Therapeutic Kinesiology:Musculoskeletal Systems, Palpation, and Body Mechanics

Therapeutic Kinesiology Instructor Manual: Ch14 p.1 TK INSTRUCTOR MANUAL: CHAPTER 1 The Spine Chapter manuals include: Objectives Lecture Notes Suggested Classroom and Student Development Activities For other chapter-by-chapter resources, see: Key Term Quizzes Muscle Origin and Insertion Worksheets Muscle OIAs List by Chapter MyTest Test Bank For additional resources see “Teaching Tips and Tools”: 7 research-based learning principles for kinesiology courses in massage 5-step self-directed learning cycle for body mechanics courses Tools that build metacognitive skills: e.g., concept (mind) maps, grading rubrics, and self-assessments inventories OBJECTIVES List the three parts of the spine and the number of vertebrae in each part. Define and contrast kyphotic and lordotic curves and identify their locations in the spine. Name and describe the typical features of a vertebra. Demonstrate palpation of the spinal curves, spinous processes, and the lamina groove. Name and describe the two types of spinal joints and their supporting ligaments. Identify the normal range of motion in each part of the spine. Identify the origins, insertions, and actions of the three layers of posterior spinal muscles. Demonstrate the active movement and palpation of each posterior spinal muscle. Identify the trigger points and pain referral patterns of the posterior spinal muscles. Identify the origins, insertions, and actions of the abdominal muscles. Demonstrate the active movement and palpation of each abdominal muscle. Identify the trigger points and pain referral patterns of the abdominal muscles. LECTURE NOTES BONES OF THE SPINE General features An osteoligamentous column of 24 vertebrae Each vertebrae contributes to overall spinal motion Supported/mobilized by spinal and trunk muscles Twenty-four vertebrae with major sections Cervical: 7 vertebrae (C-1 to C-7) Thoracic: 12 vertebrae (T-1 to T-12) Lumbar: 5 vertebrae (L-1 to L-5) Spinal curves Lordotic curves in cervical spine and lumbar spine Kyphotic curve in thoracic spine Degree of curvature varies among individuals Overall curvatures affect position of sacrum Development of spinal curves Primary curve in newborn is kyphotic full-body flexion Cervical lordosis forms as infant lifts head Lumbar lordosis forms as infant changes levels to stand Bony landmarks of a typical vertebra Spinous process Two transverse processes Vertebral body Vertebral foramen Transverse foramen Pedicle Lamina Atlas: C-1 (first cervical vertebra) Convex condyles articulate with occiput Supports weight of cranium Ring-shaped, lacks spinous process Axis: C-2 (second cervical vertebra) Has peg-like projection called dens process Dens (ondontoid) process projects into atlas Spinal movement Lateral spinal flexion occurs in coupled motion Coupled motion: Motion that combines two actions (Figure 14.12) During lateral lumbar/thoracic flexion, spine rotates in same direction During lateral cervical flexion, spine rotates in opposite direction Flexion and extension of the spine During spinal flexion, cervical and lumbar curves flatten During spinal extension, thoracic curve flattens JOINTS AND LIGAMENTS OF THE SPINE Interbody (intervertebral) joints: Semimovable fibrocartilage joints Between intervertebral disk and adjacent vertebral body Situated along front of spine Minimal gliding motion at each segment Intervertebral disks: Dense fibrocartilage (4060% fluid) Made up of nucleus pulposus and annulus fibers Work under axial compression as shock absorbers Distribute and dissipate loads along spine Nucleus pulposus: Spherical gelatinous core of disk Annulus fibers: Concentric rings of fiber around pulposus Spinal disk compression and injuries Postural stresses and injuries cause disk deterioration Tears annulus fibers Squeezes fluid to side of disk Bulging disk: partial disk rupture Herniated disk: complete disk rupture Facet (apophyseal) joints: