NECK & LOWER BACK

BY
HOSSEIN KHORRAMI PhD DOMP

khorrami4@yahoo.com
http://www.scribd.com/khorrami4
Neck Bones
 Joints

•  Atlanto-occipital joint
•  Allow head to nod up/down
•  Atlanto-axial joint
•  Allow head rotate on the axis side to side
Cervical Vertebrae

Less than 1%
Neck Muscles
Neck Muscles
 Splenius Capitis

•  Origin:
•  C3-T3
•  Insertion:
•  Occipital bone
•  Mastoid process

•  Function
•  Head & neck extension
•  Lat flexion
Same side head rotation

https://www.youtube.com/watch?v=unDACOZpBpI
 Splenius Cervicis

•  Origin:
•  Spinous process of T3-T6
•  Insertion:
•  Transvers process of C1-C3
•  Function
•  Head & neck extension
& hyperextension
•  Lat flexion
Same side head rotation
 Semispinalis Capitis

•  Origin
•  Articular process of C4-C6
•  Transverse process of C7-T6

•  Insertion
•  Occepital bone

•  Function
•  Ext & hyperext of the head
and neck
•  Head & neck rotation to the
opposite side
 Semispinalis Cervicis

•  Origin
•  Transverse process of T1-T6

•  Insertion
•  Spinous process C2-C5

•  Function
•  Ext of the head and neck
•  Head & neck rotation to the
opposite side
•  Laterally flex neck
 Semispinalis Thoracis

•  Origin
•  Transverse process of T6-T10/12

•  Insertion
•  Spinous process C6-C7 & T1-T4

•  Function
•  Ext of the neck thoracic vertebrae
•  Neck & thoracic rotation to the
opposite side
•  Laterally flex neck & thoracic
vertebrae
 Rectus Capitis Posterior Minor

•  Origin
•  Posterior tubercle of atlas (C1)
•  Insertion
•  Occipital bone

•  Function
•  Head extension
•  Control infolding movement of dura
•  Proprioception
 Rectus Capitis Posterior Major

•  Origin
•  Spinous process of axis(C2)
•  Insertion
•  Occipital bone

•  Function
•  Head extension
•  Head rotation to the same side
 Obliquus Capitis Superior

•  Origin
•  Transverse process of atlas(C1)
•  Insertion
•  Occipital bone

•  Function
•  Head extension
•  Head rotation to the same side
•  Lateral head flexion, same side
 Obliquus Capitis Inferior
•  Origin
•  Spinous process of axis(C2)
•  Insertion
•  Transverse process of atlas(C1)

•  Function
•  Head rotation to the same side
 Neck Muscles

•  Sterno-Cleido-Mastoid: flexion, side flexion, opposite

rotation
•  Splenius: extension
•  Scalene: thorax elevation
•  Levator scapulae
 Neck Movements

Movement Muscle
Flexion R+L SCM(ant fibers)
Extension Splenius cervicus & capitis + semispinalis
+trapezius+SCM(post fibers)
Side flexion, R & L SCM
Rotation, R & L SCM+ splenius+trapezius
Stabilization Trapezius & all other muscles
 Neck & Shoulder, Levator Scapulae

•  Neck stabilize
TRAPEZIUS MUSCLE

•  Origin
•  Occipital bone
•  Spinous process of C7-
T12
•  Insertion
•  Lateral clavicle
•  Acromion
•  Spine of scapula
•  Innervation
C3-C4 & XI( accessory
nerve)
Trapezius, functions

•  Elevation of scapula
•  Retraction(adduct) scapula
•  Upwardly rotate scapula
•  Depress scapula
•  Neck extension
 Vertebral Pain

•  Disc problem
•  Treatment choice:
•  LASER + Traction
•  ultrasound
•  Isometric exercises

•  Facet joint problem

•  Disc problem+ Facet Joint: 99% of all back pains
 Neck Injuries

•  Arthritis
•  MVA, whiplash
•  Bone spurs
•  Cervical spondylosis
•  Osteoporosis
•  Pinched nerves
•  Spinal stenosis
 Symptoms Of Neck Pain

•  Headaches
•  Numbness, weakness, in neck, arm, hands or fingers
•  Pain in neck, shoulder, arms or hands
•  Reduced ROM in neck
•  Walking problem, spastic gait
 RA Symptoms

•  Pain,
•  Morning stiffness
•  Swelling
•  Decreased ROM
•  Increase pain with ADLs(tying shoes, opening jar,
buttoning shirt…)
•  Fatigue
•  Occasional fever
•  Decrease ability to grasp

²  Activities of Daily Living(ADL)

 Head Forward Posture

•  Headache
•  Irritation of upper cervical facet joint
•  Tight levator scapula
•  Rounded shoulder+head forward
 Head Forward, Exercises

•  chin tuck
•  Standing
•  Supine
•  Prone
•  Hold 5sec, 5times/hr
•  Shoulder retraction, using theraband
•  strengthening of sup. Trap & ser. ant
Facet Joint pain( Spinal Osteoarthritis)

•  Joint structures that connect the vertebrae to one

another
 Facet Joint, Causes

•  Cartilage in the joints

•  Arthritis of the spine
•  Work
•  Over-use
•  Accident
•  Spondylolithesis
 Degenerative Joint Disease(DJD)

•  Both side facet joint problem

•  Mostly happens in elder people
•  Osteo-Arthritis history
•  Treatment:
•  Chin tuck
•  Isometric exercises
 Whiplash

