KINS Ch. 5

when body is upright & supports limb movements

When are trunk muscles (core) engaged?

loading or dynamic loading

activation of trunk muscles

vertebral column

triaxial jt which allows movement in 3 planes (sagittal, frontal, transverse)

flexion, extension, hyperextension

what mvmts are done in the sagittal plane (frontal axis) of the verterbral column?

lateral flexion/bending

what mvmts are done in the frontal plane (sagittal axis) of the vertebral column?

rotation (does not occur at C1 & skull=atlanto-occuipital jt)

what mvmts are done in the transverse plane (vertical axis) of the vertebral column?

pelvic girdle

3 jts that unite sacrum to hip bones:left and right sacroiliac (posteriorly) and the pubic symphysis (anteriorly)— allows only passive mvmt

lumbosacral jt which involves the vertebral column (impacts all functional mvmt and ability to perform life tasks)

All pelvic mvmt involves what?

lumbosacral jt

What is the most important articulation in the pelvic girdle and that unites the vertebra and pelvic girdle?

• structural support, strength (10x more than if were straight), and stability of vertebral column

• balance

• mvmt

• shock absorption

• upright posture

What does normal spinal curves and change from curve to curve provide for?

1. cervical (at neck)

2. thoracic (middle of back)

3. lumbar (lower back)

A healthy spine has what 3 curves?

cervical curve

lordotic=concave (anterior curve)

thoracic curve

kyphosis= convex(posterior curve)

lumbar curve

lordosis=concave (anterior curve)

convex

extends outward/posteriorly like a ball

concave

extends inward/anteriorly like a bowl

• lordosis=increased posterior concavity of LB and cervical curves (sway back)

• kyphosis=increased anterior concavity of normal thoracic curve (humpback)

• scoliosis= lateral curvatures or sideward deviations of spine

• lumbar kyphosis= reduction of normal LB lordotic curve (flat back)

What are different unhealthy spines?

• neutral pelvic tilt

• anterior pelvic tilt

• posterior pelvic tilit

• lateral pelvic tilt (pelvic obliquity)

What are the different pelvic positions?

neutral pelvic tilt

equal distribution across femurs in sitting position—combined with trunk extension allows for activity participation

anterior pelvic tilt

pelvis dips forward causing lift of buttocks and hyperlordosis in the lumbar spine— causes a shift of COG

posterior pelvic tilt

pelvis shifts backward—caused flattening of LB spine and kyphosis in thoracic spine

lateral pelvic tilt (pelvic obliquity)

one side of iliac crest higher than other

balance

maintenance of body’s COG over a BOS

• static balance

• dynamic balance

what are 2 different types of balance?

static balance

ability to maintain a position

dynamic balance

ability to move or function within a position

ability to reach while maintaining balance

What is crucial to independence?

standing balance

maintaining upright body position over a very small BOS—requires balance anterior/posterior and left/right —-vision plays a role in postural stability

sitting balance

ability to maintain a seated posture without falling and includes ability to reach

• essential (trunk control) to functional outcomes

• 82% of body weight is supported across femurs and the rest through feet while sitting with the back supported

• stability offered by sitting (lower COG, greater BOS) plus proper support for butt, feet, and back will increase fine motor function of hands

What are some components of sitting balance?

postural control

what requires motor processes, sensory processes, & musculoskeletal components (performance skills in OTPF)?

the coordination bt head, trunk, and arm movements, such as self-feeding in children

What is dependent on adequate postural control?

head stabilization

provides stable gravitational reference for vestibular system & facilitates visual info to influence functional tasks such as swallowing, reading, eye contact, vision

• scoliosis

  • structural scoliosis

  • nonstructural scoliosis

• kyphosis

• lordosis

What are some abnormalities in the trunk/Neck?

scoliosis

lateral curve of spine—-spinal deformity in frontal plane—lateral “S” curve

structural scoliosis

identified in adolescence; is more common in females; fixed rotation & lateral curvature of 2 or more vertebrae regardless of mvmt or repositioning—- can impact internal organs and be life threatening

nonstructural scoliosis

very common; may be result of leg length discrepancy or imbalance in strength or flexibility—- reversible lateral curve which is no longer visible when trunk is repositioned or during trunk flexion or lateral bending

kyphosis

humpback—- normally in thoracic vertebrae though can be in LB vertebrae due to trunk immobility—-often seen with osteoporosis

lordosis

sway back—- exaggerated normal curve

• spine

  • cervical (7)

  • thoracic (12)

  • lumbar (5)

  • sacral (5)

  • coccygeal (4-5)

• Rib cage

What are the different body structures of the trunk and neck?

spine

33 bones called vertebrae divided into 5 areas (cervical, thoracic, LB, sacral, coccygeal)—— maintains the longitudinal axis of body & protects spinal cord

cervical

allows most mvmt except at C1 (atlas) & C2 (axis)

C1 & skull

the atlanto-occipital jt allowing only slight flexion & extension & no rotation

C1 & C2 (axis)

forms atlantoaxial jt (pivot jt)—- 80% of cervical rotation occurs at this jt

Cervical retraction/axial extension

flexion of atlanto-occipital & extension at C2-C7 —- utilized in upright posture

C3-C7 mvmt

allows for cervical flexion, extension, hyperextension, rotation, & lateral bending

thoracic

allows least amount of mvmt, is the most stable due to ribs & spinous processes which point inferiorly

Lumbar

largest, support the weight of body, allows flexion and extension but very little rotation, most frequently injuried

sacral

fused vertebrae, no mvmt occurs here

coccygeal

tailbone, no movement occurs here

rib cage

sternum, 12 ribs and dorsal aspect of 12 thoracic vertebra—- protects organs, provides support for UE, aids respiration

lumbar spine

what is the most injured region of human body and absorbs the majority of our body weight plus any weight we carry?

bt L4 & L5 and bt L5 & S1

where is the most movement in the lumbar spine?

thoracic spine

what has much less mvmt bc it is attached to the rib cage?

cervical spine

what moves freely and supports head?