Small synovial plane joints Articulations between vertebral facets Move with nonaxial gliding motion Orientation of joint surfaces determines motion range Cervical facets oriented diagonally Thoracic facets oriented in frontal plane Lumbar facets oriented in sagittal plane Motion in cervical spine Cervical spine has greatest range of motion Can move freely in all directions Flexion: 4060 degrees Hyperextension: 4075 degrees Lateral flexion: 45 degrees to each side Rotation: 5080 degrees to each side Cervical spine has two functional units Cervical units can move in opposite directions Upper cervical unit: occiput, C-1, C-2 Lower cervical unit: C-3 to C-7 Cranial protraction Action of thrusting chin forward Upper unit hyperextends, lower unit flexes Example: forward head posture (FHP) Cranial retraction Action of pulling chin straight back Upper unit flexes, lower unit hyperextends Motion in the thoracic spine Greatest range of motion is rotation Flexion: 3040 degrees Hyperextension: 2025 degrees Lateral flexion: 30 degrees to each side Rotation: 30 degrees to each side Limited flexion and extension because of ribs Tendency toward excessive kyphosis Can develop chronic rotations in scoliosis Motion in the lumbar spine Have limited range in rotation Greatest range of motion is flexion Flexion: 50 degrees Hyperextension: 15 degrees Lateral flexion: 20 degrees to each side Rotation: 5 degrees to each side Chronic lumbar flexion can damage lumbar spine Because fluid in disk migrates posteriorly Stability of spine assessed with "waiter's bow" Spinal ligaments Extensive network of spinal ligaments Nuchal ligament Anterior longitudinal ligament Supraspinous ligaments Interspinous ligaments Posterior longitudinal ligament Ligamentum flavum Stabilizes and protects vertebral column MUSCLES OF THE SPINE Overview Paravertebral (posterior) Superficial: trapezius, latissimus dorsi, splenius muscles Middle paravertebral layer: erector spinae muscle group Deep paravertebral layer: transversospinalis Prevertebral (anterior) Cervical: scalenes, sternocleidomastoid, longus muscles, anterior suboccipitals Abdominals: rectus abdominis, obliques, transversus abdominis Miscellaneous: quadratus lumborum Splenius capitis and splenius cervicis Splenius capitis: Palpable bulge along length of posterior cervicals Splenius cervicis: Spasms cause stiff neck and headache Erector spinae Three segments in each group: capitis, cervicis, thoracis Spinalis: Most medial O: SPs of upper cervical and midthoracic vertebrae I: SPs of lower cervical, lower thoracic, and upper lumbar vertebrae A: Unilaterally assists thoracic and lower cervical extension, bilaterally assists lateral cervical and thoracic flexion and rotation Longissimus: Middle group O: Tendon along lumbar spine, sacrum, and iliac crest I: Lower ribs, TPs of thoracic and cervical spine, mastoid process A: Bilaterally extends spine, unilaterally generates lateral flexion and rotation of the spine Iliocostalis: Most lateral O: Sacrum and iliac crest I: Ribs and TPs of lower cervical vertebrae A: Unilaterally extends the thoracic and lumbar spine, bilaterally generates lateral flexion and rotation of thoracic and lumbar spine Transversospinalis Rotatores: Too small to palpate O: Transverse process of each vertebra I: Spinous process of each vertebra A: Assist spinal extension and rotation Multifidi: Important stabilizer; contraction fills lamina groove O: Sacrum and transverse processes of L-5 to C-2 I: Spinous processes of L-5 to C-2 A: Stabilizes posterior side of spine, assists spinal extension and rotation Semispinalis capitis: Stabilizer of neck, restrains flexion O: Transverse processes of T-6 to C-4 I: Between nuchal lines of occiput A: Extends neck, stabilizes cervical spine to restrain neck flexion Semispinalis cervicis and thoracis O: Transverse processes of T-1 to T-12 I: Spinous processes of C-4 to T-6 A: Bilaterally extends lower cervical and thoracic spine, unilaterally