•  Neck pain following an injury to the soft tissue of the

neck, such as ligaments, tendons & muscles
•  Usually caused by MVA or a sudden motion of the
neck beyond normal ROM
Sprain & Whiplash In Neck, symptoms

•  Neck pain, referred pain to upper trapezius & deltoid

•  Neck stiffness
•  Ringing in ear
•  Dizziness
•  Blurred vision
•  Concentration or memory problems
•  Irritability
•  Difficulty in swallowing
•  Sleeplessness
•  Tiredness
•  Fatigue or weakness
•  Nausea
•  Vertigo
 Treatment

•  Ice pack
•  Ultra Sound
•  TENS/IFC
•  LASER
•  Exercises
 Whiplash Treatment
•  First 2 wks:
•  RICE
•  Active ROM but pain free
•  Collar
•  After 2nd wk:
•  Active assistive pain free ROM
•  Pain free isometric exercises
•  Scapula movement active pain free
•  After 6 wk:
•  Stretching exercises pain free
•  Chin tuck
•  Gentle strengthening exercise
•  After 4mnth:
•  Isometric exercise
•  Strengthening exercise
 Neck Rotations

•  Sit with head facing forward.

•  Keeping back straight, slowly turn head to the right
until pain, stiffness, or end of motion occurs.
•  Do not go past the point of pain
•  Now slowly turn the head to the left
•  Do 1-3 sets of 10 repetitions
•  Attempt to go further with each repetition as your
pain and motion improve
•  Do not let head tilt or chin drop while rotating the
head
•  Do exercise in supine and prone positions
 Neck Exercises

•  Chin tuck
•  Sideward isometric strengthening
•  Forward isometric strengthening
•  Backward isometric strengthening
•  Stretching exercises
 NECK STRETCH

•  Stretch your neck with pulling head to the hand’s

side
•  Hold for 15sec
•  Do it for both sides
 NECK STRETCH

•  Pull down your head using both hands, GENTLY

•  Hold for 15sec
 Chin Tucks
•  Sit with head facing forward.
•  Place your index finger and middle finger on the
chin and guide head into a “double chin” position
•  The motion should be directed straight back and
should be continued to look straight ahead
•  Hold this position for up to 10 seconds
•  Do 1-3 sets of 10 repetitions
•  Do not let head tilt up or down during the exercise
 Vertebral bones

•  Cervical, 7
•  Thoracic, 12
•  Lumbar, 5
•  Sacral, 5 fused
•  Coccygeal, 4 fused
•  Four facet joints on
each vertebrae
Spinal Extensors
 Thoracic Back Pain Causes

•  Soft tissue

•  Poor posture,
•  back pack
•  Prolonged sitting at a computer
•  Overuse injuries
Postures
 Thoracic back pain

•  Scoliosis
•  Kyphosis
 Scoliosis

•  Structural
•  Surgery
•  exercise
•  Postural
•  Exercise
•  Stretching of lower side
•  Strengthening of higher side
 Exercises of scoliosis

•  McKenzie ex.
•  Hanging from a bar
•  Side flexion
•  Sit on foot, palms on the floor, extension toward the
upper side
•  Cat & camel exercise
 Kyphotic Posture

•  Increase in thoracic spine curvature

•  It is common to combine with head forward posture
•  Combine with rounded shoulder
 Exercises For Kyphosis

•  Extension ex. in prone position(for younger)

•  Extension in standing position or on a table(for elder)
•  Corner stretching
•  Strengthening exercises
 Lumbar Area Problems

•  Lordosis
•  Disc problems
•  Facet joints problems(dysfunction)
•  Degenerative vertebrae secondary to degenerative disc
•  Spondylolisthesis
 Discus

•  Nucleus pulposus
•  Annulus fibrosus
 Discus

•  Pressure on lumbar disc

•  Lying or standing: 17 PSI
•  Sitting or bending to lift: up to 300 PSI
 Disc Problems

•  Disc Prolapse: annulus fibrosus is intact

•  Disc Protrusion: annulus fibrosus involved
•  Disc Herniation: tearing annulus fibrosus & bulge out
nucleus
• 
 Herniation Stages
•  1) Disc Degeneration: chemical
changes associated with aging causes
discs to weaken, but without a
herniation

•  2) Prolapse: the form or position of the

disc changes with some slight
impingement into the spinal canal. Also
called a bulge or protrusion

•  3) Extrusion: the gel-like nucleus

pulposes breaks through the annulus
fibrosus but remains within the disc

•  4) Sequestration: nucleus pulposus

breaks through the annulus fibrosus and
lies outside the disc in the spinal canal
 Disc problem, Risk Factors

•  Aging
•  Decrease bone density, muscle & ligament weakness
•  Improper lifting
•  Smoking
•  Strenuous repetitive activities
•  Obesity
•  Sudden pressure
 Disk Problem, Sign & Symptoms

•  Unilateral pain
•  Referral pain to leg
•  Increase pain in driving and sitting
•  Increase pain with cough & sneeze
•  Lumbar disc pain
 Referral Pain

•  Referral pain to anterior thigh: L2- L3

•  Referral pain to hamstring muscle: L3-L4
•  Referral pain to calf muscle: L4-L5, most common
•  Referral pain to toes: L5-S1, most common
 Discus Problem, most common

•  L5 nerve impingement (L4-L5 discus)

•  Cannot extend big toe
•  Foot drop
•  Numbness & pain on top of the foot
•  Radiation pain into the buttock
•  S1 nerve impingement (L5-S1 discus)
•  Cannot flex big toe
•  Loss of ankle reflex
•  Weakness in ankle push off
•  Radiation pain down to the sole or outside the foot