Spine Oral Exam Mid-term Flashcards

Terms Definitions
Name all of the joints of the atlas.
- 1 anterior odontoid joint
- 2 superior facet joints
- 2 inferior facet joints
Name all of the joints of the axis.
- 2 superior facet joints
- 2 inferior facet joints
-2 odontoid (ant. & post.)
- 2 Von Luschka
-1 intervertebral disc joint
Name all of the joints of a cervical spine vertebrae.
- 2 superior facet joints
- 2 inferior facet joints
- 4 Von Luschka joints
- 2 intervertebral disc joints
Name all of the joints of a thoracic vertebrae.
- 2 superior facet joints (synovial)
- 2 inferior facet joints (synovial)
- 2 intervertbral disc joints (fibrocartilaginous)
- 4 costovertebral joints
- 2 costotransverse joints
Name all of the joints of a lumbar vertebrae.
- 2 superior facet joints
- 2 inferior facet joints
- 2 disc joints
Name all of the joints of the sacrum.
- 1 sacral coccygeal joint
- 1 L5-S1 disc joint
- 2 L5-S1 superior articular facets (junctions)
- 2 SI joints
Which part of the facet contacts the head of the rib in the thoracic spine?
Demi facet
How many vertebrae are in the spine, including the sacrum and coccyx?
33
How many total intervertebral discs are in the spine?
23
Why are there 7 cervical vertebrae but 8 cervical nerves?
The 1st cervical nerve come above C1 and the last cervical nerve comes out below C7/above T1.
If there is an L4-5 disc herniation, which nerve root will it encroach upon?
L5
(because L5 nerve root is still in the canal)
If there is a C5-6 disc herniation which nerve root will be encroached?
C6
If there is a L5-S1 disc herniation, which nerve root will it encroach upon?
S1
If there is a lateral foraminal stenosis of L4-5, which nerve root will be compressed?
L4
Where does the spinal cord end?
L1-2
What is the functional unit of the spine called? And what is it composed of?
A segment.
The inferior half of 1 vertebrae above, the superior half of the vertebrae below and everything including disc, nerve, blood vessels inbetween.
What is the weakest part of the vertebrae? And what commonly occurs here?
Pars interarticularis
Scotty dog fracture
What is unique about the curvatures of the spine?
Distribution and absorption of forces and shock.
What is the significance of the intervertebral notches?
When veretrae are stacked on top of eachother they become the lateral foramen where the nerve roots exit. DDD, DJD can develop here, narrowing the foramen, causing lateral foraminal stenosis.
What tests could be performed to determine radiculopathy?
-myotomes
-dermatomes
-neural reflexes
-neural tension
How many synovial joint surfaces are in the thoracic spine?
10
-only the the intervertebral disc are fibrocartilaginous not synovial
What runs through the transverse foramen of the cervical spine and at what level does it enter?
-vertebral artery
-C6
At which level does the 1st bifid spinous process appear?
Axis
What is the significance of the lateral wall of the uncinate process in the cervical spine?
They prevent lateral herniation and help stabilize the disc.
(the uncinate processes are WB and take pressure off of the disc)
Why are the transverse processes of the thoracic spine better "handles" for manipulation than the cervical spine?
Because in the C spine they are more anterior/lateral, while in the T spine they are more posterior.
 
