Lecture No. 1 Vertebral Motion Dynamics

Syed Ali Hussain MS OMPT

The Vertebral Motion
Segment
It is also called the Junghans
Function Unit.
It includes two adjacent vertebras
and the soft tissues in between them.

Nomenclature of Motion
Segment
An example of a vertebral motion
segment is the third cervical vertebra
(C3) situated above the fourth
cervical vertebra (C4).
The nomenclature used to describe
this union is the C3,4 motion
segment. Syed Ali Hussain MS OMPT
What is meant by
Junction
A junction or transitional segment is an area where
one region of the spine is joined to a different region.
Examples are the craniocervical, cervicothoracic,

thoracolumbar, and lumbosacral junctions.
The craniocervical junction is also known as the

occipitoatlantaI segment or O-A; the cervicothoracic
junction is synonymous with C7,T1; the
thoracolumbar junction with T12,L1; and the
lumbosacral junction with L5,S1.
Physiologic Motion
Each of the 24 vertebrae (7 cervical, 12 thoracic, and 5
lumbar) have the ability to move in 3 planes of
reference.
The sagittal plane motions include forward bending

or flexion and backward bending or extension,
the frontal plane motions include side bending or

lateral flexion to the right and left, and
the horizontal plane motions include axial rotation

to the right and left.
Motion Axes
Each of these 6 spinal motions can
be considered rotations around or
about an orthogonal axis.

X Axis or Horizontal Axis
Forward and backward bending are
rotations about the X or horizontal
axis.

Z or Anteroposterior Axis
Side bending is a rotation about the
Z or anteroposterior axis.

Y or Vertical Axis
Axial rotation occurs about the Y or
vertical axis.

For Your Understanding &
Convenience
The thumb, index, and middle fingers
of one hand can be used to assist in
recalling these 3 axes of spinal
motion.

For Your Understanding &
Convenience
The thumb pointing to the
ceiling represents the Y or
vertical axis,
the middle finger flexed to 90

degrees at the MCP joint
represents the X axis,
and the index finger at a right

angle to the middle finger,
directed anteriorly, represents
the Z axis. Syed Ali Hussain MS OMPT
Rule of Superior Motion
When manual therapists describe segmental motion, it is
understood that the superior vertebra is mentioned first.
For example, side bending right at the T5,6 motion
segment suggests that the fifth thoracic vertebra (T5) is
side bending right on T6.
Most often this will be documented as T5,6 side bending
right.
However, some clinicians way describe this in short form
as T5 side bending right.

Remember !
We can never say the lower vertebra
moved under the superior vertebra.

Rule of Superior Motion
This is the case whether spinal motion is
initiated from above down or from below up.
For example, trunk rotation that is initiated by
rotating the lower extremities and pelvis to the
right and proceeding up to and including TS is
still described as T7,S rotation left by virtue of
the fact that T7 is left rotated relative to T8.

Rule of Vertebral Body
Motion
A vertebra's motion is always described by
the direction of vertebral body motion and
not spinous process (SP) movement.
Consequently, a passive movement of the
T11 SP to the left, which induces vertebral
rotation to the right, is described as T11,12
rotation right because of the direction of
vertebral body motion.
See the SP directio

DETERMINE THE MOTION
Left Side
hats this Technique?

Right
Side
Define the Following
Coupled Motions
Non-Coupled Motions
Open Pack Position (Resting Position)
Closed Pack Position (Non Resting
Position)
Actual Resting Position

Fryette's Rules of
Spinal Motion Coupling
Although the validity of Fryette's
Rules is being questioned, they
continue to be taught within the
osteopathic profession and will be
covered here.

Rule 1
When one or more motion segments
are positioned in neutral (i-e., loose
packed) with the apophyseal (facet)
joints idling in "easy normal," side
bending and rotation are coupled
to opposite sides. aka TYPE 1
Mechanics. Syed Ali Hussain MS OMPT
Remember the Function of SCM
Muscle

Neutral Mechanics
Levels
Neutral mechanics occur in all
vertebral segments except from C2
through C7, where there is no true
neutral position of the apophyseal
joints.

