yoga anatomy mod 2€¦ · of the neck • origin - lower 1/2 of ligmentum nuchae and the spinous...
TRANSCRIPT
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Module 2
The Human Spine
Anatomy &Physiology
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Introduction to the
Vertebral Column
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Bones - vertebrae
• Vertebrae
• 33 total
• 5 sections
• From superior to inferior:
• Cervical - 7 vertebrae
• Thoracic - 12 vertebrae
• Lumbar - 5 vertebrae
• Sacrum - 5 vertebrae
• Fused in the adult
• Coccyx - 3-5 vertebrae
• Fused in the adult
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Bones - vertebrae
• Nomenclature
• The vertebrae are named for their region, using the first letter of the region and
numbered from top down
• Examples:
• C1, T8, L4
• First cervical, eighth thoracic, and fourth lumbar
• Special nomenclature
• C1 is also known as the atlas
• In Greek mythology, Atlas was the primordial Titan who supported the heavens
• In anatomy, Atlas is the vertebra that supports the head
• C2 is also known as the axis
• It forms the pivot upon which the atlas rotates
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Bones - curves
• Primary & Secondary Curves
• Kyphosis - posterior convexity
• Primary curve
• Thoracic & Sacral
• Lordosis - anterior convexity
• Secondary curve
• Cervical & Lumbar
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Bones - General Vertebral Anatomy• Vertebral Size
• Increase size from the cervical to lumbar region and decrease in size from sacral to coccygeal region.
• Typical Vertebra
• 2 major parts
• Vertebral Body
• Anterior
• Cylindrically shaped
• Vertebral Arch
• Posterior
• Irregularly shaped
• 3 non-articular processes
• 2 transverse
• 1 spinous
• 4 articular processes
• Facets
• 2 superior & 2 inferior
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Bones - vertebrae• Vertebral foramen or canal
• Hole formed between the vertebral body and arch that allows for the passages of the spinal
cord
• Intervertebral foramen
• Hole formed between two adjacent vertebra, superior and inferior vertebral notch, that allows
for the passage of the spinal nerve
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Joints - Articulations• 2 main types
• Intervertebral Joints
• Between the vertebral bodies and interposed discs
• Cartilaginous joints of the symphysis type
• Facet Joints
• Between the superior and inferior articulating facets
• Diarthrodial or synovial joints
• Synovial joints are also present where the vertebral column articulates with the ribs, with the skull, and with the pelvis
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Connective Tissue
• Intervertebral Disc (IVD)
• 23 total
• Makes up about 20%-33% of the length of the
vertebral column
• Increase in size from the cervical to lumbar region
• 3 mm - cervical
• 9 mm - lumbar
• Greatest IVD to vertebral body ratio occurs in
the cervical and lumbar region and therefore
allows for the greatest ROM
• 2 main parts
• Nucleus pulposus
• Annulus fibrosis
• Nutrition
• Imbibition
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Connective Tissue
• Vertebral end plates
• Thin layers of cartilage that cover the
superior and inferior surfaces of the
vertebral bodies
• Ligaments
• 6 main ligaments
• Anterior longitudinal ligament
• Posterior longitudinal ligament
• Ligamentum flavum
• Supraspinal ligament - becomes the
ligmentum nuchae in the cervical
region
• Interspinal ligament
• Inter transverse ligament
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Nerves• Spinal cord
• Located within the spinal canal
• Cylindrical shaped with a tapered end, the conus medullaris
• Cauda equina
• The bundle of nerves occupying the spinal canal below the conus medullaris
• Protected by the vertebra, spinal ligaments, CSF, and the meninges
• Meninges
• A collection of 3 membranes that surround and protect the spinal cord
• Dura
• Arachnoid
• Pia
• Spinal nerves
• 31 pairs that exit the spinal canal via the intervertebral foramen
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Nerves
• The spinal nerves have two
divisions
• Anterior root
• Ventral nerve root
• Motor function
• Posterior root
• Dorsal nerve root
