinal Motion - Flexion Stabilize Spine - isometrically contract (stabilization) - strong abdominal muscles when you’re lifting Protect viscera - organs Forced Expiration - Coughing
Abdominal Layers
Superficially - Rectus Abdominis Under that - External Obliques Under Ext. OblQ - Internal Obliques (perpendicular to external) Deepest - transverse abdominis (horizontal orientation)
Rectus Abdominis
- straight orientation - superior attachment - costal cartilages ribs 5-7 (another attachment on xiphoid process - inserts on pubic symphysis Horizontal tendons that bind them down - Linea Alba - down the middle, separates left and right sides - some people have 4 tendenous inscriptions and so they have an 8 pack - bind down the muscle as it contracts so that it doesn’t shorten excessively Motions - flexion - lateral flexion Attachment on Pelvis - stabilize upper portion, pull on pelvis portion = posterior pelvic tilt
External Oblique
- hand in pocket orientation, go in toward midline - inferior attachment - linea alba, pubic bone, anterior portion of iliac crest - run back toward ribs - insert on inferior surface of the lower 8 ribs motions - flexion - lateral flexion - good rotators because of oblique orientation - contra lateral rotation (when you look at the trunk on the pelvis) - ipsilateral rotation (when you look at the pelvis on the trunk) (supine, bend knees move pelvis to the side) - hike the pelvis up (in addition to quadratus lumborum) good stabilizers
Internal Obliques
- perpendicular to external obliques - come from lateral (upper) 2/3 of inguinal ligament, iliac crest, lumbodorsal fascia, lower 3 ribs - run up to linea alba Motions - flexion - lateral flexion - rotate ipsilateral (trunk on pelvis) - rotate contralateral (pelvis on trunk) - stabilizers
Transverse Abdominis
- important for stabilization, coughing and forced expiration - comes from thoracolumbar fascia, iliac crest, lower ribs 7-12, inguinal ligament (lateral, upper 1/3) - runs toward linea alba - forced expiration exercises used to recruit it - lifting - to engage it, keep spine aligned
Superior Extensors (Erector Spinae)
Erector Spinae - superficial - like the ligaments, they’re going to help with stabilization - multi-joint muscles - some pass AO - C, T, L 3 sections: Spinalis - central - capitis - AO Joint - Cervicis: Cervical - Thoracis: thoracic Illiocostalis - lateral - cervicis - doesn’t technically cross the AO joint - thoracis - lumborum, lumbar Longissumus - in between spinalis and illiocostalis - capitis - AO joint - cervicis - capitis anti-gravity muscles, especially in the thoracic spine (always low grade activity) Orientation - erector spinae - more centrally attached inferiorly -more laterally attached superiorly - ipsilateral rotation - lateral flexion - extension
Superior Extensors (Transversospinalis Group)
- deeper - tend to be more stabilizers than mobilizers - main contribution is spinal stabilization Orientation - more laterally situated inferiorly and more centrally located superiorly - affects rotation - contralateral rotation - extension Muscles: Semispinalis - thoracis - cervicis - capitis - runs from transverse processes below, spinous process above Multifidus - runs from transverse processes below - between sacrum and C4 - really deep down Rotatores - lamina below to spinous process above - cervical and thoracis - don’t cross AO joint Interspinalis - cervical - thoracis - lumbar - paired: each side of the interspinous ligament, you have a left and right spinalis muscle - capable of extension (not much rotation or lateral flexion) - main function is stabilization Intertransverserarii - contractile - main function is stabilization - cervical - thoracic - lumbar
