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Therapeutic Kinesiology:Musculoskeletal Systems, Palpation, and Body Mechanics
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Description
Chapter 14 Notes
Transcript
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
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