Spine Function and Motion
The purpose of the spine is to:
- provide structural stability
- protect the spinal cord and spinal nerve roots
- allow static postural control in weight bearing for sustained periods
- contribute to functional gait.
In most cases, functional recovery from a spine condition that is painful interferes with function is described by three phases: acute, subacute, and chronic.
6 minute video
Structure Reminders
Students are expected to recall specific structural elements, including landmarks, range of motion, joint function, ligaments, and the names of stabilizing and mobilizing muscles from PTA 132 and PTA 132L. Students are expected to recall spine motions that increase or decrease the foramen in a spine segment.
In general, ligaments function to resist excessive spine motion, especially in flexion and extension. Although facet joints are all designed to be load-bearing, these joints change in shape and function depending on their location (e.g., cervical, thoracic, and lumbar), allowing motion in some cases and restricting motion in others.
Neck conditions refer to symptom presentation between the occiput and T3; back conditions refer to symptom presentation inferior to 12th rib to the gluteal folds.
The sacroiliac joint (SI) is related to lumbar spine conditions due to the amount of forces that occur at the lumbosacral junction with loading and weight bearing. The SI joint has structural (e.g. bony, ligamentous, thoracolumbar fascia) components that provide significant stability and dynamic stabilizers that are engaged during movement (e.g. latissumus dorsi, gluteals, abdominals, biceps femoris, adductors). Knowledge of ligaments and muscle origin and insertion in the lumbopelvic region is essential for treating low back pain and for general spinal stabilization and conditioning interventions.
Healing Stage Characteristics
There are three (3) general healing stages that guide clinical-decision making in managing spine conditions. These "healing" stages can be applied based on symptom presentation in non-specific and specific spine conditions:
|
Acute - "Protect" |
Subacute - "Controlled Motion" |
Chronic - "Return/Optimize Function" |
|---|---|---|
|
Reduce pain Reduce inflammation Short term use of biophysical agents, heat/cold Apply orthoses as needed
|
Initiate exercises to address muscle imbalance Stabilization of flexors/extensors; scapula and lumbopelvic area
|
Progress functional activity training such as lifting, carrying, and reconditioning |
|
Decrease joint load
|
Initiate postural training Caution with activities and postures in end-ranges |
Integrate neuromuscular control principles to prevent recurrence |
|
Initiate aerobic conditioning
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Progress aerobic conditioning |
Sustain aerobic conditioning as a long-term routine |
|
Advance ROM in non-provoking (e.g., pain-free) directions, initially in non-weightbearing positions
Submaximal isometric strengthening |
Advance ROM in partial and full weight bearing positions |
Progress active and resistive exercise for recovering function, including combined (e.g., multiplane) motions |
In a longitudinal study, patients who initiated a physical therapy plan of care for a new onset of low back pain management were much less likely to use opioids for short-term and long-term pain management
According to the National Institute of Health, low back pain is experienced by 80% of adults and is the most frequent reason for referral to physical therapy. However, in a recent longitudinal study, only 10% of patients who saw a doctor because of low back pain were prescribed physical therapy.