Chapter 15 The Spine Impairments, Diagnosis, and Management Guidelines.

IntroductionClose proximity of spine with nerve roots and spinal cord.

Review of structure and function of spineAnterior pillar is made up of vertebral bodies, IVD and is hydraulic shock absorbing component of spine. Posterior pillar is made up of neural arches and facets which give gliding movements in spine.

Motions of spinal column.

Motion is described in terms of motion segment.That is two vertebras and joints in between two facet joint and one intervertebral joint.

Motions in spinal column

Sagittal plane motion: Motion in sagittal plane results in flexion and extension. Motion in frontal plane results in lateral flexion. Motion in transverse plane results in rotation.

The spine: Impairments, diagnosis and management guidelines.

Dr Danyal Ahmad PT, DPT.

Structure and function of IVD.

• Outer portion is annulus fibrosis.• Zig zag pattern of collagen fibers.• Inner component is nucleus pulposis.• Watery made up of proteoglycans. • Both make cartilaginous end plates for nutrition

Structure and function of IVD.• Intervertebra foramina are in posterior segment of each body. • Anterior boundary is intervertebral disc. • Posterior boundary is facet joint. • Superior and inferior boundary by pedicles of superior and inferior

vertebras. • Size increases in flexion and contralateral sidebending and vice versa.

Pathology of intervertebral disc• Herniation: any change in shape of annulus that causes it to

bulge beyond normal parameters. • Protrusion: nuclear material is contained by annulus. • Prolapse: frank rupture of nuclear material in vertebral canal. • Extrusion: still in contact with nucleus• Free sequestration

Pathology of intervertebral disc.

• Fatigue break down. • Axial over load.• Age.• Degenerative changes.

Disc pathologies and related conditions

• Compression fracture: due to excessive axial compression.

• Tissue fluid stasis: after sustained postures fluid redistribution is disturbed.

Sign and symptoms of disk lesions and fluid stasis.

• Pain with centrilization and peripherilization phenomena.

• Disability.• Abnormal Postural mechanisms

Sign and symptoms of disk lesions and fluid stasis.

• Contained nuclear protrusion can be influenced by movement because the hydrostatic mechanism is still intact. A complete tear of the outer layers of the annulus disrupts the hydrostatic mechanism, so the herniated or prolapsed nuclear material cannot be influenced by movement

Pathomechanical relationship of intervertebral disc and facet joint.

• Facets are non weight bearing.• Biomechanics are also disturbed.• Function in spinal rotation.

• Facet joint orientation

Pathology of zygapophyseal joint (characteristics of facet joints)

• Have meniscoid.• May entrap and lock.• Can result in severe disability. • Local Hypomobility and adjacent

hypermobility.

Common diagnosis and impairments from facet joint pathologies

• Pain.• Impaired mobility.• Impaired posture.• Impaired functional movement.

PATHOLOGY OF MUSCLE AND SOFT TISSUE INJURIES:STRAINS, TEARS, AND CONTUSIONS (symptoms)

• Causes. • Acute.• Sub Acute.• Chronic. • Cervical and lumbar presentations.

Common sites of lumbar strain

• Lumbosacral area.• Sacroiliac joint• L4 L5.• L5 S1.

Common sites of cervical strain

• C0-C1• C1-C2

• C4-C5.• C5-C6

Postural strain

• Due to poor posture.• Reversing car.• Sitting on computer.• Sitting with crossed legs.• Sitting slouched.

Emotional stress

• 2 – 3 days severe back ache may occur.

Pathomechanics of spinal instability (neutral zone)

• Portion which is less prone to develop pathologies.

• In spine is very small portion.

Pathomechanics of spinal instability (instability)

• More segmental movement• may occur owing to disk degeneration, spondylolysis,• spondylolisthesis, or ligamentous laxity; or it may be due• to poor neuromuscular control of the core stabilizing muscles• in maintaining the neutral zone because of fatigue,• altered recruitment pattern, reflex inhibition from pain, or• some pathology