Spine Rehabilitation

what are the (4) main functions of the vertebral column

protection for spinal cord

support for posture/gait

transmit/generate forces

attachment for ligaments/muscles

what are the primary/kyphotic curvatures of the spine

Thoracic

Sacral

what are the secondary/lordotic curvatures of the spine

Cervical

Lumbar

Are kyphotic curvatures concave or convex

Convex

Are lordotic curves convex or concave?

Concave

what are the main movements of the cervical vertebrae

Flexion/Extension

Lateral Flexion

Rotation (between C1-C2)

what are the main movements of the thoracic vertebrae

Rotation

Lateral flexion (minimal)

Flexion/Extension (minimal)

what are the main movements of the lumbar vertebrae

Flexion/Extension

Lateral flexion

Rotation (minimal)

What structures (and how) are affected if someone has an anterior pelvic tilt

ASIS moves anteriorly + inferiorly

Hip flexion + Lumbar spine extension

what mm. are responsible for an anterior pelvic tilt

Hip flexors (iliopsoas, rectus femoris, sartorius, TFL, pectineus)

Back extensors (multifidus, semispinalis, erector spinae)

What structures (and how) are affected if someone has a posterior pelvic tilt

PSIS moves posteriorly and inferiorly

Hip extension + Lumbar spine flexion

what mm. are responsible for a posterior pelvic tilt

Hip extensors (gluteus max, hamstrings)

Trunk flexors (psoas major, rectus abdominis, obliques)

where will you find intervertebral discs

between vertebral bodies C2-S1

What are the 2 components of the intervertebral disc

Annulus fibrosus - outer layer (fibrocartilaginous rings)

Nucleus pulposus - core - gelatinous

what is the function(s) of the intervertebral discs

stability + shock absorption for the column

The intervertebral joints are supported by what structures

Anterior longitudinal ligament

Posterior longitudinal ligament

The anterior longitudinal ligament prevents what motion(s)

hyperextension of the spine

The posterior longitudinal ligament prevents what motion(s)

weakly limits spine flexion

what ligaments helps prevent intervertebral disc herniation

posterior longitudinal ligament

the zygapophysial (Facet) joints are made up of bony structures

superior and inferior articular processes of adjacent vertebral bodies

where is the spinal cord located in the vertebral column

vertebral foramen

where are the spinal nerves located in the vertebral column

intervertebral foramen

how are cervical nerves named

named for pedicle of the inferior vertebra

how are spinal nerves named (excluding cervical nerves)

named for pedicle of the superior vertebra

how many pairs of spinal nerves do we have

31

how many pairs of cervical nerves do we have

8

how many pairs of thoracic nerves do we have

12

how many pairs of lumbar nerves do we have

5

how many pairs of sacral nerves do we have

5

how many pairs of coccygeal nerves do we have

1

how many bones are in the vertebral column

33

what are the divisions of the vertebral column and how many bones are there in each

Cervical: 7

Thoracic: 12

Lumbar: 5

Sacrum: 5

Coccyx: 4-5 (fused)

what are the (3) layers of the intrinsic back mm., and what mm. groups are found in each

Superficial - splenius group

Intermediate - erector spinae group

Deep - transversospinales group

what is the purpose(s) of the intrinsic back mm.

provide integrity to the vertebral column

maintain posture

control movements various regions of the spine

what mm. make up the erector spinae group

iliocostalis

longissimus

spinalis

what action(s) does the erector spinae group perform

bilateral extension of vertebral column

unilateral lateral flexion of vertebral column

what is the purpose(s) of the pelvis diaphragm

support abdomino-pelvic viscera

maintains continence

what mm. make up the pelvis diaphragm

coccygeus

levator ani

what mm. make up the levator ani m.

puborectalis

pubococcygeus

iliococcygeus

what mm. make up the anterior abdominal wall

rectus abdominus

External/Internal obliques

Transverse abdominus

what muscle(s) flexes the vertebral column and compress the abdominal wall

rectus abdominus

transverse abdominus (bilaterally)

what mm. make up the posterior abdominal wall

quadratus lumborum

psoas major

how do you perform a vertebral artery test

pt extends and rotates neck to on side, w/ eyes open, hold for 30 sec at end range, pause for 10 sec, and repeat on other side

a (+) vertebral artery test is indicative of what implications

vertebral artery insufficiency

vertebral basilar insufficiency

what are signs of a (+) vertebral artery test

tinnitus, dizziness, nystagmus, nausea, throbbing, confusion

what are the 5Rs and 3Ns

Dizziness

Dysarthria

Diplopia

Dysphagia

Drop attacks

Numbness (or tingling)

