1

2
Line of Gr
3
30–35! 4 Cervical lordosis Although highly v
5 son with ideal po
6

7
of the temporal bo
1
slightly posterior
and ankle (Fig. 8.3
2
3
4 ity courses just to
5 curvature. Conseq
6
7
torque that helps
40!
8
Thoracic kyphosis curvature, allowin
9 lar activation and
10 tissues. These ide
11
energy of maintain
12 Many persons e
1 tightness or weak
2 bution, disease, or
45!
3
Lumbar lordosis observed abnorma
4
tures may signific
pensatory strategi
5 extremities, or the
posture illustrated
icant tightness of
Sacrococcygeal kyphosis
stretch (and poten
This posture can
Fig. 8.1 Normal curvatures of the vertebral column. These curvatures discs and joints t
represent the normal resting posture of each region. (From Neumann DA: cians who treat people with back and neck pain often attempt
Kinesiology of the musculoskeletal system: foundations for physical reha- to correct faulty postures as a primary component of the reha-
bilitation, ed 2, St Louis, 2010, Mosby, Fig. 9.39.) bilitation process.!

Cervical
lordosis

Thoracic
kyphosis

Lumbar
lordosis

Sacrococcygeal
kyphosis

A B C
Fig. 8.2 Side view of the normal sagittal plane curvatures of the vertebral column. (A) Neutral position of the vertebral column during standing. (B) Ex-
tension of the vertebral column increases cervical and lumbar lordosis but decreases (straightens) thoracic kyphosis. (C) Flexion of the vertebral column
decreases cervical and lumbar lordosis but increases thoracic kyphosis. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for
Las Curvaturas de la columna no son rígidas y cambian en base al movimiento.
physical rehabilitation, ed 2, St Louis, 2010, Mosby, Fig. 9.8.)
Las curvas entregan
mayor resistencia y
elasticidad, haciéndola
10 veces mas resistente
que si fuera recta.
L.L. A
L.L.P
 CHAPTER 8 Structure and Functio

Superior view
Atlas (C1)
Axis (C2)
Apophyseal joint
Transverse Atlas (C1) (C1-C2)
foramen
Pedicle of axis
Apophyseal joint
(C2-C3)

Pedicle
C3 C4 C5

Anterior tubercle
Anterior Vertebral
tubercle canal
Posterior tubercle
C6 C7
Costal facet
(full)
Posterior T
tubercle Lamina Transverse Pair of partial
process costal demifacets
Spinous
process
A B

Fig. 8.11 (A) Superior view of the seven cervical vertebrae. (B) Lateral view of the cervical vertebral colu
musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Figs. 9.14 and
 Disco Intervertebral

• Anillo fibroso.
– Duro y elástico.
– Formado por haces fibrosos que se
agrupan en laminillas.
– Con la edad se pierde elasticidad.

• Núcleo pulposo.
– Posee un centro blando gelatinoso.
– Se torna seco y duro con la edad.
– Este núcleo se alarga o se concentra
sobre sí mismo, se desplaza hacia
adelante o atrás, o lateralmente según lo
movimientos del raquis.
– Compuesto en un 88% de agua.
 Disco Intervertebral

• Es el responsable de absorber las cargas

compresivas a las que esta sometida la columna.

• Se ha determinado que la fuerza sobre los discos

lumbares es más de tres veces el peso del tronco
y son aún mayores en actividades que involucren
cargas dinámicas como por ejemplo saltar.

• Existen fuerzas tensionales sobre el disco durante

el movimiento de la columna.

• Tipos de cargas a las que esta sujeto el DIV:

– 1. Cargas de corta duración y gran amplitud
(Levantamiento de barra).

– 2. Cargas de larga duración y pequeña amplitud.

(Trote).
 Variaciones del Disco según nivel

• El grosor del DIV varía según su ubicación en el raquis. A nivel lumbar

mide 9 mm, torácico 5 mm, cervical 3 mm.

• La relación disco-cuerpo entrega información respecto a la movilidad

de cada segmento.

• A mayor espesor del disco en relación al cuerpo vertebral, mayor será

la movilidad.

• Relación disco-cuerpo:
– Cervical (2/5)
– Lumbar (1/3)
– Torácico (1/5)
 Movimientos de núcleo

• El núcleo pulposo se desplaza según los

movimientos de la columna vertebral.

• Durante la flexión se desplaza hacia

posterior.

• En la extensión el desplazamiento es
hacia anterior.

• Durante la inclinación el disco de mueve

hacia lateral.

