Spine + Shoulder Rehab

how many vertebrae are in each section of the spinal column

7 cervical

12 thoracic

5 lumbar

5 sacral

4-5 fused coccyx

What are the 4 functions of the vertebral column

Bony protection of the spinal cord

Support for upright posture and bipedal gait

Transmit and generate forces

Attachment site for ligaments and muscles

What are the primary curvatures of the spine

Thoracic and sacral (kypotic)

What are the secondary curvatures of the spine

Cervical and lumbar (lordotic)

What movements are permitted at the cervical spine

Flexion/extension

lateral flexion

rotation (primarily between C1 and C2)

What movements are permitted at the thoracic spine

Rotation

Minimal lateral flexion

Minimal flexion and extension

What movements are permitted at the lumbar spine

flexion/extension

lateral flexion

minimal rotation

which section of the vertebral column has the largest vertebral bodies

lumbar

Which way do the ASIS move in an anterior pelvic tilt

Anteriorly and inferiorly

A person with an anterior pelvic tilt has excess hip _______ and lumbar spine _______

Hip flexion and lumbar spine extension

Which way does the PSIS move in a person with posterior pelvic tilt

PSIS move posteriorly and inferiorly

A person with a posterior pelvic tilt has excess hip ______ and lumbar ______

hip extension and lumbar flexion

What type of joints do intervertebral discs form

symphysis joints

What are the 2 components of an intervertebral disc

Anulus fibrosus and Nucleus pulposus

Functions of the intervertebral discs

Stability and shock absorption for the vertebral column

intervertebral discs are in between bodies of _____

C2-S1

What 2 ligaments support the intervertebral joints?

Anterior longitudinal ligament and the posterior longitudinal ligaments

Describe the anterior longitudinal ligament

3x as wide as the PLL, prevents hyperextension, runs on anterior surface of vertebral bodies

Describe the posterior longitudinal ligament

Thinner and weaker than ALL, weakly limits flexion, helps prevent intervertebral disc herniation

What is another name for the zygapophyseal joints

Facet joints

Where are the zygapophyseal joints located

Between adjacent superior and inferior articular processes

What type of joints are zygapophyseal joints

synovial plane joints

The lumbar spine has more _____ oriented facet joints which limits _____

vertically oriented facet joints which limits rotation

The spinal cord is located in the _________

vertebral foramen

The spinal nerves are located in the ___________

intervertebral foramen

how many pairs of spinal nerves are there

31 pairs

list the number and type of spinal nerves (adds up to 31)

8 cervical

12 thoracic

5 lumbar

5 sacral

1 coccygeal

How are cervical nerves named

Named for the vertebrae they are ABOVE.

How are the thoracic, lumbar, sacral, and coccygeal nerves named?

they are named for the vertebrae they are BELOW

Name 3 layers of intrinsic back muscles and their contents.

Superficial- Splenius mm. group

Intermediate- Erector Spinae group

Deep- Transversospinales group

What are the purposes of the intrinsic back muscles

Provide integrity to the vertebral column

Maintain posture and control movements of various regions of the spine

What 3 muscles are in the erector spinae group? What is their function?

Iliocostalis, Longissimus, Spinalis

Bilateral: spine extension

Unilateral: lateral flexion

What is the anterior insertion of the respiratory diaphragm?

Xiphoid process of the sternum

What is the anterolateral insertion of the respiratory diaphragm?

Costal cartilages of ribs 6-10

What is the posterolateral insertion of the respiratory diaphragm

Portion of rib 12

What is the posterior insertion of the respiratory diaphragm

Bodies of L1-L3 lumbar vertebrae

The epimysium of the respiratory diaphragm blends with the epimysium of the _______________________

quadratus lumborum and psoas major

What is the purpose of the pelvic diaphragm

Support abdominopelvic viscera

Maintain continence

Where is the coccygeus muscle

Ischial spine to inferior sacrum on sacrospinous ligament

Where is the levator ani muscle

Body of pubis and ischial spine to soft tissue structures medially

(puborectalis m., pubococcygeus m., iliococcygeus m.)

What structures make up the anterior abdominal wall

rectus abdominis

external and internal obliques

transverse abdominis

inguinal ligament

What structures make up the posterior abdominal wall

quadratus lumborum

psoas major

What is the vertebral artery test for?

detect vertebral artery insufficiency or vertebral basilar insufficiency

What is a positive vertebral artery test?

5 D's + 3 N's

How would you instruct a patient to perform vertebral artery test

pt is seated or supine with eyes open

pt extends and rotates neck to one side for 30s

return to neutral. pause 10 sec. repeat on other side

What are the 5 D's

dizziness

dysarthria

diplopia

dysphasgia

drop attacks

What are the 3 N's

Numbness or tingling

Nystagmus

Nausea

What is dysarthria

difficulty talking

What is diplopia

Double vision

What is dysphagia

difficulty swallowing

What is nystagmus

Involuntary rapid eye movements

What is whiplash?