Upper C-Spine
In the upper cervical spine (occiput-
atlas-axis), type 1 spinal mechanics
occur for different reasons (i-e.,
based upon unique osseous and
ligamentous characteristics).

Thoracic Spine
Although capable of type 1 spinal
mechanics, the upper thoracic segments
(T1-T4) tend to follow the lower cervical
spine (type 2 spinal mechanics) in
function;
When rotation precedes side bending,
type 2 or non-neutral coupling dominates
throughout all levels of the thoracic spine.
Rule 2
When a spinal motion segment is
positioned in either flexion or
extension such that the apophyseal
joints are in apposition (i-e.,
engaged), side bending to one side is
coupled with Y-axis rotation to the
same side. Syed Ali Hussain MS OMPT
Remember the Function of
Trapezius

For example, side bending to the right at T7,S from a
position of trunk flexion is associated with T7 rotation right.
Rule 2 is referred to as non-neutral or type 2 spinal
mechanics (coupling).
Non-neutral mechanics occur in all vertebral segments
except in the upper cervical spine (occipitoatlantal and
atlantoaxial joints) where type 1 mechanics prevail.
However, Greenman describes an exception to this rule in
the lumbar spine, whereby type 1 mechanics prevail in the
presence of L1-L5 extension.

Rule 3
When motion is introduced in one plane, the
available motion in the remaining planes is
reduced.
For example, rotation of the head-neck is greater in

an upright posture than it is in a slumped posture.
Likewise, trunk side bending is greater in a neutral

position of the spine than in a flexed or extended
position of the spine.

Rule 3 Cont.
The converse of this also applies (i-e., if
motion is increased in one plane, it will also
be increased in the other planes as well).
For example, if lumbar spine side bending is
increased through manipulative therapy,
then the other motions of flexion,
extension, and rotation will increase as well.

Coupled & Non Coupled
Movements of Spine
Spinal Level Coupled Non Coupled

Movements Movements
C0-C1-C2 Type 1 (S.B + Type 2

Rot. Opp)
C3-C7 Type 2 (S.B + Type 1
Rot. S.S)

Coupled & Non Coupled
Movements of Spine
Spinal Level Coupled Non Coupled

Thoracic & Movements Movements
Lumbar Spine
Flexion Type 2 Type 1
Neutral/Exten Type 1 Type 2

sion

Type 1 and 2 Impairment
Restricted spinal motion involving 3 or more segments
in a neutral position of the trunk is referred to as type
1 or neutral impairment (i-e., dysfunction).
For example, in a neutral trunk position a restriction in
left side bending from T9 through T12 is associated
with a restriction at the same levels in right rotation.
This is also referred to as a type 1 rotoscoliosis, and
its position can often be identified on an
anteroposterior spinal radiograph.

Type 1 and 2 Impairment
Restricted spinal motion of one segment in a non-neutral
position is referred to as type 2 or non-neutral
impairment.
For example, T3-T4 is said to be FRS (flexed, rotated, and

side bent) right when it is limited in the opposite
directions (i-e., extension, rotation, and side bending to
the left).
Conversely, L4-L5 is said to be ERS (extended, rotated,

and side bent) left when it is limited in flexion, rotation,
and side bending to the right.
Fact
These one-segment motion
impairments may not be easily seen
on a spinal radiograph but can be
readily diagnosed through
osteopathic segmental motion
analysis.

Apophyseal Joint
Kinematics
Facet Opening
Facet Closing
Facet Gapping
Roll-Gliding

Facet Opening
The term facet opening refers to the
anterior and superior glide of the
inferior articular process of the
superior vertebra on the superior
articular process of the vertebra
below.

