The

Trunk/Spine
largest segment of body
most significant functional
unit for general movement
integral role in upper and
lower extremity function
relatively little movement
between 2 vertebrae

The Vertebral
Column
7 cervical vertebrae
develop as an infant begins to lift its head

Cervicothoracic junction

12 thoracic vertebrae
present at birth
Thoracolumbar junction

5 lumbar vertebrae
develop in response to weight bearing

Lumbosacral junction

Sacrum - 5 fused vertebrae

Coccyx - 4-5 fused vertebrae

Vertebral
Articulation
each articulation
is a fully
encapsulated
synovial joint
these are often
called
apophyseal joints

Superior articular process

Inferior articular process

Note: the processes are bony outcroppings.

Costal (Rib)
Articulation

Superior
costal
facet

Transverse
costal
facet

Note: the facets are

the articular surfaces.

Inferior
costal
facet
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Transverse process

Body
Vertebral foraman

Spinous process

Intervertebral foraman
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Muscular Attachments
muscular attachments on spinous and
transverse processes

Vertebral shape
changes to reflect
movements possible
within a given region

Further
depiction
of vertebral
shapes

Motion Segment: Functional unit of the vertebral column

Neural arches
intervertebral joints
transverse & spinous processes
ligaments

Two bodies of vertebrae

common vertebral disc
ant & post longitudinal ligaments

Intervertebral Disks
shock absorbers of the spine
capable of withstanding compressive
torsional and bending loads
role is to bear and distribute loads in
vertebral column and restrain
excessive motion in vertebral segment

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Shock Absorbers

Bending Loads

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2 regions of vertebral disk

NP -- nucleus pulposus
gel-like mass in center of disk under
pressure such that it preloads disk
80-90% water, 15-20% collagen

AF -- annulus fibrosus

Disc is avascular & aneural

so healing of a damaged disc is
unpredictable & not promising
Disc rarely fails under compression
vertebral body will usually fracture
before damage to disc occurs

fibrocartilaginous material
50-60% collagen

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Anterior Motion Segment

Ant. Longitudinal ligament

very dense & powerful
attaches to ant disc & vert body
limits hyperextension and fwd mvmt
of vertebrae relative to each other

Post. Longitudinal Ligament

travels inside the spinal canal
connects to rim of vertebral bodies &
center of disc
posterolateral aspect of segment not
covered - this is a common site for
disc protrusion
offers resistance to flexion

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Posterior Motion Segment

Bone tissue in the pedicles
and laminae
is very hard providing
good protection
for spinal cord

Muscle attachments at spinous &

transverse processes
articulation between vertebrae occurs
at superior and inferior facets
these facets are oriented at different
angles related to spinal section
accounting for functional differences

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Posterior Motion Segment

Ligamentum flavum spans laminae
connecting adjacent vertebral arches
very elastic thus aids in extension
following flexion of the trunk
under constant tension to maintain
tension on disc
Supraspinous and interspinous
ligaments span spinous processes
resist shear and forward bending
of spine

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Spinal
Movement

collectively -- LARGE ROM

flex/ext
L-R rotation
L-R lateral flexion

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MOVEMENTS OF THE SPINE

ACCOMPANIED BY PELVIC TILTING

1st 50-60 in
lumbar vertebrae

Flexion beyond 50
due to anterior
pelvic tilting

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Regional ROM in Spine

Atlas (C1) & axis (C2)

account for 50% of
rotation in the cervical
region.
Thoracic region is
restricted, mainly due
to connection to ribs.
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Spine Posterior Muscular

Support
Superficial
deep
primarily
produceto
extension
and medial/lateral
flexion
erector spinae
semispinalis
deep posterior

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Spine Posterior Muscular Support

primarily produce extension and
medial/lateral flexion

Posteriorly
erector spinae
iliocostalis
longissumus
thoracis
spinalis

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spinalis

longissimus

Erector spinae

Versatile muscles that can

generate rapid force yet are fatigue
resistant

cervicis

iliocostalis
thoracis

lumborum

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Semispinalis

capitis

cervicis

thoracis
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IT

IS
intertransversarius

interspinales

Deep posterior
multifidus

rotatores

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rectus abdominis

Abdominals
transverse abdominus

internal oblique

external oblique

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Intra-Abdominal Pressure
acts like a balloon to expand
the spine thus reducing compressive
load, this in turn reduces the activity
in the erector spinae

Internal & external oblique

muscles & transverse abdominis
attached to the thoracolumbar
fascia covering the posterior
region of the trunk
when these abdominals contract - added
support for the low back is created
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Additional muscles contributing to trunk flexion

Collectively known as the iliopsoas

Powerful flexor
whose action is
mediated by the
abdominals
Quadratus lumborum
forms lateral wall of abdomen
also maintains pelvic position
during swing phase of gait
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Movement into fully flexed position

