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Posture and Function of the Spine

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Ashley Ambrosio

on 5 February 2015

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Transcript of Posture and Function of the Spine

PTA 105B
Posture & Function
of the Spine
Ch. 14

Anterior pillar
– comprised of the vertebral bodies,
intervertebral disks
: It is the hydraulic, weight-bearing, shock-absorbing potion


Posterior pillar
– comprised of the articular processes and facet joints. Also the vertebral arches, transverse processes and central spinous process.

The Spine
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.

Intervertebral Disks
Intervertebral foramina
Affected by spinal motion
Flexion = increased
Extension= decreased

Fluid Dynamics
Transport nutrients to help maintain tissue health in discs
When pressure is reduced =Nucleus imbibes H2O
Increased pressure=H2O squeezed out.

Spine function
Lordosis

– anterior forward curvature of the lumbar spine.


Kyphosis
– posterior curve, particularly, the thoracic spine
Physiologic Curves

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
7 =Artifact
* storage reservoir for fluids

Ligaments
: Interspinous and supraspinous. Capsular, ligamentum flavum and posterior longitudinal ligaments limit forward bending.
Muscles
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).
Postural Alignment
When GL passes through the hip joint there is equilibrium. When posterior to hip tilt must occur. Controlled by Iliopsoas.
Lumbar
Rectus Abdominus
Ext/Int Obliques
Quadratus lumborum
Erector Spinae
Iliopsoas
Cervical
Sternocleidomastoid
Scalene
Levator scapulae
Upper trapezius
Erectorspinae

Global Muscles
Lumbar
Transversus Abdominus
Multifidus
Quadratrus lumborum (deep portion)
Deep rotators
Cervical
Rectus capitis anterior and lateralis
Longus Coli
Core Muscles
T/A recruitment is delayed or absent in those w/LBP (Hodges & Richardson 1996,1997, Hodges 2003)
Transversus Abdominis
When contracted they pump up thorracodorsal fascia.
Multifidus
Center of gravity of head
Anterior to joint axis
Results in flexion moment
Muscle control in C-Spine
Mechanical Stress
Stress to pain sensitive structures
I.e.. Sustained stretch to jt. Capsule, ligaments = Pain
Once stress is relieved= no more pain
Impaired Posture
(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
Lateral Sling
glut med/min, TFL, lateral stabilizers of thoracopelvic region
Postural Support
Anterior shift of entire pelvis
Results in increased lordosis of lumbar, increased kyphosis in thoracic, fwd head.
Causes: fatigue.
These people rely on passive structures for support. They rest on their ligaments
Muscle impairments
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
Muscle impairments
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
Muscle impairments
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

Management guidelines
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:
Verbal reinforcement
Visual reinforcement
Tactile reinforcement
Axial extension (Cervical retraction)
Scapular 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:
Musculoskeletal impairments:

Tension/Cervical Headache

Postural correction
Pain management
Mobility impairments
Increase joint mobility in the cervical spine & flexibility in sub occipital muscles.
Muscle Performance
Cervical stabilization exercises.
Lower trapezius, rhomboids and serratus anterior muscles.
Stress Management

Management Guidelines

Functional Units
Facet Joints
Thoracic Veterbrae
Facets are limited in extension by the spinous processes. Side bending
Lumbar spine

Capsular ligaments limit rotation
Contra lateral intertransverse ligaments limit side bending.
Anterior longitudinal ligament limits backward bending.
Lumbodorsal Fascia
Ribs
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.
Stability
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.
Longitudinal Sling
peroneii, biceps femoris, sacrotuberous ligament, deep lamina of TDF, erector spinae
Causes: pregnancy, obesity, weak abs
Muscle impairments
Tight: illiopsoas, TFL, Rectus, erector spinae
Weak: Abs
Sources of sx
Stress to ant. Longitudinal lig
Narrowing of posterior disc space = n. root irritation
Approximation of facets

Common faulty postures
Pelvic/lumbar region
Relaxed/Slouched/Swayback (B)
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
Impairments
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)
Pain syndromes
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