BASIC KINESIOLOGY OSTEOKINEMATICS

●​ Def: movement of bony partners

TOPIC OUTLINE ●​ Types
○​ Translatory
I.​ Terminologies ■​ Aka linear
A.​ Kinesiology ■​ Def: point on the same segment travel the same
B.​ Biomechanics distance, velocity, direction, & time
C.​ Kinetics ○​ Angular
D.​ Kinematics ■​ Aka rotatory
II.​ Osteokinematics ■​ Def: segments travel on a different points on the
III.​ Arthrokinematics other surface, often following the pattern of an
IV.​ Kinematic Chain arch
V.​ Body Planes
A.​ Anatomic Position
ARTHROKINEMATICS
B.​ Fundamental Position
C.​ Cardinal Planes ●​ Def: minute movements within the joint & its surfaces
VI.​ Joint Classifications ●​ Types: rolling, spinning, & gliding
VII.​ Degrees of Freedom
VIII.​ Arthrokinematic Movements
IX.​ Screwhome Mechanism
X.​ Other Concepts
A.​ Equilibrium
B.​ Gravity
C.​ Levers
D.​ Torque
E.​ Newton’s Laws of Motion
XI.​ Muscle
A.​ Muscle & Contraction Types
B.​ Insufficiencies
XII.​ Bone & Joints
A.​ Classifications of Bones
B.​ Open Pack & Close Pack Positions KINEMATIC CHAINS
C.​ Capsular Patterns ●​ Def: combination movement of joints
XIII.​ Addenda ●​ Open kinematic chain
○​ Moving segment: distal
○​ Fixed segment: proximal
TERMINOLOGIES ○​ Purpose: mobility & fast movements
●​ Close kinematic chain
●​ Kinesiology
○​ Moving segment: proximal
○​ Kines in latin: move
○​ Fixed segment: distal
○​ Logos in latin: study
○​ Purpose: stability, for powerful & slow movements
○​ Def: study of movement
●​ Biomechanics
○​ Def: application of mechanics to the human body BODY PLANES
○​ Static bodies are bodies that are at rest or in uniform
motion
○​ Dynamic bodies are bodies that either accelerate or ANATOMICAL POSITION VS FUNDAMENTAL POSITION
decelerate
●​ Kinetics ANATOMICAL FUNDAMENTAL
○​ Def: force that either produce or arrest motion
○​ 1° sources of force (mnemonic: GMEF) Head Midline Midline
■​ Gravity
■​ Muscles Arms Slightly abducted At sides
■​ Externally applied resistance
■​ Friction FA Supinated Neutral
○​ Determinants of motion
■​ Type of motion: whether it is translatory or Palms Facing forward Facing body
angular
■​ Loc of motion: determining the axis & the plane Feet Apart Apart
■​ Magnitude of movement: measuring the
displacement Toes Extended Extended
■​ Directions of motion
●​ Positive motions are movements that go
superiorly, laterally, or anteriorly ●​ Cardinal planes
●​ Negative motions are movements that go ○​ Def: imaginary planes that cross the body
inferiorly, medially, & posteriorly ○​ Relationship with each other: perpendicular
●​ Kinematics ○​ Frontal plane
○​ Def: types of motion without regard for forces that ■​ Aka coronal, XY plane, or AP
produce the motion ■​ Divides the body into: front & back
■​ Axis: Z axis
■​ Movements
●​ Abduction & adduction (except thumb)
●​ Flexion & extension at the thumb
●​ Ulnar & radial deviation
 ●​ Pronation & supination ●​ Amphiarthrodial
●​ Lateral flexion ○​ Aka amphiarthrosis
●​ DF & PF ○​ Degree of movement: slightly movable
○​ Sagittal plane ○​ Composition: cartilaginous tissue
■​ Aka vertical, YZ plane, or ML ○​ Focus: stability + mobility
■​ Divides the body into: right & left ○​ Stability: less stable
■​ Axis: X axis ○​ Examples
■​ Movements ■​ Symphysis
●​ All flexion & extension (except thumb) ■​ IV joints
●​ Abduction & adduction of thumb ■​ Synchondrosis
○​ Transverse plane ●​ Diarthrodial
■​ Aka horizontal, XZ plane, or SI ○​ Aka diarthrosis
■​ Divides the body into: upper & lower ○​ Degree of movement: freely movable
■​ Axis: Y axis ○​ Focus: mobility
■​ Movement
●​ Rotation
●​ Pronation & supination DEGREES OF FREEDOM
●​ Inversion & eversion ●​ Def: number of planes & axes in which a joint can move
○​ Special cases ●​ Types of joint categorized by DOF
■​ Pronation & supination with elbow flexed to 90° ○​ Non axial
●​ Plane: XY (coronal) ■​ # of planes & axes: 0
●​ Axis: Z ■​ Movement: planar movement only
■​ Rotation of hip with the hip & knees flexed to ○​ Uniaxial
90° ■​ # of planes & axes: 1
●​ Plane: XY (coronal) ■​ Examples
●​ Axis: Z ●​ Trochoid
■​ Shoulder abduction to 90° with elbows flexed to ●​ Hinge
90° ●​ Carpals & tarsals
●​ Plane: YZ (sagittal) ○​ Biaxial
●​ Axis: X ■​ # of planes & axes: 2
■​ Examples
●​ Condyloid
●​ Modified hinges
○​ Multiaxial
■​ # of planes & axes: 3
■​ Examples
●​ Ball & socket
●​ SC joint
●​ Condyloid vs ellipsoid joints
○​ Condyloid
■​ Characteristic of concavity: shallow
■​ Characteristic of convexity: spherical
○​ Ellipsoid
■​ Characteristic of concavity: deep
■​ Characteristic of convexity: flat
●​ Concave convex rule
○​ If the convex bone is moving, slide is in the opposite
direction
○​ If the concave bone is moving, slide is in the same
direction

ARTHROKINEMATIC MOVEMENTS
●​ Rolling
○​ Aka rocking
○​ Def: several points meet different points
●​ Sliding
○​ Aka gliding
○​ Def: one point meets several points
●​ Spinning
○​ Def: one point moves around the same point
JOINT CLASSIFICATIONS ●​ Linear
●​ Synarthrodial ○​ Aka translatory
○​ Aka synarthrosis ○​ Def: movement along a straight path
○​ Degree of movement: immovable to slightly movable ●​ Rectilinear
○​ Composition: fibrous connective tissue ○​ Def: movement along a straight path moving up &
○​ Fxns: shock absorption & force transmission down
○​ Focus: stability ●​ Curvilinear
○​ Stability: most stable ○​ Def: movement along an arc
○​ Examples
■​ Sutures
■​ Gomphosis
■​ Syndesmosis
 ●​ Weight
○​ Aka resistance
○​ Distance from axis to line of action
●​ Force
○​ Aka effort
○​ Distance from moving force to axis
●​ Mechanical advantage
○​ Def: ratio between effort (force) arm length &
resistance (weight) arm length
●​ Class levers (mnemonic: Wife Fucking Went Everywhere
but only FEW bopis)
●​ Class I lever
○​ Component arrangement: WFE
○​ 1° fxn: balance
○​ Mechanical advantage: 1

