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

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

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

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 Vertebral
Articulation Superior articular process

each articulation
is a fully
encapsulated
synovial joint
these are often
called
apophyseal joints Inferior articular process

Note: the processes are bony outcroppings. 3

 Costal (Rib) Superior
costal
Articulation facet

Transverse
costal
facet

Inferior
costal
facet
Note: the facets are
the articular surfaces. 4
 Body
Transverse process
Vertebral foraman

Spinous process

Intervertebral foraman

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 Muscular Attachments
muscular attachments on spinous and
transverse processes

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Vertebral shape
changes to reflect
movements possible
within a given region

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Further
depiction
of vertebral
shapes

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Motion Segment: Functional unit of the vertebral column

Neural arches Two bodies of vertebrae

intervertebral joints common vertebral disc
transverse & spinous processes ant & post longitudinal ligaments
ligaments 9
 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
fibrocartilaginous material
50-60% collagen
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
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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 Flexion beyond 50

lumbar vertebrae 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

primarily produce extension

and medial/lateral flexion
Superficial to deep
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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 longissimus spinalis

Erector spinae
Versatile muscles that can generate
rapid force yet are fatigue resistant

iliocostalis
cervicis thoracis lumborum

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 Semispinalis

capitis cervicis thoracis

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IT

IS

intertransversarius interspinales

Deep posterior
multifidus rotatores 23
 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 counter-
balanced 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
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extended periods of time
 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 37
 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 vs.
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
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 Pelvic Tilt and
Sitting
erect sitting vs.
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
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standing
 L3 Load
lowest when lying
supine
normal when
standing upright
140% when
sitting with no
back support 180% when sitting
150% when hunched over with no
hunched over 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
disk integrity lose ability to retain ability to distribute
decreases with water in disk so load across disk
age disks dry out changes

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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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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

1) Muscle strain from

lifting may create muscle
spasms
2) distorted posture for long
Vertebral instability
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 muscular
torque torque

axis axis
W W

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