• Durante los movimiento de rotación las

fibras del anillo contiene al núcleo y lo
mantienen en su lugar.
 capsule Posterior
Interspinous ligament longitudinal ligament
Psoas
L1

Estabilizadores pasivos
major Supraspinous L3 Anterior
ligament longitudinal ligament
Transverse L1 A Apophyseal joint
process L2
capsule Posterior
Interspinous ligament longitudinal ligament
Quadratus Psoas
lumborum major Supraspinous L3 Anterior
ligament longitudinal ligament
Transverse A
process

Quadratus Pedicle (cut) Intertransverse

Iliacus lumborum ligament
L5 Ligamentum flavum

1. Disco intervertebral. Iliacus

Ala
L5
Pedicle (cut)

Ligamentum flavum
Intertransverse
ligament

2. L. Longitudinal anterior. Auricular

Ala Posterior Apophyseal joint
capsule
surface longitudinal ligament
3. L. Longitudinal posterior. (articulates
with ilium) Auricular
surface
Posterior
longitudinal ligament
Apophyseal joint
capsule
Ventral (articulates Intervertebral disc
4. foraminaL. Amarillo.
sacral
Ventral Piriformis
with ilium)
Intervertebral disc
sacral Anterior
5. L. Supraespinoso. foramina Piriformis
Sacral longitudinal ligament Anterior
Coccyx promontory Sacral longitudinal ligament
Coccyx promontory
6. L. Interespinoso.
Fig. 8.17 Anterior view Fig.of8.17
the Anterior
lumbosacral
view of region. Muscular
the lumbosacral attach-
region. Muscular attach- B B Anterior
Anteriorview
view
7.are indicated
ments L. Intertransverso.
in ments are indicated
red; superior in red; superior
attachments attachments
of the of thelum-
quadratus quadratus lum-
Anterior
Anterior
borum are shown in gray. (From Neumann DA: Kinesiology of the muscu-
borum are shown in gray. (From Neumann DA: Kinesiology of the muscu-
8. system: Capsula Articular
longitudinal
loskeletal system: foundations for physical rehabilitation, ed 2, St Louis, longitudinal
ligament
loskeletal foundations Fig. 9.26.) rehabilitation, ed 2, St Louis,
for physical
2010, Mosby, ligament
on of the Vertebral
2010, Mosby,Column
Fig. 9.26.) Pedicle (cut)
Coccyx Pedicle (cut)
Intervertebral disc
Coccyx Lateral to
Sometimes referred viewas the tailbone, the coccyx is a small Posterior
Intervertebrallongitudinal
disc
triangular bone consisting of four fused vertebrae (see
Sometimes referredFig.
to 8.17).
as theThetailbone,
base of the the coccyx is a small
L1 coccyx articulates with the inferior
Posterior
ligament

triangular bone consisting of four

sacrum, forming fused vertebrae
the sacrococcygeal joint.! (see longitudinal
ligamentcanal
Vertebral
Fig. 8.17). The base of the
Apophyseal jointcoccyx articulates
L2
with the inferior
sacrum, forming theSupporting
sacrococcygeal
capsule joint.!
Structures of the
Posterior
Vertebral canal
InterspinousVertebral longitudinal ligament
as ligament Column Ligamentum flavum
or Supraspinous L3
! ligament Anterior
Supporting Structures of the
A longitudinal ligament
As with any other joint in the body, the joints of the spine
Vertebral
Quadratus
Column
are supported by ligaments that (1) prevent unwanted Ligamentum
or flavum
umborum
! excessive movements, and (2) protect underlying struc- C Posterior view

tures (Fig. 8.18). Both functions are particularly important

L. L. A
L. L. A
L. L. P
L. L. P
Column

Lateral view

L1

Apophyseal joint L2
capsule Posterior
Interspinous ligament longitudinal ligament
Supraspinous L3 Anterior
ligament longitudinal ligament
A

Pedicle (cut) Intertransverse

Column

Lateral view

L1

Apophyseal joint L2
capsule Posterior
Interspinous ligament longitudinal ligament
Supraspinous L3 Anterior
ligament longitudinal ligament
A

Pedicle (cut) Intertransverse

s Interspinous ligament
r Supraspinous L3 Anterior
ligament longitudinal ligament
A

Quadratus
umborum

Pedicle (cut) Intertransverse

ligament
Ligamentum flavum

Auricular Posterior Apophyseal joint

surface longitudinal ligament capsule
articulates
with ilium)
Intervertebral disc
rmis
Anterior
longitudinal ligament

Muscular attach- B Anterior view

he quadratus lum-
Anterior
ogy of the muscu-
longitudinal
n, ed 2, St Louis, ligament

Pedicle (cut)

Intervertebral disc
occyx is a small Posterior
vertebrae (see longitudinal
ligament
xion producing a slight posterior migration of the nucleus pulposus and widening of the inter-