SCREW HOME MECHANISM

●​ Def: ER movement of the tibia on the femur
●​ Occurs at: last 20° knee extension
●​ Aka locking of knee joint
●​ OKC vs CKC
○​ In OKC, the femur moves towards ER
●​ Class II lever
○​ In CKC, the tibia moves towards IR
○​ Component arrangement: FWE
○​ 1° fxn: power
EQUILIBRIUM ○​ Mechanical advantage: >1
○​ Longer arm length: effort or force
●​ Def: state where opposing forces are balanced
●​ Types
○​ Unstable
■​ COG: displaced
■​ Body: seeks new position
○​ Stable
■​ COG: displaced
■​ Body: returns to same position
○​ Neural
■​ COG: not displaced or nondisplaced ●​ Class III lever
■​ Body moving ○​ Component arrangement: FEW
○​ 1° fxn: speed
○​ Mechanical advantage: <1
CENTER & LINE OF GRAVITY ○​ Longer arm length: weight or resistance
●​ Sexual differences
○​ In men, the COG is higher d/t broad shoulders
○​ In women, the COG is lower d/t broad pelvis
●​ Loc of COG in the body: slightly anterior to S2
●​ Composition of COG with regards to height: 55% of body’s
height
●​ COG per region TORQUE
○​ Head: sphenoid sinus
○​ Neck: basioccipital ●​ Aka moment arm
○​ Trunk: anterior to T11 ●​ Def: force that can rotate a lever on an axis
○​ UE: just above elbow ●​ Relationships
■​ Arm: medial head of triceps ○​ With distance: directly proportional
■​ FA: pronator teres ○​ With force: inversely proportional
■​ Hand: 3rd MCP ●​ In a longer arm there is lesser force
○​ LE: just above knee joint ●​ In a shorter arm there is greater force
■​ Thigh: Adductor Brevis/Magnus
■​ Leg: Popliteus NEWTON’S LAWS OF MOTION
■​ Foot: 2nd MTT
●​ Line of gravity (mnemonic: TO-AO-TAT-PAA) ●​ First Law
○​ Through the odontoid process ○​ Aka: Law of Inertia/Equilibrium
○​ Anterior to the AO joint ○​ Principle: object at rest remain at rest & object in
○​ Through the cervical spine uniform motion remain in motion, unless outside
○​ Anterior to the thoracic spine (unbalanced) force acts upon it
○​ Through the lumbar spine ○​ TLDR: object will not move without any force
○​ Posterior to the hip ●​ Second Law
○​ Anterior to the knee ○​ Aka: Law of Acceleration
○​ Anterior to the ankle ○​ Principle: Acceleration is produced when a force acts
on a mass. More mass require more force
○​ TLDR: to move a bigger mass, you need a big force
LEVERS ●​ Third Law
●​ Axis ○​ Aka: Law of Action-Reaction
○​ Aka pivot or fulcrum ○​ Principle: For every action that occurs there is equal
○​ Def: point where lever rests & opposite reaction
○​ TLDR: ricochet principle
 MUSCLE TYPES
AT THE UPPER EXTREMITY
●​ Agonist
○​ Aka prime mover Articulation Capsular pattern
○​ Def: principal mm that performs action
●​ Antagonist: GH ER > AB > IR
○​ Def: opposes action of agonist; passively lengthens
to allow joint motion SC & AC Elevation with pain at ROM extremes
●​ Synergist
○​ Def: acts as stabilizer, prevents/rules out unwanted HU F>E
unnecessary motions; assist motion; obstructs
unwanted motion RH F>E>S>P

MUSCLE CONTRACTION TYPES PRU S>P

●​ Concentric (positive work): shortening DRU Pain at ROM extremes

●​ Eccentric (negative work): lengthening
●​ Isometric: contraction with same length RC F=E
●​ Isotonic: same tone; same tension, same load
●​ Isokinetic: same rate of movement MCP F&E

ACTIVE & PASSIVE INSUFFICIENCY

AT THE LOWER EXTREMITY
●​ Active insufficiency
○​ Aka position of maximal contraction Articulation Capsular pattern
●​ Passive insufficiency
○​ Aka position of maximal elongation Hip IR > F > AB

Knee F>E
CLASSIFICATIONS OF BONES

●​ Long Bones Ankle PF > DF

○​ Def: length is greater than its width
○​ Ex. Femur, humerus, tibia, ulna Subtalar Limitations of varus ROM
●​ Short Bone
○​ Def: length is almost equal to its width Midtarsal DF > PF > AD > IR
○​ Ex. Carpals, tarsals
●​ Sesamoid Bones MTP F & E or variable
○​ Def: sesame seed shape
○​ Ex. patella, pisiform
●​ Irregular Bone ADDENDA
○​ Def: complex shape
●​ Shunt Muscle: Proximal Attachment (origin) is near to joint;
○​ Ex. Sphenoid bone, hip bone, vertebra
eg: Brachioradialis
●​ Flat Bones
●​ Spurt Muscle: Proximal Attachment (origin) is far to joint ;
○​ Def: thin & sometimes curved bones
eg: biceps, brachialis
○​ Ex. partial bone of skull, scapula, sternum, ribs
●​ End Feel: sensation felt by PT when performing passive
ROM to the patient
OPEN PACK & CLOSE PACK POSITION
●​ Open pack position
○​ Stress on joint: minimal
○​ Congruency of joint: minimal
○​ Ligament status: lax
○​ Joint contact: separated
●​ Close pack position
○​ Stress on joint: maximal
○​ Congruency of joint: maximal
○​ Ligament status: taut
○​ Joint contact: compressed

CAPSULAR PATTERN

AT THE AXIAL SKELETON

Articulation Capsular pattern

TMJ Mouth opening

Atlanto Occipital F>E

Atlanto Axial Rotation

Spine SIde flexion = Rotation > F > E

 HEAD, NECK, & TMJ ●​ Cranial bones (mnemonic: PT FOES)
○​ Parietal bone (2)
○​ Temporal bone (2)
TOPIC OUTLINE ○​ Frontal bone
○​ Occipital bone
I.​ Axial & Appendicular Skeleton ○​ Ethmoid bone
A.​ Scalp & Layers ○​ Sphenoid
II.​ Skull
A.​ Cranium
B.​ Cranial Bones
C.​ Facial Bones
D.​ Sutures
E.​ Anatomical Landmarks
F.​ Fontanelles
G.​ Foramen
H.​ Muscles
III.​ Neck
A.​ Muscles
B.​ Triangles
IV.​ Temporomandibular Joint
A.​ Muscles for Mastication
B.​ Dentition
●​ Facial bones (mnemonic: NiLaPa Zy V MaMA)
C.​ Tongue
○​ Nasal (2) that make up the nose bridge
○​ Inferior conchae (2)
○​ Lacrimal bone (2)
AXIAL & APPENDICULAR SKELETON ○​ Palatine (2): roof of hard palate
●​ Number of bones: 206 bones ○​ Zygomatic (2): cheek bone
○​ Axial bones: 80 bones ○​ Vomer (1): separates nostrils
○​ Appendicular bones: 126 bones ○​ Maxilla (2): upper jaw
●​ Scalp ○​ Mandible (1)
○​ Def: soft tissue from inion that covers the cranial
vault
●​ Layers of the scalp (mnemonic: SCALP)
○​ Skin
■​ Depth: outermost layer
■​ Houses the hair follicles & sebaceous glands
○​ Connective tissue
■​ Aka epicranium
■​ Houses the veins & arteries & fxns for blood
supply
○​ Aponeurosis
■​ Aka galea aponeurotica
■​ Def: tendinous sheath that provides an insertion
site for the occipitofrontalis muscle
○​ Loose areolar tissue
■​ Aka loose connective tissue
■​ Houses the blood vessels & valveless emissary
veins
■​ Termed the dangerous layer because infection
at this site may spread to the brain
○​ Pericranium
■​ Aka periosteum
■​ Depth: innermost layer
■​ Functions to separate the scalp from the skull &
to provide the skull with nutrition

SKULL
●​ Def: part of the axial skeleton that is composed of the
cranium & facial bones
●​ Composed of 8 cranial bones & 14 facial bones making 22
bones
●​ Cranium QUESTION
○​ Composed of the cranial & facial bones
○​ Its upper portion is aka the cranial vault & its lower Which cranial bone is the 2nd most difficult to visualize?
portion is aka the base
Ethmoid bone
○​ It is connected by the sutural ligament
●​ 3 layers of skull bone
○​ External & internal layers are composed of compact ●​ Sutures
bone ○​ Def: fibrous synarthrodial joint that connects the
○​ The dipole is the middle layer, it is composed of facial & cranial bones
trabecular or spongy bone ○​ Coronal suture
■​ Aka frontal suture
■​ Connects frontal & parietal
 ○​ Sagittal suture
■​ Connects parietals ANATOMICAL LANDMARKS
○​ Lambdoid ●​ Nasion: depression at the root of nose
■​ Connects occipital & parietal ●​ Philtrum: depression between nose & lip
○​ Squamosal ●​ Nasolabial folds: creases at the side of the mouth
■​ Connects temporal & parietal ●​ Pterion
○​ Trivia: thinnest portion of the skull
○​ Loc: lies superficial to the middle meningeal
○​ Trauma to this bone would lead to epidural
hemorrhage
●​ Inion
○​ Aka external occipital protuberance or bump of
knowledge in the elderly
○​ Def: small eminence between the two superior nuchal
lines
○​ Primarily used as a measurement for head
circumference

FONTANELLES
●​ Def: soft spots that allow brain growth
●​ Fxns as a landmark for blood withdrawal
●​ Anterior fontanelle
○​ In terms of size & shape, it is large & diamond
shaped fontanelle that closes at 18-24 months
○​ It serves as the junction between the frontal & ●​ Glabella
parietal bones ○​ Def: skin between the eyebrows
○​ Assessment ○​ Primarily used as a measurement for head
■​ If depressed, it implies dehydration circumference
■​ If bulging, it implies ↑'d ICF ○​ Glabellar tap reflex: reflex for PD patients, where
○​ Bregma: junction between frontal & sagittal suture tapping the glabella leads to Myerson’s sign
●​ Posterior fontanelle (persistent blinking)
○​ In terms of size & shape, it is small & triangular
shaped that closes at 9-12 months
○​ It serves as the junction between the sagittal &
lambdoid suture
○​ Lamda: aka lambdoid, it is the junction between
sagittal & lambdoid suture
●​ Sphenoidal suture
○​ Aka anterolateral suture
○​ Connects the parietal, frontal, temporal, & sphenoid
●​ Mastoid suture
○​ Aka posterolateral suture
○​ Connects the occipital, parietal, & temporal

