A-Orthone 1A: Copy
Terms in this set (97)
What structure serves as the weight bearing unit of the vertebral column?
What are the shock absorbers in the spine?
The vertebral body is constructed with a strong outer layer of cortical bone and a hollow cavity. What structure reinforces the hollow cavity of the vertebrae with horizontal and vertical struts?
How many vertebrae make up the spine? How many does each section have?
Made up of 29 vertebrae
5 Sacral & the Coccyx
The Functional Spinal Unit
Smallest physiological motion unit of spine exhibiting biomechanical characteristics of entire spine.
What is motion segment?
Adjacent vertebrae with disc and facet joints in between
How many pair of zygapophyseal joints does the vertebral column have?
What are zygapophyseal joints classified as and why?
because their articular surfaces are flat
What is the largest avascular structure in the body?
Intervertebral Disc (IVD)
How much of the IVD contributes to the length of the
How much of the IVD contributes to the length of the
What are the major stresses the IVD must withstand?
What are the primary spinal junctions?
What is the location of the line of gravity acting on a person standing with ideal posture?
1. Through Mastoid Process
2. Anterior to 2nd Sacral Vertebrae
3. Posterior to the hip
4. Anterior to the knee
What are the two types of spinal stability?
STATIC & DYNAMIC
What are the subsystems of spinal stability?
What structures comprise the Passive Spinal System?
3. Zygapophyseal Joints
4. Joint Capsule
When is passive stiffness a factor in the spine?
What structures comprise the Active Spinal System?
Muscles & Tendons
When is active stiffness a factor in the spine?
at end range
What is the Neutral Zone in a spinal segment?
Position where minimal loading is occurring in the passive & active structures and spinal movements are produced with minimal internal resistance
What activity has been shown to have significant effect on reducing the stiffness of the passive tissues in the spine because of the viscoelastic nature of the muscles, tendons, ligaments, and IVDs?
Acute repetitive loading or
If you see a patient with flat back posture what do they have less of?
Which patients more often have Cervical Radiculopathy?
What happens to the Cervical Region and the Craniovertebral junction with forward head posture?
Cervical area becomes hypermobile and CT joint becomes stiff
What would be the motions of choice for Cervical radicular patients?
Which patients more often to have Lumbar Radiculopathy?
What would be the motions of choice for lumbar radicular patients?
Describe the orthokinematics of Facet joints in the cervical spine for rotation.
Ipsilateral side = Posterior Glide/Opening
Contralateral Side = Anterior Glide/Closing
Describe the orthokinematics of Facet joints in the cervical spine for lateral flexion.
Ipsilateral = Posterior Inferior Glide Superior Facet
Contralateral = Superior Anterior Glide Superior Facet
What must be aware of when treating pts with spinal issues?
Ruling out if the pain is referred from organs or other pathologies
What is the Osteopathic System?
Palpation of the soft tissues over the TP of the spine to determine if a rotational dysfunction is present
ERS- extended, rotated side flexed
FRS- flexed, rotated side flexed
What is the best way to decide if a pt is suitable for manipulation in the cervical spine?
: Cardiovascular, neurological, arthritis, and bad experience with thrust manipulation
What is a general term for age-related wear and tear of the spinal disks?
What is a defect of the Pars Interarticularis, which can be congenital or acquired, commonly asymptomatic?
Spondylolysis or Scottie Dog fx
What population is Spondylolysis most common in?
Adolescence athletes (Cheerleaders, gymnasts) from repeated extension
What are patients with Spondylolysis also susceptible to?
If the Scottie Dog is decapitated what type of fracture is it?
Slippage of vertebrae on another,
common at L5-S1
caused by Pars Interarticularis fx & separation; decapitated Scottie Dog.
Why is slippage of vertebrae most common at L5-S1?
1. Frontal plane facets orientation
2. Entire upper body weight on L5-S1
What population is Spondylolisthesis most common in?
Low tone sedentary kids
What are the Grades of Spondylolisthesis?
Grade 1: 25% slippage
Grade 2: 25%-50%
Grade 3: 50%-75%
Grade 4: 75%-100%
What planes are the Cervical, Thoracic, L5-S1, and Lumbar Vertebrae in?
Cervical, Thoracic, L5-S1
Why is there more clinically instability in the Lumbar Spine?
Facet joint orientation causes more sheering
We contract multifidus against downward force of body weight and increased compression against a small surface. If we have Instability across a given segment what muscles would we want to strengthen?
Posterior musculature to help facilitate stability.
Describe the orthokinematics of Facet joints in the Lumbar Spine during (1) Flexion, (2) Extension, (3) Rotation?
1. FLEX: Slide up
2. EXT: Slide down
3. RIGHT ROTATION: R opens, L closes
What does the Sacrum act as in the body?
Center of stability because of lots of axes of motion
What plane of motion are the facets of L5-S1 located in?
What is the name of the Sacrum Superior Facets that prevent L5 from sliding forward?
Describe the Iliosacral or SacroIliac Joint?
Articulation between the Innominate and the Sacrum
What is the Innominate Bone?
Ilium, Pubis, & Ischium
What are the Iliosacral Lesions: Ilium malpositioned on Sacrum (UD-IO-AP)?
1. Up slips (accompanies posterior innominate)
2. Down slips (accompanies anterior innominate)
5. Anterior rotation
6. Posterior rotation
What are the SacroIliac Lesions: Sacrum is malpositioned on the Ilium (NC-TRT)?
5. Torsion (Tilt + Rotation)
What is a Sacral Nutation?
What is Sacral Counternutation?
What is a Nutated Sacrum the same as?
What is a counternutated Sacrum the same as?
