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Posture and Function of the Spine
Transcript of Posture and Function of the Spine
Posture & Function
of the Spine
– comprised of the vertebral bodies,
: It is the hydraulic, weight-bearing, shock-absorbing potion
– comprised of the articular processes and facet joints. Also the vertebral arches, transverse processes and central spinous process.
Consist of the annulus fibrosus and nucleous pulposus, and the cartilaginous end-plates.
With flexion of the trunk on the hips, the anterior portion of the disk is compressed and the posterior distracted.
Affected by spinal motion
Flexion = increased
Transport nutrients to help maintain tissue health in discs
When pressure is reduced =Nucleus imbibes H2O
Increased pressure=H2O squeezed out.
– anterior forward curvature of the lumbar spine.
– posterior curve, particularly, the thoracic spine
Cervical, frontal plane w/ some oblique angulations toward the transverse plane. Allows for relatively free flexion and extension. From 2nd cervical to 3rd thoracic, side bending and rotation occur together and are toward the same side.
Inert Structures Influencing Movement
Frontal plane with slight angulations in the upper thoracic region. Rotation, forward and side bending are allowed.
Facets typically aligned in the sagittal plane. This allows forward, backward and some side bending, but limits rotation except in the lower lumbar segments. In extension the facet joints approximate each other and limit and stabilize the spine in extension.
1 = 1st sacral vertebrae
2 = 2nd lumbar vertebrae
3 = 3rd Lumbar vertebrae
4 = Intervertebral Disk
5 = Lumbar cistern*
6 = Spinal Cord
* storage reservoir for fluids
: Interspinous and supraspinous. Capsular, ligamentum flavum and posterior longitudinal ligaments limit forward bending.
Cervical And Lumbar Lordosis
Curves of the Spine
Gravity line through the ankle anterior to the joint so it tends to rotate the tibia forward. Stability is provided by the plantar flexor muscles (soleus).
When GL passes through the hip joint there is equilibrium. When posterior to hip tilt must occur. Controlled by Iliopsoas.
Quadratrus lumborum (deep portion)
Rectus capitis anterior and lateralis
T/A recruitment is delayed or absent in those w/LBP (Hodges & Richardson 1996,1997, Hodges 2003)
When contracted they pump up thorracodorsal fascia.
Center of gravity of head
Anterior to joint axis
Results in flexion moment
Muscle control in C-Spine
Stress to pain sensitive structures
I.e.. Sustained stretch to jt. Capsule, ligaments = Pain
Once stress is relieved= no more pain
(Etiology of Pain)
Postural fault = posture that deviates from normal alignment but has no structural impairments.
Postural pain syndrome = pain that results from mechanical stress when a faulty posture is maintained for a prolonged period.
Postural dysfunction = differs from pain syndrome because adaptive shortening of soft tissue and muscle weakness are involved.
Postural habits = good posture necessary to avoid postural pain syndrome and postural dysfunction.
Pain syndromes related to impaired posture
glut med/min, TFL, lateral stabilizers of thoracopelvic region
Anterior shift of entire pelvis
Results in increased lordosis of lumbar, increased kyphosis in thoracic, fwd head.
These people rely on passive structures for support. They rest on their ligaments
Tight upper abs, intercostals, hip ext, low lumbar ext.
Weak lower abs, exts of low t/s, hip flxrs
Sources of sx.
Stress to ligaments (iliofem, ant longit. Lig)
Narrowing of intervertebral foramen in lower l/s = nerve root irritation, esp. with arthritis.
Approximation of facets in low l/s.
Decreased lordosis; post tilt; hips extended
Causes: continued slouching in standing or sitting; too many flexion exercises
Tight: rectus ab, intercostals and hip extensors
Weak: lumbar extensors and maybe hip flexors
Sources of sx.
Lack of lumbar curve=no shock absorption
Stress to post longit ligament
Increase post disc space = imbibement extra fluid posteriorly= protrude post with fast extension
Increased T/s curve/flexion, protracted scap,fwd head (upper cervical ext)
Causes: Gravity, slouching, poor ergonomic setup at work/home office
Sources of sx.
Stress to upper cerv ant. Longitudinal ligaments ; stress to lower cervical post long ligaments
Fatigue: thoracic erector spinae & scap retractors
Irritation of upper c/s facets
Narrowing of intervertebral foramina in upper c/s
Scap protraction = tight pec minor/scalenes= stress to neuro vascular bundle=TOS
Impinged occipital n. from tight UT= tension H/A
Lower c/s disk lesions from faulty flexed posture
Decrease thoracic curve, depressed scap and clavicles, decreased c/s lordosis
Tight anterior neck muscles, thoracic extensors and retractors, scapular movement restrictions.
