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. What would you like to do?
What does bipedal standing sacrifice?
BOS..makes us less stable, but more functional
requires more weight be borne by the vertebral column, pelvis, and lower extremities
Segments are aligned so that the effects of what are minimal?
gravity and stress on soft tissues
What does the vertebral column help provide?
- base of support for the head and internal organs
- base of attachment for ligaments, bones, muscles, rib cage, and pelvis
- link between upper and lower extremities
- protection for spinal cord
What do the curves of the spine help to do?
- decrease shock
- maintain balance in an upright position
- help protect the vertebral column from fractures
When standing, what muscles are working to hold us upright?
gastrocnemius and soleus
What should the plumb line fall thru from a lateral view?
- ear lobe
- shoulder joint
- just anterior to bodies of thoracic vert.
- through S2
- slightly posterior to hip joint
- through greater trochanter
- slightly ant. to midline of knee, but posterior to patella
- slightly anterior to lateral malleolus
What should the plumb line fall thru from a posterior view?
- head upright
- symmetrical shoulder height
- position of scapula from s.p. are even
- straight verterbral column
- symmetrical height of iliac crest and PSIS
- no varus or valgus of feet
- no pronated or supinated feet
What should the plumb line look like from an anterior view?
- head in midline and upright
- nose, sternum, umbilicus line midline
- heights of iliac crest and ASIS even
- position of patella normal
What motions are available at the cervical spine?
- extension (hyperextension)
What motions are available at the thoracic spine?
roation and flexion/extension
What motions are available at the lumbar spine?
What are some characteristics of increased lumbar lordosis?
- anterior pelvic tilt
- abdomen protrudes infront of plumb line
- tightness of hip flexors
sway back...pelvic segment forward, thoracic segment backward
What are some characteristics of decreased lumbar lordosis?
- posterior pelvic tilt
- hamstring tightness
What is another name for straight back?
decreased thoracic kyphosis
What are some characteristics of forward head posture?
- head lies anterior to plumb line
- excessive cervical lordosis
- tightness of cervical extensors muscles
What are some characteristics of increased thoracic kyphosis/rounded shoulders?
- shoulder lie ant. to plumb line
- weakness in thoracic spinal extensor musculature, rhomboids, middle trap, tightness of pec mm. and subscap. mm.
What are the two types of scoliosis?
lateral SB accompanied by rotation
What type of scoliosis is caused by muscle imbalances or leg length discrepancies, and it goes away with forward bend?
What type of scoliosis is caused by structural changes, and it doesnt straighten out with forward bending (rib hump)?
How are scoliosis conditions named?
direction of convexity
if more than one curve is present, the superior segment is named first
What are some postural changes associated with scoliosis?
- unequal waist angle
- unequal shoulder height
- rib hump
- unequal pelvic height
What does fryettes law state?
SB and rotation is a coupled motion in the spine, they must happen together
What can cause a protracted/retracted scapula?
- musculature imbalance
The effects of improper posture can cause what?
- elongation of structures that have been subject to tension (stretching..wolfes law)
- weakening of elongated muscles (disturbance of length/tension relationship)
- weakening of elongaed ligaments (loss of passive resistance)
- adaptive shortening of structures held in shortened position
- decreased ROM due to restriction caused by shortened structures
- maintenance of faulty posture by shortened structures (stuck in the position)
- degeneration of articular cartilage due to abnormal weight bearing
*usually anatagonists of the elongated structures are shortened
What is the loss of motion/decreased ROM?
What is a defect in the lamina, common in lumbar region, but can occur anywhere?
What is a forward slippage of a vertebra leading to decreased joint space?
avoid extension motions, flexion is better
How do you perform a cervical compression test?
- press down on top of pt head while sitting or lying down
- compression may reproduce pain referred to the upper extremity from the cervical spine, and help locate the neurological level of existing pathology
How do you perform a cervical valsalva test?
- have pt hold breath and bear down as they were having a BM
- tests the intrathecal pressure
- if a herniated disc or tumor is present is the cervical canal, the pt may develop pain in the cervical spine secondary to the increased presure
How do you perform a cervical adson test?
- take radial pulse, continue to feel pulse, abduct, extend, and ER arm
- instruct to take a deep breath and turn head toward the arm being tested
- if theres a compression of the subclavian artery, you will feel a marked diminution or absence of radial pulse
subclavian artery can be compressed by an extra cervical rib or tightened scalenus m.
How do you perform a lumbar straight leg raise?
- lay supine, lift leg upward by supporting at calcaneous, keep knee straight
- if painful, must determine if problems are in sciatic nerve or bc of hamstring tightness
- HS tightness-only posterior thigh, sciatic n.- extends all the way down the leg
- at the point where the pt exeperiences pain, lower leg slightly and then DF the foot to stretch the sciatic n. and reproduce sciatic pain (if no pain with DF, pain is probably from HS)
How do you perform a lumbar valsalva maneuver?
- have pt bear down like having a BM
- increased intrathecal pressure
- used to determine pathology of disc
During lifting, the back acts like a lever arm with the fulcrum located where?
What are the rules for lifting?
- dont bend, lift, and twist in combination
- plan lift before performing
- dont jerk
- maintain good posture (pelvic neutral)
- get close, and stay close
- stagger your stance when reaching
What would you like to do?
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