Kinesiology

The Spine

Spinal Column Structure

Base of support.
Link between upper and lower extremities.
Protects spinal cord.
Stability vs. mobility

Example: cervical vs. thoracic spine

5 Regions of Vertebral
Column
Cervical
Thoracic
Lumbar
Sacral
Cocygeal
33 bones and 23 disks

Curvatures Viewed Laterally

Prior to birth C-shaped.
4 distinct curves in an adult.

Cervical Lordosis
Thoracic Kyphosis

Lumbar Lordosis

Spinal Motion
Spinal movement is the combination of:

Intervertebral joints
Facet joints

Intervertebral Joints

Intervertebral Disc
Intervertebral disk make up 20-30% of the
height of the column and thickness varies
from 3mm in cervical region, 5mm in
thoracic region to 9 mm in the lumbar
region.
Ratio between the vertebral body height and
the disk height will dictate the mobility
between the vertebra

Highest ratio in cervical region allows for

motion
Lowest ratio in thoracic region limits motion

Disc Structure
Nucleus Pulposus (NP) is located in the center
except in lumbar lies slightly posterior.

Gelatinous mass rich in water binding PG

(proteoglycan) AKA (glycoaminoglycos) GAGprotein molecule.
Chondrotin-4 sulfate in PG molecule gives the disc a
fluid maintaining capacity (hydrophyllic) decreases with age.
Hydration of the disc will also decrease with
compressive loading - this loss of hydration
decreases its mechanical function.

Disc Structure
80-90% is H2O decreases with age.
Disc volume will reduce 20% daily (reversible)
which causes a loss of 15-25 mm of height in
the spinal column.
Acts as a hydrostatic unit allowing for uniform
distribution of pressure throughout the disc.

Disc Structure
Compressive stresses on the disc translate into
tensile stresses in the annulus fibrosis

This makes the disc stiffer which adds stability and

support to the spine.

Bears weight and guides motion.

Avascular - nutrition diffusion through endplate.

Annulus Fibrosis
Collagen arranged in sheets called lamellae (outer layers).
These lamellae are arranged in concentric rings -10-12
layers that lessen in number with age and thicken (fibrose).
Enclose the nucleus and oriented in opposite directions at
an angle of 120 degrees (or 45-65 degrees).
Controls the tensile loading from shear, accessory motions
in the anterior compartment and disc forces which can be
up to 5x the external compression force.

Annulus Fibrosis
Mostly avascular and lacking innervation
but the outermost layers are probably
innervated (sinovertebral nerve).
Thickest anteriorly.
Outermost 1/3 connects to vertebral body
via Sharpies fibers.
Outer 2/3 connect to the end plate.

Disc Pathology - Herniation

Highest incidence at C5-6, C6-7, L4-5, and

L5-S1.
Disc herniation

Disc protrusion or bulge - contained

Annulus intact.
Localized usually lateral
Diffuse usually posterior
Prolapsed not contained
Annular fibers disrupted inner layers

Extrusion - migration through all layers

Longitudinal Ligaments
Supraspinous

Anterior longitudinal

Posterior longitudinal

Ligamentum flavum (elastic)

PLL diverts herniation posteriolaterally

Posterior Structures (Elements) of

Motion Segment
Pedicles and lamina form the neural arch.
Facet joints between the superior and
inferior articulating surfaces.
Transverse and spinous processes.
Interspinous and supraspinous ligaments.
Ligamentum lavum.
Intervertebral foramina.

Facet Joint
Articulation between
the superior (concave)
and inferior (convex)
facets.
Guide intervertebral
motion through their
orientation in the
transverse and frontal
planes.

Facet Joint Capsule

Limit motions.
Strongest in thoracolumbar and
cervicothoracic regions where the curvatures
change.
Resist flexion and undertake tensile loading
in the superior portion with axial loading or
extension.
Resists rotation in lumbar region.

Intervebral Foramina
Exit for nerve root.
The size is dictated by the
disc heights and the pedicle
shape.
Will lose space with
osteophytic formation,
hypertrophy of ligaments
and loss of disc height with
aging lateral stenosis.
Decreases by 20% with
extension and increases
24% with flexion

Spinal Stability
The columns ability to react to multiple
forces placed on it.
Degeneration increases instability.
Body reacts to restore through fibrosus and
osteophytic changes.

Types of Segmental Loading

Axial Compression
Bending
Torsion
Shear

Axial Compression
Caused by gravity, ground reaction forces, muscle
contraction and ligaments reaction to tensile
forces.
Intradiscal loads can range from 294N to 3332N
depending upon position.
Most load in anterior segment, posterior can load
from 0-30% depending upon segments position.
Compression at the disk causes tension at the
annulus, changing the angle of the fibers and
increasing the stability.

Axial Compression (contd)

Creep will occur in the disc, will be larger
with increased force and aging.
5-11% of H2O is lost through creep.
Creep is rapid 1.5-2mm in 10 min.
Plateaus at 90 minutes.

Bending
Combination of compression, shear and
tensile forces on the segment from translation.
Bending into flexion will be resisted by
posterior annulus, PLL and the facet capsule
and anterior compressive forces on the
anterior structures causing disc displacement.
For extension posterior compressive forces in
anterior segment and there is a tensile load in
facet capsule and ALL.

Torsion
Caused by axial rotation and coupled motions.
Stiffness may increase due to facet
compression with certain motions i.e., flexion
increases torsional stiffness at L3-4.
Annulus fibrosus resists, 1/2 fibers CW other
1/2 CCW facets may help depending upon the
orientation (resists in a tensile manner).
When combined with flexion the amount of
force required for tissue failure is decreased.