If you have an Anterior Innominate how will your legs appear?
If you have an Posterior Innominate how will your legs appear?
What is the most common lesion at the Innominate?
Posteriorly rotated Innominate
As Posterior Longitudinal Ligament (PLL) degenerates it also hypertrophies. Based on the location of the PLL what type of radicular symptoms will you see as a result of the hypertrophic PLL?
Bilateral radicular symptoms
If a pt has unilateral radicular symptoms where might the spinal compromise be?
The Intervertebral Foramen
If a pt has bilateral radicular symptoms where might the spinal compromise be?
If you stretch out your Ligamentum flavum in flexion, in which direction will it buckle?
What contributes to Lumbar Spinal Stenosis?
, causing PLL & Ligamentum Flavum to buckle centrally
Central Canal compression
, causing bilateral radicular symptoms
When is it particularly important not to lift and twist?
Young & early in the morning
: Discs are very hydrophilic & at night you're lying down, joint gathers more fluid
How should you always assess dermatomes?
DISTAL PORTION OF DERMATOME 1st to proximal
How does pulling your belly in stabilize the posterior Lumbar region?
Transverse Abdominis contracts distributing force into the Thoracolumbar Facia that also attaches to the spine and helps approximate the segments.
What is the action of External Obliques?
1. Rotates trunk to opposite
2. Sideside bends same side
What is the action of Internal Obliques?
Rotates and bends same side
If you have a pt with lower back pain, what movement would provoke their symptoms?
What tests would you use to dx a disc lesion (Disc Herniation)?
1. Slump Test
2. Straight Leg Test
How can you rule in Myofacial px?
If you had a pt with radicular px into their legs what dx should you think of?
1. Piriformis Syndrome
2. Disc Herniation
3. SI Pain
How could you differentiate between Piriformis Syndrome and Disc Herniation?
What are the signs & sx of Piriformis Syndrome?
1. Weak Glut Max, Med, Biceps Femoris
2. Ipsilateral short leg
3. Palpation reproduce symptoms
4. Restricted hip ADD & IR
5. Neurologic symptoms in posterior limb if Peroneal N. involved
Describe Lower Crossed syndrome?
:Erector Spina & Psoas
: Abs & Glut Max
What are conditions associated with lower back pain?
3. Stenosis - A narrowing of the spinal canal.
Name the types of disc herniation?
- nucleus breaks Annulus
- Nuclear spilling
What other condition would present with anterior thigh px?
2. Femoral Acetabular Impingement
3. Acetabular Pathology Syndrome
What are the signs & sx of 3rd lumbar nerve root compression?
1. Px midlumbar, upper buttock, ant thigh, medial knee
2. Prone knee flexion and SLR
3. Loss of extension
4. Iliopsoas weakness
5. Hypoesthesia medial knee
6. Reduced patellar reflex
What are the signs & sx 4th lumbar nerve root compression?
1. Px lumbar, iliac crest, inner buttock, outer thigh, great toe
2. SLR and crossed SLR
3. Latearl deviation of the lumbar spine
4. Weak dorsiflexion
5. Hypoesthesia outer lower leg and great toe
6. Diminished patellar reflex
What are the signs & sx 5th lumbar nerve root compression?
1. Px sacroiliac areas, lower buttock, lateral thigh & leg, inner three toes,foot medial sole
3. Lateral deviation
4. Weak Extensor Hallucis & Hip ABs
5. Hypoesthesia outer leg & inner three toes
6. Diminished Achilles' reflex
What are the signs & sx 1st, 2nd, and 3rd sacral roots compression?
1. Px low back & butocks to sole of foot, heel
3. Weakness Calf Muscles
4. Atrophy Gluteal Mass
5. Hypoesthesia outer two toes, outer foot, outer leg
What are the signs & sx 4th sacral roots compression?
1. Pain lower sacral and peroneal area
2. Saddle paresthesia
3. No positive dural signs
4. Bladder, bowel, or genital dysfunction
5. Reduced anal wink
More of a medical issue, could be tumor, refer to doctor/hospital
What is a Vertical Prolapse (aka Schmorl's Nodes)?
Herniation through end plate, often asymptomatic. Maybe, developmental, degenerative, traumatic (common in paratroopers)
What is Ankylosing Spondylitis?
Spinal arthritis, affecting young males, causes ankylosis (stiffening) of vertebral & sacro-iliac joints.
What are the signs & sx of Ankylosing Spondylitis?
1. Bamboo spine, brittle, rigid
2. Sacroiliac inflammation/ pain
4. Fatigue (systemic sx)
5. Ocular inflammation, uveitis
6. Reduced rib expansion/inhalation
7. Weight loss (systemic sx)
8. Possible atlantaixal subluxation
What issue is important to address with Ankylosing Spondylitis?
Posture, stand them up straight, sleep prone
What is Osteitis Pubis?
Noninfectious inflammation of the SI joint
What causes Osteitis Pubis?
Unknown, often happens to athletes producing sheering forces (Soccer, kickers, hurdlers)
What are the signs & symptoms Osteitis Pubis?
1. Px Perineal, Suprapubic & inguinal areas
2. 3rd & 4th decade of life
What population is at risk to developing Osteitis Pubis?
Athletes who participate in activities that create shearing forces (hurdler, soccer)
What is Peripartum Posterior Pelvic Pain?
SI disfunction, 3rd trimester of pregnancy, px is experienced between the posterior iliac crest and the gluteal fold. More than 50% of women experience this
What is treatment for Peripartum Posterior Pelvic Pain?
Combo Manual therapy & exercise
What is Coccydynia?
Coccyx stuck in flexion
Why is Coccydynia more common in the Northeast US?
Falling one ice