Neck & Trunk. Glory Hospital

Transcription

1 Neck & Trunk Glory Hospital

2 Controlling the body s position in space Antigravity movement We use multiple sensory for posture control - Vestibular system in gravity - Visual system in our enviroment - Somatosensory systerm(the support surface)

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4 Characteristics of the Neck & Trunk Atlanto-occipital joint Atlanto-occipital junction is key-point of mechanical balance Atlanto-axial joint Axis can trun head and neck without shoulder Cervical is very smaller but most highter mobility Under the C3 structure is light and simply

5 Characteristics of the Neck & Trunk Thoracic connect cervical and lumbar spine Thoracic spinous process are long, sharp And directed downwards - Thoracic spine kyphosis - Hyperextension protect

6 Important of Neck & Trunk Cervical proprioceptive modify vestibular response -vestibular sway depend on cervical proprioceptive Vestibular signals about movement and position of the head are critical for self-motion perception, which draws on spatially representing one s own-body movements with respect to the external environment Three major vestibular reflexs - Vestibulo- ocular(vor) - Vestibulo-collic(VCR) - Vestibulo-spinal(VSR)

7 Important of Neck & Trunk Vestibulo-ocular(VOR) - Keep the eyes still in space when the head moves(visual fixation) Vestibulo-collic(VCR) - Keep the head still in space or on a level plane when you walk Vestibulo-spinal(VSR) - Adjusts posture for rapid changes in position

8 Important of Neck & Trunk Head turns to the left -Eyes trun to the right to maintain frontal gaze Left semicircular canal excitation -L medial rectus R lateral rectus contraction!

9 Important of Neck & Trunk Ventromedial part VOR MVST: C and T levels Ext VSR VCR LVST: Extensor(+), Flexor(- ) (calf muscle.)

10 Important of Neck & Trunk Rotation of the thoracic spine is critical for normal function. The thorax is a central area of force transmission between the legs and lumbopelvis, and the arms and neck, and axial rotation is the dominant motion of the thoracic region. Appropriately controlled Thoracic rotation is essential for movement of the upper body and orientation of the upper extremities for use of the hands. Recticulospinal track is to maintain our posture, Before we lift weight our arms, muscle of the leg are excited to support our body posture. This posture control is via the fast acting excitatory action of the pontine reticulospinal track.

11 Important of Neck & Trunk MRST: UL, Trunk, LL LRST: Flexor(+), Extensor(-)

12 Movement of Neck & Trunk Neutral neck position: extension 30~35 The biggest movement: C5~6 Cervical Flexion and Extension

13 Movement of Neck & Trunk Neck flexor Sternocleidomastoid Longus colli Longus capitis Scalenus anterior Scalenus medius Neck extensor Longissimus cervicis Iliocostalis cervicis Spinalis cervicis Semispinalis capitis Semispinalis cervicis Splenius cervicis Splenius capitis Trapezius(upper)

14 Movement of Neck & Trunk Bilateral- Under the C3 level cervical flexion Unilateral-lateral flexion and rotation rotation is contralateral! Sternocleidomastoid

15 Movement of Neck & Trunk Scalenus -anterior -medius Bilateral- cervical flexion -posterior Unilateral- lateral flexion scalenus anterior part rotation Longus capitis Longus colli

16 Movement of Neck & Trunk Erector spinae cervicis muscle Bilateral - neck extension Unilateral - lateral flexion

17 Movement of Neck & Trunk Bilateral- neck extension Unilateral- contralateral rotation

18 Movement of Neck & Trunk Bilateral- neck extension Unilateral- lateral flexion and rotation rotation is ipsilateral!

19 Movement of Neck & Trunk When the scapulae are stable a co-contraction of both sides can extend the neck!!! Upper trapezius

20 Movement of Neck & Trunk Capital Flexion and Extension Capital flexion- C1,2: flexion, C3~7: extension Capital extension- C1,2: extension, C3~7:felxion AO joint movement

21 Movement of Neck & Trunk Capital flexor Rectus capitis anterior Longus capitis Capital extensor Rectus capitis posterior major Rectus capitis posterior minor Obliquus capitis superior Obliquus capitis inferior Longissimus capitis Spinalis capitis Semispinalis capitis Splenius capitis

