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Cervical Spine

 

TheCervical Spine

The cervical portion of the human spine comprises seven bony segments, typically referred to as C-1 to C-7, with cartilaginous discs between each vertebral body. The neck supports the weight of the head and protects the nerves that carry sensory and motor information from the brain down to the rest of the body. In addition, the neck is highly flexible and allows the head to turn and flex in all directions. From top to bottom the cervical spine is gently curved in convex-forward fashion. It is the least marked of all the curves of the spinal column.

 

Caution

 

Disclaimer:

This website is an information and education resource for health professionals and individuals with injuries. It is not intended to be a service for patients and should not be regarded as a source of medical or diagnostic information, or used as a substitute for professional medical instruction or advice. Not all conditions and treatment modalities are described on this website. Any liability (in negligence or otherwise) arising from any third party acting, or refraining from acting, on any information contained on this website is hereby excluded.

 

 

Thoracic Spine

The thoracic spine is the portion of the human spine between the neck and low back. The thoracic spine has twelve bony segments, typically referred to as T1 through T12, with cartilaginous discs between each vertebral body. The distinctive characteristic of the thoracic spine is the presence of 12 pairs of rib, which help protect vital organs, but also constrain movement. The natural curvature of the thoracic spine is concave forward, called a kyphosis, although this natural kyphosis can be abnormally accentuated, either because of age or posture. The ribs naturally expand with inhalation, and the diaphragm in part attaches to the thoracic spine, so proper function of the thoracic spine is necessary for normal breathing patterns. The thoracic spine is a vital link in the kinetic chain connecting the upper body and lower body, both because of its location and because of muscle and fascia attachments in the region. Oftentimes, patients may have dysfunctions of the thoracic spine, whether because of breathing, daily movements, or athletic activities.

 

Authors:

Lake Washington Sport & Spine

Gary P Chimes, MD, PhD

Lake Washington Physical Therapy

Benjamin Wobker, PT, MSPT, CSCS

 

References:

Orthopedic Physical Assessment, 4th Edition. David J. Magee, 2006. Physical Rehabilitation: Assessment and Treatment, 4th Edition. Susan B. O’Sullivan and Thomas J. Schmitz, 2001. www.emedicine.medscape.com/article/93635-overview

Thoracic Spine

 

Disc Injuries

Intervertebral discs are structures in between the cervical vertebrae that act as shock absorbers for the spine. They help aid cervical motion and help protect various structures in the neck such as the cervical vertebrae and nerve roots. The intervertebral disc is made up of two parts, the annulus fibrosus and the nucleus pulposus. The nucleus pulposus contains a gel made primarily of water and proteoglycans and acts to resist axial compression and distribute compressive forces. The annulus fibrosus is made primarily of collagen fibers and encloses the nucleus pulposus; which helps withstand tension within the disc.

 

A cervical disc injury typically involves these two structures. The more common injury involves tearing of the annulus fibrosus with protrusion of the nucleus pulposus (disc herniation). The second type of disc injury is an annular tear without herniation of the nucleus pulposus (internal disc disruption).

 

A person with a cervical disc injury may present with neck pain, radicular pain, and weakness in their upper extremity due to myelopathy. Intervertebral disc injury is most commonly associated with compression of the cervical spine with the neck in flexion or hyperextension. This can lead to a herniation of the nucleus pulposus (HNP) and most commonly occurs at the posterolateral aspect of the disc due to the compromised reinforcement and typical mechanism of injury. Due to the common direction of protrusion, nerve roots are often compressed resulting in radiating symptoms that can include upper extremity numbness, tingling, and muscle weakness.

 

Possible Treatments in Physical Therapy

1. Manual Intervention: to focus on improving cervical ROM, normalize mechanics of the spine and shoulder girdle

2. Soft Tissue Mobilization: as indicated to reduce muscle guarding and soft tissue overload to restore normal resting muscle length and full pain free ROM.

3. Strengthening: to improve neuromuscular control of the injured cervical spine and shoulder girdle. Postural training and reconditioning.