• Sensory function
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Muscles - superficial layer
• Splenius capitus - a broad,
strap like muscle in the back
of the neck
• Origin - lower 1/2 of
ligmentum nuchae and the
spinous processes of C6-T4
• Insertion - mastoid process
and occipital bone
• Action - extend, rotate, and
laterally flex the head
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Muscles - superficial layer
• Splenius cervicis
• Origin - spinous processes of
T3-T6
• Insertion - posterior transverse
processes of C1-C3
• Action
• Bilaterally: extenders head
and neck
• Unilaterally: lateral flexion
and rotation to same side
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Muscles
• Erector spinae group
• A series of longitudinal muscles
that run the length of the spine
• Can be divided into 3 groups
from lateral to medial
• Iliocostalis
• Longissimus
• Spinalis
I Love Spine
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Muscles - intermediate layer
• Iliocostalis - spans 3 regions: lumborum,
dorsi, cervicis
• Origin - broad tendon from posterior
iliac crest, posterior sacrum,sacral
and lumbar spinous processes, and
supra spinous ligament
• Insertion - angles of the lower ribs
and cervical transverse processes
• Action
• Bilaterally: extends the vertebral
column and head,
• Unilaterally: side bends the
vertebral column
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Muscles - intermediate layer
• Longissimus - spans 3 regions: thoracis,
cervicis, capitis
• Origin - broad tendon from posterior
iliac crest, posterior sacrum, sacral and
lumbar processes, and supraspinous
ligament
• Insertion - ribs, transverse processes of
cervical and thoracic vertebra, mastoid
process
• Action
• Bilaterally: extend the vertebral
column and head
• Unilaterally: side bends vertebral
column
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Muscles - intermediate layer
• Spinalis - spans 3 regions: dorsi,
cervicis, capitis
• Origin - spinous processes of the
lumbar, thoracic, and cervical
regions
• Insertion - spinous processes of
upper thoracic and mid cervical
regions, and the skull
• Action
• Bilaterally: extends the vertebral
column and head
• Unilaterally: side bends the
vertebral column
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Muscles - deep layer
• Semispinalis - a
transversospinalis muscle
• Semispinalis capitis
• Origin - transverse
processes C7-T6
• Insertion - between inferior
and superior nucheal line
of occipital bone
• Action: extends the head
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Muscles - deep layer
• Semispinalis cervicis
• Origin - transverse
processes of T1-T6
• Insertion - spinous
processes of C2-C5
• Action - extends the
cervical spine
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Muscles - deep layer
• Semispinalis dorsi
• Origin - transverse
processes of T6-T10
• Insertion - spinous
processes C6-T4
• Action - extends vertebral
column
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Muscles - deep layer
• Multifidus - small muscles that
span the entire spine, from the
sacrum to axis
• The muscle spans three joint
segments.
• Origin - sacrum, PSIS, and
transverse processes
• Insertion - spinous processes
• Action - functions primarily as
a spinal stabilizer
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Muscles - deep layer
• Levator costarum
• Origin - transverse
processes of C7-T12
• Insertion - superior
surface of the ribs
immediately inferior to the
proceeding vertebra
• Action - assists in
elevation of the thoracic
rib cage
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Kinesiology
• Intervertebral joints
• Extremely limited movement
• Translation
• 3 - side to side, superior and inferior, anterior to posterior
• Rotation
• 3 - side to side, vertical axis, anterior to posterior
• Kinetic chain
• The compound effects of these small amounts of translation and rotation at a series of vertebrae produce a large ROM for the column as a whole.
• Flexion and extension
• Lateral Flexion
• Rotation
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Kinesiology
• Coupled motion
• Coupling - consistent association of one motion about an axis with
another motion around a different axis.
