ANATOMI DAN KINESIOLOGI

KEPALA DAN TULANG BELAKANG

Dr. Dewi Nur Fiana.,Sp.KFR

Fakultas Kedokteran Universitas Lampung
CRANIOCERVIKAL REGION

• Joint:
 Atlanto-occipital joint
 Atlanto-axial joint complex
 Intracervical articulations (C2 to C7)
APPROXIMATE RANGE OF MOTION FOR THE
THREE PLANES OF MOVEMENT FOR THE JOINTS
OF THE CRANIOCERVICAL REGION
Joint or Region Flexion and Axial Rotation Lateral Flexion
Extension (Horizontal (Frontal Plane,
(Sagittal Plane, Degrees)
Plane, Degrees)
Degrees)
Atlanto-occipital Flexion: 5 Negligible About 5
joint Extension: 10
Total: 15
Atlanto-axial Flexion: 5 35-40 Negligible
joint complex Extension: 10
Total: 15
Intracervical Flexion: 35-40 30-35 30-35
region (C2-C7) Extension: 55-
60
Total: 90-100
Total across Flexion: 45-50 65-75 35-40
craniocervical Extension: 75-
region 80
Total: 120-130
• SAGITTAL PLANE KINEMATICS: Extension

The volume of the cervical vertebral canal is

greatest in
full flexion and least in full extension
FLEXION
EXAMPLES OF CONNECTIVE TISSUES THAT
MAY LIMIT MOTIONS OF THE VERTEBRAL
COLUMN
Motion of the Connective Tissues
Vertebral Column
Flexion Ligamentum nuchae
Interspinous and supraspinous
ligaments
Ligamentum flava
Apophyseal joints*
Posterior annulus fibrosus
Posterior longitudinal ligament
Beyond neutral Apophyseal joints
extension Cervical viscera (esophagus and
trachea)
Anterior annulus fibrosus
Anterior longitudinal ligament
Axial rotation Annulus fibrosus
Apophyseal joints
Alar ligaments
Lateral flexion Intertransverse ligaments
Contralateral annulus fibrosus
Apophyseal joints
PROTRACTION AND
RETRACTION
HORIZONTAL PLANE KINEMATICS

Axial Rotation
FRONTAL PLANE KINEMATICS

Lateral Flexion
THORACIC REGION

• Consists of a rigid rib cage  ribs, thoracic vertebrae,

sternum
• The rigidity of the region provides:
(1) a stable base for muscles to control the cranio
cervical region
(2) protection for the intrathoracic organs
(3) a mechanical bellows for breathing
• Has the smallest disc-to-vertebral body height ratio
reduces thoracic mobility  stable
ROM FOR THE THREE PLANES OF
MOVEMENT FOR THE THORACIC
REGION
Flexion and Axial Lateral
Extension Rotation Flexion
(sagital (horizontal (Frontal
plane) plane) plane)
Flexion: 30-40 30-35 25-30
Extension: 20-
25
Total: 50-65
Sagital Plane Kinematics: Flexion
EXTENSION
KINEMATICS OF AXIAL
ROTATION
KINEMATICS OF LATERAL
FLEXION
 LUMBAR REGION

Approximate Range of Motion for

the Three Planes of Movement for
Flexion and Axial Rotation Lateral Flexion
the Lumbar(Horizontal
Extension Region (Frontal Plane,
(Sagittal Plane, Degrees)
Plane, Degrees)
Degrees)
Flexion: 40-50 5-7 20
Extension: 15-20
Total: 55-70
SAGITTAL PLANE
KINEMATICS: FLEXION
• 40 -50 degrees of flexion and 15 -20 degrees of
extension occur at the lumbar spine
• The degree of flexion of the lumbar spine
significantly affects the diameter of each
intervertebral foramen and the potential
deformation of the nucleus pulposus
• flexion increases the diameter of the
intervertebral foramen by 19%  used
therapeutically to temporarily reduce the
pressure on a lumbar spinal nerve root that is
impinged on by an obstructed foramen
excessive or
prolonged flexion of the
lumbar : increased
compression force on the
anterior side of the disc 
deforming the nucleus
pulposus in a posterior
direction
• A disc with a weak, cracked, or distended
posterior annulus  posterior migration of
nucleus pulposus
• Persons with a herniated : pain or altered
sensation, muscle weakness, reduced reflexes
in the lower extremity, consistent with the
specific motor and sensory distribution of the
impinged nerve root
EXTENSION
• Increase the natural lordosis
• Extension of the lumbar spine affects the
diameter of the intervertebral foramina and the
potential for deforming the nucleus pulposus
 Full extension
Spinal cord
deform the NP in
an anterior
direction