FORAMEN

●​ Cribriform plate: CN 1
●​ Superior orbital fissure: CN3, CN4, CN5v1, & CN6
●​ Foramen rotundum: CN5v2
●​ Foramen ovale: CNv3
●​ Internal auditory meatus: CN7 & CN8
●​ Jugular foramen: CN9, CN10, & CN11
●​ Hypoglossal canal: CN12
●​ Foramen magnum: CN11 (spinal part), MO, spinal cord, &
vertebral arteries
●​ Foramen lacerum: internal carotid artery
●​ Foramen spinosum: middle meningeal artery

MUSCLES
●​ Occipitofrotalis
○​ Action: raising eyebrow
○​ Facial expression: surprise
●​ Corrugator supercilii
○​ Action: medial movement of eyebrows
○​ Facial expression: frowning
●​ Relevant conditions
●​ Procerus
○​ Diplopia
○​ Action: nose wrinkling
■​ Aka double vision
○​ Facial expression: distaste
■​ Strong: medial/lateral rectus
●​ Orbicularis oculi
■​ Weak: C/L rectus
○​ Palpebral portion: soft closure & lacrimal dilation
○​ Lateral strabismus
○​ Orbital portion: forceful closure
■​ Def: both eyes are pulled to lateral
○​ Innervation: CN7
■​ Strong: lateral recti
●​ Levator palpebrae superioris: 80% eye opening
■​ Weak: medial recti
○​ Innervation: CN3
○​ In (+) lesion: ptosis
●​ Mueller’s muscle: 20% eye opening NECK
○​ Innervation: SNS
●​ Nasalis: compresses & dilates nostril ●​ Hyoid bone
●​ Zygomaticus major ○​ Def: mobile floating & U-shaped bone at the neck
○​ Action: draws angle of mouth superolaterally ○​ Vertebral level: C3
○​ Facial expression: true smile ●​ Suprahyoids & infrahyoids: fxn as 2° muscles of
●​ Risorius mastication
○​ Trivia: muscle for dimples ○​ Suprahyoids (mnemonic: Genie, Di My Style lolo)
○​ Facial expression: fake smile ■​ Geniohyoid
●​ Zygomaticus minor ■​ Digastric
○​ Action: protrusion of upper lip ■​ Mylohyoid
○​ Facial expression: accessory muscle for smiling & ■​ Stylohyoid
sadness ○​ Infrahyoids (mnemonic: ThyMoSteSte)
●​ Depressor anguli oris: depresses mouth angle ■​ Thyrohyoid
●​ Levator labii superioris: elevates upper lip ■​ Omohyoid
●​ Levator anguli oris ■​ Sternohyoid
○​ Action: elevates angle of mouth ■​ Sternothyroid
○​ Facial expression: sneering ●​ Digastric
●​ Orbicularis oris ○​ Doubly innervated muscle
○​ Action: closing lips ■​ Anterior belly: C5
○​ Facial expression: kissing ■​ Posterior belly: C7
●​ Mentalis ●​ Ansa cervicalis
○​ Action: protrusion of lower lip ○​ Def: loop of nerves serving as innervation of
○​ Facial expression: pouting infrahyoids
●​ Buccinator ○​ Aside from thyrohyoid which is innervated by C1
○​ Compresses cheek ●​ Scalenes
○​ Sucking ○​ Common action: I/L flexion & rotation of neck
○​ Puffing ○​ Anterior & middle scalene action: rib 1 elevation
○​ Blowing ○​ Posterior scalene action: rib 2 elevation
●​ Platysma
○​ Aka egad muscle TRIANGLES OF THE NECK
○​ Action: depresses mouth angle

MUSCLES OF THE EYE

●​ Extraocular muscles
○​ Superior Rectus
■​ Innervation: CN 3
■​ Action: superiorly/upward; elevates eyeball
○​ Inferior Rectus
■​ Innervation: CN 3
■​ Action: inferiorly/downward
○​ Medial Rectus
■​ Innervation: CN 3
■​ Action: medially/inward
○​ Lateral Rectus
■​ Innervation: CN 6
■​ Action: laterally/outward
○​ Superior Oblique ​ ●​ Anterior Triangle
■​ Innervation: CN 4 ○​ Boundaries
■​ Action: downward & inward ■​ Superior: mandible
○​ Inferior Oblique ■​ Anterior: anterior neck line/midline of neck
■​ Innervation: CN 3 ■​ Posterior: anterior border of SCM
■​ Action: upward & inward
●​ Submental Triangle
○​ Lateral: anterior belly of digastric MUSCLES FOR MASTICATION
○​ Inferior: hyoid ●​ Minimum mandibular depression for mastication: 18 mm
○​ Anterior: anterior neck line/midline of neck ●​ Mouth Closing
●​ Submandibular ○​ Temporalis
○​ Aka Digastric Triangle ■​ Posterior Fiber: retrusion
○​ Superior: mandible ■​ Anterior Fiber: mouth closing, protrusion
○​ Anterior: anterior belly of digastric ■​ Superior Fiber: mouth closing
○​ Posterior: posterior belly of digastric ○​ Internal/medial pterygoid
●​ Carotid Triangle ○​ Masseter
○​ Superior: posterior belly of digastric belly ●​ Mouth Opening
○​ Inferior: superior fibers of omohyoid ○​ External/lateral pterygoid
○​ Posterior: anterior border of SCM ●​ Protrusion
○​ Contains carotid pulse ○​ Internal pterygoid
●​ Muscular Triangle ○​ Masseter
○​ Superior: superior fibers of omohyoid ○​ External pterygoid
○​ Inferior: anterior border of SCM ●​ Retrusion
○​ Anterior: anterior neck line/midline of neck ○​ Posterior fibers of temporalis
●​ Posterior Triangle ●​ Lateral deviation
○​ Anterior: posterior border of SCM ○​ Internal & external pterygoid
○​ Posterior: trapz ●​ Pterygoids
○​ Inferior: clavicle ○​ Trivia: 1° muscle for lateral deviation
●​ Occipital Triangle ○​ Ipsilateral: External/ lateral Pterygoid
○​ Anterior: posterior border of SCM ○​ Contralateral: Internal/ Medial Pterygoid
○​ Posterior: trapz
○​ Inferior: inferior fibers of omohyoid
●​ Supraclavicular DENTITION
○​ Aka Subclavian Triangle
●​ Deciduous
○​ Superior: inferior fibers of omohyoid
○​ Aka Milk Teeth
○​ Anterior: posterior border of SCM
○​ Inferior: clavicle ○​ Eruption: 6 mos - 2 yrs
○​ Total number: 20
■​ 4 incisors
TEMPOROMANDIBULAR JOINT
■​ 2 canine/cuspids
●​ Articulation: temporal bone & mandible ■​ 4 molars
●​ Type: synovial diarthrodial ●​ Permanent Teeth
●​ TMJ disc fxns to separate the upper & lower joint ○​ Eruption: 17-30 yo
○​ Fxns of the TMJ parts (mnemonic: STIR)
○​ Total number: 32
■​ Superior joint fxns for translation
■​ Inferior joint fxns for rotation ■​ 4 incisors
●​ CPP: clenched teeth ■​ 2 canine/cuspids
●​ OPP: mouth slightly open with teeth not in contact ■​ 4 premolars/bicuspids
●​ CP: mouth opening ■​ 6 molars
●​ Functional ranges ●​ First tooth to erupt: lower central incisors
○​ Opening: 40 mm
●​ Second tooth to erupt: lower lateral incisors
○​ Rotation: 25 mm
○​ Glide: 15 mm ●​ Last tooth to erupt: 3rd molar
●​ Movements
○​ Opening TONGUE
■​ Arthrokinematics: bilateral anterior rotation at
first 26 mm, followed by bilateral anterior ●​ Innervation: CN12
translation ○​ Aside from palatoglossus which is innervated by CN 9
■​ N: 35-55 mm or 10 via the palatopharyngeal plexus
○​ Protrusion ●​ Muscle actions
■​ Arthrokinematics: bilateral anterior translation ○​ Palatoglossus: Elevation
■​ N: 3-6 mm (or ≤7 mm) ○​ Genioglossus: Protrusion
○​ Retrusion ○​ Hyoglossus: Depression
■​ Arthrokinematics: bilateral posterior translation ○​ Styloglossus: Retrusion
■​ N: 3-4 mm
○​ Lateral deviation (mnemonic: ipsirot-contrans)
■​ Aka excursion
■​ I/L: rotation
■​ C/L: translation
■​ N: 10-15 mm
●​ Mouth opening phases
○​ Early Phase: 35-50%
■​ Hallmark: rolling towards posterior side
○​ Late Phase: 50-65%
■​ Hallmark: translation anterior & inferior
●​ Knuckle Test (PIP)
○​ 3 finger breadths: Normal
○​ 2 finger breadth: Functional
 BACK & SPINE ANATOMY PARTS OF A VERTEBRA