At what level does the 1st vertebral body appear?
C2 (AXIS)
What are some conditions that can cause transverse ligament laxity?
-downs syndrome
-pregnancy
-RA (attacks the synovium of the joints causing high susceptibility to instability in the C spine. Therefore people with RA are directly contraindicated for manipulation)
What percentage of motion occurs at the AA joint and why?
50% of motion because it is a convex on convex relationship
The anterior odontoid joint should not translate more than how many mm before its an emergency?
3 mm within the atlantodental interval
What ligament wraps around the dens and type of cartilage does it become the closer it gets to the bone?
-transverse ligament
-hyaline cartilage
What is the attachment site of the transverse ligament?
Medial tubercles of the Atlas
What is the difference between arthrokinematics and osteokinematics?
arthrokinematics- motion within the joint (roll/glide)
osteokinematics- the resultant movement of the limb (flexion/extension)
What is the definition of component motion?
Motions that take place in a joint to facilitate a particular active motion. Motion that takes place between 2 joint surfaces and takes place from natural classical motion.
(under voluntary control i.e. roll/glide)
What is the definition of joint play?
Occurs only in response to an outside force.
(not under voluntary control)
ex: distraction
What percentage of the lumbar facet joints are in the saggital plane?
- 2/3 in saggital plane
What percentage of the lumbar joint is in the frontal plane, and why is this significant?
- 1/3 The frontal plane hook provides stability and helps prevent spine slippage. If this frontal plane orientation begins to wear then slippage can occur leading to spondylolisthesis.
Where does the ligamentum flavum start?
- C2/C3. If it began at C1/C2 it would limit rotation. This is a membrane not the ligamentum flavum.
Where does the ligamentum nuchae run?
- Occiput to C7
What does the tectorial membrane turn into?
- posterior longitudinal ligamnet at C2
What is the attachment site for the disc?
- annulus fibrosis
What attaches to the dens?
- the alar ligament and the apical ligament
What composes the cruciform ligament?
- the transverse ligament of atlas and the superior and inferior longitudinal ligaments of atlas
Where does the apical ligament attach?
- from the superior portion of the odontoid to the foramen magnum
Where does the alar ligament attach?
- from the posterior lateral odontoid of C2 to the occiput
Which direction do the fibers of the interspinous ligament run?
- superior posterior to allow for forward bending
Why do more discs herniate in the lumbar spine versus the C spine?
1. The PLL is very wide in the cervical and becomes more narrow in the lumbar spine.
2. No uncinate processes are in the lumbar spine.
3. The lumbar spine has more weight and increased force production
4. Nucleus pulposus is more posteriorly located in the lumbar spine and more anterior in the cervial spine.
5. lateral walls of the Von Luschka prevent herniation
6. The disc begin to dry out in the lumnbar spine by age 55-60.
What is the best position to put a patient in to hydrate the disc?
- supine with legs  at 90 90
(within 1 hour, 80% imbibition occurs)
Where does the supraspinous ligament stop and what does this allow?
- L3-L4 to allow for forward bending
How does the disc receive nutrients?
The disc is avascular, but the outer 2 layers of the annulus are vasucular and imbibe nutrients through the nutrient foramen in the endplate into the disc. It is the unweigthing of the disc that allows for diffusion.
Explain the purpose of the glycoaminoglycans and the proteoglycans?
- GAGs and proteoglycans are are protein aggregates that are negatively charged attracting water. The negative charges repel each other expanding causing an enlargement of the disc. This is why when a herniation occurs the disc will continue to expand.
How are the fibers of the annulus related to function?
- annular fibers are 30-45 degrees angled fibers. Only 50% of the fibers will support your spine whenever you lift and twist.
Can disc material re-enter the disc? Why or why not?
No. It is like putting toothpaste back into the tube.  Exercises are effective for pain relief, but the theory that McKenzie has that nucleus pulposus can be relocated has no supporting evidence.
What are the two reasons Dr. Paris began studies in manipulative and manual therapy?
- incident in gymnasium
- his father's story
In what year did Americans begin/adopt manual therapy?
- 1980
What are Maigne's two rules for manipulation and why are they important?
1. Manipulate in the direction of least restriction
2. cause no pain
These rules apply to gross techniques of manipulation for those that are less trained in manipulation
What was Alan Stoddard known for? What were his view of causes of back pain?
He was an MD and DO and was a great maniplator who used spring testing techniques (to sense resistance to pressure)
He believed that back pain came from the SI joint, the disc and the facets (compare to Paris and Cyriax)
What did osteopaths, chiropractors, Cyriax, Stoddard, and Kaltenborn view as the cause of back pain?
chiropractors thought that it was a vertebrae out of place, osteopaths saw it as the ‘law of the Artery’, Cyriax saw it as just the disc, Stoddard saw it as the SI joint, facet and disc, and Kaltenborn stayed out of it and wanted to normalized mechanics and function of a joint.
What ideas is Kaltenborn known for?
-the convex-concave rule
-he gave classifications to graded movement with traction (i.e. PA glides are easier with a grade I distraction vesus a grade II)
What is Maitland known for?
-used manipulation techniques to treat ‘reproducable s/sx’ rather than to reduce a disc and developed graded oscillations and concepts such as reactivity.
What is Robert Elvey known for?
-He started neural tension techniques.
Who wrote the book "The Spinal Lesion" and what is included in it?
-Stanley Paris
-It includes a classification system that is a hybrid of Kaltenborn's and Stoddard's that talked about movement. This system is called 'passive intervertebral motion' or 'PIVM' (see separate card)
describe passive inter vertebral movement (PIVM) classified by Paris
0 fused-no therapy
1 considerable restriction-non thrust
2 slight restriction- non thrust to thrust (be careful!)
3 normal-
4 slight increase-
5 considerable increase- stabilization (posture training)
6 unstable-stabilization to surgery
 
