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53 Cards in this Set

  • Front
  • Back
What are the parts of the spine?
Cervical Spine

♣ 7 vertebraeThoracic Spine

♣ 12 vertebraeLumbar Spine

♣ 5 vertebraeSacral Spine

♣ 5 vertebrae--fusedCoccyx

♣ 4 vertebrae

What is the breakdown of the cervical spine?
Atlas (C1)

Axis (C2)

♣ Odontoid process


Anterior curve (lordosis)

What is the breakdwon of the thoracic spine?

Articulate w/ POST ribs

Larger body than cervical vertebrae

POST curves (kyphosis)

What is the breakdown of lumbar spine?

Largest vertebral body

What is the breakdown of sacral and coccyx spine?
Sacral spine is fused and posterior curve

Coccyx levels 2-4 are fused

What are the parts of the vertebrae?
Spinous process

Transverse process


Facet joint




What are the parts of intervertebral disc?

Nucleus Pulposus

♣ Both avascular and aneural giving limited capacity to heal

What is annulus of intervertebral disc?
Fibroelastic cartilage

Stability, movement b/w vertebral bodies, limited shock absorption

What is nucleus pulposus of intervertebral disc?
♣ Transmits forces, equalizes stress, promotes movement

♣ Movement of intervertebral segments affects fluid mechanics

What the posture?
“A position or attitude of the body, the relative arrangement of body parts for a specific activity, or a characteristic manner of bearing one’s body”

A composite of the positions of the different joints in the body at any one moment

Explain Center of Gravity
An object could be balanced by placing something directly below the center of gravity.
What is the posture of head? (COG)
ANT to atlanto-occipital joint, POST cervical muscles contract.

♣ A forward head posture places greater demands on muscles.

♣ Extreme FLEX causes ligamentum nuchae tension

What is the posture of trunk? COG
Gravity line goes thru bodies of lumbar & cervical vertebrae, curves are balanced

Erector spinae muscles help & shift w/ movement

What is the posture of the hip?
Gravity line varies w/ body movement-usually thru the hip w/ no external forces required

♣ If POST to joint, the pelvis POST'ly rotates & creates iliopsoas tension

♣ In relaxed standing, iliofemoral ligament provides passive stability & no muscle tension

♣ If ANT to joint, active support of hip extensors

What is the posture of the knee?
Gravity line is ANT to joint keeping knee in extension

♣ ACL, POST capsule, tension in hamstrings & gastrocnemius provide stability

♣ Soleus provides active stability by pulling POST'ly on tibia

♣ W/ knee FLEX'd, quads contract due to gravity line shifting POST'ly

What is the posture of ankle?
Gravity line ANT to joint, causes tibia to rotate forward about ankle Plantarflexors (primarily soleus) provide stability
How is posture observed?
Plumb Line-Observe

♣ Anterior, Posterior

♣ Midline, symmetry

♣ Lateral

♣Ear, Acromion, Lateral elbow, Greater trochanter, just anterior to knee, just anterior to lateral malleolus

What are the subdivision of spinal posture stability?
Passive Structures – bones, ligaments

Active Structures - muscles

Neural Control – proprioception, feed forward control

What is the role of inert structures in the spine?
Inert structures provide most control when not in neutral alignment (ligaments stretched to provide stability at end-range)
Global vs. Core Muscles
Both global (superficial) and core (deep) muscles function to maintain upright posture
Lumbosacral angle
Angle that the superior border of the first sacral vertebrae makes with the horizontal, normal: 30°
Lordotic posture
⇧'d lumbosacral angle to approximately 40°

♣ Often seen w/ kyphosis & forward head: kypholordotic posture

Relaxed or slouched posture
“Swayback” entire pelvic segment shifts ANT'ly, hips extended, thoracic segment shifts POST'ly

♣ Lumbosacral angle approx 40 degrees

Flat low back
⇩'d lumbosacral angle, ⇩'d lumbar lordosis, hip extension & POST tilt of pelvis

♣ Lumbosacral angle 20°

Round back (kyphosis)
⇧'d thoracic curve, protracted scapulae, forward head
Flat upper back
⇩'d thoracic curve, depressed scapulae, depressed clavicle, flat neck
“S” curve or “C” curve, some asymmetry at hips, pelvis & lower extremities

♣ Any lateral curvature of spine

♣Can be cervical, thoracic and/or lumbar

♣75-85% idiopathic

♣Other causes: Neurological, degenerative, osteoporosis, trauma, post-surgical factors

Humpback or Gibbus
Localized, sharp POST angulation of the thoracic spine
Dowager’s Hump
Thoracic vertebral bodies degenerate and wedge in an ANT direction due to osteoporosis; seen in older patients
Forward Head
⇧'d flexion of lower cervical and upper thoracic regions, ⇧'d extension of occiput on atlas, ⇧'d extension of upper cervical vertebrae
Flat neck
⇩'d cervical lordosis, ⇧'d flexion of occiput on atlas
MVA with hyperextension cervical injuries.
Hyperextension can cause variety of injuries

♣ Tearing of Sternocleidomastoid

♣ Tearing of longissimus coli muscle

♣ Pharyngeal edema

♣ Tearing of ANT longitudinal ligament

♣ Separation of cartilaginous end-plate of intervertebral disc

♣ Results: PAIN, weakness, paralysis, neurological symptoms

MVA with hyperflexion cervical injuries.
♣ Tears of POST cervical muscles

♣ Tears of ligamentum nuchae

♣ Tears of POST longitudinal ligament

♣ Intervertebral disc injury

♣ Results: PAIN, weakness, paralysis, neurological symptoms

What types of surgeries are commonly used to treat cervical disorders?
♣ ANT cervicaldiscectomy and fusion (ACDF)

♣ POST foraminotomy

♣ POST laminectomy


Muscular strains

♣ Very common

♣ Mechanism of injury = flexion/extension, lateral flexion, acceleration/deceleration (whiplash), hyperflexion, rotation

♣ Involved Muscles: sternocleidomastoid, trapezius, scalenes, erector spinae, rhomboids and levator scapulae


Treatmentfor Strains

♣Acute Phase : analgesics, NSAIDS, muscle relaxants, relative rest, control pain and swelling

♣After Acute Phase: AROM exercises-but AVOID mechanism of injury!

