The Spine Flashcards
(19 cards)
3 purposes
- protection
- stability
- mobility
(vertebral bodies also a site of venous reservoirs for the circulatory system)
Protection
Houses and protects elements of the central to peripheral NS:
* brainstem
* spinal cord
* spinal plexus
* cauda equina
* nerve roots
Stability
provides a ridgit column for stability for head and extremity movement against mutidirectional forces.
* tension
* compression
* bending
* twisting
Mobility
allows segemental, 3 dimensional motion directly within the ridgid column when needed
Spinal regions
- sub-cranial (OA)
- cervical (7)
- Thoracic (12)
- Lumbar (5)
- sacral (5)
- coccyx (4)
Spinal segments consists of:
- Adjacent halves of 2 vertebrae
- the disc
- the contents of the vertebral and intervertebral foramen (sc, nerve roots exit)
- the facets (bony articulation, synovial joint)
- associated ligaments
- associated muscle, fascia, and integument innervated by the spinal nerve
Joints of the Spinal Motion Segment
- a tripod design
- the disc anteriorly (motion happens)
- two synovical facet joints posteriorly
The Disc
the anterior joint of the spinal segment
Annulus fibrosis
* fibro collagenous circular
* layers which are laid down perpendicular to one another (shear strength resist tension)
Nucleus pulposis
* centrally located proteoglycan rich gellatenous material (resists compression)
Vertebral end plates
* articulate with disc
The Facets created by…
- inferior articular process of superior vertebra
- superior articular process of inferior vertebrae
- thoracic spine has additional facets for articulation with ribs
T/S: angle
L/S: perpendicular
Spinal curves- Spinal plane development
- Born with one long C curve
- C spine lordosis develops with onset of head lift
- L spine lordosis develops with onset of sitting
- Curves develop due to gravity and force distribution
Spinal curves- Frontal plane
- the norm is relative
- symmetry between R and L
- Scoliosis- a lateral curvature
Concepts of Spinal Motion
Physiologic (voluntarily)
* regional
* segemental (L1 moves on L2)
Joint Play (external force)
* distraction
* translation
To Assess Joint Motion in the musculoskeletal system…
Physiologic
* through the range
* end feel (passive ROM)
Non physiologic
* component motions
* joint play
…Active…AA (guided)…passive
Quality…subjective response…quantity
Goni assessment
ROM measured using several told
1. tape measure
2. goniometer
3. inclinometer
4. C-ROM device
Mostly performed in an upright postion (sitting or standing)
To assess strength in the musculoskeletal system…
Dynamic
* eccentric
* concentric
Static
* postural strength
* endurance
Quantify by MMT or functional tests
Qualify by:
…coordination and motor control
…functional movememt patterns
Subjective or pain response
- Deep segmental
- Multisegmental
-posterior erector spinae
-anterior and lateral cervical longitudinal muscles - Muscles of the head and neck
- The abdominal core
- The pelvic floor
- The stabilizing muscles of the lower extremities (provide force to move you)
To Assess the neural elements…Neuro screening
- By subjective and medical history
-risk factors
-flags - dermatomes/myotomes/DTRs
- Neurotension tests (slump test, SLR)
- Nerve root vs peripheral nerve vs neuropathy
Cervical Spine concerns
- instability/fx-h/o trauma, MVA, RA
- Neurological signs/symptoms from history
-chord signs (upper C spine lesion), UMN lesion
-paresis (significant weakness)
-ataxia
-abnormal reflex (babinski, hoffman) - vertebral artery sign- dizziness or drop attacks with head turning or cervical extension
4 treatment objectives of Kaltenborn for spinal dysfunctions
- control pain and inflammation
- in the presense of limited movement, restore normal motion
- in the presence of hypermobility, stabalize
- inform, instruct and train ( a lot of education)