TOPIC OUTLINE

I.​ Back & Spine

A.​ Vertebral Column
B.​ Curves
II.​ Vertebra
A.​ Parts
B.​ Typical
C.​ Atypical
III.​ Joints
IV.​ Intervertebral Discs
A.​ Nucleus Pulposus
B.​ Annulus Fibrosus
V.​ Biomechanics of the Spine
VI.​ Important Landmarks ●​ Spinal canal is aka neural canal or vertebral foramen
VII.​ Ligaments ●​ Distance to VB
A.​ Intersegmental ○​ Pedicle: closer
B.​ Intrasegmental ○​ Laminae: further
C.​ Others ●​ Pedicles
VIII.​ Range of Motion ○​ Connects the TPs to the VB
IX.​ Muscles ○​ Widest at: L5 (Lapad)
A.​ In the Back & Spine Region ○​ Narrowest at T5 (Tipid)
B.​ In the Thoracolumbar Region ●​ Laminae
○​ Connects the SPs to the TPs
●​ Facet process
BACK & SPINE ○​ Aka Z joint or articular process
○​ Typically paired into superior facets & inferior facets
●​ Fxns (mnemonic: SIRENA)
(mnemonic: SIAPOS at ISBAI)
○​ Supports head
■​ Superior facet
○​ Important attachment of muscles & ligaments
●​ Articulates with inferior facet above
○​ Ribs attachment
●​ Orientation: posterosuperior
○​ Encloses & protects the spinal cord
■​ Inferior facet
○​ N-ables mobility & flexibility of the trunk
●​ Articulates with superior facet below
○​ Ability to transmit weight of head & trunk to LE
●​ Orientation: anteroinferior
●​ Vertebral column
○​ Average length
■​ In males: 72 cm TYPICAL VERTEBRAE
■​ In females: 62 cm
○​ Number of vertebrae ●​ Cervical vertebrae
■​ Cervical: 7 ○​ VB: small
■​ Thoracic: 12 ○​ SP: short & bifid
■​ Lumbar: 5 ○​ TP: transverse foramen for vertebral A&V + Symp nn
■​ Sacral: 5 fusing into 1 ○​ VC: large & triangular
■​ Coccygeal: 4 fusing into 1 ○​ Facet (mnemonic: sword slash center)
■​ Total ■​ SF: posterosuperior
●​ In infants: 33 ■​ IF: anteroinferior
●​ In adults: 26 ●​ Thoracic vertebrae
●​ Curves ○​ VB: medium & heart shaped
○​ Primary curve ○​ SP: long & downwards
■​ Aka kyphosis ○​ TP: costal facets
■​ Def: the only curve present at birth ○​ VC: small & circular
■​ 1° curves in the spine: thoracic & sacral ○​ Facet (mnemonic: sword slash down to L/R)
○​ Secondary curve ■​ SF: posterolateral
■​ Aka lordosis ■​ IF: anteromedial
■​ Cervical lordosis is developed in 2-3 months ●​ Lumbar vertebrae
when baby raises the head ○​ VB: large & kidney shaped
■​ Lumbar lordosis is developed in 10-12 months ○​ SP: short, flat, & quadrilateral
when baby is standing & walking ○​ TP: long & slender (conical)
○​ VC: triangular
○​ Facet (mnemonic: sword back to scabbard)
■​ SF: superomedial
■​ IF: inferolateral

ATYPICAL VERTEBRAE
●​ C1 vertebra
○​ Aka atlas
○​ Formed by 2 lateral masses joining at the anterior &
posterior aspects
○​ What makes it atypical? No body & SP
○​ Associated fracture: Jefferson’s fracture
●​ C2 vertebra ●​ IVD compression
○​ Aka axis, peg, epistropheus ○​ Supine: 25%
○​ What makes it atypical? ○​ Sidelying: 75%
■​ (+) peg-like odontoid ○​ Standing upright: 100%
■​ Large SP & small TP ○​ Sitting upright: 140%
○​ Associated fracture: Hangman’s & teardrop fracture ○​ Standing + forward bend: 160%
●​ C7 vertebra ○​ Sitting + forward bend: 185%
○​ Aka vertebra prominens ○​ Standing + forward bend + weights: 220%
○​ What makes it atypical? Longest non-bifid SP & an ○​ Sitting + forward bend + weights: 275%
absent foramen transversarium ●​ Vertebral endplates
○​ Associated fracture: clay shoveler’s fracture ○​ Aka cartilaginous endplates
●​ T1-T4 vertebra ○​ Fxn: prevent vertical herniation or schmorl’s nodes
○​ What makes them atypical? Horizontal SP ●​ Schmorl’s node
●​ L5 vertebra ○​ Def: herniation of the NP towards the VB
○​ What makes it atypical? Stoutest vertebra ○​ MOI: wear & tear
○​ MC site & direction: lumbar (posterolateral direction)

JOINTS
●​ The back has a 3-joint complex composed of
○​ 1 adjacent VB + IVD
○​ 2 pairs of facets
●​ Joints of Von Luschka
○​ Other names (mnemonic: UNU)
■​ Uncovertebral joints
■​ Neurocentral joints (peripheral nerves pass
through them)
■​ Uncinate process
●​ Nucleus pulposus
○​ Eruption: 6-9 yo, therefore it is NOT considered a true
○​ Depth: inner layer
joint
○​ Desc: gel-like material
○​ Age of full development: 18 yo
○​ Hallmark: contains proteoglycans which absorb
○​ Loc: inferior aspect of C3 to superior aspect of C7
80-90% H2O
○​ Total number of JVL: 12 joints
■​ Effect of aging: ↓'d proteoglycans
○​ LOM present in JVL affectation: side bending
■​ Collagen composition: 15-20%
○​ Fxn: absorbs compression & distributes it to AF
●​ Annulus fibrosus
○​ Depth: outer layer
○​ Desc: fibrocartilaginous pulp
○​ Collagen composition: 50-60%
○​ Hallmark: contains lamellae which are angled with
each other at 30°
○​ Hallmark structure attached: sharpey’s fibers
■​ Attached on: outer AF
■​ Fxn: protection & ↑'d strength
○​ Hoop’s stretch
■​ Def: resultant stretch caused by force
●​ Atlanto-occipital joint dissemination from NP during compression
○​ Aka yes joint
○​ Contributes 50% to cervical flexion & extension
○​ Type: condyloid joint BIOMECHANICS OF THE SPINE
●​ Atlanto-axial joint ●​ Flexion
○​ Aka no joint ○​ VB: approximate
○​ Contributes 50% to cervical rotation ○​ SP: separate
○​ Type: pivot or trochoid ○​ IVD: flat anteriorly
●​ Exit points of spinal nerves ○​ Facet: opening towards anterosuperior direction
○​ At the cervical spine: CerBELOW (C8 nerve exits ○​ Foramina: opens
below the C7 vertebra) ●​ Extension
○​ At the thoracic spine: TAASic (T4 nerve root runs ○​ VB: separate
between the T4 vertebra and T5 vertebra) ○​ SP: approximate
○​ IVD: flat posteriorly
INTERVERTEBRAL DISCS ○​ Facet: closing towards posteroinferior direction
○​ Foramina: closes
●​ Lateral Flexion
○​ VB: I/L approximation
○​ SP: C/L separation
○​ IVD: flat I/L
○​ Facet
■​ I/L closed
■​ C/L open
○​ Foramina
■​ I/L closed
■​ C/L open
●​ Contributes to 25% of vertebral column height
●​ Present only in C2 to S1 vertebrae
●​ IV disc height to VB height ratio: 1:4/3
●​ Rotation ●​ Supraspinous ligament
○​ VB: I/L rotation ○​ Connects: tips of SP
○​ SP: C/L rotation ○​ Course: C7 to sacrum
○​ IVD: at its weakest ○​ Taut: flexion
○​ Facet ○​ Lax: extension
■​ I/L closed ○​ Prevents: shear & forward bending
■​ C/L open
○​ Foramina
■​ I/L closed
■​ C/L open
●​ In the VB
○​ During compression: approximate
○​ During distraction: separate
○​ During shearing forces: multidirectional sliding
(except inferomedial)
●​ Other motions
○​ Coupling motions in the spine: lateral flexion &
rotation