Example
For example, the facets are said to
open bilaterally in spinal flexion;
open on the left during flexion, side
bending, and rotation to the right or
open on the right during flexion, side
bending, and rotation to the left.
Facet Opening

Facet Closing
The term facet closing refers to the
posterior and inferior glide of the
inferior articular process of the
superior vertebra on the superior
articular process of the vertebra
below.

Example
For example, the facets are said to
close bilaterally in spinal extension;
close on the left during extension, side
bending, and rotation to the left
or close on the right during extension,
side bending, and rotation to the right.

Facet Closing

Facet Gapping
The term facet gapping refers to the
separation or distraction (traction) of the
joint surfaces in a perpendicular direction.
If a thoracic or lumbar facet gaps on the
left, this implies that the inferior articular
process of the superior vertebra separates
away from the superior articular process
of the inferior vertebra.
Gapping of the facets generally occurs
in the thoracic and lumbar spine in
response to neutral rotation on the
ipsilateral side.

On the contralateral side of the
rotation, the facets approximate each
other as they are compressed together.
No gapping occurs in either the upper
(occiput-atlas-axis) or lower (C2-C7)
cervical spine because of the absence
of a neutral articular position.

Torsion Test

Roll-Gliding
According to Kaltenborn, the vertebral motion
segment, not unlike the extremity joints, moves in
a roll-gliding fashion.
Except for the occipital condyles, which are
convex surfaces moving on the concave surfaces
of the atlas, the remainder of the motion
segments of the spine behave or function as a
concave surface (superior vertebra) moving on a
convex one (inferior vertebra).
What Does this Suggests
This suggests that the roll of the
superior component (concave rule)
will glide in the same direction on the
inferior component below, whereas
the inferior component (convex rule)
will glide in the opposite direction of
its toll. Syed Ali Hussain MS OMPT
Significance
We have previously described the X, Y, and Z
motion ,axes, but only will regard to rotation.
However, to appreciate how a rigid body
moves in space (i-e., the helical) axis of
motion), we need to consider not only
rotation about a given axis, but also the
translation that occurs along a different axis

For example, forward bending of the T7-T8
motion segment involves anterior rotation
(roll) of T7 about an X axis as well as anterior
translation (glide) of T7 along the Z axis.
Backward bending of T7-T8 involves X-axis
posterior rotation and Z-axis posterior
translation of T7.
For side bending of T7-T8 ,about a Z axis,
there is vertebral translation of T7 in the same
direction along the X axis.
The roll-gliding that occurs with Y-axis rotation is
dependent upon the vertebral segment involved.
At the ,atlanto-axial segment, axial rotation about the Y

axis is associated with a cranio-caudal translation along
the same Y axis such that there is a slight of height as
the extreme of rotation is reached.
The vertical height is then restored when the head is

rotated to neutral.
Consequently, each vertebral motion segment has a

total of 6 degrees of freedom, 3 for rotation and 3 for
translation.
Lets Make it a bit Easy
In summary, it can be said that motion of
the superior component of the motion
segment demonstrates rotation and
translation in the same direction,
whereas the inferior component of the
segment rotates and translates in
opposite directions.
If we accept the premise that the superior and
inferior components of the motion segment have
relative motions that are out of phase with each
other, then it can also be said that the superior
component of the segment will roll in one
direction, while the Inferior component will glide
in the opposite direction.
For example, the backward bending of T5-T6

involves a backward roll of T5 about the X axis,
with an anterior glide of T6 along the Z axis.
Consequently, a mobilization/manipulation
of T6 in a postero-anterior (PA) direction
will improve backward bending range at
the T5-T6 segment.
Since translation is a mechanically simpler
movement to perform manually,
therapists routinely manipulate the
inferior component of a segment to
achieve improvement in range.
Motion Barriers
There are 4 barriers (3 normal and 1
abnormal) to joint motion.
Physiologic Barrier
Elastic Barrier
Anatomic Barrier
Restrictive Barrier

Physiologic Barrier
The end of an active, voluntary effort
in a normal joint is the physiologic
barrier for that motion.
Every movement in the body has an
associated physiologic barrier.

