Regional Anatomy

Canadian College of Massage and Hydrotherapy

Term 1

Joints of the Spine and Muscle of the Back

 Agenda

• Anterior intervertebral joints

• Posterior facet joints
• Craniovertebral joints
• Intrinsic muscles of the back

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 Anterior Intervertebral Joints
• Cartilaginous joint (symphyses) between
adjacent vertebral bodies of the spine which are
designed for strength and weight bearing.
• Articular surfaces are covered with hyaline
cartilage and are connected by a intervertebral
disc (IVD) and ligaments.
• The IVDs are the thickest in the lumbar spine;
they are also thicker anteriorly (wedge shaped)
in the cervical and lumbar regions creating the
lordotic curve.
• There is no IVD between C1 and C2 (no body).

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The IVDs consists of 2 major parts:
• Annulus Fibrosus:
– Fibrous rim of IVD
– Composed of concentric
lamellae of fibrocartilage
run obliquely from one
vertebrae to another
– Thinner posteriorly
• Nucleus Pulposus:
– Central core of the IVD
– More cartilaginous than
fibrous, highly elastic
– Located more posteriorly
– Like a semifluid ball
bearing during flex, ext, rot,
lat.flex of the spine
– Avascular (nourished by
diffusion)

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 Ligaments supporting the anterior
intervertebral joints:
• Anterior Longitudinal Ligament (ALL):
– Strong broad fibrous band
– Connects the bodies of the vertebrae and the
IVD
– Extends from anterior sacrum to the anterior
tubercle of C1 and occipital bone anterior to
the foramen magnum
– Functions to stabilize joints and prevent
hyperextension

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 Ligaments supporting the anterior
intervertebral joints
• Posterior Longitudinal Ligament (PLL):
– Narrow; somewhat weaker than the ALL
– Runs along the posterior vertebral bodies
inside the vertebral canal
– Broadest superiorly where it’s continuous with
the tectorial membrane, attaching to the
internal aspect of the foramen magnum
– Attaching in the spine from C2 to the sacrum
– Prevents hyperflexion

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Ligaments supporting the posterior
intervertebral joints
• Ligamentum Flavum - also called the
Yellow Ligament. It is a broad, elastic
band that connects the laminae of
adjacent vertebrae. It consists of mostly
elastic fibers which appear yellow in color.
– main function: preserve the normal curves
of the spine and to straighten the spine after
it has been flexed.

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Ligaments supporting the posterior
intervertebral joints
• Interspinous Ligament - This is a weak
ligament that attaches adjacent SPs in the
thoracic and lumbar regions
• Supraspinous Ligament - This is a strong
“cord-like” ligament that attaches the tip of the
SPs from C7 to the spine of the sacrum. It is
thicker and broader in the lumbar region.
• Note: the interspinous and supraspinous
ligaments thicken and widen in the cervical
spine for attachement of muscles and is
called the ligamentum nuchae.

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Ligaments supporting the posterior
intervertebral joints
• Intertransverse Ligament - thin ligament
which connects adjacent TVP’s
• Limits lateral flexion

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 (a) Ligamentum
Flavum

(b) Interspinous
Ligament

(c)
Supraspinous
Ligament

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 Posterior Facet Joints
(Zygapophyseal Joints)
• Plane type of synovial joints between the
inferior articular facet of one vertebrae and
the superior articular facet of the vertebrae
below.
• The facets are covered with hyaline
cartilage and each one is surrounded by a
thin, loose articular capsule which allows
for a greater degree of motion.
• These joints are designed for movement
and bear only a minimum amount of
weight.
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 Posterior Facet Joints
(Zygapophyseal Joints)
• When these joints move
together, they can produce
flexion/extension/lateral
flexion and rotation
• The orientation of the facet
change by region:
– Cervical spine: horizontal
plane (raise the roof)
– Thoracic spine: coronal
plane (wax on, wax off)
– Lumbar spine: sagittal
plane (choo choo train)

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 Craniovertebral Joints
• Joint between the vertebrae and the skull
(cranium)
• Consists of:
1. Atlantooccipital
2. Atlantoaxial joints.
• Both are synovial joints