INTRASEGMENTAL VERTEBRAE
IMPORTANT LANDMARKS
●​ Def: ligaments that connect individual or adjacent
●​ In the cervical spine vertebrae
○​ C3 level: hyoid ●​ Ligamentum nuchae
○​ C4 level: thyroid ○​ Connects: tips of SP
○​ C6 level ○​ Course: C7 to occiput
■​ Cricoid
■​ Larynx & trachea junction
■​ Pharynx & esophagus junction
■​ Middle cervical sympathetic ganglion
■​ Adam’s apple (laryngeal prominence)
■​ First ring of trachea
■​ Suprasternal notch
○​ Back of neck: suboccipital region
●​ In the thoracolumbosacral spine
○​ T2 level: superior angle of scapula
○​ T3 level: spine of scapula ●​ Ligamentum flavum
○​ T7 level: inferior angle of scapula ○​ Aka yellow ligaments
○​ T10 level: xiphoid process ○​ Connects: adjacent laminae
○​ L4 level: iliac crest ○​ Promotes: extension movement
○​ L5 level: iliac tubercle
○​ S2 level: SI joint & PSIS

INTERSEGMENTAL LIGAMENTS
●​ Def: ligaments that connect multiple vertebrae
●​ Anterior longitudinal ligament
○​ Connects: anterior VBs via anterior disks
○​ Taut: extension
○​ Lax: flexion
○​ MOI: whiplash
○​ Prevents: hyperextension & forward VB translation ●​ Interspinous ligament
●​ Posterior longitudinal ligament ○​ Connects: adjacent SPs
○​ Connects: posterior VBs ○​ Prevents: shear & forward bending
○​ Superior continuation: tectorial membrane (C1 & C2)
○​ Tapered at below L2 vertebral level
○​ Loc: inside spinal canal
○​ Taut: flexion
○​ Lax: extension
○​ Trivia: contributes to posterior disc protrusion below
L2 2° tapered shape

●​ Intertransverse ligament
○​ Connects: adjacent TPs
 ●​ Cruciform ligament
OTHER LIGAMENTS
○​ Transverse cruciform ligament
●​ Anterior atlanto occipital membrane ■​ Course: inner atlas → odontoid process →
○​ Continuation of ALL anterior atlas
○​ Course: anterior arch of atlas to anterior margin of ○​ Vertical cruciform ligament
foramen magnum ■​ Course: posterior axis → anterior foramen
○​ Prevents: extension magnum
○​ Assists the alar ligament ○​ General course: anterior foramen magnum to dens
●​ Membrana tectoria
○​ Upward continuation of PLL
○​ Insertion: inside the foramen magnum superior to
occipital bone
○​ Covers
■​ Posterior odontoid
■​ Apical ligaments
■​ Cruciform ligaments

●​ Posterior atlanto occipital membrane

○​ Course: posterior arch of atlas to posterior margin of
foramen magnum
○​ Prevents: flexion
●​ Transverse ligament
○​ 1° fxn: holds the dens against the atlas
○​ Prevents: posterior subluxation of dens

RANGE OF MOTION IN THE SPINE

SPINAL REGIONS RANGE OF MOTION

●​ Apical ligament
○​ Course: anterior foramen magnum to apex of dens
AO AA C3-C7 T/S L/S
●​ Alar ligament
○​ Connects: odontoid process & medial occipital
Flexion 10° 5° 45° 15° 40°
condyles
○​ Prevents: skull & atlas rotation on axis (aka wings)
Extension 25° 10° 45° 15° 25°

Lateral flexion 5° 10° 30° 15° 5°

Rotation 0° 45° 30° 40° 5°

●​ Site of greatest rotation: upper thoracic spine

●​ Site of greatest lateral flexion: lower thoracic spine
●​ Site of least rotation: lumbar spine
 MUSCLES OF BACK & SPINE

●​ Superficial group (mnemonic: TRaLaLa)

○​ Trapezius
■​ Aka shawl muscle
■​ Upper fibers: scapular elevation
■​ Middle fibers: scapular retraction
■​ Lower fibers: scapular depression + retraction
○​ Latissimus dorsi
■​ Aka broadest muscle & crutch walking muscle
■​ Action in OKC: shoulder EXADIR
■​ Action in CKC: elevates body
○​ Levator scapula
○​ Rhomboids
●​ Intermediate group
○​ SA posterior superior
○​ SA posterior inferior
●​ Deep group (mnemonic: SES, Tra LINIS)
○​ Splenius
■​ Aka bandage muscle
●​ In the head: splenius capitis
●​ In the neck: splenius cervicis
○​ Erector spinae
■​ Aka sacrospinalis or chief back extensors
■​ Orientation: longitudinal
■​ Muscles (Erect na ses, I Love Sex)
●​ Iliocostalis
●​ Longissimus
●​ Spinalis
○​ Transversospinalis
■​ Orientation: oblique
■​ Muscles (mnemonic: SeMuRai)
●​ Semispinalis
●​ Multifidus
●​ Rotatores
○​ Levatores costarum: lower ribs elevation
○​ Interspinals & intertransversarii
○​ Suboccipital muscles
■​ Trivia: deepest muscle of the back

MUSCLES OF THE THORACIC & LUMBAR REGION

●​ Anterior group (mnemonic: Ante! May pec-pec sa recto, tra

na oh)
○​ Pectoralis
■​ Action in OKC: shoulder depression
■​ Action in CKC: forced inspiration
○​ SA
○​ Rectus abdominis
■​ Desc: two vertically oriented muscles
■​ Separated by: linea alba
■​ Actions
●​ Upper RA: crunches or partial sit up
●​ Lower RA: leg raising
○​ Transverse abdominis
■​ Aka corset muscle
■​ Trivia: deepest abdominal muscle
■​ 1° fxn: ↑'s intraabdominal p° to keep organs in
place
○​ Obliques
■​ Trivia: most superficial abdominal muscle
■​ Orientation
●​ EO: downward & inward (▼)
●​ IO: downward & outward (▲)
■​ Mnemonic: External exposed; Internal inside
●​ Lateral group
○​ Quadratus Lumborum
■​ Aka hip hiking muscle
■​ Forms the lateral wall of abdomen
■​ Fxn: maintains pelvic position during swing
phase
○​ Psoas major: aka flexor of LE & back
●​ Posterior group (deep group of back muscles)
 HEAD, NECK, BACK, ●​ Ssx
○​ Posterior neck pain & tenderness
& SPINE CONDITIONS ○​ Cervical LOM

TOPIC OUTLINE

I.​ Whiplash
II.​ Bony defects
A.​ Spondylosis
B.​ Spondylolysis
C.​ Spondylolisthesis
D.​ Stenosis
E.​ Tietze’s syndrome
F.​ Coccydynia
III.​ Spina bifida
IV.​ Torticollis SPONDYLOLYSIS
V.​ LBP
VI.​ Disc herniation ●​ Causative factor for spondylolisthesis
VII.​ Abnormal postures ●​ Def: defect of pars interarticularis
VIII.​ Scoliosis ○​ In the posterior aspect: between superior & inferior
articulating facet
○​ In the transverse aspect: between lamina & pedicle
WHIPLASH INJURY ○​ In the lateral aspect: between superior & inferior
articulating facet
●​ Trivia: MC cause of cervical sprain & strain ●​ Xray
●​ MOI ○​ View used: oblique (mnemonic: FOLS)
○​ Hyperextension followed by flexion 2° MVA ○​ Manifestation: scotty dog with collar
○​ Rear-end collision ●​ Age: children & adolescents who participate in extreme
●​ MC affected ligament: ALL sports
●​ Epidemiology ●​ MC site: L4-L5 or L5-S1
○​ Sex: F
○​ Age: 30-50
●​ Ssx
○​ AP neck pain & tenderness
○​ Headache
○​ Cervical LOM
○​ (-) neurological findings
●​ Special tests
○​ Lhermitte’s test
■​ Sig: dural/meningeal irritation, MS, cervical or
dorsal column trauma
■​ Pt position: long sitting
■​ Procedure: PT flexes neck
■​ (+): electric like sensation down spine
SPONDYLOLISTHESIS
○​ Spurling’s test
■​ Aka foraminal compression test ●​ Def: anterior slippage of superior VB
■​ Sig: ●​ Ideal position: flexion to prevent slippage
●​ Nerve root compression ●​ Avoid position: extension
●​ Muscle spasm ●​ Retrolisthesis: posterior slippage of superior VB
■​ Pt position: sitting with head flexed to I/L side ●​ Xray
■​ Procedure: PT applies downward p° ○​ View used: lateral (mnemonic: FOLS)
■​ (+) ○​ Manifestation: scotty dog decapitated
●​ I/L radiculopathy ●​ Meyerding’s Grading of Spondylolisthesis
●​ C/L pain ○​ Grade I: ≥1%
○​ Grade II: ≥26%
○​ Grade III: ≥51%
○​ Grade IV: ≥76%
○​ Grade V: 100% slippage (aka spondyloptosis)
●​ Classifications of spondylolisthesis (mnemonic: DID TraP)
○​ Dysplastic
■​ Def: congenital par interarticularis defect
○​ Isthmic
■​ Trivia: MC classification
■​ Def: discontinuity of isthmus
■​ Isthmus: narrowest part of neural arch
SPONDYLOSIS ■​ MOI: repetitive hyperextension
○​ Degenerative
●​ Aka OA of the spine ■​ Def: degeneration of pars interarticularis with
●​ Involves the VB & IVD neural arch intact
●​ MC site: C5-C6 since it is the most mobile ■​ MC site: L5
●​ Age affectation: ≥60 yo ■​ MC affected: >50yo
●​ Xray ○​ Traumatic​
○​ ↓'d joint space ■​ Def: damage to pars interarticularis
○​ Osteophyte formation
 ○​ Pathologic
TIETZE’S SYNDROME
■​ Def: destruction 2° bony lesions
●​ Aka costochondritis
●​ Def: painful swelling of costochondral junction
●​ Aggravating factors
○​ Sneezing
○​ Coughing
○​ Deep inspiration
○​ Twisting
●​ Pain may spread to arms or shoulders
●​ Mx: mobilization & stretching
●​ Rachitic rosary: expansion of anterior rib ends at the
costochondral junction
SPINAL STENOSIS
●​ Def: narrowing of SC
●​ Dimateres
○​ Spinal canal: 17 mm
○​ Spinal cord: 10 mm
○​ Relative stenosis: ≤12 mm
○​ Absolute stenosis: ≤10 mm
●​ Causes
○​ Facet joint or ligamentum hypertrophy
○​ Disc protrusion
○​ Spur formation
●​ Ideal position: flexion