4. Traction: manual and/or mechanical traction of the cervical spine will help reduce compressive forces on the herniated disc by unloading the cervical spine. 5. Modalities: as indicated to reduce pain and inflammation at the cervical spine.

 

References:

Orthopedic Physical Assessment, 4th Edition. David J. Magee, 2006. Physical Rehabilitation: Assessment and Treatment, 4th Edition. Susan B. O’Sullivan and Thomas J. Schmitz, 2001. www.emedicine.medscape.com/article/93635-overview

Disc Injury

 

Disc HNP

 

Cervical Extension

 

Cramped Airplane

Spine segments

 

DJD Desert

Posture on beach

 

Degenerative Disc Disease

The intervertebral disc is one of the most common sources of neck pain. Intervertebral discs are structures in between the cervical vertebrae that act as shock absorbers for the spine. They help aid neck motion, transmit loads from one vertebral body to the next, and help protect various structures in the neck such as the cervical vertebrae and nerve roots. The intervertebral disc is made up of two parts, the annulus fibrosus and the nucleus pulposus.

 

The nucleus pulposus contains a gel made primarily of water and proteoglycans and acts to resist axial compression and distribute compressive forces. The annulus fibrosus is made primarily of collagen fibers and encloses the nucleus pulposus; which helps withstand tension within the disc.

 

The intervertebral disc undergoes the most age-related changes of all connective tissue. Over time and with repeated stresses, the nucleus pulposus becomes replaced with fibrocartilage, and the gel within the disc decreases in water and proteoglycans causing a loss of disc height.

 

The degenerative changes are seen in three stages. The first stage is the Dysfunction Stage. This stage involves outer annular tearing, cartilage destruction, and joint dysfunction. The symptoms include local neck pain, muscle guarding, and decreased cervical mobility. The second stage is known as the Instability Stage. At this stage disk resorption occurs as well as a loss of disk height. The symptoms include a feeling of the neck “catching” when moving. The last stage is the Restabilization Stage. During this stage the progressive degeneration leads to osteophyte formation and stenosis. Symptoms are those of the dysfunction stage.

 

Possible Treatments in Physical Therapy:

1. Patient Education: emphasizing proper body mechanics and ergonomics with daily activities. An understanding of the natural history of disc injury.

2. Manual Treatment: as indicated to decrease soft tissue tension due to secondary muscle guarding.

3. Strengthening/Stretching Program: emphasizing postural stabilization and neuromuscular re-education to maintain a neutral spine throughout static and dynamic activities.

 

References:

Orthopedic Physical Assessment, 4th Edition. David J. Magee, 2006. www.emedicine.medscape.com/article/1265453-overview

 

Mobile Device

Spine

Sleeping Posture

 

 

Cat Posture

 

 

Postural Dysfunction

Postural dysfunction is one of the most common causes of neck pain. There are many causes of postural dysfunction. Some are due to poor positional habits; others can be structural in nature.

 

Poor postural habits are the most common cause of postural dysfunction. For various reasons an individual is unable to maintain correct posture and begins to slouch when sitting or standing for long periods of time. This is often the result of muscle imbalances causing what’s known as an upper crossed syndrome or a forward head and rounded shoulders posture. Due to the adaptive nature of soft tissue the deep neck flexors, rhomboids, and serratus anterior muscles get weak while the pectorals, upper trapezius and serratus anterior muscles adaptively shorten. These muscles must work together against gravity in a biomechanically correct position to maintain upright posture.

 

Structural factors that may be the cause of postural dysfunction primarily involve changes in bone and are therefore not easily correctable. These changes include scoliosis, thoracic kyphosis, and excessive lumbar lordosis. However, with proper strengthening and stretching in conjunction with proper postural care instruction, symptoms can be reduced.

 

Possible Treatments in Physical Therapy

1. Ergonomic Evaluation: it is important to assess your home and work environment to ensure proper body mechanics can be maintained for prolonged periods of time. This may include features for your desk or chair to allow for good postural support. 2. Strengthening/Stretching Exercises: to strengthen the muscles necessary to maintain good postural alignment and stretch the muscles that have adaptively shortened due to poor prolonged postures.

