SPINAL MOVEMENTS

Lecture No 02

DANISH LATIF
PhD*
SPINAL MOVEMENTS

The Mobile Segment

 SPINAL MOVEMENTS
Can we actively produce
isolated movement
of the individual mobile
segment of the spine
The Mobile Segment

How many Joints

In each mobile segment ?
 SPINAL MOVEMENTS
The Intervertebral Disc Joint

• Synchondrosis
• Nucleus pulposis &
Annulus Fibrosis
• Functions
• Static
• Movement
• Stabilization
LUMBAR DISC

Dr Abdul Ghafoor Sajjad 6

 SPINAL MOVEMENTS
The Intervertebral Disc Joint

• Bears Soft Load Impulses

• The anterior aspect

compress slightly with
spinal flexion and Vice
Versa

• Posterior Disc Herniation is

common
 SPINAL MOVEMENTS
The Facet Joint
• Zygapophyseal joints
• Synovial Joint
• Orientation of the
Facet Joint surface in
different spinal level
• Cervical 45
• Thoracic 60
• Lumber 90
 SPINAL MOVEMENTS
 Spinal Flexibility is
influenced by
 Person’s Age
 Health of tissue
surrounding
spine
 Physical
conditioning
 Hereditary
Factors
Spinal ROM
SPINAL MOVEMENTS

Disc Diameter  Mobility

SPINAL CURVATURE
 THREE-DIMENSIONAL JOINT
POSITIONING
For practical purposes, we classify joint
positions into five categories:
1. Zero position
2. Resting position (Loose-packed position)
3. Actual resting position
4. Non-resting positions
5. Close-packed position
Zero Position
 Also known as position of reference

 Joints ROM measurements are taken from the

zero starting position

 ROM is measured with a goniometer on both

sides of zero
Zero Position
RESTING POSITION
 First described by McConnell
 It is a position in which
◦ Joint capsule and ligaments are most relaxed
◦ Little joint contact
◦ Maximum joint play
 Also called Loose/open-packed position
 How we measure the Open packed position
RESTING POSITION
THE ACTUAL RESTING POSITION
 Sometimes we are unable to test
our patients joint in the resting
position due to pain or
significantly limited motion.
 Thisis often the position where
treatment is initiated.
 NONRESTING POSITIONS
 As your skills improve and your patients
impairments decrease you will find that you
need to perform joint play testing out of the
resting position.

 In order to judge the degree of capsular

looseness or tightness in these positions it is
important to have a thorough sense of how
these tissues feel normally in the resting
position.
CLOSED-PACKED POSITION
 Joint surfaces are in maximal contact to each
other

 Most ligaments & capsules surrounding the

joint are taut
UNDERSTANDING MOVEMENT
 Osteokinematics

◦ gross movements of bones at joints

 flexion / extension
 abduction / adduction
 internal rotation / external rotation
 Arthrokinematics

◦ small amplitude motions of bones at

joint surface
 roll
 glide (or slide)
 spin
BONE AND JOINT MOVEMENT
 Two types of bone movements are important
in OMT system:
1. Rotations: curved (angular) movement
around an axis
2. Translations: linear (straight-lined)
movement parallel to an axis in one plane
 BONE AND JOINT MOVEMENT
Bone
Movements

Rotations Translations

Combined
Standard bone
bone Traction Compression Gliding
movement
movement

Coupled Non coupled

movements movements
ROTATIONS
 Curved (angular) movements around an
axis
 Produce roll-gliding
 Two types

A. Standard bone movement

B. Combined bone movement
 ROTATIONS
A. Standard bone movement
◦ Anatomical movements
◦ Uniaxial
◦ e.g. flexion, extension etc
 ROTATIONS
B. Combined bone movement
◦ Functional movements
◦ Multiaxial
◦ e.g. Flex. + Lat. Flex. + Rot.
◦ Two types
i. Coupled movements
ii. Non coupled movements
i. COUPLED MOVEMENTS

 Movement combinations that result in the

most ease of movement
 These movements have
◦ greatest range
◦ least resistance to movement
◦ softest end-feel
 e.g. lumbar side bending and rotation to
opposite side are coupled when erect (or in
extension)
ii. NON COUPLED MOVEMENTS
 Movement combinations that result in less
ease of movement
 These movements have
◦ less range
◦ more resistance to movement
◦ harder end-feel
 e.g. lumbar side bending and rotation to the
same side (in ext)
ROTATIONS
 Standard, uniaxial
◦ MacConaill 's "pure, cardinal swing"
 Combined, multiaxial
◦ MacConaill 's "impure arcuate swing"
BONE AND JOINT MOVEMENT
 Two types of bone movements are important
in OMT system:
1. Rotations: curved (angular) movement
around an axis
2. Translations: linear (straight-lined)
movement parallel to an axis in one plane
Translation
 During translation of a bone all parts of the
bone move in a straight line, at equal
distance, in the same direction, and at the
same speed
 Produces joint play movements of traction,

compression, and gliding

 Before a/m movement, first we know about

the treatment plane.

