Trick movements of spine

Trick Movement spine

1. Trick Movements of Spine Dr. Chhavi Singh Tomar Asst. Prof. / Vice – Principal Nims College of Physiotherapy & Occupational Therapy Nims University

2. Objectives  Identify the main structures of the spine.  Identify normal curvatures of the spine, including the cervical, thoracic, and lumbar regions.  Identify mobile segment.  Ligaments of spine.  To know about different spine movements. 2

3. Introduction “ The vertebral column also known as back bone is a complex structure which meet the demands of mobility and stability of the trunk and extremities, also protect the spinal cord” 3

4. Vertebrae total 33 vertebras are divided as  Cervical (neck) - 7 vertebrae (C1-C7)  Thoracic (chest) - 12 vertebrae (T1-T12)  Lumbar (lower back) - 5 vertebrae (L1-L5)  Sacral (pelvis) - 5 fused vertebrae (S1-S5)  Coccygeal (tail) - 4 vertebrae (Co1-Co4) 4

5. Cervical Spine  Seven vertebrae  More flexible  Supports the head  Wide range of motion Rotation to left and right Flexion Up and down Lateral bending  Peripheral nerves Shoulder, Chest and diaphragm Arms 5

6. Thoracic Spine  Twelve vertebrae  Mid-back or dorsal region  Ribs attached to vertebrae  Relatively immobile  Peripheral nerves Intercostal 6

7. Lumbar Spine  Lower back  Five vertebrae  Carries the weight of the upper body Larger, broader  Peripheral nerves Legs Pelvis 7

8. Sacral and Coccygeal region  S acrum Triangular structure Base of the spine Connects spine to pelvis Nerves to pelvic organs  Coccyx Few small bones Remnant of tail 8

9. Spinal Curvatures Two types of curvature Primary curvature Secondary curvature 9

10. Primary Curvature  Called khypotic curves  During fetal development, the spine assumes the shape of the letter "C,"  This C-shaped curve is the primary curve of the spine and is well-suited for the fetus to confine in the womb. Develops in pregnancy -mid term Concave anteriorly Convex poseriorly Primary curvature remains in adults as Thoracic and sacral curvatures 10

11. Secondary curvatures The cervical curve of the neck region is the first to develop.  Opposite to direction of primary curves.  Convex anteriorly  Concave posteriorly  Develops in early childhood.  i.e. cervical and lumbar curvatures  Called Lordotic curvatures 11

12. Mobile Segment “ The smallest functional unit of the spine is called as mobile segment” Parts:  Two adjacent vertebras  Intervertebral disc  Soft tissues which secure them, i.e. Ligaments and muscles. 12

13. Mobile Segment  The anterior portion of the segment is composed of Two superimposed intervertebral bodies The intervertebral disc The longitudinal ligaments  The posterior portion of the segment is composed of Vertebral arches, The intervertebral joints formed by the facets, The transverse and spinous processes, Ligaments 13

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15. Anterior Portion The Vertebral Bodies  are designed to bear mainly compressive loads  progressively larger caudally as the superimposed weight of the upper body increases.  lumbar region are thicker and wider ; their greater size allows them to sustain the larger loads to which the lumbar spine is subjected. 15

16. Anterior Portion Intrvertebral disc  Two principle functions: To separate two vertebral bodies thereby increasing available motion Transmit load from one vertebral body to next.  Three main parts Nucleus pulposus Annulus fibrosus Vertebral end plates: Cartilaginous layer covering the superior and inferior surfaces of the disc 16

17. Posterior Portion The Facets Cervical Spine:  Two uppermost cervical vertebrae (Cl and C2), facets are parallel to the transverse plane  The facets of C3 to C7 are oriented at a 45° angle to the transverse plane and are parallel to the frontal plane allowing flexion, extension, lateral flexion and rotation. Thoracic Spine:  The facets oriented at a 60° angle to the transverse plane and at a 20° angle to the frontal plane.  allows lateral flexion, rotation, and some flexion and extension. 18

18. Posterior Portion The Facets Lumbar Spine:  The facets are oriented at right angles to the transverse plane and at a 45° angle to the frontal plane.  This alignment allows flexion, extension, and lateral flexion, but almost no rotation.  The lumbosacral joints differ from the other lumbar intervertebral joints in that the oblique orientation of the facets allows appreciable rotation. 19

19. Posterior Portion The Facets  The facets guide movement of the motion segment and have a load- bearing function, and may have some role in the lateral stability of the motion segment  Load sharing between the facets and the disc varies with the position and the health of the spine.  The loads on the facets are greatest with axial rotation of the spine. 21

20. Clinical Condition  With disc degeneration, a greater amount of force is transferred to the facet joints, thereby redistributing the load through the motion segment .  Because the facets are not the primary support structure in extension, if total compromise of these joints occurs, an alternate path of loading is established.  This path involves the transfer of axial loads to the annulus and anterior longitudinal ligament as a way of supporting the spine.  High loading of the facets is also present during forward bending, coupled with rotation. 22

21. Posterior Portion vertebral arches and intervertebral joints  They play an important role in resisting shear forces.  For Example: This function is demonstrated by the fact that patients with deranged arches or defective joints (e.g., from spondylolysis and spondylolisthesis) are at increased risk for forward displacement of the vertebral body. 23

22. Posterior Portion Transverse and Spinous Processes Serve as sites of attachment for the spinal muscles that, when activated Initiate spine motion Provide extrinsic stability. 24

23. THE LIGAMENTS OF THE SPINE 25

24. Kinematics  The movements available in the vertebral column as a whole are Flexion and extension lateral flexion rotation  Agonistic muscle initiate and carry out motion  antagonistic muscles control and modify the motion  co-contraction of both groups stabilizes the spine. 27

25. Kinematics  The ROM differs at various levels of the spine and depends on the orientation of the facets.  Motion between two vertebrae is small and does not occur independently.  All spine movements involve the combined action of several motion segments.  The skeletal structures that influence motion of the trunk are The rib cage, which limits thoracic motion The pelvis, which augments trunk movements by tilting. 28

26. SEGMENTAL MOTION OF THE SPINE  The vertebrae have six degrees of freedom: rotation about and translation along a transverse, a sagittal, and a longitudinal axis.  The motion produced during flexion, extension, lateral flexion, and axial rotation of the spine is a complex combined motion resulting from simultaneous rotation and translation which is called as coupling. 29

27. Kinematics Coupling is defined as the association of one movement about an axis with another movement around a different axis. The most predominant movements that exhibit coupled behaviors are lateral flexion and rotation. Pure lateral flexion and pure rotation do not occur in any region of the spine. 30

28. THE MUSCLES  The spinal muscles can be divided into  flexors and extensors.  The trunk muscles play an important role in the mechanical behavior of the spine, including spine stability and intradiscal pressure.  The main flexors are the abdominal muscles and the psoas muscles.  The main extensors are the erector spinae, the multifidus, and the intertransversarii attached to the posterior elements. 31

29. THE MUSCLES  When extensor muscles contract symmetrically, extension is produced.  When right and left side flexors and extensor muscles contract asymmetrically, lateral bending or twisting of the spine is produced. 32

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