KINESIOLOGY OF BACK AND SPINE

At birth all are kyphotic posture

Normal kyphosis 20-30 degrees
33 Vertebral column at birth
23 Vertebral column at adulthood

Primary curves (thoracic and sacral segment)

Secondary curves (cervical and lumbar segment)

Functions of the Spinal Column

To
To
To
To
To

provide stability and maintain an erect posture.

allow mobility of the head, neck, and trunk in space.
support and transmit loads from the upper boy to the pelvis.
absorb shock.
protect spinal chord.

Components of the Spinal Column

Bony
o
o
o
o
o

structure: 32-33 vertebrae

7 cervical vertebrae
12 thoracic vertebrae
5 lumbar vertebrae
5 fused sacral vertebrae: sacrum
3-4 coccyx

Cervical Spine
3 atypical vertebra
4 typical vertebra
Joints of Luschka it refers to the uncovertebral joint of the cervical
spine. Present only in the cervical spine. (C3-C7)
Thoracic Spine
It has a 12 vertebrae
Heart shape vertebral body
Spinous process is directed downward and overlaps each other posteriorly.
Costotransverse joint are formed through union of the ribs and the transverse
processes of the vertebra of the same level.
Lumbar Spine
5 pairs and a total of 10 facet joints
Functions:
Protect organs
Support head
Transmits force between the upper and lower extremities
Provides stability and mobility for locomotion and other activities.
.

Joint structure
o Lumbar area
Facet joint: (apophyseal or zygapophyseal joint)
Intervertebral joint: fibrocartilage joint
o Thoracic area
Facet joint: (apophyseal or zygapophyseal joint)
Intervertebral joint: fibrocartilage joint
o Thoracic area
Facet joint: (apophyseal or zygapophyseal joint)
Intervertebral joint: fibrocartilage joint
Uncovertebral joint (joint of von Luschka) : fibrocartilage joint.
Atlanto-occipital joint
Atlantoaxial (AA) joint
Anterior atlantoaxial joint

Spinal Curvature

At birth, the spinal column is convex backward (kyphosis)

Dividing into 2 columns (anterior and posterior) or 3 columns (anterior,
middle and posterior)

Anterior column
o Vertebral body
o Intervertebral disc (IVD)
o Incinate process
o Intervertebral joint
o Incovertebral joint
o Anterior atlantoaxial joint
Function of Anterior portion
Weight bearing
Shock absorption
Mobility in all direction
Posterior column
o Intervertebral foramen
o Pars interarticularis
o Superior articular facet
o Transverse process
o

Function of Posterior portion

Protection of the spinal cord
Guidance and limitation of motion and elongated processes to
increase the leverage of muscle of the trunk and extremities.

JOINTS OF THE SPINE

1. Facet Joint

Synovial joint
Components
o Plane inferior articular process of the upper vertebra
o Plane superior articular of the lower vertebra
Joint type : plane
o 6-direction motions when moving together
Flexion/ extentsion
Sidebending to the left / right
Rotation to the left / right
o Arthrokinematic movements
Anterior glide with flexion
Posterior glide with extension
o Closed-packed position : maximum extension
Orientation of Facet Joints
o AO joint : anterior, inferior, and medical
AA Joint : nearly horizontal
C2-C7 : 20-45 from transverse plane and 20 posterior to
frontal plane
Lumbar: 90from transverse plane and 45 posterior to
frontal plane

2. Intervertebral Joint
Fibrocartilage
Structure
o Annulus fibrosus
It is responsible for tensile strength when the spine is
distracted.
o Nucleus pulposus
It is responsible for compressive force and contains type II
collagen
o Cartilaginous end plate
It lie between the nucleus and vertebral bodies
Functions
o To bear and distribute loads
o To restrain excessive motions
o To allow slight motions
Motions
o Flexion
Nucleus pulposus moving posterior
Anterior fibers compressed
Posterior fibers stretched
o Extension
Nucleus pulposus moving anterior
Anterior fibers compressed

Posterior fibers stretched

Rotation
Nucleus pulposus to opposite
Annular fibers under shear stress

3. Occipito-Atlantal joint (OA Joint) or Atlanto-Occipital Joint (AO Joint)

Proximal component : concave superior facet of atlas

Distal component : convex occipital condyles
Osteokinetic motions
o Head flexion (nodding)
o Head extension
o Slight sidebending with rotation to the opposite side
Accessory movements
o Anterior glide with head extension
o Posterior glide with head flexion

4. Atlanto-Axial Joint (AA Joint)

Proximal component : convex superior facet of axis
o Distal component : convex inferior facet of atlas
o Osteokinetmatic motions : head rotation

Anterior Atlanto-Axial Joint

o Synovial joint
o Anterior transverse ligament
o Motion : slight flexion / extension / rotation