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 Posterior Skull
• Atlanto-occipital Joint:
– Condyloid synovial joint between superior articular
surface of C1 and the occipital condyles (right and
left)
– Allows for flexion and extension of the head (nodding)
– This joint has a thin, loose capsule
– The skull and C1 are connected by the anterior and
posterior atlanto-occipital membranes
– These membranes join the arches of C1 to the
foramen magnum
– C1 is also supported by the tectorial membrane
which is a superior continuation of the PLL from the
body of C2 to the internal surface of the occipital bone

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 Posterior skull
• Atlanto-axial Joint:
– Consists of an articulation between the dens
(C2) and C1
• Represents a pivot joint
– And between the superior articular facets of
C2 (axis) and the inferior articular facets of
C1(atlas)
• Represents a plane joint
• These joints allow for rotation of the skull

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 Ligaments supporting the Atlanto-
Axial Joint
• Transverse Ligament:
– Strong band extending between the lateral masses of
C1
– Secures the dens to the anterior arch of C1
• Superior/Inferior Bands:
– Vertically oriented bands extending from the
transverse ligament
• Superiorly to the occipital bone
• Inferiorly to the body (dens) of C2

NOTE: the transverse ligament and superior/inferior

bands are together called the cruciform ligament

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 Ligaments supporting the Atlanto-
axial Joint
• Alar Ligament:
– Extends from the sides of the dens to the
lateral margins of the foramen magnum
– Checks rotation and side to side movements
of the head
• Apical Ligament:
– Extends from apex of dens to the anterior
margin of the foramen magnum
– Weaker ligament

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 Apical Ligament
Transverse Lig. Inferior Band Superior Band
Alar Ligaments

CRUCIFORM LIGAMENT
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 What type of view
is this?

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 Muscles of the Back
• The muscles of the back are divided into 3
groups:
1. Superficial (extrinsic)
2. Intermediate (extrinsic)
3. Deep (intrinsic)
• Extrinsic muscles are concerned with limb
movement and respiration
• Intrinsic muscles are concerned with
movement of the spine
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Label diagram
1. Occiput
2. Cervical spine (C/S)
3. Thoracic spine (T/S)
4. Lumbar spine (L/S)
5. Sacrum
6. Iliac crest
7. Scapula
8. Ribs

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Superficial Back Muscles
(Extrinsic)
• Trapezius
• Latissimus Dorsi
• Levator Scapula
• Rhomboids

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 Intermediate Back Muscles
(Extrinsic)

• Serratus Posterior Superior

• Serratus Posterior Inferior

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Deep Back Muscles (Intrinsic)
• The deep layer of back muscles is
divided into 3 groups:
1. Superficial
2. Intermediate
3. Deep

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Deep Back Muscles (Intrinsic)
Superficial muscles:
• Consists of Splenii (bandage-like)
muscles
• Can be difficult to palpate; located deep
to superior trapezius; between superior
trapezius and SCM
– Splenius capitis
– Splenius cervicis

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 Splenius Capitus
ORIGIN:
• inferior half of ligamentum nuchae
• SPs of C7-T3

INSERTION:
• Mastoid process
• Lateral third of Superior Nuchal line
INNERVATION:
• Dorsal division of inferior cervical
nerves

ACTION:
• Unilaterally: ipsilateral rotation and
lateral flexion
• Bilaterally: extension of head and
neck

COMMENTS:
• Deep to trapezius
• fibers run supralaterally
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 Splenius Cervicis
ORIGIN:
• SPs of T3-T6

INSERTION:
• TVPs of upper cervical
vertebrae (C1-C4)

INNERVATION:
• Dorsal division of inferior
cervical nerves

ACTION:
• Unilaterally: ipsilateral
rotation and lateral flexion
• Bilaterally: extension of head
and neck

COMMENTS:
• deep to splenius capitis
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Deep Back Muscles (Intrinsic)
Intermediate Muscles
• Erector spinae muscles lie within a fascial
compartment between posterior and anterior layers of
the thoracolumbar fascia
• Arranged in 3 vertical columns (from lateral to medial)
– Iliocostalis (cervicis, thoracis, lumborum)
– Longissimus (capitis, cervicis, thoracis)
– Spinalis (capitis, cervicis, thoracis)
• Most of the erector spinae originate from a common
broad tendon which is attached to the posterior
sacrum, iliac crest, and SPs of the lumbar spine and
T11-T12 thoracic vertebrae