Shear
Facet joint resists especially in the lumbar
area.
Annulus will undergo some tensile forces
depending upon direction and the fiber
orientation or angle.
Discs also resist but if creep occurs - the
facet may undergo more loading.

Mobility
Amount and direct of motion in a segment is
determined by:

Vertebral body/disc size.

Facet orientation frontal vs. sagittal.

Flexion
Superior vertebra will anterior tilt and forward
gliding will occur:

Widening the intervertebral foramina 24%.

Adds compressive forces on the anterior aspect of
the anterior segment moving the nucleus pulposus
posteriorly.

Tensile forces placed on posterior annulus,

flavum, capsule and PLL.
Central canal is widened
Rationale for some of Williams flexion
exercises

Extension
Superior vertebra will tilt and glide
posteriorly and the intervertebral foramina
narrowed up to 20%.
The central canal is also narrowed.
Nucleus pulposus moves anteriorly

Lateral Flexion
Superior vertebra will translate, tilt and
rotate over inferior - direction will differ.
Concavity towards, convexity opposite
Tensile forces on convexity, compressive
forces on concavity
Extension in ipsilateral facet.
Flexion in contralateral facet.

Rotation
Accessory motions are like lateral flexion
due to same coupling in cervical and upper
thoracic spine.
Exception with lower T/S and L/S in neutral
coupling then opposite (in most references).
If the motion segment is flexed or extended
spine (in most references) the coupling will
be the same.

Regional Structural and

Functional Differences

Differences are apparent due to connection

requirements, sacral, upper C-spine, all
junctions
Vertebral body size increases with support
requirements.
Cervical, thoracic,lumbar, and
sacral/cocygeal.

Cervical
CO - occipital
C1 - Atlas
C2 - Axis
C3-6 - general basic
structure

Cervical Region Function

Mobility > Stability.
Upper cervical unit
C0-2
Lower Cervical unit
C2-7

C0-1
C0 occiput containing the occipital
condyle convex.
C1 - no body, disk and spinous process allows
for free space and a large neutral zone and
cord protection - this means more motion.
Lateral facets of CO on C1 - concave C1 on
convex CO - flex/ext or nodding and minimal
to no lateral flexion/rotation.

Dens

C1-2
2 facets laterally and 1 medially with dens and
anterior arch

transverse ligament helps control (C1 on C2 anterior

displacement), stabilizes allows nodding
also provides cartilaginous surface as does the alar
ligament - limits flex/ext so right rotation requires left
lateral facet to slide anterior and right lateral facet to slide
posterior so rotation is coupled with extension.

Can account for up to 50% of rotation in the neck

and most of the initial ROM.

C2-7
50% wider than they are deep.
Transverse process holds foramen for
vertebral artery, vein and plexus, and grove
for the spinal nerve.
Facet orientation is roughly 45 degrees(3565) in the transverse plane w/ loose capsule allows for motion in all planes and more
rotation and lateral flexion than other regions.

Thoracic Spine Function

Articulation for the ribs
Least mobility
Increasing load bearing
Lat flex flex/Ext

Thoracic Spine Body

T1 - similar to cervical in (C7a).
Normally the vertebral body equals width and depth.
The ratio of disc diameter to height is highest. This
will:

Decrease tensile forces

Decrease possibility of disc injury

Posterior aspect becomes thicker as you go lower ribs bigger (articulates) and more compressive forces.
End-plates become larger (higher compressive forces)
as you go caudally.

Thoracic Spine
Less flexible due to rib articulation, smaller disc
to body ratio, spinous process.
Flavum and ALL are thicker; facet capsule less
flexible.
Upper thoracic spine facet orientation

Limits flexion extension - 60/20 transv/front

Allows coupled lat/rot. (rot of spinous process to the
convex side)

Facets are more sagittal in T9-12 to allow flex/ext

and rot of spinous process will be toward
concavity (lumbar coupling).

Thoracic Spine
Rib articulation consists of 2 articulations to
the thoracic vertebra

Anterior surface of the lateral process

Lateral aspect of the vertebral body.
Bucket handle motion of the ribs with breathing.
Extension and contralateral lateral flexion ribs
separate.
Flexion and lateral flexion ipsilaterally
compresses ribs.

Thoracic Spine
Scoliosis will cause a rib
hump.
Combination of tranverse
plane rotation and frontal
plane sidebend
contralateral coupling.
Convex side will occur
on the ipsilateral rotated
side causing hump.

Lumbar Spine
Most load bearing
structures in the
skeletal system
Sagittal plane motion
Largest body/disc,
lamina and pedicles
short and thick for
load bearing.

Lumbar Spine
L5 transitional, wedge shape of body and disc
Anterior > posterior.
L5-S1 most flexion extension.
Coupling of motion - right lateral flexion will
result in right sidebend and left rotation of
vertebral body (when L/S in neutral)

Spinal Musculature
Mobility vs. Stability
Slow twitch SO vs. fast twitch FOG
Energy storage
Consider the line-of-pull of all spinal
muscles

Spinal
Muscles

Common Theme

Small angle of insertion

Therefore:
Rotary component

Compressive component

Common Theme

Small angle of insertion

Therefore:
Rotary component

Compressive component

When are active vs. passive exercised indicated? When are they not?

Hip Flexors &

Abdominals

General Comment Regarding

Function
Contracture vs. contraction

General Comment Regarding

Function
Contracture of hip
flexors and effect on
lumbar spine

General Comment Regarding

Function
Abdominals

Pelvic stability/balance
Guy-support system