what idea is 'Codman's Paradox' based on?
  The body works on DIAGONALS , not on sagittal or frontal. 
-abd of the shoulder joint should be measured more in the scapular plane. -Straight abd is considered ER and straight flexion is IR and scaption is neutral.
What is McKenzie known for?
-his techniques involve repetitive motion  -Repeptitive ext is good for pts and pain is often centralized.
-just like Codman noticed if u do back and forth motions to the shoulder, u can centralize pain, McKenzie saw this in the back too by using repetitive motion. (He assumed he was putting the disc back into place. By MRIs and CTs we now see that is impossible.)
 
What is Mulligan known for?
 -He developed concepts of performing manipulation with active movements along facet planes. He manipulated with movement (pts do AROM at same time).
-Having the pt help u manipulate their joints is a therapeutic advantage.
(he wrote the chapter on traction in Paris’s “The Spinal Lesion” book.)
 
What was Rocobado known for?
He worked with a dentist and became interested in the TMJ joint
When did manual therapy (MT) come to America?
-it was around in the 1920s but faded out (was taken by chiropractors)
-there was a rebirth in the 1960s
What is the brief timeline of the 1960's rebirth of MT in the US?
1961-no manipulation in US, only done by chiropractors
1963- Paris comes to Boston and the Dean at Allied Health at Boston U said PTs were not allowed to perform, teach, write, etc about manipulation
1967- North American Academy of Manipulation Medicine is founded and PTs aren’t welcome, only physicians (founded by Trevell, Maigne and Mennell).
1967-APTA turns down request for manipulation section.
1968-North American Academy of Manipulative Therapy is formed in Boston.
 
What is Paris's definition of manipulation?
"the skilled passive movement to a joint"
 
later changed to "the skilled passive movement to a joint with a therapeutic intent"
who founded the International Federation of Orthopaedic Manipulative Therapy (IFOMT)? What was different about this section in the APTA?
-Stanley Paris
-  To be in IFOMT u had to pass an exam within the orthopaedic section of the APTA unlike any other section
What events lead to the beginning of The University of St. Augustine?
In 1979 the following activities in Atlanta, Ga enabled the formation of USA:

-Atlanta back clinic (first multidisciplinary clinic in the country and owned and run by a PT)
-southwestern clinics (West Paces ferry Headache and Facial Pain clinic, Back School of atl, Clayton General hospital)
-Doctoral Studies
-Institute of PT 
(The Institute of Graduate Health Sciences became the University)
What are some unique features of The University of St. Augustine?
-FIRST proprietary school of PT and OT
-One of the first to offer the DPT and the t-DPT and t-OTD
-The only school to offer the dual degree
-The first to offer a full on-line DPT option (boca raton and san diego)
-Also offers DHSc and EdD- mostly online
-2nd campus in San Diego
 
 
location
Type I
Capsule
Type II
Capsule
Type III
Capsule, ligaments
Type IV
Most tissues
Who created a classification of "end feels"?
what does it refer to?
-Paris and Patla have identified 5 normal and 9 abnormal end feels
- it is about the sense of motion at the end of a passive range. Differentiating between them helps PTs to select the correct treatments.