• sacrum

• coccyx

• hip bones (fusion of ilium, ishium, pubis)

what are the 4 bones of the pelvic girdle?

• 2 sacroiliac jts (part of synovial & syndesmosis {fibrous jt with ligaments providing stability}) and symphysis pubis, lumbosacral (most important articulation in pelvic girdle)

• also known as pelvis—- BOS of body in sitting

what are the 4 jts of the pelvic girdle?

pressure ulcer

localized injury to skin and/or underlying tissue usually over a bony prominence as a result of pressure, or pressure in combination with shear force and/or friction

IT (ischial tuberosities)= protuberances of hip bones that support weight of body in sitting

what are a common source of pressure ulcers?

proper positioning of pelvis and trunk

What is essential to avoiding pressure ulcers?

improper alignment & inappropriate seating surface

what are 2 main causes of pressure ulcers in wheelchair bound pts?

sitting in a wheelchair for an extended period of time

36%-50% of pressure ulcer formation in elderly was attributed to what?

• anterior longitudinal ligament

• posterior longitudinal ligament

• supraspinal ligament

• interspinal ligament

• ligmentum flavum

• nuchal ligament

What are the thoracic vertebrae ligaments?

anterior longitudinal ligament

runs down anterior vertebrae in thoracic and lumbar regions—prevents excessive hyperextension

posterior longitudinal ligament

runs down through the vertebral foramen—prevents excessive flexion— thicker superiorly to support skill—- thinner inferiorly which increases risk of disc injury in the LB area

supraspinal ligament

extends from C7 to sacrum along the tips of spinous processes

interspinal ligament

runs bt successive spinous processes

ligmentum flavum

connects adjacent laminae anteriorly

nuchal ligament

takes place of the supraspinal & interspinal ligaments in cervical region— very thick—- serves as an attachment for the trapezius of spenius capitis muscles

anterior and posterior by function—- anterior muscles flex and posterior muscles extend (most are paired)

muscles of the neck and trunk can be divided into What?

• sternocleidomastoid

• scalene (3)

• prevertebral group (4)

what are the anterior muscles of the neck?

• erector spinae group (3)

• splenius captis

• splenius cervicis

• suboccipital group (4)

what are the posterior muscles of the neck?

• rectus abdominus

• external oblique

  • internal oblique

• transverse abdominis

what are the anterior muscles of the trunk?

• erector spinae group (3)

• transversospinalis group (3)

• interspinales

• intertransversarii

what are the posterior muscles of the trunk?

• quadrates lumborum

what are the lateral muscles of the trunk?

valsalva maneuver

• transverse abdominis muscle (deepest abdominal muscle) which plays a role in pelvis and trunk stability

• compression of abdomen that facilitates defecation, child birth, lifting, coughing, vomiting, and sneezing

• attempting forceful exhalation against a closed airway

• can be used as a diagnostic tool for heart or treatment for abnormal heart rhythms and to relieve chest pain

• to be avoided with pts with CAD, recent heart attack or low blood volume

abnormal postural/orthopedic alignments

what occurs due to muscle imbalance?

muscle imbalance

antagonist muscle stronger than agonist

muscle balance

what contributes to trunk stability & UE control and decreases risk of orthopedic deformity?

OT

who addresses standing and sitting posture during functional activity and in W/C measurement/training?

40 degrees

how many degrees is cervical in flexion?

75 degrees

How many degrees is cervical in extension?

35-45 degrees

how many degrees is cervical in lateral flexion?

45-50 degrees

How many degrees is cervical in rotation?

20 degrees

How many degrees is thoracic in lateral flexion?

35 degrees

How many degrees is thoracic in rotation?

20 degrees

how many degrees is lumbar in lateral flexion?

5 degrees

how many degrees is lumbar in rotation?

105 degrees

how many degrees is thoracolumbar in flexion?

60 degrees

how many degrees is thoracolumbar in extension?

body of vertebral structure

a cylindrical mass of cancellous bone. this is the anterior and weight-bearing portion of the vertebrae. it is not palpable on back. C1 does not have a body

facet of vertebral structure

a small, flat, smooth surface on a bone. A facet refers to the articulation of the thoracic vertebrae and rib bone

facet jt of vertebral structure

the facet jt is the articulation bt the superior articular process of the vertebrae below and corresponding inferior articular process of the vertebrae above

foramen of vertebral structure

an opening

intervertebral foramen of vertebrae

opening formed by inferior vertebral notch and superior vertebral notch that allows passage of nerve root

lamina of vertebral structure

portion of vertebrae that connects spinous process to transverse process

neural arch of vertebral structure

posterior portion of vertebrae

pedicle of vertebral structure

portion of vertebral arch. It lies posterior to body and anterior to lamina

spinous process

posterior projection found on neural arch. It also is an attachment point for muscles and ligaments. the seventh cervical vertebra, also known as the vertebrae prominens, has an unusually long spinous process. one can easily palpate this aspect. this is where cervical and thoracic area conjoin

transverse process

union of lamina and pedicle, where the ligaments and muscle attach to spine