 TREATMENT PLANE
 Treatment plane lies on
the concave articulating
surface, perpendicular
to a line from the center
of the convex
articulating surface
 It moves when the
concave surface moves
 It remains essentially
still when the convex
surface moves
TREATMENT PLANE
TRACTION
 Longitudinal

bone
separation
away from the
treatment plane
TRACTION/DISTRACTION
 Traction and distraction are not synonymous.
 Traction is a longitudinal pull.
 Distraction is a separation, or pulling apart.
COMPRESSION

 Decrease in space
between two joint
surfaces
 Longitudinal bone

approximation
towards the
treatment plane
GLIDING

 Translatory

movement where
the joint surfaces
are passively
displaced parallel
to the treatment
plane
JOINT ROLL-GLIDING
ASSOCIATED WITH BONE
ROTATIONS
In a healthy joint, functional
movement (bone rotation)
produces joint roll-gliding.
 Roll-gliding is a combination of

rolling and gliding movement

which takes place between two
joint surfaces
Roll

 New points on one surface meet new

points on the opposing surface
Glide
 Specific point on one surface comes
into contact with a series of points on
another surface

 Surfaces must be congruent either flat

or curved
 Follow Concave-Convex Rule
JOINT ROLL-GLIDING
JOINT ROLL-GLIDING
ROLLING AND GLIDING
 Since there is never pure congruency
between joint surfaces; all motions
require rolling and gliding to occur
simultaneously
 This combination of roll and glide is

simultaneous but not necessarily in

proportion to one another
JOINT ROLL-GLIDING
 Combined rolling-gliding in a joint

◦ The more congruent (flat or curved)

the surfaces are, the more gliding
there is
◦ The more incongruent the joint
surfaces are, the more rolling there is
Abnormal roll-gliding
 Usually the restricted movement is
associated with an impaired gliding
component which may allow joint
rolling to occur without its associated
gliding.
 Joint rolling movements in the absence

of gliding can produce a damaging

concentration of forces in a joint.
Abnormal roll-gliding
 A common goal in our approach to OMT is to
restore the gliding component of roll-gliding
to normalize movement mechanics.
Abnormal roll-gliding
 Determining the Direction of the
Restricted Gliding
 The direction of limitation for joint gliding
may be determined either directly (using
glide testing) or indirectly using Kaltenborn
Concave-convex rule.
 The Direct Method
(Glide Testing)
 The therapist applies passive translatoric
gliding movements in all possible directions
and determines in which directions joint
gliding is restricted.
 This is the preferred method as it gives the

most information about the degree and

nature of gliding restrictions !
 The Indirect Method
(Concave-Convex Rule)
 The therapist determines which bone
rotations are decreased and also notes
whether the moving joint partner is convex
or concave
 Indirect method is used when

◦ Patient has severe pain

◦ Joint is extremely hypomobile
◦ Therapist is inexperienced with
direct assessment
Concave-Convex & Convex-Concave
Rule
 The shape of the joint surface influences
the direction of the accessory movement
 One joint surface is MOBILE & one is STABLE
 Concave-Convex & Convex-
Concave Rule
 Concave-convex rule:
concave joint
surfaces slide in the
SAME direction as the
bone movement
(convex is STABLE)
◦ If concave surface is
moving on stationary
convex surface – glide
occurs in same
direction as roll
 Concave-Convex & Convex-
Concave Rule
 Convex-concave rule:
convex joint surfaces
slide in the OPPOSITE
direction of the bone
movement (concave is
STABLE)
◦ If convex surface is
moving on stationary
concave surface –
gliding occurs in
opposite direction to roll
Concave-Convex & Convex-
Concave Rule
Concave-Convex & Convex-
Concave Rule
Concave-Convex Rule of Joint Movement