Normal:
Muscle- as in SLR
Ligament-as in knee abd
Capsule- shoulder elevation
Cartilage- elbow ext
Soft tissue- knee flexion
 
Describe the breakthrough for MT in 1996
In 1996- a large breakthrough in evidence of MT occurred when the Agency for Health Care Policy and Research (AHCPR) said that valid literature was a milestone in the acceptance of MT.
They said the tx of acute low back pain included MT amongst others such as posture training.
What do studies show concerning orthopaedic surgery versus conservative treatment for back pain?
-paresis does not require immediate surgery (wait 2 months).
-Conservative management (medical+ sometimes PT) is equal to or better than surgery -PT and surgery both have a 70% success rate. -Aggressive rehab (medical, injection+ stabilization) gives 90% improvement @ 31 months –young age is a positive factor.
 
describe the 2 schools of thought for the treatment of back pain
1.       Those that tx s/sx: Maitland, McKenzie, Cyriax (disc), Sarhmann
2.       Those that tx dysfunction: Kaltenborn, Paris, Mulligan, Osteopathy, Chiropractic
 
explain spinal instabilty as described by Paris
Spinal instability: is where the osseo-ligamentous and or neuromuscular component of the spinal segment are unable to hold the segment either in spinal neutral or at other points in range, against creep and slippage and other aberrant motions (paris)
-it is not hyper mobility
- it is a patho-anatomical entity
-it is quite common
- single largest reason for back pain
- it is treatable
- stabilization will reduce/remove the pain
-thus, instability can become a stabilized and painless hypermobility
 

 
(Tight joints lead to instabilities
Hypermobility is NOT instability (until or unless fatigued)
In an unstable spine with a torn disc, forward bending extrudes the disc and backward bending extrudes it further back.)
 
describe the innervation and vascularization of a disc as decribed by Paris
If the outer capsule tears (outer rings of annulus) u will see an effort at healing bc the otter portions are vascularized. These pts need to be treated with stabilization exercises to stop a further herniation through the tear.
A normal healthy disc has no innervations so has no way of conducting pain except from its periphery where it IS innervated. However, a degenerated disc is painful bc nerves accompany the ingrowth of vascularization and other materials (bloody disc)
 