COCCYDYNIA
●​ Aka coccyalgia
●​ Def: pain on coccyx & lower sacrum
●​ Precipitating factor: improper sitting (slouched)
●​ Mx
○​ Postural program
○​ Avoid bicycling
●​ Disappears in: 1-2 weeks

ANKYLOSING SPONDYLITIS
●​ Aka bamboo spine, marie-strumpell disease, von beckterev
●​ Xray finding: bamboo spine
●​ Def: fusion of VBs
●​ Trivia: MC cause of LBP in adolescents
●​ Common posture: flexion
●​ Ideal position: extension
●​ Best exercise: swimming
●​ Special test
○​ Schober’s test
■​ Procedure: measure 10 cm above & below S2
■​ N: <5 cm SPINA BIFIDA
■​ Abn: >5 cm
■​ Hypermobility: >10 cm ●​ Def: incomplete closure of a posterior neuropore
●​ Arnold-chiari malformation: herniation of cerebellar tonsil
through foramen magnum
●​ Types of SB
○​ Spina bifida occulta
■​ Desc: closed SB
■​ Manifestation: tuft of hair
■​ Trivia: MC & most mild form
■​ OI: (-) posterior arch of vertebra but skin is
intact
○​ Spina bifida cystica
■​ Meningocele
●​ Aka meningeal cyst
●​ OI: meninges + CSF
■​ Myelomeningocele
●​ Aka meningomyelocele
●​ OI: meninges + CSF + SC
●​ Hallmark: affectation of cauda equina
 ●​ Innervated structures of the spine
○​ In the bone
■​ Z joint
■​ Joint capsule
■​ Outer AF
■​ VB periosteum
○​ Ligaments
■​ ALL
■​ PLL
■​ Interspinous
○​ Muscles
■​ ES
TORTICOLLIS
■​ multifidi
●​ Aka wry neck or cock robin deformity
●​ Affected muscle: SCM
ABNORMAL POSTURES
●​ Intervention: cervical collar & positioning
●​ CI: stretching & US ●​ Forward head posture
○​ Components
■​ AO & upper cervical extension
■​ Lower cervical & upper thoracic flexion
■​ Mandibular retrusion
○​ Weak muscles: flexors
○​ Tight muscles: extensors
○​ Management
■​ Stretching of extensors
■​ Strengthening of flexors
●​ Flat neck posture
○​ Seen in exaggerated military response
○​ Components
■​ AO flexion
LOW BACK PAIN ■​ ↓'d cervical lordosis
■​ Mandibular protrusion
●​ Viscerogenic LBP
○​ Def: internal organ disease ○​ Weak muscles: extensors
○​ Hallmark: unlocalized pain ○​ Tight muscles: flexors
●​ Structural kyphosis
●​ Vasculogenic LBP: caused by blood vessel obstruction
●​ Neurogenic LBP: caused by NR compression or ○​ Severity: often irreversible/fixed
impingement ○​ Types (mnemonic: COGStructural)
■​ Congenital kyphosis
●​ Spondylogenic LBP: caused by bone disease
●​ Psychogenic LBP: caused by malingering or hysterical ●​ Def: defect of spinal segmentation leading
patients to failure of anterior spine formation
■​ Osteoporosis
●​ Mechanical LBP: aka postural LBP; caused by faulty
biomechanics of posture ●​ Def: ↓'d bone mass or density
●​ Special tests for malingering ●​ Type I OP
→​Classification: 1° OP
○​ Hoover’s test
○​ Waddel’s sign: light head compression → overreact →​Aka postmenopausal OP
○​ Waldron sign: light head rotation → overreact →​Cause: ↓'d Ca++ reabsorption 2°
estrogen loss
→​Mx: hormonal replacement therapy
DISC HERNIATION →​Recommended daily Ca++: >1200 mg
●​ Type II OP
●​ MC direction of bulging in lumbar area: posterolateral
→​Classification: 1° OP
●​ Stages (mnemonic: BuPES) →​Aka senile OP
○​ Bulging →​Cause: malabsorption of Ca++
■​ Aka protrusion
→​Recommended daily Ca++: >1200 mg
■​ NP: bulges out ●​ Type III OP
■​ AF: intact →​Classification: 2° OP
○​ Prolapse
→​Age: any
■​ NP: herniation →​Cause (seco-NEDIN-ary)
■​ AF: incomplete defect ■​Nutritional deficiency
○​ Extrusion
■​Endocrine disorder
■​ NP: herniation ■​Drug use
■​ AF: complete defect ■​Immobility
○​ Sequestration
■​Nephropathy
■​ NP: complete herniation ■​ Gibbus deformity
■​ AF: complete tear ●​ Def: collapse of a single vertebra
■​ Hallmark: separated fragments
●​ Manifestation: dowager’s hump
■​ Scheuermann’s disease
●​ Other names (mnemonic: schet, JEJE)
→​Juvenile kyphosis
→​Early or adolescent kyphosis
→​Juvenile discogenic disease
→​Epiphysisitis of vertebra
●​ Def: anterior vertebral wedging of at least
5° of 3 consecutive vertebrae
 ●​ Epidemiology ●​ Scoliosis across different walks of life
→​Sex: M ○​ Infantile scoliosis
→​Age: 12-16 ■​ MC type: levoscoliosis
●​ MC site: T10-L2 ■​ Age: first 3 years of life
●​ FMHx: (+) ○​ Juvenile scoliosis
●​ Postural kyphosis ■​ MC type: dextroscoliosis
○​ Aka round back ■​ Age: 4-14 yo
○​ Components ○​ Adolescent
■​ Thoracic kyphosis ■​ MC type: dextroscoliosis
■​ Protracted scapula ■​ Trivia: MC type & age range
■​ Forward head posture ■​ Age: 10-16 yo
●​ Flat upper back ○​ Screening age
○​ Exaggerated military posture ■​ Girls: 9-11 yo
○​ Components ■​ Boys: 11-13 yo or 12-14 yo
■​ ↓'d thoracic kyphosis ●​ Special test
■​ Depressed clavicle & scapulae ○​ Lateral bending test
■​ Flat neck posture ■​ Sig: reversible scoliosis
●​ Lordotic posture ■​ Procedure: pt laterally bends to convex side
○​ Components ■​ (+): leveling of shoulders
■​ ↑'d lumbar lordosis ○​ Forward bending test
■​ ↑'d anterior pelvic tilt ■​ Aka Adam’s FBT
■​ Increased hip flexion ■​ Sig: possible scoliosis
■​ ↑'d lumbosacral angle ■​ Procedure: pt bends forward with arms dangling
●​ N: 30° (Brunnstrom) ■​ (+): posterior rib hump
●​ N: 140° (Magee) ○​ Plumb line
○​ Weak muscles: abdominals & hip extensors ■​ Sig: possible scoliosis
○​ Tight muscles: back extensors & hip flexors ■​ Procedure: pt aligns plumb line with pt’s back
●​ Sway back ■​ (+): gluteal cleft deviation to the L/R
○​ Aka slouched standing ●​ Scoliosis 2° LLD
○​ Components ○​ True LLD: from ASIS to medial malleolus
■​ Excessive anterior pelvic shift ○​ Apparent LLD: from umbilicus to medial malleolus
■​ ↑'d lumbar lordosis ○​ Orthotic management
■​ Hip extension ■​ <1 inch diff: heel elevation via heel wedge or
■​ ↑'d thoracic kyphosis insoles
○​ Weak muscles: back extensors & hip flexors ■​ >1 inch diff: sole support via sole wedge or
○​ Tight muscles: abdominals & hip extensors external support
●​ Terms
○​ 1° curve: first curve to appear
SCOLIOSIS ○​ 2° curve: curve as a result of the first curve
●​ Def: lateral curvature of the spine ■​ Compensated 2° curve: 1° curve degree = 2°
●​ Normal curvature of the spine: 10° curve degree
●​ MC type: idiopathic thoracic dextroscoliosis ■​ Decompensated 2° curve: 1° curve degree ≠ 2°
●​ MC affects: adolescent females curve degree
●​ Types ○​ Major curve: larger scoliotic curve
○​ Structural (fixed) ○​ Minor curve: smaller scoliotic curve
■​ Neuromuscular type ○​ Apical vertebra: most superior to midline & most
■​ Osteopathic type rotated
■​ Idiopathic type ○​ End vertebra: most tilted vertebra
○​ Non structural ●​ Scoliosis severity
■​ Aka functional, postural, or positional scoliosis ○​ Mild: ≤20°
■​ Causes (mnemonic: MaHaL) ○​ Moderate: 20-40°
●​ Muscle guarding or spams ○​ Severe: >40°
●​ Habitual asymmetrical posture ○​ Accompanies pain & DJD of spine: 40-50°
●​ Leg length discrepancy ○​ Accompanies cardiopulmonary changes & ↓'d life
●​ Failure of formation vs failure of segmentation expectancy: 60-70°
○​ Failure of formation ●​ Convex vs concave side
■​ Wedge vertebra: partial failure of U/L vertebral ○​ Convex side
formation ■​ High: shoulder
■​ Hemivertebrae: complete failure of U/L ■​ Rib hump: posterior rib hump
vertebral formation ■​ Structure oriented: VBs
○​ Failure of segmentation ○​ Concave side
■​ Congenital bar: U/L failure of segmentation ■​ High: pelvis or hip
■​ Block vertebrae: B/L failure of segmentation ■​ Rib hump: anterior rib hump
■​ Structure oriented: SPs
●​ Assessment
○​ Nash moe method
■​ Aka pedicle method
■​ Sig: measures vertebral rotation
■​ Grading
●​ Grade 0
→​Rotation: no rotation
→​Pedicles: both visible
●​ Grade I
→​Rotation: initiates direction to midline
→​Pedicles: C/L disappearing
 ●​ Grade II ●​ TMJ capsulitis
→​Rotation: 2/3 to midline ○​ Hallmark: pain on opening
→​Pedicles: C/L disappears ○​ LOM
●​ Grade III: ■​ Mouth opening
→​Rotation: at midline ■​ C/L excursion
→​Pedicles; I/L at midline ●​ TMJ synovitis
●​ Grade IV ○​ Manifestations: same as capsulitis
→​Rotation: beyond midline ○​ Hallmark: swelling
→​Pedicle: I/L beyond midline ●​ Hypomobility
○​ Hallmark: (-) pain + LOM
●​ Hypermobility
○​ Hallmark: (-) pain + excessive ROM