22 Movement of Neck & Trunk Bilateral- capital flexion Unilateral- AO joint lateral flexion rectus capitis lateralis AO joint lateral flexion

23 Movement of Neck & Trunk Rectus major Rectus minor Obliquus superior Obliquus infereor AOJ,AAJ extension AOJ extension AOJ extension AAJ extension Bilateral Unilateral AOJ lateral flexion AAJ rotation(il) AOJ lateral flexion AOJ lateral flexion AAJ rotation(il)

24 Movement of Neck & Trunk Suboccipital muscle important of eye movement This muscle have a lot of muscle spindle: 1g 36

25 Movement of Neck & Trunk Bilateral- capital extension Unilateral- lateral flexion in same side

26 Movement of Neck & Trunk Movement most of C2~7 AO joint a little movement Except for some almost neck muscle unilateral contraction Cervical lateral flexion

27 Movement of Neck & Trunk Cervical rotation AA joint movemnt + C2~7 movement Contralateral Sternocleidomastoid Scalenus anterior Semispinalis capitis Ipsillateral Erector spinae Splenius Rectus capitis major Obliquus capitis inferior

28 Movement of Neck & Trunk

29 Movement of Neck & Trunk UPPER-TRUNK- INITIATED MOVEMENTS Moment SPINE SCAPUA PELVIS/HIP Anterior Flexion Abduction Elevation Pelvis moves forward, more hip flexion Posterior Extension Adduction Less hip flexion Lateral WB NWB Lateral flexion, concavity Lateral flexion, concavity Depression Downward rotation Elevation Not much movement Pelvis stays on support Flexion rotation Direction of weight shift LE WB Trunk rotation Extension rotation Direction of weight shift LE WB Trunk rotation UPPER-TRUNK- INITIATED ROTATION Anterior and lateral Weight on side to which body is rotating Rotation back of side to which body is rotating Posterior and lateral Pelvis stays on support, weight on both legs Rotation back on side to which rotating

30 Movement of Neck & Trunk Thoracic region flexion : 35 Thoracic region Extension : 20~25 Trunk Flexion & Extension

31 Movement of Neck & Trunk Thoracic lateral flexion : 25 Thoraco lumbar axial rotation: 35 Trunk lateral flexion Trunk Rotation

32 Movement of Neck & Trunk Rectus abdominis Trunk Flexion Obliquus externus abdominis Obliquus internus abdominis Transverse abdominis (comperssion of adbomen) Trunk Extension Iliocostalis thoracis &lumborum Logissimus thoracis Spinalis thoracis Semispinalis thoracis multifidi Rotatores thoracis & lumborum Intertransversarii thoracis& lumborum Quadratus lumborum

33 Movement of Neck & Trunk Rotation Bilateral- same side- Trunk Internal flexion Oblique Rotation Unilateral- opposite Trunk side lateral External flexion oblique Bilateral- Trunk extension Unilateral- lateral flexion and Rotation quadratus lumborum

34 Movement of Neck & Trunk

35 Movement of Neck & Trunk Global muscle system - Longissimus thoracis(pars thoracic) - Iliocostalis lumborum(pars thoracic) - Quadratus lumborum(lateral fiber) - Rectus abdominis - Obliquus externsus abdominis - Obliquus internus abdominis Local muscle system(primary function of joint stabilization) - Interspinales - Multifidus, Transvers abdominis - Logissimus thoracis(pars lumborum) - Iliocostalis lumborum(pars lumborum) - Quadratus lumborum(medial fiber) - Obliquus internus(thoraco lumbar facia part)

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37 Movement of Neck & Trunk # ANTICIPATORY POSTURAL ADJUSTMENTS in the trunk are executed before or along with a focal movement of the limb. # Their major role is 1to prepare the trunk against destabilizing forces imposed by the movement of the limb 2to orient the trunk in space. # The central nervous system uses several strategies (postural preparation, anticipatory postural adjustments, reactive postural adjustments) to regulate control of posture during movement.