What is joint injury?
Joint injury includes such conditions referred to as osteoathrosis, instability and the after effects of sprains and strains, are IMPAIRMENTS (DYSFUNCTIONS) rather than diseases.
What treatment of the joint is appropriate when a hypermobility is noted?
stabilization NOT manipulation
What are the three things that literature shows supporting inmprovement n back pain?
education
exercise
manipulation
How can a tight joint capsule lead to DJD in the gait cycle when referring to the hip?
Normally in initial contact the joint approximates tightly, in midstance the hip joint is unweighted and then procedes to the close packed position in terminal stance. However, a tight hip capsule will not allow for the unweighting during midstance leading to DJD. Tight hip flexors, joint capsule, rec fem, iliopsoas, weak glute med are all factors.
As a PT do we treat pain or impairment and why?
Since impairment is the caus eof pian, the primary goal of physical therapy should be to correct the impairment rather than the pain.
What are the three classifications of movement including joint manipulation and their components?
Classical movement- active, passive
Accessory Movement- component motion, joint play
Manipulation- distraction, non-thrust, thrust
What is another term for classical movement and give examples?
osteokinematic
forward bending, side-bending, backward bending, rotation
According to the Guide to Physical Therapy Practice what is the definition of manipualtion/mobilization?
"A manual therapy technique comprised a continuum of skilled passive movement to the joints and/or related soft tissues that are applied at varying speeds and amplitudes, including a small amplitude high velocity therapeutic movement."
What are three components of pain and what do they represent?
1. Physical- actual tissue damage
2. Emotional- anxiety
3. Rational- patient's understanding
According to Paris what is definition of pain?
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in such terms of damage.
Kypholordosis can be casued from what tight muscle?
tight psoas
Flat back posture can be caused from what tight muscle?
hamstrings
With forward head posture what position is the atlas in?
posterior, becasue your cervical spine is in backward bending and the atlas folows the occiput.
Make sure you can name 5 out of the 10 clinical philosophies.
pg. 2, 3 out of FCO
When a patient presents with increased spinal tone in standing but in prone tone disappears what could this be indicative of?
muscle guarding around an instability or an unstable segment
What could an osteophyte within the spine indicate or lead to?
Osteophytes indicate instablity and are the body's method of trying to acieve stability. They can lead to myelopothy due to Sharpey's fibers on the annulus being irritated.
How do you know if a patient is presenting with a true spondylolisthesis or a small spinal process?
1. Have the patient lie prone with pillow under abdomen and observe for changes. If it changes it is an unstable spondylolistheses. If it does not change it is an anomaly or a stable spondylolisthesis.
2. Look at standing versus prone tone and shaking with AROM indicative of stable spondylolisthesis.
Describe the spondylolisthesis grading system for slippage?
- It is a fraction out of 5. Grade 1+ is where the sx begin to develop. Grade II is symptomatic.
If a patient shifts towards the side of pain what type of bulge is the indicative of?
medial disc bulge
If a patient shifts away from the side of pain what type of disc bulge is this indicative of?
lateral disc bulge
What are Paris's credentials?
PT, Ph.D., FAPTA
FNZSP, NZMTA (hon. life), IFOMT (founder+hon life) FAAOPMT, MCSP
 
Who is said to be the first to speak of manual therapy and physical therapy techniques?
hippocrates
Who coined the term “Orthopaedics”and what does it mean?
Abrose Pare
  in its original form means “straight child”
Who wrote the first book on manipulation and in what year?
Wharton Hood
1870 (*key date)
When did osteopathy first appear and by whom?
  Osteopathy came first on July 22, 1874 by an MD, Andrew Taylor Still
What is the 'Law of the Artery' and what does it refer to?
it was created by Andrew Taylor Still, applies to Osteopathy, and talks about the importance of proper blood supply to tissues and prober blood nutrition
Who founded chiropractic and when?
1896
DD Plamer and his son BJ Palmer
What is the 'Law of the Nerve' and what does it refer to?
the body will be healthy at all times provided the vital nerve forces are intact. Vital force is interrupted with vertebrae subluxation(although this cause is not supported by evidence)
this law refers to chiropractic
who wrote a book in 1934 that first addressed the role of facet joint planes and the need to manipulate them (although 'arthrokinematics' had not been coined yet)
Thomas Marlin
Who first took x-rays of joints after manipulation to show the effects such as gas within the joint?
Mennell
who was a believer in transverse friction to restart the inflammation process for healing.
Cyriax
Dermatome L2 corresponds to which anatomical area?
lateral thigh
Dermatome L3 corresponds to which coresponding anatomical area?
medial knee
Dermatome L4 corresponds to which coresponding anatomical area?
medial calf
Dermatome L5 corresponds to which coresponding anatomical area?
lateral calf
Dermatome S1 corresponds to which coresponding anatomical area?
lateral foot
Dermatome C4 corresponds to which coresponding anatomical area?
top of acromioclavicular joint/ upper trap
Dermatome C5 corresponds to which coresponding anatomical area?
lateral side of upper arm (deltoid)
Dermatome C6 corresponds to which coresponding anatomical area?
volar surface of 1st and 2nd digit of hand
Dermatome C7 corresponds to which coresponding anatomical area?
volar surface of 3rd digit of hand
Dermatome C8 corresponds to which coresponding anatomical area?
volar surface of 5th digit of hand
Dermatome T1 corresponds to which  anatomical area?
medial surface of lower forearm
Dermatome T2 corresponds to which coresponding anatomical area?
medial surface of arm
Myotome C3 corresponds to which muscular action?
lateral cervical flexion
Myotome C4 corresponds to which muscular action?
shoulder shrug
Myotome C5 corresponds to which muscular action?
elbow flexion
Myotome C6 corresponds to which muscular action?
wrist extension
Myotome C7 corresponds to which muscular action?
elbow extension
Myotome C8 corresponds to which muscular action?
thumb extension
Myotome T1 corresponds to which muscular action?
hand intrinsics
Myotome L2 corresponds to which muscular action?
hip flexion
Myotome L3 corresponds to which muscular action?
knee extension (quads)
Myotome L4 corresponds to which muscular action?
DF (ant. tib)
Myotome L5 corresponds to which muscular action?
extensor hallucis longus (toe extension)
Myotome S1 corresponds to which muscular action?
great toe flexion (FHL)
or
plantar flexion (gastroc/soleus)
Myotome S2 corresponds to which muscular action?
knee flexion (hamstrings)
Name 5 structures that can compress the spinal cord?
1. bosses and bars
2. ligamentum flavum
3. disc
4. posterior longitudinal ligament
 