○​ Cobb’s method
■​ Trivia: MC & gold standard
■​ Def: angle of intersection between SEV & IEV
line
○​ Risser-ferguson method
■​ Trivia: easiest method
■​ Def: angle of intersection between SEV & IEV
long axis

●​ Spinal orthoses
○​ Apex above T6: milwaukee brace
○​ Apex below T6: miami brace
○​ Apex below T8: boston, wilmington, or yamamoto
●​ Surgical approaches
○​ Anterior approach
■​ Corrects curvature & rotation
■​ Trivia: more invasive but most effective
■​ Ex: thoracotomy
○​ Posterior approach
■​ Corrects curvature
■​ Trivia: less invasive
■​ Harrington rods: use of sublaminar wire to fuse
the spine
■​ Cotrel-dubousset: use of pedicle screws
■​ Luque sublaminar wiring
●​ Klapps exercise
○​ T3 level: low quadruped (low = 3 letters)
○​ T6 level: quadruped on elbows (elbows = 6 letters)
○​ T8 level: quadruped (Quadrup-8)
○​ T10 level: quadruped on all fingers (all fingers = 10
letters)

TMJ DISORDERS
●​ Disc displacement
○​ Hallmark: click on opening, typically has reduction
○​ MC direction: anterior displacement
●​ TMJ displacement
○​ Hallmark: click on closing
 HEAD, NECK, BACK, & SPINE ●​ Schwabach
○​ Sig: bone conduction hearing loss
SPECIAL TESTS ○​ Pt position: sitting
○​ Tuning fork position: PT & pt’s mastoid process
○​ (+) sign: mismatch of PT & pt’s sensation
TOPIC OUTLINE

I.​ Head CERVICAL SPINE

A.​ Hearing Loss Types ●​ Spurling’s test
B.​ Tests for Hearing Loss ○​ Sig: radiculopathy/radiculopathy or NR impingement
II.​ Cervical Spine ○​ Pt position: head in lateral flexion
A.​ Provocative Tests ○​ Procedure: PT compresses
B.​ Relieving Tests ○​ (+) sign: pain in I/L dermatomal distribution
C.​ Others ●​ Reverse spurling’s test
III.​ Upper Limb Tension Test ○​ Sig: tension myalgia
IV.​ Thoracic Outlet Syndrome ○​ Pt position: head in lateral flexion
V.​ Slump Test ○​ Procedure: PT compresses
VI.​ Straight Leg Raising Test ○​ (+) sign: pain in C/L side
VII.​ Lumbar & Sacroiliac Pathology
VIII.​ Other tests
A.​ For Malingering
B.​ For UMNL
C.​ For Increased Intrathecal Pressure

HEAD & HEARING LOSS

●​ Hearing loss types

○​ Conductive hearing loss
■​ Damaged area: outer & middle ear
■​ Problem: sound reception
○​ Sensorineural hearing loss
■​ Damaged area: inner ear
■​ Problem: sound interpretation
●​ Jackson compression test
●​ 1° tool for testing hearing loss types: tuning fork
○​ Sig: radiculopathy/radiculopathy or NR impingement
●​ Weber test
○​ Pt position: head in rotation
○​ Sig: hearing loss
○​ Procedure: PT compresses
○​ Pt position: sitting
○​ (+) sign: pain in I/L dermatomal distribution
○​ Tuning fork position: midline of the head
○​ (+) sign: one ear hears louder

●​ Maximal cervical compression test

●​ Rinne’s test ○​ Sig: radiculopathy/radiculopathy or NR impingement
○​ Sig ○​ Pt position: head in lateral flexion & rotation
■​ Air conduction impairment ○​ Procedure: PT compresses
■​ Bone conduction impairment ○​ (+) sign: pain in I/L dermatomal distribution
○​ Pt position: sitting
○​ Tuning fork position
■​ 1-2 cm beside the ear
■​ Mastoid process
○​ Normal: air conduction must be twice as long as
bone conduction
○​ (+) sign: failure to meet time quota
●​ Distraction test
○​ Sig: radiculopathy/radiculopathy or NR impingement ●​ Sharp-purser
○​ Pt position: sitting ○​ Sig: AA instability 2° lax transverse ligament
○​ Procedure: PT places hand on chin & occiput then ○​ Pt position: sitting
distract cervical spine ○​ Procedure: hand on forehead & finger on SP while pt
○​ (+) sign: relief of sx flexes the head
○​ (+) sign: sliding of atlas on axis (forehead hand
moves up & finger on SP goes down)