38 Movement of Neck & Trunk an unexpected (filled circles) and expected (unfilled circles) ventral load. co-contraction of the trunk flexors and extensors has been found to increase the stability of the spine (Bergmark 1989; Gardner-Morse & Stokes 1998)

39 unilateral flexion (a) and extension (b) of the arm 39

40 Network system 1. Lovett reaction Righting Reflex Lovett Reactor In order to maintain postural homeostasis, the body is continuously compensating, keeping itself balanced over the feet and its head over the cervical spine with the eyes level to the horizon. Lovett (1905) described a coupling of motion the different vertebrae in the spine (commonly referred to as the Lovett Reactor): each vertebrae is coupled in motion with another vertebrae : Spinal Coupling: C1 should move in a similar direction as L5 C2 should move in a similar direction as L4 C3 should move in a similar direction as L3 C4 should move in the opposite direction as L2 C5 should move in the opposite direction as L1 This continues downward to T5 which moves in the opposite direction as T6

41 Stand up Move your hip to one side Network system The following simple experiment demonstrates this automatic, subconscious postural reflex: Your ribcage automatically tilts in the opposite direction Your neck automatically tilts in the same direction as your hip This automatic reflex (tilt in posture) maintains your head over your cervical spine, your eyes level to the horizon and your weight over your feet. In essence, the Lovett Reactor is a description of what occurs in the pelvis, vertebrae when the Righting Reflex is working correctly.

42 Networking system 2. Janda s Approach Our bodies not a single and connected by one. In this functionally connected muscle called muscle sling. Muscle sling provide stability and mobility with movement Trunk muscle sling facilitated upper and lower crossed gait pattern and rotation trunk stability

43 Network system Muscle sling Anterior Spiral Posterior Biceps-pectoralis major-internal oblique-contralateral hip abductor Rhomboid-Serratus anterior-external oblique -contralateral internal oblique- hip adductor Hamstring-gluteus maximus- thoracolumbar fascia-contralateral latissimus dorsi- triceps

44 Network system Upper crossed Syndrome

45 Network system Typical muscle imbalances in the upper crossed syndrome Weak Tight Longus capitis & colli(deep neck flexor) Serratus anterior Rhomboids Lower & middle trapezius Rotator cuff (teres minor, supra,infara spinatus) Pectoralis Upper trapezius Levator scapula Sternocleidomastoid Suboccipital Subscapularis Latissimus dorsi

46 Network system Lower crossed Syndrome

47 Network system 3. Myofascial Superficial back line Plantar fascia-> Gastrocnemius-> Hamstring-> Erector spinae->occipital ridge (suboccipital muscle)

48 Network system Superficial Front Line Tibialis anterior-> Quadriceps->Pelvic ->Rectus abdominis-> Sternalis-> Sternocleidomastoid-> Scalp fascia

49 Network system Spiral line Splenius capitis,cervicis-> Rhomboid major and minor-> Serratus anterior -> External oblique-> Internal oblique-> ASIS-> Tensor fascia lata-> Tibialis anterior-> 1 st metatarsal-> Biceps femoris-> erector spine

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53 Network system 4. Kapandji Approach Difference in Characteristics of Quiet Standing!! Efficient Inefficient

54 Reference Anne Shumway-Cook& Marjorie Woollacott(2014), 운동조절개정 4 판, 영문출판사 Calais-Germain(1993),Anatomy of Movement,Eastland Press I.A. Kapandji(2001), 관절생리학개정 5 판, 영문출판사 Jung sun hong. From the normal development cerebral palsy treatment Ideas.3rd. Lee, L. J., Coppieters, M. W., & Hodges, P. W. (2009). Anticipatory postural adjustments to arm movement reveal complex control of paraspinal muscles in the thorax. Journal of Electromyography and Kinesiology, 19(1), Lovett RM The Mechanism of the Normal Spine and Its Relation to Scoliosis. Boston Medical and Surgical Journal, Vol CLIII, No 3. Laurie Lundy-Ekman(2013), Neuroscience Fundamentals for rehabilitation(4 th ), Elsevier

55 Reference Hodges, P. W., & Richardson, C. A. (1997). Contraction of the abdominal muscles associated with movement of the lower limb. Physical therapy, 77(2), Phil Page. The Janda Approach. Assessement and Treatment of muscle Imbalance. Susan Ryerson(1997), Functional Movement Function. Reeducation Thomas W. Myers(2014), Myofascial Meridians for Manual & Movement Therapists(3 rd ), Elsevier