5. Uncovertebral Joint (Joint of von Luschka)

Fibrocartilage
Structure
o Unciform process, uncinatr process, semilunate process,
neorocntral lip
o Posterolateral edge of the superior rim projects upwards to
articulate with the body above
o Antero-inferior margin of the body projects downwards.
LIGAMENTS
Ant. Longitudunal Ligament
o Biggest and strongest lig. In the vertebral column
o Runs from sacrum to C2
o C2 to occiput it changes its name to Ant. Atlanto occipital ligament and
ant. Atlanto axial ligament
o Only ligament that limits trunk extension
Post. Longitudinal Ligament
o Half of strenght of ALL
o Runs from sacrum to C2
o C2 to occiput changes its name to tectorial membrane

o Prevent flexion
Ligamentum Flavum
o Runs from lamina of sacrum to C2
o C2 to occiput in changes its name to Post. Atlanto occipital lig. And
post. Atlanto-axial lig.
o Tight in all position of the trunk
Supraspinatus Ligament
o Runs to spinous process of sacrum to C6
o C6 to occiput changes its name to ligamentum nuchae
Intertransverse Ligament
o Connects transverse process to another process
o Prevent flexion
Interspinous Ligament
o Prevent lat. Bending and flexion of the trunk

DERMATOMAL LEVEL
Nerve
Dermatome
Root
C1
Vertex of skull
C2
Temple, forehead, occiput
C3
Entire neck, posterior cheek, temporal
area, prolongation forward under
mandible
C4
Shoulder area, clavicular area, upper
scapular area
C5
Deltoid area, anterior aspect of entire arm
to base of thumb
C6
Anterior arm, radial side of hand to thumb
and index finger
C7
Lateral arm and forearm to index, long,
and ring fingers
C8
Medial arm and forearm to long, ring, and
little fingers
T1
Medial side of forearm to base of little
finger
T2
Medial side of upper arm to medial elbow,
pectoral and midscapular areas
T3-T12
T3-T6, upper thorax; T5T7, costal margin;
T8T12, abdomen and lumbar region
L1
Back, over trochanter and Groin
L2
Back, front of thigh to knee
L3
Back, upper buttock, anterior thigh and
knee, medial lower leg
L4
Medial buttock, lateral thigh, medial leg,
dorsum of foot, big toe
L5
Buttock, posterior and lateral thigh,
lateral aspect of leg, dorsum of foot,
medial half of sole, first, second, and third
toes
S1
Buttock, thigh, and leg posterior
S2
Same as Sl
S3
Groin, medial thigh to knee
S4
Perineum, genitals, lower sacrum

MYOTOMAL LEVEL
Spin
al
Nerv
e
C1
C2
C3
C4
C5
C6
C7
C8
T1
L2
L3
L4
L5
S1
S2

Action

Neck Flexion
Neck Flexion
Neck Lateral Flexion
Shoulder Elevation
Shoulder Abduction
Elbow Flexion & Wrist Extension
Elbow Extension & Wrist Flexion
Thumb Extension
Finger Abduction
Hip Flexion
Knee Extension
Ankle Dorsiflexion
Great toe Extension
Ankle Plantarflexion, Hip
Extension, Ankle Eversion
Knee Flexion

Kinematics of the Spine

Coupled Motions between Sidebending and rotation

Sidebending with ipsilateral Rot (Lysell, 1969)

Ipsilateral facets glide down and backward (extension)
Contralateral facets glide up and forward (flexion)
Axis : close to ipsilateral facet
o Compensatory derotation at AA joint for the pure
horizontal motion
o Compensatory sidebending at AO joint for pure frontal
plan motion

MUSCLES AROUND THE SPINE

1. Muscles for Trunk Flexion

Abdominal muscles
o Rectus abdominis
o Obliquus extemus abdominis
o Obliquus intemus abdominis
o Transverse abdominis
2. Muscles for Trunk Extension
Erector spinae
Deep layer muscles
o Multifidus
o Rotator
o Interspinalis
o Intertransversarii
o
3. Muscles for Trunk Side bending
Anterior and posterior muscles at the same side contract together
4. Muscles for Trunk Rotation
Ipsilateral obliquus intermus abdomis
Contralateral obliquus extemus abdomis
Multifidus
5. Muscles for Neck Flexion
Stemocleidomatoid flexes lower cervical but need assistance of
flattening cervical lordosis from
o Longus capitis
o Rectus capitis anterior
o Rectus capitis lateralis
o Supra and infra-hyoid muscles
6. Muscles for Head Tension
Suboccipital muscles
o Rectus capitis posterios major
o Rectus capitis posterior minor
o Obliquus capitis superior
o Obliquus capitis inferior
SPINE STABILITY
Factor Affecting Stability of the Spine

Ligaments
o Anterior longitudinal ligament (ALL)
o Posterior longitudinal ligament (PLL)
o Ligamnetum of flavum
o Intersoinous ligament
Muscles : dynamic