If a patient presents with unlevel greater trochanters and unlevel pelvis in standing then upon sitting presents with both level greater trochanters and pelvis what pathology could contribute to this?
leg length discrepency
pronated foot
If a patient presents with unlevel pelvis and level greater trochanters in both standing and sitting what pathology could contribute to this?
-pelvic torsional rotation
-anomaly
-muscular imbalance
-scoliosis
-SI torsion/ rotation
If a patient presents with level greater trochanters and unlevel pelvis in standing then upon sitting presents with both level greater trochanters and pelvis what pathology could contribute to this?
-avascular necrosis (Legg-Calve Perthes Disease)
-asymmetrical femoral neck angle
-slipped femoral epiphysis
-DJD of hip
In the spine, what do flat areas indicate?
stiffness
-there will also be an area of compensation that must act as a hinge
What is 'functional motion'?
motions that are normally performed throughout the day (i.e. FB, BB, trunk rot)
-in fxn'l SB of the neck, the head follows the neck to look in front of the shoulder
what is 'non-functional' motion of the spine?
this applies to SIDE BENDING
it describes the motions are not normally performed (i.e. neck or trunk SB in the frontal plane)
What is considered the 'mid-cervical' region?
C2/3----->C6/7
Describe the 'rules of combined motion' concerning SB in the cervical spine
Fxn'l SB: causes rot to same side in midcervical and subcranial spines (due to facet planes)
non-fxn'l SB: causes rot to same side in the midcervical spine but rotation in the OPPOSITE direction in the subcranial spine
what is considered the 'subcranial' spine?
C0/1----->C1/2
lumbar and thoracic spine rotation and side bending occur to the ______ side.
OPPOSITE
rotation and SB always occur to the _____ side in the cervical spine
SAME
rotation produces SB to the ______ side in the subcranial spine
OPPOSITE
(rot R and SB L to keep head from cocking)
concerning the subcranial spine, how does the atlas move in relation to the occiput?
the atlas follows the occiput
(moves posterior in BB, anterior in FB, L in L SB and R in R SB)
What are some symptoms of subcranial instability due to a torn subcranial ligament?
what causes these symptoms?
trouble speaking and difficulty swallowing
this is due to compression of the hypoglossal nerve
What occurs in midcervical FB?
-facets translate up and fwd (40% displacement)
-lateral interbody articulations translate anteriorly (more than lumbar spine due to von lushka jnts)
-intervertebral discs bulge anteriorly, flatten posteriorly
-spinal canal lengthens
-canal also narrows but volume remains the SAME
describe the mechanics in mid-cervial BB
-facets translate down and back
-at end range the facet tilts and gaps superiorly
-lateral interbody joints translate POSTERIORLY
-the spinal canal NARROWS and shortens
-disc and lig flava bulge into the spinal canal
-each vdrtebrae steps back on the one below
you have an elderly woman as a pt with an MD dx of MS due to decreased balance, gait, strength, etc. She presents with forward head posture with her cervical spine in constant extension. What do you think could be causing this and what else do you test to
she may have buckling of the lig flava with calcification or bone spurs causing central stenosis and myelopathy.
you may test babinski and clonus to see CNS pathology
how do the mechanics differ in a healthy disc vs. a nonhealthy disc in BB?
in a healthy disc the NP translates anteriorly
in a nonhealthy disc the NP follows the last of least resistance sending it further backward
centralization of pain must NOT be associated with __________
centralizing the NP
Since putting the nucleus back into the disc is not possible, how does BB then relieve pain?
1.gate control theory: firing of mechanoreceptors in post. annulus and facets will gate pain
2. elevates the H2O content of the disc by repetitive motion (makes it less acidic)
3. mobilizes the facet joints more than FB!
4. promotes circulation flushing away chem irritants
5. relieves the fear of movement
6. neural tension is reduced due to slackening of cauda equina
7. over time the disc protrusion looses proteoglycans and its ability to attract H2O and thus shrinks
 
