Kinematics of cervical to thoracic spine

Mechanism of support of discs in Cx sp

Tough ligaments/ synovial joints 

→ X draw fluid in nucleus pulposus ( gel like center of intervertebral discs that help support the disc ) 

→ less common to have herniation 

→ more common to have degenerative 

Clinical implications:

1. Middle to older age 

2. Changes in symptoms over a day: X worse in the morning → worse through the day

3. Aggravating factors: sustained/ prolonged flexion

Coupling of movement in C2-7 ( F + E )

	Rotation	Translation
Flexion	Anterior	Anterior
Extension	Posterior	Posterior

Coupling of movement in C2-7 ( LF + rotation

	Rotation	Translation	Lateral flexion	Axial rotation
Lateral flexion	Lateral	Medial	/	Ipsilateral
Axial rotation	Y	Medial	Ipsilateral	/

Coupling in C 0-1 ( F + E + rotation )

	Rotation	Translation	Lateral flexion
Flexion	Forward	Backwards	N/A
Extension	Backwards	Forwards	N/A
Rotation	/	N/A	Y

Method of coupling in C1-2 ( F + E + rotation )

	Rotation	Translation	Lateral flexion
Flexion	Forward	Backwards	N/A
Extension	Backwards	Forwards	N/A
Rotation	N/A	N/A	Contralateral

Restraints to movement in upper cervical sp ( F

Flexion	Extension	Clinical implications
Alar ligaments  Posterior short + long ligaments  Short suboccipital extensors  Dura mater: from foramen magnum - C2 body	Transverse ligaments	Cervicogenic headache patients → presenting w/ craniocervical flexion → neural tissue mechanosensitivity  Trauma: whiplash injury

Mechanical thoracic conditions

Mechanical

Degenerative joint disease Postural overload on thoracic structures  Work related thoracic pain: trauma

Non-mechanical thoracic conditions

Inflammatory:  Scheuemann’s disease Ankylosing spondylitis  Metastatic disease:  Spinal tumours: 70% spinal tumours   Neurological/ congenital disorder  Scoliosis Spinal cord injury Myelopathy Radiculopathy T4 syndrome: upper limb paraesthesia  Metabolic:  Osteoporosis: spinal wedge fracture Shingles affecting thoracic nerves Rib stress fracture Slipping rib #

Types of joints in thoracic region + features

Types of joints	Features of Th spine
Intervertebral Zygapohyseal  Costovertebral  Costotransverse  Sternocostal joints	↓ disc height  Longer spinous processes  ↑ stability from sternum + rib cage  → less movement in Th region

Structures in costovertebral + costotransverse joints

Structures in costovertebral joints	Structures in costotransverse joints
Corresponding number vertebral body Vertebral body of above Th spine Head of rib	Tubercle of rib Transverse process of same numbered vertebrae

Distribution of mvmt in thoracic sp

• General: small degree of movement from T1-11

• Greater degrees of movement in transitionary regions

Regions	Flex-ext	Lateral flexion	Axial rotation
T1-2	/	/	9’
T11-12	12’	9’	/
T12-L1	12’	8’	/

Rib cage mvmt w/ thoracic sp mvmt

Th spine movement direction	Rib rotation direction
Flexion	Anterior rotation ( cephalad )
Extension	Posterior rotation ( caudad )
Rotation	Posterior rotation
Lateral flexion	Anterior rotation

Clinical implications of movement in Th spine

Region	Clinical implication	Ax pointers	Mx pointers
C7-T4	Hypomobility in this region affects amount of movement in head	Examine w/  Neck movements  Unilateral arm movement	Use of head/ arm movements
T4-8		Bilateral arm elevation → 15’ Th extension  → restriction of rib movement → restrict segmental movement	Consideration of breathing pattern when treating rib dysfunction
T8-L1	Rotatory instability in transitional area