♣Cervical isometrics, deep neck flexor retraining, education in cervical spine mechanics, postural exercises



♣Mechanical compression or inflammation of a nerve root with causes neurological symptoms into upper extremities

♣Caused by disc herniation, spondylosis, osteophytes

♣Goals: relieve symptoms, reduce pain and swelling, control muscle spasm, centralizesymptoms



♣Symptoms: peripheral pain, radicular signs, localcervical pain, scapular pain

♣Treatment: relieve pain and swelling, positional relief

♣Accurately identify positions that relieve or exacerbate symptoms

♣Gradually strengthen directions that relieve pain and avoid those that make pain worse



♣Usually chronic disc disease (wear and tear)—degeneration of bones

♣Symptoms: spinal cord compression or nerve root compression with radicular signs

♣Most commonly found in 40s and 50s, more men than women, C5-C6 and C6-C7 levels


CervicalSpondylosis Treatment

♣Pain relief w/ thermal or electrical agents

♣Usually pain with extension and relief with flexion

-Perform FLEX exercises & axial EXT

♣Traction - relieves cord compression & minimizes joint compression

♣AROM & general mobility exercises to maintain functional ROM once pain is controlled

♣Cervical stabilization including isometrics once pain is controlled

♣Chronic condition – need to educate patients onlong-term management including posture exercises, flexibility exercises, &stability exercises


Cervicogenic Headaches and Tension Headaches

♣Occur 2° to posture,tension, soft tissue injury, TMJD

♣Cervicogenic headaches are due to neck movements and begins in neck


Cervicogenic Headaches and Tension Headaches Treatment

♣⇩'d cervical AROM

♣TTP OA –C3-4 joint dysfunctions

♣ Deep flexor strength impairments

♣ Best research is for mob, manips, and self-mobs by patient + ther ex for deep neck flexor mm. and serratus anterior, lower trap


Thoracic Outlet Syndrome (TOS)

♣Compression of vascular and/or neurological tissues as they exit the superior triangle opening of thorax

♣Proximal compression of subclavian artery and vein and brachial plexus

♣Potential Causes: cervical rib, shortened or hypertrophied anterior scalene, malunion of clavicle and first rib

♣Symptoms: radicular signs of pain, numbness, tingling, weakness,skin temperature changes


Thoracic Outlet Syndrome (TOS) Treatment

Postural education

Stretching anterior scalenes and pectoral muscles

Strengthening scapular retraction

Thoracic extension



Educate on protection

Possible surgery


Muscule strains

Direct contact or indirect overstretching or contraction of the thoracic spine muscles

♣Treatment: control of pain and swelling, ice, NSAIDs, moist heat, US, e-stim, massage, AROM, strengthening, breathing exercises

CERVICAL SPINE: Classification Based Treatment Mobility
Mobility: recent onset of symptoms; no radicular/referred symptoms; restricted ROM; no signs of nerve root compression

♣ Mobility treatment: Cervical and thoracic mob and manip; AROM

CERVICAL SPINE: Classification Based Treatment Centralization
Centralization: radicular/referred symptoms; peripheralization or centralization with ROM; signs of nerve root compression; may have cervical radiculopathy

♣ Centralization treatment: traction; repeated movements to centralize

CERVICAL SPINE: Classification Based Treatment Conditioning/Exercise
Conditioning/Exercise: relatively low pain scores; longer duration of symptoms; no signs of nerve root compression

♣ Conditioning/Exercise treatment: strengthening and endurance exercises for muscle of neck and upper quarter; aerobic conditioning exercise

CERVICAL SPINE: Classification Based Treatment Pain control
Pain control: high pain and disability scores; very recent onset; symptoms d/t trauma; referred or radiating symptoms; poor tolerance for examination and most interventions

♣ Pain control treatment: gentle AROM; ROM for adjacent regions; physical modalities as needed; activity modifications to control pain

CERVICAL SPINE: Classification Based Treatment


Headaches: unilateral headache with onsetpreceded by neck pain; headache triggered by neck movements; headache pain elicited by pressure on posterior neck

♣ Headache treatment: cervical spine moband manips;postural education; strengthening of neck and upper quarter

How scoliosis is named
NAMING: by side of convexity and location of primary curve
Describe the effect of scoliosis on muscle imbalance.
♣ Muscle fatigue and ligamentous strain on side of convexity

♣ Mobility impairment in structures on concave side

Structuralvs. Nonstructural

♣Irreversiblelateral curve of spine.

♣Vertebraeare fixed in rotation (toward convexity)

♣Does not correct with position change or voluntary movement


♣Reversiblelateral curve

♣Canbe changed with position changes

♣ Musclecontraction

♣Functional/Postural Scoliosis