Lindsey E. Eberman, MS, ATC, LAT

Chapter 10Thoracic and Lumbar Spine

Curves in the Spine

Cervical Spine- Lordotic, greatest ROM

Thoracic Spine- Kyphotic, greatest protection of spinal cord at expense of ROM

Lumbar Spine- Lordotic, equal balance between protection and ROM

Characteristics of Vertebrae

Joints

Costovertebral Joint Rib and thoracic vertebrae

Zygopopheseal Joint Superior and inferior articulating facets

Intervertebral Joint Vertebral bodies

Ligamentous Support

Ligament Name Description

Anterior Longitudinal Ligament (ALL) A primary spine stabilizer

About one-inch wide, the ALL runs the entire length of the spine from the base of the skull to the sacrum. It connects the front (anterior) of the vertebral body to the front of the annulus fibrosis.

Posterior Longitudinal Ligament (PLL) A primary spine stabilizer

About one-inch wide, the PLL runs the entire length of the spine from the base of the skull to sacrum. It connects the back (posterior) of the vertebral body to the back of the annulus fibrosis.

Supraspinous Ligament This ligament attaches the tip of each spinous process to the other.

Interspinous Ligament This thin ligament attaches to another ligament, called the ligamentum flavum that runs deep into the spinal column.

Ligamentum Flavum The strongest ligament

This yellow ligament is the strongest one. It runs from the base of the skull to the pelvis, in front of and behind the lamina, and protects the spinal cord and nerves. The ligamentum flavum also surrounds the facet joint capsules.

Sacrum and Coccyx

Spinal Nerves

Extrinsic Muscles

Muscle Action

Iliocostalis Lumborum B: ExtensionU: Same side lateral bending

Iliocostalis Thoracis B: ExtensionU: Same side lateral bending

Longissimus Thoracis B: ExtensionU: lateral bending

Spinalis Thoracis B: ExtensionU: Same side lateral bending

Semispinalis Thoracis B: Extension of thoracic and cervical spineU: Opposite side rotation

Multifidus B: StabilizationU: Opposite side rotation

Rotatores B: Extension, StabilizationU: Rotation

Intrinsic Muscles of the Spine

History

Key Questions ADLs Time of day Postural positions

Location of Pain Pain radiating into extremities, peripheral

parasthesia (numbness) Impingement- pressure on a nerve root exiting the

intervertebral foramen Dural irritation- proximal to site of pain

Pain around PSIS, radiating pain into hip/groin SI joint pathology

Sciatic nerve dysfunction/irritation Piriformis spasm

History

Onset of Pain Acute

Patients may be capable of describing a singular incident

Chronic Accumulation of repetitive stress,

macrotrauma Insidious

Being a disease that progresses with few or no symptoms to indicate its gravity

History

MOI Direct blow

Contusions Hyperextension sports

Gymnastics, Offensive line (FB), Cheerleading, Diving, Crew (Rowing), Weightlifting

Compressive forces Shear forces

History

Consistency of pain Constant

No change in pain level with change in posture Chemical- Dural sheath irritation

Intermittent Symptoms inc and dec with repositioning

Mechanical- Compression/stretching of nerve root

Bowel/Bladder signs Incontinence or urinary retention

Lower nerve root lesion (Cauda equina syndrome)

Spinal cord injury

History

History of spinal injury Structural degeneration Predispositions

Changes Activity

Level Intensity Duration

Surfaces Footwear

Training shoes Competition shoes

Sleeping location/habits

Inspection- General

Postural Malalignments

Frontal Curvature

Test for Scoliosis

Patient position- Standing with hands held in front with arms straight

Examiner- Seated in front or behind patient

Procedure- Patient bends forward, sliding hands down front of legs

Positive test- Asymmetrical hump observed along lateral aspect of thoracolumbar spine and rib cage

Implications Functional scoliosis-

disappears during flexion Structural scoliosis-

present at rest and during flexion

Inspection- General

Gait Altered running or walking gait

Slouching Shuffling Shortened gait

Skin Markings Cafe-au-lait spots

Neurofibromatosis 1 Increased cell growth of neural tissues Normally benign Painful with pressure of local nerves

Inspection- Thoracic Spine

Breathing patterns Irregular, shallow breathing

Injury to T vertebrae, pressure on T nerve roots, trauma to costal cartilage or ribs

Bilateral comparison of skin folds Asymmetry, unevenness

Bilateral muscle imbalance, kyphosis, scoliosis Shape of chest

Vertebral rotation causing rib prominence posteriorly

“Rib hump”

Inspection- Lumbar Spine

General movement and posture Improper standing or sitting Improper lifting mechanics

Lordotic curvature Reduced curve

Acute pain, muscle spasm, hamstrings tightness Increased curve

Hip flexor tightness, abdominal muscle weakness

Standing posture Lateral shift in trunk or pelvis

Impingement

Inspection- Lumbar Spine

Erector muscle tone Unilateral hypertrophy or atrophy

Weak muscles Poor, abnormal posture

Faun’s beard Tuft or hair in lumbar or sacral spine

Spina bifida occulta

Palpations- Thoracic Spine

1. Spinous processes

2. Supraspinous ligaments

3. Costovertebral junction

4. Trapezius5. Paravertebral

muscles6. Scapular

muscles

Palpations- Lumbar Spine

1. Spinous processes

2. Step-off deformity

3. Paravertebral muscles

Palpations- Sacrum and Pelvis

1. Median sacral crests

2. Iliac crests3. Posterior superior

iliac spine4. Gluteal muscles5. Ischial tuberosity6. Greater trochanter7. Sciatic nerve8. Pubic symphysis

Palpations- Sacrum and Pelvis

1. Iliac crest2. Tensor fascia latae3. Gluteus medius4. Iliotibial band5. Greater trochanter6. Trochanteric bursa

Palpations- Pelvis

1. Pubis2. Anterior superior

iliac sine3. Anterior inferior

iliac spine4. Sartorius5. Rectus femoris

ROM- Goniometric Measurements

Patient position- standing with knees extended, spine in neutral position

Procedure Initial- measure

distance between C7 and S1

Motion- trunk fully flexed or extended

Final- measure distance between C7 and S1

ROM- Goniometric Measurements

Patient position- standing with knees extended and spine in neutral position

Procedure Fulcrum- Aligned over S1

SP Stationary arm- Aligned

over median sacral crest Movement arm- Aligned

with C7 SP

ROM- Goniometric Measurements

Patient position- seated with feet firmly planted on floor

Procedure Fulcrum- Aligned over

the center of patient’s head

Stationary arm- parallel to line formed by iliac crests

Movement arm- parallel to line formed by acromion processes