A cervical sprain

What types of movements hurt with a cervical sprain?

AROM

PROM

RROM

What should you avoid in a patient with whiplash?

immobilization

In the acute phase, how would you treat whiplash?

Modalities to decrease pain + improve ROM

Focus on neuromuscular control of neck in static positions

progress to include surrounding muscle (arms)

What 2 neurological factors should you address in whiplash rehab?

Eye-neck coordination

Gaze stability

What are likely objective findings for a patient with a cervical disc pathology?

P! with flexion in AROM and PROM

Radicular symptoms into arms

Sensory and motor deficits

Define centralization

Mitigation of distal symptoms towards the spine in response to movement or intervention

Define peripheralization

Symptoms become more distal with movements or provoking activities.

What type of patient education should you provide for a cervical disc pathology?

Posture education

What types of joint mobs can be used for centralization? (cervical disc pathology)

Traction or cervical retraction

What are common causes of a rib stress frcature

Overhead or rotational activities

increase in training volume

Describe the pain associated with a rib stress fracture

Pain may be specific or vague

Possibly radiating into the shoulder or upper back

What are some objective findings for a patient with a rib stress fracture

Pain with rib springing

Rotation will increase pain

P! with MMT for muscles that attach to the fx site.

Rib stress fx rehab is guided by ____________

symptom resolution

About how long is rest and recovery for a rib stress fx?

3-8 weeks

What type of joint mobs would you do for a rib stress fx?

Grade 3/4 mobs that address thoracic spine hypomobility

How would you progress strengthening for a rib stress fx?

Single plane movements with trunk support

Multi plane movements without trunk support

Weight bearing

What is the most common physician diagnosis?

Non-specific back pain

What is sway back?

Occurs when the lumbar spine curves too far anteriorly

What pathologies can sway back cause?

Increased stress on the facet joints

Nerve root compression

Pars interarticularis

What are rehab considerations for sway back?

hip flexor and lumbar extensor stretching

Glute max + ab strengthening

Pelvic tilts

What is flat back

Loss of or decrease in lordosis

What pathologies can flat back cause?

posterior disc compression

vertebral compression fracture

What are rehab considerations for flat back?

Strengthening spinal extensors, hip flexors, and lumbar stabilizers

Stretch hamstrings,

What are common MOI's for lumbar sprains and strains?

Improper lifting

Poor posture

Trauma

Long-term overuse or misuse

How long does it take for most lumbar sprains/strains to heal?

1-2 weeks

What is a spondylolysis

fx of one or both pars with no anterior movement of the vertebral body

What is a spondylolisthesis

Bilateral pars fx with anterior slippage

MOI for lumbar fractures

Continual compression and extension or cyclic loading from flexion and extension

How do lumbar fractures present?

P! with insidious onset

P! with extension

Typically unilateral

Can feel soreness in gluteal ridge

Treatment considerations for lumbar fractures

Avoid trunk extension

segmental and global stabilization exercises (intrinsic back + abs)

Stretch hip flexors

Gentle joint mobs (no high velocity)

treatment considerations for lumbar disc pathology

Avoid whatever motion causes pain when beginnign rehab

McKenzie extension exercises

How do lumbar disc pathologies present

Almost always occur posteriorly or posterolaterally

May cause radicular pain

MOI for lumbar disc pathology

Usually occurs with some form of flexion

greatest risk is at full flexion

Lumbar disc pathologies are most common at

L4/L5

what type of joint is the sternoclavicular joint

saddle

What is the only bone articulation between the shoulder and the trunk

the sternoclavicular joint

The sternoclavicular joint relies on what 3 things for stability?

ligaments

capsule

intra-articular disc

What ranges of motion are permitted at the sternoclavicular joint

elevation/depression

protraction/retraction

upward/downward rotation

The acromioclavicular ligaments provide __________ stability

horizontal

the coracoclavicular ligaments provide _______ stability

vertical

What 2 structures are in the subacromial space?

supraspinatus tendon and subacromial bursa

How much space is in the subacromial space during arm elevation?

at rest: 10-11mm of space

90 deg. abduction: 5.5-6mm of space

120 deg. abduction: <5mm of space

The glenoid fossa is positioned ______ anterior to the frontal plane

30-45 degrees

How much of the humeral head is in contact with the glenoid at any given time?

25-30%

What are the static stabilizers of the GH joint?

capsule

glenoid labrum

glenohumeral ligaments

Which GH ligament would cause anterior instability if it was not working properly?

Inferior glenohumeral ligament

what are the dynamic stabilizers of the GH joint?

rotator cuff mm.

deltoid mm.

What is the open-packed position of the shoulder

scaption