Impaired performance in scap protractors and intercostals.
Source of sx.
Fatigue in postural ms.
Neurovascular bundle compression btwn clavicle & ribs
Decrease in shcok absorption
Pain from mechanical stress/ms. Tension
Impaired mobility: ms., jt., fascial restrictions
Impaired ms. Performance, imbalances
Poor ms. Endurance
Insufficient postural control of stabilizing ms
Decreased cardio endurance
Altered kinesthetic awareness and neuromuscular control
Lack of knowledge of healthy mechanics
Develop awareness of spinal control/alignment in various positions
Teach patient that bad posture = pain
Develop strength, endurance, neuro control
Increase mobility in restricted ms, jt, fascia
Teach safe body mechanics
Improve aerobic capacity
Proprioception and Control:
Axial extension (Cervical retraction)
Lumbar pelvic tilt and neutral spine.
Thoracic spine extension
Total spinal movement
Management of Impaired Posture
Common complaint with impaired posture. 15-20% of chronic HA related to musculoskeletal impairments. Often associated with tension in the posterior cervical muscles, and attachment of extensors.
Signs and Symptoms:
Increase joint mobility in the cervical spine & flexibility in sub occipital muscles.
Cervical stabilization exercises.
Lower trapezius, rhomboids and serratus anterior muscles.
Facets are limited in extension by the spinous processes. Side bending
Capsular ligaments limit rotation
Contra lateral intertransverse ligaments limit side bending.
Anterior longitudinal ligament limits backward bending.
Structure of bones and soft tissue of the lower extremities designed for weight bearing. Support and balance the trunk in the upright posture.
Posterior curves in the thoracic and sacral areas. Kyphosis of the thoracic spine
Plumb line typically used for reference.
GL is anterior to the knee joint so it keeps the knee in extension. Stability provided by the ACL, PCL, posterior capsule, and tension in the gastroc and hamstrings. If the knees flex, then the quadriceps must contract to keep the knee from buckling.
When gravitational line shifts anteriorly, stability provided by hip extensor muscles.
During relaxed standing, iliofemoral ligament provides passive stability to joint and no muscle tension is necessary.
GL goes through the cervical and lumbar vertebrae with curves balanced.
In the head, the GL falls anterior to the atlanto-occipital joints. Posterior cervical muscles contract to keep the head balanced. When forward head occurs, greater demand is placed on these structures along with tension in the ligamentum nuchae.
TrA is an anticipatory muscle for stabilization of low back. Recruited prior to initiation of movement from UE or LE.
Stability is achieved through motion NOT rigidity (small segmental mvt. in L spine in opposite direction, T/A fires. Movement is used to dampen or dissipate or dampen forces.
T/A, diaphragm & IAP(intra ab pressure) help control flex & ext of certain L spine segments.
T/A has an impact on stiffness of SIJ by way of interaction with thoracodorsal fascia.
Valsalva DELAYS activation of TrA
Are also anticipatory for stabilization of lumbar region.
Co contraction of multifidus and T/A increase stiffness of SIJ, form a ring/corset of support for the lumbopelvic region.
People with posture issues often have stress to these muscles, including levator scap.
Weight of head counterbalanced by cervical extensors (upper trap, cerv erector spinae
Impaired Muscle Endurance
When muscles fatigue, then we rely on other structures = mechanical stress.
Impaired Postural Support from Trunk Muscles
Muscles that are on continual stretch = weak
Muscles that are short = lack of elasticity
“Slings” to stabilize the pelvis (between thorax and legs)
Posterior Oblique Sling
lats, gluteus maximus (opposite side) & intervening thoracodorsal fascia.
Anterior Oblique Sling
external oblique, contra lateral internal oblique, adductor of thigh, intervening anterior abdominal fascia.
peroneii, biceps femoris, sacrotuberous ligament, deep lamina of TDF, erector spinae
Causes: pregnancy, obesity, weak abs
Tight: illiopsoas, TFL, Rectus, erector spinae
Sources of sx
Stress to ant. Longitudinal lig
Narrowing of posterior disc space = n. root irritation
Approximation of facets
Common faulty postures
Flat low back posture C
Lordotic posture A (anterior tilt, T/S kyphosis)
C/S & T/S faulty postures
Round back w/ fwd head B
Flat upper back and neck posture D
Plan of care
Motor control requires timing of muscle action and inaction.
Efficient movement requires coordinated muscle action so that stability is achieved (does not collapse) while motion is controlled and not restrained (stability without rigidity)