Compressed Cauda equina

spinal nerve Defect in
sc root annulus
a relatively fibrosus
us pulposus
cleus pulpo- Herniation
of nucleus
the annulus pulposus
uid,and
cture it tends
Function of the Vertebral Column
djacent ver-
Nucleus Annulus
umbar
nsion
spine pulposus
Flexion
fibrosus
l bodiesofbut
Anterior migration
nucleus pulposus
Posterior migration
of nucleus pulposus

result, the
pressure is Widening of

Fig. 8.34
intervertebral
us pulposus foramen Superior view of a herniated nucleus pulposus in the lumbar

cleus pulp- region pushing on a spinal nerve and the nerves composing the cauda
equina. (From Neumann DA: Kinesiology of the musculoskeletal system:
e that of the
foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Fig.
9.60, bottom Fig.)
with spinal
r combined B

lposus mayflexion producingtechnique. Slouching—sitting with of the a

inter-rounded, flexed, low
and flexion on the intervertebral disc. (A) Lumbar extension producing a slight anterior migration of the nucleus pulposus
al foramen. (B) Lumbar a slight posterior migration of the nucleus pulposus and widening
 Art. Cigoapoficiaria

Disco intervertebral Lig Amarillo

Lig Interespinoso

Lig Longitudinal ant Lig Supraespinoso

Lig Longitudinal post

gion.

ig. 8.40 Illustration of an anterior spondylolisthesis at the L5-S1

 Movimiento de Flexión

light anterior migration of the nucleus pulposus

he nucleus pulposus and widening of the inter-
• Inclinación y deslizamiento de la
vertebra superior hacia adelante.
ed Cauda equina
rve
oot
• FacetasDefect
deslizan
in hacia arriba
annulus
fibrosus

• Apertura posterior del espacio

intervertebral
Annulus
fibrosus
• Disco intervertebral se aplasta
hacia delante y se abre hacia
of a herniated nucleus pulposus in the lumbar
atrás.
l nerve and the nerves composing the cauda
A: Kinesiology of the musculoskeletal system:
habilitation, ed 2, St Louis, 2010, Mosby, Fig.

• Desplazamiento del núcleo

pulposo
—sitting with a rounded, hacia
flexed, low atrás
ural lordosis in the lumbar spine. Such
chronic, can increase the likelihood of
migrating posteriorly. Over time, the
nnulus fibrosis may weaken from being
weakened, the annulus fibrosis is not
sterior migration of the nucleus pulpo-
tion of the nuclear material can also
 Movimiento de Flexión

• Tensión ligamento
interespinoso

• Tensión ligamento amarillo

• Tensión de capsula de
articulaciones facetarias.

• Tensión de LLP

From Neumann DA: Kinesiology of the musculoskeletal system: foundations for
physical rehabilitation, ed 2, St Louis, 2010, Mosby, Table 9.9.
ing forward to pick an object off the floor. Paradoxically, this
freedom of motion may be partially responsible for the high
incidence of herniated discs in the lumbar region. The arthro-
kinematic motions of flexion of the thoracic and lumbar
regions are shown in Fig. 8.28.

Thoracolumbar flexion

85°

Hamstrings

O
ON

I
EX
XI

FL
E
Capsule of

IDE
FL
E

apophyseal joint
SLID

Capsule of L2

SL
apophyseal joint T5 Interspinous
ligament Compressed
annulus
Supraspinous fibrosus
Interspinous ligament

IDE
ligament T6 Posterior L3 Posterior
E

SL
longitudinal longitudinal
SLID

Supraspinous ligament ligament

ligament

T7 L4

A B

Thoracic region Lumbar region

Fig. 8.28 Kinematics of thoracolumbar flexion. (A) Kinematics at the thoracic region. (B) Kinematics at the lumbar region. (From Neumann DA: Kinesiol-
ogy of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Fig. 9.52.)
 Widening of
intervertebral

Movimiento de Extensión
foramen

Narrowing of
intervertebral
foramen

B
Effects of extension and flexion on the intervertebral disc. (A) Lumbar extension producing a slight anterior migration of the nucleus pulposus
• Inclinación de la vertebra
ing of the intervertebral foramen. (B) Lumbar flexion producing a slight posterior migration of the nucleus pulposus and widening of the inter-
ramen.
superior hacia atrás.