Intervertebral
disc
Nucleus
pulposus

pinous
erspinous
nts
 SOME CONTRASTING KINESIOLOGIC EFFECTS
OF LUMBAR FLEXION AND EXTENSION

Structure Effect of Flexion Effect of Extension

Nucleus pulposus Deformed or pushed Deformed or pushed
posteriorly anteriorly
Annulus fibrosus Posterior side stretched Anterior side stretched
Apophyseal joint Capsule stretched Capsule slackened
Minimizes articular (neutral extension only)
contact area Maximizes articular
Articular loading contact area (neutral
decreased extension only)
Articular loading
increased
Intervertebral foramen Widened Narrowed
Posterior longitudinal Increased tension Decreased tension
ligament (elongated) (slackened)
Ligamentum flavum Increased tension Decreased tension
(elongated) (slackened)
Interspinous ligament Increased tension Decreased tension
(elongated) (slackened)
LUMBOPELVIC RHYTHM DURING TRUNK
FLEXION AND EXTENSION

“The kinematic relationship

between the lumbar spine and hip
joints during sagittal plane
movements”
EFFECT OF PELVIC TILTING ON THE
KINEMATICS OF THE LUMBAR SPINE
HORIZONTAL PLANE KINEMATICS:
AXIAL ROTATION
• Only about 5 to 7 degrees of horizontal plane rotation occur
to each side throughout the lumbar region
FRONTAL PLANE KINEMATICS: LATERAL
FLEXION
• About 20 degrees of lateral flexion occur to
each side in the lumbar region
• The posture of the pelvis during sitting can
have a substantial influence on the spinal
alignment throughout the vertebral column
• SITTING POSTURE AND ITS EFFECT ON
ALIGNMENT WITHIN THE LUMBAR AND
CRANIOCERVICAL REGIONS
DISKUS INTERVERTEBRALIS
 Struktur
 Diskus intervertebralis terdiri
atas bagian tengah nucleus
pulposus dan dikelilingi
annulus fibrosus

 nucleus pulposus mengandung

glycosaminoglycans tinggi
kandungan air (80%)
kelenturan yang tinggi

 Annulus fibrosus terdiri atas 15-

25 layer konsentrik/menyerupai
cincin yang mengandung
kolagen

The detailed organization of the annulus fibrosus shown with the

nucleus pulposus removed. Collagen fibers are arranged in multiple
concentric layers, with fibers in every other layer running in identical
directions. The orientation of each col- lagen fiber (depicted as θ) is
about 65 degrees from the vertical. (Modified from Bogduk N: Clinical
anatomy of the lumbar spine, ed 4, New York, 2005, Churchill
Diskus intervertebra

• Fungsi :
1. menyatukan vertebra,
memungkinkan terjadi
gerakan
2. membentuk spinal
curve, terutama di
daerah cervikal dan
lumbal
4. sebagai shock
absorbent
Karakteristik diskus berdasarkan
area :
1. Cervikal
• ukuran diskus > ukuran korpus
vertebra.
• Lebar < korpus.
• Diskus di Bag. Anterior lebih tebal
daripada posterior  lordosis servikal
• Nukleus pulposus berada lebih anterior
2. Thorakal
• Tinggi diskus bag anterior = posterior
• Diskus di daerah ini tidak
mengakibatkan kurva Kifotik thorakal
oleh bentuk korpus vertebra
tthorakalDiskusnya lebih tipis bila
dibandingkan level vertebra yang lain.
• Nukleus pulposus di tengah – tengah
diskus.
3. Lumbal
 Mekanisme persebaran gaya di
diskus intervertebralis:Tekanan
Hidrostatik

FIGURE 9-36. THE MECHANISM OF FORCE TRANSMISSION THROUGH AN

INTERVERTEBRAL DISC. A, COMPRESSION FORCE FROM BODY WEIGHT AND MUSCLE
CONTRACTION (STRAIGHT ARROWS) RAISES THE HYDROSTATIC PRESSURE IN THE
NUCLEUS PULPOSUS. IN TURN, THE INCREASED PRESSURE ELEVATES THE TENSION IN
THE ANNULAR FIBROSUS (CURVED ARROWS). B, THE INCREASED TENSION IN THE
ANNULUS INHIBITS RADIAL EXPANSION OF THE NUCLEUS. THE RISING NUCLEAR
PRESSURE IS ALSO EXERTED UPWARD AND DOWNWARD AGAINST THE VERTEBRAL
ENDPLATES. C, THE PRESSURE WITHIN THE DISC IS EVENLY REDISTRIBUTED TO
SEVERAL TISSUES AS IT IS TRANSMITTED ACROSS THE ENDPLATES TO THE ADJACENT
VERTEBRA. (MODIFIED FROM BOGDUK N: CLINICAL ANATOMY OF THE LUMBAR SPINE,
PERUBAHAN DISKUS INTERVEBRALIS PADA
GERAKAN
PROLAPSUS DISKUS INTERVERTEBRALIS

