Download A primary spine stabilizer

Chapter 10
Thoracic and Lumbar Spine
Lindsey E. Eberman, MS, ATC, LAT
Curves in
the Spine
Cervical SpineLordotic, greatest
ROM
Thoracic SpineKyphotic, greatest
protection of spinal
cord at expense of
ROM
Lumbar SpineLordotic, equal balance
between protection
and ROM
Characteristics of Vertebrae
Joints

Costovertebral Joint


Zygopopheseal Joint


Rib and thoracic vertebrae
Superior and inferior articulating facets
Intervertebral Joint

Vertebral bodies
Ligamentous Support
Ligament Name
Description
Anterior Longitudinal Ligament (ALL)
A primary spine stabilizer
About one-inch wide, the ALL runs the
entire length of the spine from the base of
the skull to the sacrum. It connects the
front (anterior) of the vertebral body to the
front of the annulus fibrosis.
Posterior Longitudinal Ligament (PLL)
A primary spine stabilizer
About one-inch wide, the PLL runs the
entire length of the spine from the base of
the skull to sacrum. It connects the back
(posterior) of the vertebral body to the back
of the annulus fibrosis.
Supraspinous Ligament
This ligament attaches the tip of each
spinous process to the other.
Interspinous Ligament
This thin ligament attaches to another
ligament, called the ligamentum flavum
that runs deep into the spinal column.
Ligamentum Flavum
The strongest ligament
This yellow ligament is the strongest one. It
runs from the base of the skull to the
pelvis, in front of and behind the lamina,
and protects the spinal cord and nerves.
The ligamentum flavum also surrounds the
facet joint capsules.
Sacrum and Coccyx
Spinal
Nerves
Extrinsic Muscles
Intrinsic Muscles of the Spine
Muscle
Action
Iliocostalis Lumborum
B: Extension
U: Same side lateral bending
Iliocostalis Thoracis
B: Extension
U: Same side lateral bending
Longissimus Thoracis
B: Extension
U: lateral bending
Spinalis Thoracis
B: Extension
U: Same side lateral bending
Semispinalis Thoracis
B: Extension of thoracic and cervical spine
U: Opposite side rotation
Multifidus
B: Stabilization
U: Opposite side rotation
Rotatores
B: Extension, Stabilization
U: Rotation
History

Key Questions




ADLs
Time of day
Postural positions
Location of Pain

Pain radiating into extremities, peripheral
parasthesia (numbness)
 Impingement- pressure on a nerve root exiting the


Pain around PSIS, radiating pain into hip/groin


intervertebral foramen
Dural irritation- proximal to site of pain
SI joint pathology
Sciatic nerve dysfunction/irritation
 Piriformis spasm
History

Onset of Pain

Acute


Chronic


Patients may be capable of describing a
singular incident
Accumulation of repetitive stress,
macrotrauma
Insidious

Being a disease that progresses with few
or no symptoms to indicate its gravity
History

MOI

Direct blow


Hyperextension sports



Contusions
Gymnastics, Offensive line (FB),
Cheerleading, Diving, Crew (Rowing),
Weightlifting
Compressive forces
Shear forces
History

Consistency of pain

Constant
 No change in pain level with change in posture


Intermittent
 Symptoms inc and dec with repositioning


Chemical- Dural sheath irritation
Mechanical- Compression/stretching of nerve root
Bowel/Bladder signs

Incontinence or urinary retention
 Lower nerve root lesion (Cauda equina
syndrome)
 Spinal cord injury
History

History of spinal injury



Structural degeneration
Predispositions
Changes




Activity
 Level
 Intensity
 Duration
Surfaces
Footwear
 Training shoes
 Competition shoes
Sleeping location/habits
Inspection- General
Postural Malalignments
Frontal Curvature
Test for Scoliosis




Implications


Functional scoliosisdisappears during
flexion
Structural scoliosispresent at rest and
during flexion

Patient positionStanding with hands held
in front with arms
straight
Examiner- Seated in
front or behind patient
Procedure- Patient bends
forward, sliding hands
down front of legs
Positive testAsymmetrical hump
observed along lateral
aspect of thoracolumbar
spine and rib cage
Inspection- General

Gait


Altered running or walking gait
 Slouching
 Shuffling
 Shortened gait
Skin Markings

Cafe-au-lait spots
 Neurofibromatosis 1



Increased cell growth of neural tissues
Normally benign
Painful with pressure of local nerves
Inspection- Thoracic Spine

Breathing patterns


Bilateral comparison of skin folds


Irregular, shallow breathing
 Injury to T vertebrae, pressure on T nerve
roots, trauma to costal cartilage or ribs
Asymmetry, unevenness
 Bilateral muscle imbalance, kyphosis, scoliosis
Shape of chest

Vertebral rotation causing rib prominence
posteriorly
 “Rib hump”
Inspection- Lumbar Spine

General movement and posture



Lordotic curvature



Improper standing or sitting
Improper lifting mechanics
Reduced curve
 Acute pain, muscle spasm, hamstrings
tightness
Increased curve
 Hip flexor tightness, abdominal muscle
weakness
Standing posture

Lateral shift in trunk or pelvis
 Impingement
Inspection- Lumbar Spine

Erector muscle tone

Unilateral hypertrophy or atrophy
Weak muscles
 Poor, abnormal posture


Faun’s beard

Tuft or hair in lumbar or sacral spine

Spina bifida occulta
Palpations- Thoracic Spine
1.
2.
3.
4.
5.
6.
Spinous
processes
Supraspinous
ligaments
Costovertebral
junction
Trapezius
Paravertebral
muscles
Scapular
muscles
Palpations- Lumbar Spine
1.
2.
3.
Spinous
processes
Step-off
deformity
Paravertebral
muscles
Palpations- Sacrum and Pelvis
1.
2.
3.
4.
5.
6.
7.
8.
Median sacral
crests
Iliac crests
Posterior superior
iliac spine
Gluteal muscles
Ischial tuberosity
Greater trochanter
Sciatic nerve
Pubic symphysis
Palpations- Sacrum and Pelvis
1.
2.
3.
4.
5.
6.
Iliac crest
Tensor fascia latae
Gluteus medius
Iliotibial band
Greater trochanter
Trochanteric bursa
Palpations- Pelvis
1.
2.
3.
4.
5.
Pubis
Anterior superior
iliac sine
Anterior inferior
iliac spine
Sartorius
Rectus femoris
ROM- Goniometric Measurements


Patient positionstanding with
knees extended,
spine in neutral
position
Procedure



Initial- measure
distance between
C7 and S1
Motion- trunk fully
flexed or
extended
Final- measure
distance between
C7 and S1
ROM- Goniometric Measurements


Patient positionstanding with knees
extended and spine in
neutral position
Procedure



Fulcrum- Aligned over S1
SP
Stationary arm- Aligned
over median sacral crest
Movement arm- Aligned
with C7 SP
ROM- Goniometric Measurements


Patient position- seated
with feet firmly planted
on floor
Procedure



Fulcrum- Aligned over
the center of patient’s
head
Stationary armparallel to line formed
by iliac crests
Movement armparallel to line formed
by acromion processes