onal Considerations
• Facetas deslizan hacían abajo.
Compressed
spinal nerve
Cauda equina
Defect in
al Migration of the Intervertebral Disc root annulus
nt between any two vertebrae results in a relatively fibrosus
placement, or migration, of the nucleus pulposus
• Apertura anterior del espacio
e intervertebral disc. Recall that the nucleus pulpo-
Herniation
of nucleus
gelatinous center of the disc, encased by the annulus
intervertebral pulposus
Because the nucleus pulposus is mostly fluid, it tends
e away from the compressed regions of adjacent ver-
Nucleus Annulus
ig. 8.33). For example, extension of the lumbar spine pulposus fibrosus
ses the posterior aspects of the vertebral bodies but
• Disco intervertebral se aplasta
s the anterior aspect (Fig. 8.33A). As a result, the
pulposus is pushed anteriorly, where the pressure is
hacia atrás y se ensancha
Fig. 8.34hacia
xion, on the contrary, pushes the nucleus pulposusSuperior view of a herniated nucleus pulposus in the lumbar
region pushing on a spinal nerve and the nerves composing the cauda
ly (Fig. 8.33B). As a general rule, the nucleus pulp-
delante. equina. (From Neumann DA: Kinesiology of the musculoskeletal system:
he disc is pushed in a direction opposite that of the
foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Fig.
otion.
9.60, bottom Fig.)
migrations of the nucleus pulposus with spinal
nt are considered normal. Over time or combined
• Desplazamiento del núcleo
technique. Slouching—sitting with a rounded, flexed, low
essive pressure, however, the nucleus pulposus may
back—reduces the natural lordosis in the lumbar spine. Such
ugh small cracks created within a fragmented annu-
pulposo hacia delante.a posture, especially if chronic, can increase the likelihood of
is, which may lead to a herniated nucleus pulposus.
ted nucleus pulposus occurs most commonly in the the nucleus pulposus migrating posteriorly. Over time, the
egion and, furthermore, most often occurs in a poste- posterior wall of the annulus fibrosis may weaken from being
tion, in the direction of the spinal cord, cauda equina over-stretched. When weakened, the annulus fibrosis is not
roots (Fig. 8.34). Such a herniation may cause local able to restrict the posterior migration of the nucleus pulpo-
 Movimiento de Extensión

• Tope óseo de facetas

articulares

• Tope óseo de procesos

espinosos

• Tensión de LLA
 n Fig. 8.30A and B, rotation to the right causes the facet joint Lateral flexion (or side bending) of the thoracolumbar region
surfaces on the left (opposite the side of the rotational action) is typically limited to about 45 degrees in either direction (Fig.
to quickly collide. Immediate compression of the facet sur- 8.31). The arthrokinematic motions involved between verte-
faces is very limiting; in fact, the average amount of rotation brae are illustrated in Fig. 8.31A and B.!
Anterior migration P
of nucleus pulposus o
Thoracolumbar extension

W
int

35°-40°

EX Narrowing
EX of
Hip flexors and ligaments
TE

intervertebral
NS

TE
NS
ION

foramen
ION
SLIDE

T5 SLIDE 2 L
Anterior
longitudinal
ligament Anterior
longitudinal
T6 L3
ligament
SLIDE

SLIDE

Capsule of
apophyseal joint

T7
A L4
B
A Fig. 8.33 Effects
B of extension and flexion on the intervertebral disc. (A) Lum
and narrowing of the
Thoracic region Lumbarintervertebral
region foramen. (B) Lumbar flexion producing a s
vertebral
Fig. 8.29 Kinematics of thoracolumbar extension. (A) Kinematics at foramen.
the thoracic region. (B) Kinematics at the lumbar region. (From Neumann DA: Kine-
siology of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Fig. 9.53.)
 Movimiento de Flexión lateral

• En el lado de la convexidad
facetas deslizan hacia arriba.

• En el lado de la concavidad
facetas deslizan hacia abajo.

• El disco se ensancha en el lado de

la convexidad y se aplasta en el
lado de la concavidad.

• El núcleo se desplaza hacia el lado

de la convexidad.
 Thoracic region
LATERAL
Thoracolumbar lateral flexion FLEXION Superior facets of T6

SLIDE
Superior facet of T 7 T6

SLIDE
A
T7
45!

Lumbar region
LATERAL
FLEXION Superior facets of L1

L1
Intertransverse

SLIDE
ligament

SLIDE
Inferior facet of L1

B
L2 Superior facet of L 2

31 Kinematics of thoracolumbar lateral flexion. (A) Kinematics at the thoracic region. (B) Kinematics at the lumbar region. (From Neumann DA:
ogy of the musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Fig. 9.55.)
 Movimiento de Flexión lateral

• Tope óseo de facetas en el

lado de la inclinación.

• Tensión de ligamento
intertransverso y amarillo del
lado opuesto al movimiento.
Movimientos acoplados