assists rotation of the lower spine Abdominal muscles Rectus abdominis: Prime flexor, relaxed in neutral spine O: Costal cartilage of 5th, 6th, and 7th ribs, xiphoid process I: Pubic crest and pubic symphysis A: Flexes the trunk, posteriorly tilts pelvis External oblique: Isolated contraction lifts and cinches waist O: External surfaces of lower eight ribs I: Anterior iliac crest, abdominal aponeurosis to linea alba A: Compresses abdominal viscera, bilaterally flexes spine, unilaterally side-bends spine and rotates trunk to opposite side Internal oblique: Both obliques stabilize lumbars during hip flexion/trunk rotation O: 10th to 12th ribs I: Iliac crest, thoracolumbar fascia, abdominal aponeurosis to linea alba A: Compresses abdominal viscera, bilaterally flexes spine, unilaterally side-bends and rotates trunk to same side Transversus abdominis: Primary SIJ and lumbar stabilizer O: Iliac crest, inguinal ligament, thoracolumbar fascia, internal surface of lower ribs I: Abdominal aponeurosis to linea alba A: Compresses abdominal viscera, stabilizes lumbar spine and sacroiliac joints Quadratus lumborum The "hip hiker" Often develops trigger points Unilateral spasm can cause extreme lumbar pain Stabilizes lower ribs during inhalation O: Posterior medial iliac crest I: Transverse processes of L-1 to L-4 and 12th rib A: Unilaterally side-bends the lumbar spine or hikes the hip, assists forced exhalation during coughing SUGGESTED CLASSROOM AND STUDENT DEVELOPMENT ACTIVITIES PROVIDE AN OVERVIEW OF THE CLASS Before class, write a short schematic overview of the class on the board, then go over it at the beginning of class. For example: Today's class covers: Bones of spine Joints and ligaments Muscles of spine Activities: Review, lecture and assessments, palpation exercises, recap SPINAL FLEXION AND HYPEREXTENSION ASSESSMENT Begin this exercise by discussing the markers of normal spinal flexion and hyperextension (see p. 447). Demonstrate this assessment first on a volunteer. Assess the following elements: Where the spine is rigid and lacks flexion or hyperextension. Where the spine is hyperflexible and tends to bend and seemingly hinge. When hiked or protracted shoulders cause hyperflexibility in the thoracic spine. When students retract the shoulders or drop the head behind the body in hyperextension. Where the spinal muscles are adaptively shortened. Where the spinal muscles are stretch-weakened. When hip inflexibility causes hyperflexion in the lumbar spine. Have students works in pairs, with one student observing while the other student gets into a position of spinal flexion (see Figure 14.13a). Instruct the observer to give the student in flexion both verbal and tactile feedback about the position of flexion. Repeat the same process with one student in the cobra pose of hyperextension (see Figure 14.13b). Switch roles and repeat step b. Bring the students back into a large group and discuss the findings. Also discuss what kind of body would restore a continuity of tone and movement to the spine, identifying where it needs more motion, and where it needs stabilization. OBSERVATION EXERCISE: Spinal movement In forward bending/rolling down to check lumbar pelvic rhythm. In seated pelvic rock to check base of support (see "Seated Pelvic Rock" on p. 379). PALPATION EXERCISES The vertebrae (p. 444) Splenius capitis and splenius cervicis (p. 461) Erector spinae: spinalis, longissimus, iliocostalis (p. 465) Transversospinalis: multifidi and semispinalis capitis (p. 468) Rectus abdominis, obliques, and transversus abdominis (p. 475) Quadratus lumborum (p. 479) Self-care exercises Arcing exercise for spinal movement (p. 451) Waiter’s bow exercise for neutral spine (p. 455) Stretching the posterior spinal ligaments (p. 457) Correcting a lumbar swayback with lumbar multifidus training (p. 469) Stretching and strengthening the spinal extensors (p. 470) © 2013 by Education, Inc. Foster, Instructor Resources for Therapeutic Kinesiology