NPTE Spine Anatomy

Normal cervical flexion ROM

60-90 degrees

Normal cervical extension ROM

50-70 degrees

Normal cervical rotation ROM

70-90 degrees

normal cervical lateral flexion ROM

40-50 degrees

C Flexion Arthrokinematics

OA: roll ant, slide post

AA: Ant tilt

C3-7: opens the facets

C Extension Arthrokinematics

OA: roll post, slide ant

AA: post tilt

C3-7: closes the facets

C Rotation Arthrokinematics

Turn to R: close R, open L

Turn to L: close L, open R

C Lateral Flexion Arthrokinematics

SB to R: close R, open L

SB to L: close L, open R

SCM Origin

manubrium, medial 1/3 of the clavicle

SCM insertion

mastoid process of temporal bone, sup nuchal line of occipital bone

SCM Innervation

spinal accessory nerve (CN XI)

SCM action

IL SB, CL rotation, neck flexion (if B), elevation of sternum and clavicles (breathing)

Scalenes Origin

C vertebrae

Scalenes Insertion

1st (ant, middle) and 2nd (post) ribs

Scalenes Innervation

Ant rami of C spinal nerves (C3-8)

Scalenes action

Rib elevation (breathing), neck flexion, IL SB, rotation (assist), stabilization

Levator scapulae origin

Post tubercles of TPs of C1-4

Levator scapulae insertion

Sup part of the med border of the scapula, btw the sup angle and the spine of the scapula

Levator scapulae innervation

Dorsal scapular nerve

Levator scapulae action

Scapular elevation

Spurling’s Maneuver

Sensitivity: .3-.93; Specificity: .74-.95; (-)LR: .07-.75; (+)LR: 1.9-18.6

Assesses for nerve root irritation at intervertebral foramen

Indicated for pts with neck p! with peripheral sxs

Sitting

Pt SB and rotates head to involved side. PT provides compressive force through head (~15lbs)

(+): radicular p! into UE to same side head is SB/rotated

Sharp-Purser Test

Sensitivity: .69; Specificity: .96; (-)LR:.32; (+)LR:17.3

Assesses integrity of transverse lig and upper C stability

Indicated for pts with neck pain secondary to trauma

Sitting

PT stands beside pt. Pt performs slight C nod. PT then places 1 hand on the forehead, while other hand placed on the SP of C2. A posteriorly directed force is applied by the hand on the forehead, while hand on SP of C2 stabilizes

(-): firm end feel

(+): sliding motion of head (excessive AP mvmt)/decrease in sxs

Normal L flexion ROM

40-60 degrees

Normal L extension ROM

20-35 degrees

Normal L Rotation ROM

30-45 degrees

Erector Spinae Origin

Sacrum, iliac crest, spinous and transverse processes of L and T vertebrae

Erector Spinae Insertion

Spinous and transverse processes of vertebrae, ribs, and occipital bone

Erector spinae innervation

Lat branches of post primary divisions of spinal nerves

Erector Spinae Action

Extension (B), IL lateral flexion, rotation, stabilization, and posture maintenance

QL Origin

Post ½ of iliac crest, iliolumbar lig, and TPs of the lower 3 L vertebrae

QL insertion

Inf border of the 12th rib, TPs of L1-4

QL innervation

12th thoracic nerve, ant rami of L spinal nerves L1-4

QL Action

Extension (B) and IL lateral flexion of L spine, stabilization of 12th rib during inspiration

Multifidus Origin

PSIS, dorsal surface of sacrum, mammillary processes of L vertebrae, TPs of T vertebrae, and articular processes of C4-7 vertebrae

Multifidus Insertion

SPs of vertebrae (except C1) (2-4 vertebral segments above their origin)

Multifidus Innervation

Med branches of post rami of spinal nerves

Multifidus action

Extension (B), IL lateral flexion, and CL rotation of vertebral column

SLR Test

Tractions sciatic nerve, LS nerve roots, and dura mater

Pt position - supine, no pillow; leg placed in slight hip IR and adduction, knee extension, neutral ankle

Leg is raised passively (hip flexion)

If pt experiences p!/tightness —> lower leg slightly to relieve sxs

Then perform sensitizer - ankle DF/C flexion

(+): reproduction of back p!, <70 degrees hip flexion with reproduction of sciatica, neuro p!

Slump Test

Assesses neural excursion within vertebral canal and intervertebral foramen

Detects impairments in neural tissue mobility

Pt seated with hands behind back

Instruct pt to “slump” the back (*overpressure*)

Pt actively flexes C spine (*overpressure*)

Pt actively straightens knee

Passively DF ankle with knee extended

If sxs are present, pt can extend neck, which should slacken nervous tissue, improving sxs

STOP when sxs reproduced

(+): reproduction of sxs

Prone Instability Test

Sensitivity: .72; Specificity: .58; (-)LR:.48; (+)LR: 1.7

Used to determine if pt has L spine “instability.” Tests for the likelihood of a pt responding favorably to spinal stabilization tx plan

Indicated for pts with LBP with suspected weakness/coordination impairments

Prone, legs fully off plinth resting on floor; holding plinth with both hands

PT performs PA pressure against L spine at each SP. P! is documented. PT repeats pressure after pt lifts legs off ground

(+): p! with pressure in resting position and p! decreases in the legs elevated position