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 ILIOCOSTALIS (lumborum,
thoracis, cervicis)
ORIGIN:
• Common tendon (lumborum)
• Posterior surface of ribs 1-12
(thoracis and cervicis)

INSERTION:
• TVP’s L1-L3, posterior surface of
ribs 6-12 (lumborum)
• posterior surface of ribs 1-6
(thoracis)
• TVP’s of lower cervical vertebrae
[C5 – C7] (cervicis)

INNERVATION:
• Dorsal primary division of spinal
nerves

ACTION:
• Bilaterally: extend the vertebral
column
• Unilaterally: ipsilateral side flexion
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 LONGISSIMUS (thoracis,
cervicis, capitis)
ORIGIN:
• Common tendon (thoracis)
• TVPs of upper T1-T5 (cervicis and
capitis)

INSERTION:
• Ribs 4-12 and the TVP’s of T4-T12
(thoracis)
• TVPs of C1-C7 (cervicis)
• Mastoid process (capitis)

INNERVATION:
• Dorsal primary division of spinal
nerves

ACTION:
• Bilaterally: extend the vertebral
column
• Unilaterally: ipsilateral side flexion

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 SPINALIS (cervicis, thoracis)
ORIGIN:
• SPs T11-L2 (thoracis)
• Ligamentum Nuchae
• SP of C7

INSERTION:
• SPs T1-T8 (thoracis)
• SPs C2-C6 (cervicis)

INNERVATION:
• Dorsal primary division of
spinal nerves

ACTION:
• Bilaterally: extend the vertebral
column
• Unilaterally: ipsilateral side
flexion
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ILIOCOSTALIS LONGISSIMUS SPINALIS

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Deep Back Muscles (Intrinsic)
Deep muscles
• Found deep to the erector spinae in the
laminar groove between the TVPs and SPs
• Collectively known as the Transversospinal
muscles:
– Semispinalis (thoracis, cervicis, capitis)
– Mulitifidus
– Rotatores
– Interspinalis
– Intertransversarii

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 SEMISPINALIS MUSCLE
ORIGIN:
• TVPs of thoracic spine
• Articular processes of C5-C7

INSERTION:
• SPs of upper thoracic spine
• SPs of C2-C7
• Superior nuchal line

INNERVATION:
• Dorsal primary division of
spinal nerves

ACTION:
• Extend the spine and head

COMMENTS:
• Semispinalis = “half the spine”
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 MULTIFIDUS MUSCLE
ORIGIN:
• Sacrum
• TVPs of the vertebral column (C/S,
T/S, L/S)

INSERTION:
• SPs of vertebral column (C/S, T/S,
L/S)
– Except C1
• Span 2 – 4 vertebrae

INNERVATION:
• Dorsal primary division of spinal
nerves

ACTION:
• Extend the spine
• Contralateral rotation

COMMENTS:
• only muscles with fibers that lie
across the posterior sacrum

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 ROTATORES
ORIGIN:
• Sacrum
• TVPs of the vertebral column (C/S, T/S,
L/S)

INSERTION:
• SPs of vertebral column (C/S, T/S, L/S)
• Except C1
• Span 1-2 vertebrae

INNERVATION:
• Dorsal primary division of spinal nerves

ACTION:
• Extend the spine
• Contralateral rotation

COMMENTS:
• only difference b/w rotatores and mulitifidi is:
Rotatore mm. are shorter
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 INTERSPINOUS MUSCLE
ORIGIN:
• SPs above (C/S to L/S)

INSERTION:
• SPs below

INNERVATION:
• Dorsal rami of spinal nerves

ACTION:
• assist with extension of the
spine

COMMENTS:
• Well developed in the C/S

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INTERTRANSVERSARII MUSCLE
ORIGIN:
• TVP of vertebrae above (C/S
to L/S)

INSERTION:
• TVP of vertebrae below

INNERVATION:
• Ventral rami of spinal nerves
(&, in some cases, dorsal
rami of spinal nerves)

ACTION:
• unilaterally: ipsilateral
flexion
• bilaterally: assist with
extension of spine

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