●​ Shoulder abduction test

○​ Aka Bakody sign
○​ Sig: C4-C5 or C5-C6 radiculopathy/radiculopathy or
NR impingement
○​ Pt position: sitting
○​ Procedure: elevate arm until it rests on the head UPPER LIMB TENSION TEST
○​ (+) sign: relief of sx
●​ Aka elvey’s test or upper limb neurodynamic test
●​ ULTT I
○​ Shoulder: abducted to 110°
○​ Elbow: extended
○​ FA: supinated
○​ Wrist: extended
○​ Nerve: median & AIN
●​ ULTT II
○​ Shoulder: abducted to 10°
○​ Elbow: extended
○​ FA: supinated
○​ Wrist: extended
●​ Scalene cramp test ○​ Nerve: median, axillary, & musculocutaeneous
○​ Sig ●​ ULTT III
■​ Trigger points ○​ Shoulder: abducted to 40°, extension to 25°, & IR
■​ Plexopathy ○​ Elbow: extended
○​ Pt position: sitting ○​ FA: pronated
○​ Procedure: pt places chin on supraclavicular space ○​ Wrist: flexed & UD
○​ (+) sign ○​ Nerve: radial
■​ Pain on shoulder ●​ ULTT IV
■​ Radiating pain ○​ Aka bikele’s sign if performed actively
○​ Shoulder: abducted 10-90°
○​ Elbow: flexed
○​ FA: supinated
○​ Wrist: extended & RD
○​ Nerve: ulnar

●​ Pettmans distraction test

○​ Sig: lax tectorial membrane
○​ Pt position: supine
○​ Procedure
■​ Similar to distraction test
■​ Perform with cervical flexion
○​ (+) sign: pain

●​ Key rules to include in ULTT

○​ Shoulder depression
○​ Lateral flexion of neck
○​ Elbow will be moved last
 THORACIC OUTLET SYNDROME ●​ Halstead maneuver
●​ Before testing for TOS, PT should assess for the integrity of ○​ Sig: TOS
the radial pulse ○​ Pt position: sitting
●​ Wright test ○​ Procedure: PT places UE on extension + C/L rotation
○​ Sig: TOS (Hadjay!) & palpates for radial pulse
○​ Pt position: sitting ○​ (+) sign: weak radial pulse
○​ Procedure: PT places UE on hyperabduction &
palpates for radial pulse
○​ (+) sign: weak radial pulse

●​ Allen test
○​ Sig: TOS
○​ Pt position: sitting
○​ Procedure: PT places UE on flexion + rotation to both
●​ Costoclavicular test sides & palpates for radial pulse
○​ Aka military brace test ○​ (+) sign: weak radial pulse
○​ Sig: TOS
○​ Pt position: sitting
○​ Procedure: PT places UE on extension & palpates for
radial pulse
○​ (+) sign: weak radial pulse

SLUMP TEST
●​ Aka sitting dural stretch test
●​ Slump I
○​ Hip: flexion
○​ Knee: extension
●​ Roos test ○​ Ankle: DF
○​ Aka east or hands up test ○​ Nerve: cervical & lumbar nerve + sciatic nerve
○​ Sig: TOS ●​ Slump II
○​ Pt position: sitting ○​ Hip: flexion + abduction
○​ Procedure: pt places UE on hands up position ○​ Knee: extension
○​ (+) sign: inability to sustain ○​ Ankle: DF
○​ Nerve: obturator nerve
●​ Slump III
○​ Aka sidelying slump
○​ Hip: flexion to 20°
○​ Knee: flexion
○​ Ankle: PF
○​ Nerve: femoral nerve
●​ Slump IV
○​ Aka long sitting slump
○​ Cervical: flexion & rotation
●​ Adson test ○​ Hip: flexion
○​ Sig: TOS ○​ Knee: extension
○​ Pt position: sitting ○​ Ankle: DF
○​ Procedure: PT places UE on extension + I/L rotation ○​ Nerve: cervical & lumbar nerve + sciatic nerve
of head (Adtoy!) & palpates for radial pulse
○​ (+) sign: weak radial pulse
 STRAIGHT LEG RAISING TEST
●​ Aka lasegue test
●​ Nerve bias mnemonic: SciTi Ti Su CoNe Po
●​ SLR I
○​ Hip: flexion + adduction
○​ Knee: extended
○​ Ankle: DF
○​ Foot: -
●​ Stork standing test
○​ Toes: -
○​ Aka lumbar extension test or one leg stance test
○​ Nerve: sciatic & tibial
○​ Sig: pars interarticularis fracture or spondylolisthesis
●​ SLR II
○​ Pt position: single leg stance
○​ Hip: flexion
○​ Procedure: pt maintains position + PT pulls into trunk
○​ Knee: extended
extension
○​ Ankle: DF
○​ (+) sign: pain
○​ Foot: everted
○​ Toes: extended
○​ Nerve: tibial nerve
●​ SLR III
○​ Hip: flexion
○​ Knee: extension
○​ Ankle: DF
○​ Foot: inverted
○​ Toes: -
○​ Nerve: sural
●​ SLR IV
○​ Hip: flexion + IR
○​ Knee: extension
○​ Ankle: PF
○​ Foot: inverted
○​ Toes: - ●​ Flamingo test
○​ Nerve: common peroneal ○​ Sig: SI joint pathology
●​ SLR V ○​ Pt position: single leg stance
○​ Aka well leg raising ○​ Procedure: pt hops on the leg
○​ Hip: flexed ○​ (+) sign: pain
○​ Knee: extended
○​ Ankle: DF
○​ Foot: -
○​ Toes: -
○​ Nerve: disc prolapse
●​ Modifications
○​ Braggard: SLR + DF
○​ Siccard: SLR + big toe extension
○​ Turyn: big toe extension only

●​ Yeoman’s test
○​ Sig: SI joint pathology 2° SI ligament damage
○​ Pt position: prone with knee flexed to 90°
○​ Procedure: PT brings hip to hyperextension
○​ (+) sign: pain

LUMBAR & SACROILIAC PATHOLOGY

●​ Gaenslen
○​ Sig: L4 NR pathology
○​ Pt position: sidelying
○​ Procedure
■​ Upper leg is brought to hyperextension
■​ Lower leg is brought to KTC ●​ Gillet’s test
○​ (+) sign: pain ○​ Aka sacral fixation or posterior ipsilateral rotation
○​ Sig: SI joint hypomobility
○​ Pt position: standing
 ○​ Procedure: PT palpates PSIS then asks pt to perform
1 KTC TESTS FOR MALINGERING
○​ (+) sign: I/L thumb (on KTC side) does not move ●​ Burn’s test
○​ Sig: malingering
○​ Pt position: kneeling on top of chair
○​ Procedure: pt reaches the floor
○​ (+) sign: overbalancing

●​ Hoover’s test
●​ Piedallu’s test ○​ Sig: malingering
○​ Sig: SI joint pathology ○​ Pt position: supine
○​ Pt position: standing ○​ Procedure: pt performs SLR
○​ Procedure: PT palpates PSIS then asks pt to perform ○​ (+) sign: (-) downward force on C/L leg which should
trunk flexion be a compensatory technique
○​ (+) sign: if one PSIS is higher

TESTS FOR MUSCULAR DYSFUNCTION

TESTS FOR UMNL
●​ Beevor’s sign
●​ Romberg test
○​ Sig: weak rectus abdominis
○​ Sig
○​ Pt position: supine
■​ Dorsal column deficit
○​ Procedure: pt performs sit up for scapular clearance
■​ Cerebellar deficit
○​ (+) sign: umbilicus deviates to one side
○​ Pt position: standing
○​ Procedure: closes eyes for 20-30 seconds
○​ (+) sign
■​ Swaying in eyes closed
■​ Swaying in eyes open
●​ Lhermitte’s test
○​ Sig: radiculopathy, meningeal irritation, & spinal cord
lesion
○​ Pt position: long sitting
○​ Procedure: PT flexes the cervical spine & hip
●​ Gluteal skyline ○​ (+) sign: sharp-electric pain in spine
○​ Sig: buttock asymmetry
○​ Pt position: prone
○​ Procedure: pt contracts the buttocks while PT
observes
○​ (+) sign: weakness of gluteus maximus
●​ Brudzinski-Kernig ●​ Milgram’s test
○​ Brudzinski is aka cervical flexion, sotto hall, ○​ Sig: ↑'d ITP
hyndman, or lidner ○​ Pt position: supine
○​ Sig: radiculopathy, meningeal irritation, & spinal cord ○​ Procedure: pt performs bilateral SLR & holds it for 30
○​ Pt position: supine seconds
○​ Procedure ○​ (+) sign: inability
■​ PT flexes the cervical spine & hip
■​ Flex at the knee
○​ (+) sign
■​ Pain
■​ Relief

INCREASED INTRATHECAL PRESSURE

●​ Naffzigger
○​ Sig: ↑'d ITP
○​ Pt position: supine
○​ Procedure: PT squeezes the jugular veins for 30
seconds then pt coughs
○​ (+) sign: pain

●​ Valsalva maneuver
○​ Sig
■​ ↑'d ITP
■​ Sciatica
○​ Pt position: sitting as if bearing down
○​ Procedure: pt maintains position
○​ (+) sign:
■​ Localized pain
■​ Pain radiates to LE