• Coupled motion varies from region to region and is dependent upon
several factors
• Spinal posture and curves
• Orientation of the articulating facets
• Fluidity, elasticity, and thickness of the IVD
• Extensibility of the muscles, ligaments, and joint capsules
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Cervical Spine
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Bones• 7 cervical vertebra
• C1-C7
• Typical Cervical Vertebrae
• Body
• Small
• Uncinate processes C3-C7
• Arches
• Superior facets
• Face superior, posterior, and medial
• Inferior facets
• Face inferior, anterior, and lateral
• Transverse processes
• Transverse foremen
• Contains the vertebral artery, vein, and
venous plexus
• Spinous process
• Short, slender, and bifid
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Bones
• Atypical Cervical Vertebra
• Atlantoaxial complex
• C1 - Atlas
• No vertebral body
• No IVD between C1 & occiput
• No spinous process
• Ring shaped
• 5 articulating facets
• 2 superior that are slightly concave to
articulate with the slightly convex
occipital condyles
• 2 inferior that are slightly convex
• 1 located on the interior surface of the
anterior arch that articulates with the
dens of C2
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Bones
• Atypical cervical vertebra
• Atlantoaxial complex
• C2 - Axis
• Odontoid process or
dens
• No IVD between C1 &
C2
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Joints
• Atlanta-occipital joint
• Plane synovial joint
• Composed of the 2 concave superior zygapophyseal facets of the
atlas that articulate with the 2 convex occipital condyles of the skull
• Atlanto-axial joint
• 3 separate joints
• 1 Atlanto-Odontoid joint
• Synovial pivot joint in which the dens of the axis rotates in an
osteoligmentous ring
• 2 lateral joints between the superior zygapophyseal facets of the
axis and the inferior zygapophyseal facets of the atlas
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Connective Tissue
• Ligaments
• Cruciform ligament
• Transverse band
• Longitudinal band
• Alar ligaments
• Apical ligament of the
dens
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Connective Tissue
• Ligamentum nuchae - a
fibrous membrane that
represents the extension of
the supraspinous ligament in
the neck
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Nerves• Spinal nerves
• 8 pairs of cervical spinal nerves
• Brachial plexus
• Formed by 5 cervical nerve roots
• Combine into 3 trunks
• Divide into 6 divisions
• Combine into 3 cords
• Divide into 5 branches or peripheral
nerves
Real Truckers Drink Cold Beer
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Muscles
• Sternocleidomastoid (SCM)
• Origin - sternum, medial portion
of the clavicle
• Insertion - mastoid process
• Action
• Bilaterally: flexes neck, raises
sternum
• Unilaterally: tilts head
towards side of contraction
and rotates head away from
side of contraction
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Muscles
• Scalenes
• Origin - transverse
processes of C2-C7
• Insertion - first and second
ribs
• Action - elevate ribs and
laterally flex head
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Muscles
• Platysma
• A thin sheet like muscle that
covers the anterior cervical
region
• Action - tenses the neck and
depresses the lower lip and
angles of the mouth
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Muscles
• Levator scapulae
• Origin - Transverse
processes of C1-C4
• Insertion - superior medial
border of the scapula
• Action - elevates scapula
when spine is fixed.
Laterally flexes head when
shoulder is fixed
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Kinesiology
• The cervical spine is designed for a relatively large amount of mobility
• The neck moves about 600 times an hour whether we are awake or asleep
• Cervical ROM
• Flexion and extension
• Lateral Flexion
• Rotation
• Atlanto-occipital joint
• Permits primarily a nodding motion of the head
• Flexion and extension in the saggital plane around a coronal axis
• Atlanto-axial joint
• Rotation, lateral flexion, Flexion and extension
• 55%-58% of the total cervical rotation occurs at the Atlanto-axial joint
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Thoracic Spine
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Bones
• 12 thoracic vertebra
• T1 - T12
• The majority of the thoracic
vertebra adhere to the basic
structural design of all vertebrae
except for some minor variations
• T1 & T12 are transitional
vertebrae and therefore
possess characteristics of the
cervical and lumbar
vertebrae, respectively
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Bones
• Typical thoracic vertebrae
• Body
• Equal transverse and anteroposterior diameters
• Demifacets for articulating with heads of ribs are located on the posterolateral corners
• Arches
• Transverse processes have thickened ends that support oval facets for articulating with the heads of ribs
• Spinous processes vary by groups of 4
• First four point posteriorly
• Second four point almost inferior
• Third four point more distally and horizontally
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Joints
• Facet joints
• Superior facets face posteriorly, in an almost
vertical plane
• Inferior facets face anterior
• Costovertebral and costotransverse joints
• Demifacets and oval facets articulate with the
ribs
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Nerves
• 12 thoracic nerves
• Intercostal nerves
• Anterior divisions of the
thoracic spinal nerves T1-
T11
• Subcostal nerve
• T12 lies below the last rib
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Kinesiology
• Law of side bending and rotation in the
thoracic spine
• Side bending and rotation occur to the
opposite side, except when the movements
are begun in flexion; then they occur to the
same side
• This is an example of coupled motion
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Lumbar Spine
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Bones
• 5 vertebra
• L1 - L5
• The first four lumbar vertebrae are similar in
structure. The fifth vertebra has structural
adaptations for articulation with the sacrum.