Elastic Barrier
The elastic barrier is the point at
which the soft tissue slack is taken
up during a passive movement in a
normal joint (i-e., "the beginning of
the end").

Anatomic Barrier
The anatomic barrier is the absolute
end-point in the passive range of
motion in a normal joint beyond
which tissue injury occurs (i-e., "the
end").

Restrictive Barrier
The premature motion loss in an impaired
joint is known as the restrictive barrier.
It may represent a restriction at any point
in the overall range of motion of a joint.
It is associated with an abnormal (end-feel
(i-e., hard or non-yielding versus resilient
and supple (flexible).

Causes of Restrictive
Barrier
Restrictive barriers have multiple causes
(i-e., muscle splinting, capsular fibrosis,
internal derangement, Myofascial
tightness) and are responsible for causing
either a major motion loss when 50% or
more of the range is restricted, or a minor
motion loss involving less than 50% of the
range of motion in a specific direction.

Lecture No. 1 Vertebral Motion Dynamics

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Syed Ali Hussain MS OMPT

Syed Ali Hussain MS OMPT

Syed Ali Hussain MS OMPT

Examples are the craniocervical, cervicothoracic,

The craniocervical junction is also known as the

The sagittal plane motions include forward bending

the frontal plane motions include side bending or

the horizontal plane motions include axial rotation

Syed Ali Hussain MS OMPT

Syed Ali Hussain MS OMPT

Syed Ali Hussain MS OMPT

Syed Ali Hussain MS OMPT

Syed Ali Hussain MS OMPT

the middle finger flexed to 90

and the index finger at a right

understood that the superior vertebra is mentioned first.

For example, side bending right at the T5,6 motion

segment suggests that the fifth thoracic vertebra (T5) is

side bending right on T6.

Most often this will be documented as T5,6 side bending

However, some clinicians way describe this in short form

as T5 side bending right.

Syed Ali Hussain MS OMPT

Syed Ali Hussain MS OMPT

initiated from above down or from below up.

For example, trunk rotation that is initiated by

rotating the lower extremities and pelvis to the

right and proceeding up to and including TS is

still described as T7,S rotation left by virtue of

the fact that T7 is left rotated relative to T8.

Syed Ali Hussain MS OMPT

Syed Ali Hussain MS OMPT

hats this Technique?

Syed Ali Hussain MS OMPT

Syed Ali Hussain MS OMPT

Syed Ali Hussain MS OMPT

Syed Ali Hussain MS OMPT

Syed Ali Hussain MS OMPT

Syed Ali Hussain MS OMPT

position of trunk flexion is associated with T7 rotation right.

Rule 2 is referred to as non-neutral or type 2 spinal

Non-neutral mechanics occur in all vertebral segments

except in the upper cervical spine (occipitoatlantal and

atlantoaxial joints) where type 1 mechanics prevail.

However, Greenman describes an exception to this rule in

the lumbar spine, whereby type 1 mechanics prevail in the

presence of L1-L5 extension.

Syed Ali Hussain MS OMPT

For example, rotation of the head-neck is greater in

Likewise, trunk side bending is greater in a neutral

Syed Ali Hussain MS OMPT

Syed Ali Hussain MS OMPT

Spinal Level Coupled Non Coupled

C0-C1-C2 Type 1 (S.B + Type 2

Syed Ali Hussain MS OMPT

Spinal Level Coupled Non Coupled

Neutral/Exten Type 1 Type 2

Syed Ali Hussain MS OMPT

in a neutral position of the trunk is referred to as type

1 or neutral impairment (i-e., dysfunction).

For example, in a neutral trunk position a restriction in

left side bending from T9 through T12 is associated

with a restriction at the same levels in right rotation.

This is also referred to as a type 1 rotoscoliosis, and