list characteristics of normal motion
happens smoothly regardless of speed
relaxation of antagonist
full range-according to body type
pain free
normal strength of muscles
PROM>AROM
what are the characteristics of abnormal motion?
limited range
unwillingness to move
pain during or at end range
painful arc
compensatory or 'trick' movements
signs of instability (see other card)
in the lumbar spine, if the LEFT facet were limited, what patterns may emerge?
FB=deviation to the left
BB=deviation to the right
SBR=limited
RL=limited
SBL=free
RR=free
**what is the myofacial pattern of the lumbar and cervical spine?
lumbar=FB limited all other mvmts are relatively free
cervical=no consistent pattern; depends on muscles involved
how do you know if restrictions in lumbar movements are myofacial or arthrokinematic?
if upsliding in SB is ok but the spine stays flat in FB its not the facets but erector spinae fascia that is tight
what are the clinical signs of instability?
1. Hx or demonstration of tissue relaxation/creep
-inability to sit for long periods
-discomfort increases as the day progresses and relieved by mvmt or rest
2. increased muscle tone while standing
3. presence of a 'step' or rotation (spondylolysthesis, retrolisthesis, or spondylolysis)
4. disappearance of muscle tone, step or rotation in prone lying
5. shaking with FB
6. difficulty in coming upright from FB
7. grade 5 or 6 on passive motion palpation
8. radiological evidence of motion studies of FB and BB showing incr. angulation btwn vertebrae and more imprtantly=excessive translation
what are u observing for in lumbar and thoracic movement?
smooth transition of motion
increase of the thoracic kyphosis
loss of reversal of lumbar lordosis
role of the hip
signs of instability
What are the patterns of restriction of the facet capsular pattern in the cervical spine (T3/4 and up) if the L facet were limited
FB=possible deviation L
BB=deviate R
SBR=restricted
RR=most restricted
SBL=relatively free
RL=relatively free
describe the mechanics of motion in the cervical spine
FB=US B
BB=DS B
SBR= DS R, US L
RR= DS R, US L
SBL= DS L, US R
RL=DS L, US R
(SBR and RR are 'coupled motions')
(less consistent than lumbar spine)
functional and nonfunctional SB and ROT are _______in the cervical spine
the same
what are the boundries of cervical spine?
T3/4 and above are cervical (no gapping)
T3/4 and below move as lumbar
/ 171
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