3. Neuromuscular Re-education: to retrain proper posture and body mechanics and restore normal movement patterns.

Desk Posture


 

 

 

 

 

 

References: Orthopedic Physical Assessment, 4th Edition. David J. Magee, 2006. www.emedicine.medscape.com/article/313121-overview

Radiculopathy

 

Radiculopathy

 

Radiculopathy

 

Radiculopathy

 

 

Radiculopathy

Cervical radiculopathy is a condition in which there is a dysfunction of the cervical nerve roots causing radiating pain as well as possible numbness, tingling, or weakness down the arm. The most common causes of cervical nerve root dysfunction are the result of herniated discs or impingement in the younger population, and cervical degenerative disk disease in the elderly population. There are seven vertebrae in the cervical spine and eight nerve roots that exit below each vertebral body through structures of the cervical spine called the intervertebral foramina. The foramina progressively narrow down the cervical spine and the nerve root occupies 25-33% of the foraminal space. Thus, a bulging disc or osteophyte formation due to degenerative changes can cause nerve root compression in the cervical foramen. As discussed above, the symptoms typically include some combination of, but not necessarily all, radiating pain, numbness, tingling, or weakness down the arm. The distribution of symptoms is dependent upon the involved nerve root. Cervical extension, side bending, rotation, or a combination of the three often aggravates the symptoms as these motions close the foramen and cause further compression of the nerve root. Patients may report alleviation of symptoms when raising their arms over head and placing their hand behind their head as this decreases tension on the nerve root.

 

Possible Treatments in Physical Therapy:

1. Manual Intervention: to focus on improving cervical ROM, normalize mechanics of the spine and shoulder girdle

2. Soft Tissue Mobilization: as indicated to reduce muscle guarding and spasm to restore normal resting muscle length and full pain free ROM.

3. Strengthening: to improve stability of the injured cervical spine and shoulder girdle. Postural training and reconditioning.

4. Traction: manual and/or mechanical traction of the cervical spine will help reduce compressive forces on the herniated disc by unloading the cervical spine.

5. Modalities: as indicated to reduce pain and inflammation at the cervical spine.

Radiculopathy MRI

 

 

 

 

 

 

 

 

 

 

References:

Orthopedic Physical Assessment, 4th Edition. David J. Magee, 2006. Physical Rehabilitation: Assessment and Treatment, 4th Edition. Susan B. O’Sullivan and Thomas J. Schmitz, 2001. www.emedicine.medscape.com/article/93635-overview

Whiplash x-ray

 

Whiplash bumpercars

 

Whiplash Rollercoaster

 

Whiplash Swing

Whip Lash

Cervical whiplash is one of the most common injuries sustained in a motor vehicle accident. The cervical strain caused by a whiplash injury is due to sudden forces creating an acceleration-deceleration moment in which the neck is forced into extension while the shoulders move forward under the head. During the forced cervical extension, the inertia of the head is overcome and the head begins to accelerate forward. The neck then acts as a lever to increase forward acceleration of the head, forcing the neck to bend forward.

 

The forces placed on the head and neck cause various stresses to be placed on the structures of the cervical spine. Shearing and compressive forces can cause injury to the facets of the cervical spine, intervertebral discs, alar and transverse ligaments, and neural structures. The muscular component also plays a major role in the whiplash injury and may be the primary cause of injury. The response of muscle guarding increases with the increase of forces placed on the body. During the whiplash injury this occurs when the muscles of the cervical spine make subconscious efforts to protect the body from sudden and forceful movement causing a muscle strain and/or spasm.

 

Possible Treatments in Physical Therapy

1. Clearing Examination: A careful and thorough screening should always be done prior to treatment to rule out possible complications that could occur as a result of acute trauma to the cervical spine.

2. Manual Therapy: joint and soft tissue mobilizations as indicated to restore range of motion, reduce muscle guarding and acute pain.

3. Strengthening: of the paravertebral muscles and postural strengthening may be indicated to improve stability and biomechanics.

4. Ice and other modalities: as needed to reduce acute inflammation and pain.

 

References:

Orthopedic Physical Assessment, 4th Edition. David J. Magee, 2006. www.emedicine.medscape.com/article/306176-overview



 

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