ruptur discus, slipped disk, hernia nucleus

pulposus paling banyak ditemukan pada
regio lumbal (L5-S1, ; L4-L5, kedua
tersering).

biasanya terjadi postero-lateral, karena:

• saat mengangkat barang dengan
posisi fleksi-- regangan terjadi paling
besar di posterior anulus
• anulus bagian posterior lebih lemah
dibandingkan bagian anterior
VERTEBRA LIGAMENTS

PRIMARY LIGAMENTS THAT STABILIZE THE VERTEBRAL COLUMN. A, LATERAL

OVERVIEW OF THE FIRST THREE LUMBAR VERTEBRAE (L1 TO L3). B, ANTERIOR
VIEW OF L1 TO L3 VERTEBRAE WITH THE BODIES OF L1 AND L2 REMOVED BY
CUTTING THROUGH THE PEDICLES. C, POSTERIOR VIEW OF L1 TO L3
VERTEBRAE WITH THE POSTERIOR ELEMENTS OF L1 AND L2 REMOVED BY
VERTEBRAL MUSCLES
ABDOMINAL MUSCLES
ADDITIONAL MUSCLE OF
ABDOMINAL
• ILIOPPSOAS
• QUADRATUS LUMBORUM
ARRANGEMENT OF SPINAL
NERVE
Medulla Spinalis :
Awal : Foramen magnum.

Akhir : batas atas L1 – L2

Ujung caudal menjadi cone shaped conus

medullaris.

Ujung distal conus  fillum terminae keluar

melekat di coccygeus.
Perkembangan MS :
• Sampai umur 3 bln panjang MS = panjang columna vert.
• Sesudah umur 3 bln, MS tidak bertambah panjang lagi
hanya bertambah lebar saja.
• Shg ujung caudal MS terletak lebih tinggi dari segmen vert.
(akar syaraf L,S, & C letaknya di segmen vert. T12 – L1).
• Penamaan akar syaraf :
- Cervical : ditempat ia bertumpu
(C1-C8  antara C7 – Th1)
- Mulai dari thoracal : sesuai (Th1  antara Th1-Th2).

 Nervus spinalis tdd : 8 N.cervical, 12 N .thoracal, 5

N. lumbal, 5 N.sacral & 1 N.coccigeus.
• SCOLIOSIS
• Artinya curvatura (B. yunani)
• Merupakan deformitas coulumna vertebralis dengan
karakteristik curvatura yang abnormal di tiga bidang,
khusunya bidang frontal dan horisontal
• V.thoracalis  paling sering
• Terdiri atas scoliasis fungsional dan struktural
• HYPERKIPHOSIS regio thorakalis
• Saat berdiri kiphosis sudut 40-45 derajat masih normal
• Diakibatkan : trauma, abnormalitas ertumbuhan,
proses degeneratif
• Reversal of muscle action occurs when the origin becomes
more movable and moves toward the insertion, which has
become more stable.
• • Concentric contractions occur when the body part is
moving against gravity.
• • Eccentric contractions occur when the body part is
moving in the same direction as the pull of gravity
Action Muscle
1. HEAD (Occiput on C1)
• Flexion Prevertebral group.
• Extension Suboccipital group.
2. NECK
• Flexion : Sterneocleidomastoid.
• Extension :Splenius capitis, splenius
cervicis, erector spinae
• Lateral bending Sternocleidomastoid,splenius capitis,
splenius cervicis, scalenes, erector spinae
• Rotation Splenius same side : splenius capitis, splenius
cervicis
• Rotation opposite side : Sternocleidomastoid
3. TRUNK
• Flexion : Rectus abdominis, external oblique, internal
oblique
• Extension : Erector spinae, transversospinal,
interspinales
• Lateral bending : Quadratus lumborum,erector spinae,
internal oblique, external oblique, Intertransversarii
• Rotation same side : Internal oblique
• Rotation opposite side : External oblique,
transversospinalis
• Compression of Rectus abdominis : external oblique,
internal oblique, transverse abdominis
Terima Kasih