1) initiated by abdominals (1/3 of flexor moment) and iliopsoas
2) once it has begun gravity becomes a contributing factor
such that the erector spinae act eccentrically to control
the movement (thru ~50-60)
3) beyond 50-60 flexion continues by anterior tilt of pelvis
this mvmt is controlled by an eccentric action of hamstrings and gluteus
maximus while erector spinae contribution diminishes to zero
4) in this fully flexed position the posterior spinal ligaments and the passive
resistance in the erector spinae resist further flexion
5) this places the ligaments at or near the failure strength placing a greater
importance on the load sustained by the thoracolumbar fascia loads
supported thru the lumbar articulations
6) return to standing posture initiated by posterior hip muscles
7) erector spinae (1/2 of extensor moment) muscle active initially but peak
activity during the final 45-50 of movement

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Strength of Trunk Movements

Extension
Flexion (70% of extension)
Lateral Flexion (69% of extension)
Rotation (43% of extension)

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Postural
Alignment
2 naturally occurring curves
LORDOTIC (in lumbar
region)
KYPHOTIC (in upper
thoracic lower cervical
regions)
Abnormalities -- accentuated
vertebral curves
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Lumbar
Lordosis
exaggeration of the lumbar
curve
associated w/weakened
abdominals (relative to
extensors)
characterized by low back
pain
prevalent in gymnasts,
figure skaters, swimmers
(flyers)
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Thoracic
Kyphosis
exaggerated thoracic curve
occurs more frequently than
lordosis
mechanism -- vertebra
becomes wedge shaped
causes a person to hunch
over

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Kyphosis
aka Swimmers Back
develops in children
swimmers who train with an
excessive amount of
butterfly
also seen in elderly women
suffering from osteoporosis

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Scoliosis
lateral deviation of the
spinal column
can be a C or S shape
involves the thoracic and/or
lumbar regions
associated w/disease, leg
length abnormalities,
muscular imbalances
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Scoliosis
more prevalent in females
cases range from mild to
severe
small deviations may
result from repeated
unilateral loading (e.g.
carrying books on one
shoulder)
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Consequences of
Pelvic Tilt
in normal standing the line of gravity
passes ventral (anterior) to the center
of the 4th lumbar vertebral body

Tm

TW

This creates a forward bending

torque which must be counterbalanced by ligaments and muscles
in the back
any movement or displacement of this
line of gravity affects the magnitude of
the bending moment (or torque)
slouched posture support comes from
ligaments this is bad for extended
periods of time

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Pelvic Tilt and

Lumbar
Loading
relaxed standing:
the angle of
inclination of the
sacrum (sacral
angle) is 30 to the
transverse plane

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Pelvic Tilt and

Lumbar
Loading
posterior pelvic tilt
reduces the sacral angle
or flattens the lumbar
spine (reduces lordosis)
causes the thoracic spine
to extend which adjusts
line of gravity such that
muscle expenditure is
minimized
BUT load is now passed
on to ligaments

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Pelvic Tilt and

Lumbar
Loading
anterior pelvic tilt
increases sacral angle
accentuate lumbar
lordosis and thoracic
kyphosis
this adjusts line of gravity
to increase muscle
energy expenditure

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Pelvic Tilt and

Sitting
Sitting (relative to standing)
pelvis posteriorly tilted
lumbar curvature is flattened
line of gravity (already
ventral to lumbar spine)
shifts further ventrally
increases the moment
created by body weight
about the lumbar spine
increased muscular support
increases the load on the
spine

vs.

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Pelvic Tilt and

Sitting
erect sitting
pelvis tilts anteriorly
increases lumbar curvature
reduces the moment arm of
body weight
reduces need for muscular
support
reduces load on lumbar
spine
however, pelvis still much
more tilted than during
normal erect standing

vs.

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L3 Load
lowest when
lying supine
normal when
standing upright
140% when
sitting with no
back support
150% when
hunched over

180% when sitting

hunched over with no
back support
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apparent that lumbar load is strongly related to support needed

to maintain lumbar lordosis
in erect, supported sitting the addition of a back rest reduces
lumbar load
reclining seated position reduces disc pressure even further

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Spinal Injuries

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Progression
of Disc
Degeneration

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Degenerative Disks
lose ability to retain ability to distribute
disk integrity
water in disk so
load across disk
decreases with
disks dry out
changes
age

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Herniated Disks
NP protrudes out
from between the
vertebrae
nerves are
impinged by the
bulging NP
lead to numbness
and/or pain
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Tearing of Annulus

Disk Herniation

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50

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Whiplash
Rapid flexion/extension injuries in cervical region
strain posterior ligaments
dislocate posterior apophyseal joints
7th cervical vertebra is likely site for fracture in this injury

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Low Back Pain

Vertebral instability

1) Muscle strain from

lifting may create muscle
spasms
2) distorted posture for long
periods of time
3) avoid crossing legs at the
knee
4) tight hamstrings or
inflexible iliotibial band
5) weak abdominals

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Lift With Your Legs

What does this mean?
the idea is to keep the weight (W) as close
to the axis of rotation as possible

smaller
muscular
torque

muscular
torque
axis

axis

W
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