Nystagmus

Nauseau

Dysarthria is the medical term for what condition

slurred speech

Diplopia is the medical term for what condition

double vision

Dysphagia is the medical term for what condition

difficulty swallowing

Nystagmus is the medical term for what condition

involuntary eye movement

True/False: when treating a pt with cervical whiplash it is important to avoid immobilization

True

in the acute phase of treating a pt with cervical whiplash, what kind of strengthening should you be working on

neuromuscular control of the neck

surrounding musculature

when treating a pt with cervical whiplash what neurological treatment should you incorporate

eye-neck coordination

gaze stability

what are some objective observations associated with a cervical disc pathology

painful cervical flexion

radicular symptoms into arms

sensory/motor deficits

what is centralization

radicular symptoms move from the arms or shoulders back toward the neck

what is peripheralization

radicular symptoms/p! move away from the neck further into the arms or hands

True/False: peripheralization indicates improvement and reduced nerve irritation

False, peripheralization worsening of the nerve irritation or disc pressure

when treating a pt with a cervical disc pathology what type of treatment can be done to cause centralization of the symptoms

cervical traction or retraction

if someone has a rib stress fracture where may their p! radiate to

into the shoulder or upper back

what motion(s) commonly cause rib stress fracturs

overhead and rotational activities

True/False: rib fractures are commonly precipitated by an increase in training volume

true

what active/passive ROM will increase p! if someone has a rib stress fracture

rotation

when treating a pt with a rib stress fracture how should you progress their strengthening

single plane movements w/ trunk support

multi-plane movements w/o trunk support

weight-bearing exercises

______________ occurs when the lumbar spine curves too far anteriorly

sway back (or lumbar lordosis)

when treating a sway back what structures should you focus on stretching

hip flexors

lumbar extensors

when treating a sway back what structures should you focus on strengthening

gluteus maximus

abdominals

____________ occurs when there is a loss or decrease in lordosis

flat back

what are some secondary causes of sway back (lumbar lordosis)

increased stress on facet joints

nerve root compression

pars interarticularis

what are some secondary causes of flat back

posterior disc compression

vertebral compression fracture

when treating a flat back what structures should you focus on strengthening

spinal extensors

hip flexors

lumbar stabilizers

when treating a flat back what structures should you focus on stretching

hamstrings

what are common causes of lumbar sprains/strains

improper lifting

poor posture

trauma

long-term overuse/misuse

how long does it usually take to resolve/rehab a lumbar sprain/strain

1-2 weeks

______________ is a fracture of one or both pars with no anterior movement of the vertebral body

spondylolysis

_____________ is a bilateral pars fracture with resultant anterior slippage

spondylolisthesis

if someone has a lumbar fracture how will their p! present

insidious onset

painful lumbar extension

unilateral

soreness in gluteal ridge area

what are the common MOI for a lumbar fracture

continuous/repetitive compression and extension

cyclic loading from flexion and extension

True/False: when treating a lumbar fracture you should focus on trunk extension

false, you should avoid trunk extension

when treating a lumbar fracture what mm. should you strengthen

deep back intrinsics

erector spinae

abdominals

when treating a lumbar fracture what mm. should you stretch

hip flexors

True/False: When treating a lumbar fracture, gentle joint mobs are recommended to help with the p!

true

True/False: when treating a lumbar fracture it is recommended to use high-velocity joint mobilization techniques

false

where do lumbar disc pathologies most commonly occur

L4/L5

If someone has a lumbar disc pathology how will their p! present

posterior or posterolaterally

may have radicular p!

when treating a lumbar disc pathology what motion should be avoided at the beginning of rehabilitation

whatever motion causes p!

what spine movements would most likely increase a patient’s radicular symptoms with a lumbar disc herniation

lumbar flexion

what is the first rehabilitation goal of a patient with a cervical herniated disc

centralization of the symptoms

what motion will anteriorly pelvic tilting cause at the lumbar spine

extension

what motion will posteriorly pelvic tilting cause at the lumbar spine

flexion

what lumbar joint mobilizations should be avoided with spondyloses within the lumbar spine

grade 3/4 PA joint mob