• Typical lumbar vertebrae
• Body
• Massive, kidney shaped
• Arches
• Facets
• Superior facet are vertical and concave
and face medial and posteriorly
• Inferior facets are vertical and convex
and face lateral and posteriorly
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Bones
• The fifth lumbar vertebra is a transitional vertebra that differs from the rest of the lumbar vertebrae in that it has a wedge shaped body. The IVD between L5 & S1 is also wedged shaped. This wedged shape helps form the lumbosacral angle.
• The inferior facets of L5 face anteriorly to articulate with the posterior facing superior facets of S1
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Nerves
• Lumbar plexus
• L1-L4 nerve roots
• And sometimes T12 nerve root
• Controls the muscles of the anterior
thigh and medial leg with cutaneous
innervation to the same area
• Sacral plexus
• L4-S3 nerve roots
• These nerve roots join together to form
the sciatic nerve
• Sciatic nerve is the largest and longest
nerve in the body
• Supplies the muscles of the
posterior leg
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Kinesiology
• The orientation of the facet joints from L1-L4 limits lateral flexion and rotation; however, the orientation highly favors flexion and extension.
• Law of side bending and rotation in the lumbar spine
• Side bending and rotation occur to the same side, except when movements are begun in flexion; then they occur to the opposite side
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The Sacrum
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Bones
• The sacrum is created by the
fusion of five vertebrae
• Base
• Superior part
• 2 oval superior facets that
articulate with L5
• Apex
• Distal end
• Articulates with the coccyx
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Joints
• Sacroiliac joint
• Consist of the Articulations between the left and right articular surfaces
of the sacrum and the left and right iliac bones
• The articulating surfaces of the sacrum are auric ulnar (c) shaped and
covered with hyaline cartilage
• The articulating surfaces of the ilia are also c-shaped and the type of
cartilage coving the surface continues to be a matter of debate
• The structure and function of the SI joints change significantly from
birth through adulthood
• At birth, the surfaces are smooth and move freely
• After puberty, the joint surfaces develop ridges and grooves that
begin to limit movement. At this point, the SI joints begin to serve
more of a weight-bearing, and stability role
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Connective Tissue
• Three ligaments that support the SI joint
• Anterior sacroiliac ligament
• Connects the anterior sacrum to the medial ilium
• Posterior sacroiliac ligament
• One part runs from the dorsum of the sacrum to the tuberosity of the ilium; the other part runs obliquely from the third tubercle of the posterior sacrum to the posterior superior iliac spine (PSIS)
• Interosseous sacroiliac ligament
• Connects the tuberosity of the sacrum and the ilium
• Ligaments that connect the sacrum and the ischium
• Sacrotuberous ligament
• Connects the sacrum to the tuberosity of the ischium
• Sacrospinous ligament
• Connects the lateral sacrum and the coccyx to the ischium
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Kinesiology
• Nutation is the commonly used term to refer to movement of the sacral promontory of the sacrum anteriorly and inferiorly while the coccyx moves posteriorly in the relationship to the ilium
• Counternutation refers to the opposite movement in which the anterior tip of the sacral promontory moves posteriorly and superiority while the coccyx moves anterior in relationship to the ilium
• Nutation and counternutation are passive movements but they must accompany extension and flexion for them to be normal, healthy, and complete
• Active spinal extension ( back bend) - the sacrum passively nutates
• Active spinal flexion ( forward bend) - the sacrum passively counternutates
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The end
• Pathologies and injuries will be covered
during module 8
• Muscles not covered in this module will be
covered during modules 3,4,5
• The rib cage will be covered in module 4
along with cranial anatomy ( time permitting)