The Spine

Structure and Function of the Spine http://www.emory.edu/ANATOMY/AnatomyManual/back.html http://www.delawarebackpain.com/patient%20information

Motions of the Spinal Column http://www.chiro.org/Vertebral_Subluxation/Anatomy_101.shtml Flexion approximates the anterior vertebral bodies and separates the spinous processes Extension approximates the spinous processes and the anterior vertebral bodies separate Side bending Rotation Compression/ Distraction Anterior/Posterior/Lateral Shear

Disk Disease A: breakdown of the annulus (Herniation) B: nucleus pressing against outer annulus (Protrusion) Protrusion= C: extrusion of nuclear material, but still in contact with the disk (Extrusion) D: free sequestration of the nuclear material (nuclear material has separated from the disk) -different texts may describe the terms for disk disease slightly differently 1.Herniation= any change in the shape of the annulus that causes it to ‘bulge’ beyond normal parameters 2.Protrusion= nuclear material is contained by the outer layers of the annulus 3.Prolapse: rupture of nuclear material into the vertebral canal a. Extrusion= movement of the nuclear material beyond the disk space b. Free Sequestration= extruded nucleus that has separated from the disk

Effects of Posture/Position on Intervertebral Disk Pressure http://pilatesatthebungalow.com/Pilates/Welcome.html

Passive Lumbar Extension May have to start with pillows under the abdomen Allow 5-10 mins. within each position before progressing Symptoms should decrease and/or centralize, if they increase…STOP!

Lateral Shift Correction Perform lateral glide slowly to ensure no over-correction, patient should extend once they are in neutral. Have patient progress to prone passive extine (propping up on elbows or push up as previously described)

Self Correction of Lateral Shift Standing Back Bend Only do the standing back bend if there is not lateral shift

Self Correction of a Lateral Shift (when there is deviation of the trunk as it flexes) Patient flexes the lower extremity opposite the side of the shift and places it on a chair with about 90˚of hip flexion They flex their trunk over the raised thigh and apply pressure by pulling up on the ankle