BALANCE OF THE MUSCLE SUSPENSION IN THE SPINAL COLUMN.
BALANCE OF THE MUSCLE SUSPENSION IN THE SPINAL COLUMN.
SUMMARY.
This article presents in practical form the physical evaluations and function that the different muscles of our back fulfill, in function to maintain a harmonic balance avoiding thus the dysfunctions or neuromusculoskeletal alterations. The 85 percent of our population, will suffer sometime in his life some incident in the lumbar spine or other area of the spine. Product for the lack of physical activity, focused on the general maintenance of the person, in addition to the work life that can develop, that is why you should address the rehabilitation and recovery in an integral way with application of various techniques or therapies.
REMINDER ASPECTS.
The Vertebral column is composed of 7 cervical, 12 thoracic are protected by the rib cage, responsible for protecting the internal organs, this area of the spine is with limited movements in the turns. The 5 lumbar, which have limited movements in lateral inclination, the sacrum, which has a preponderance in its inclination as an example; if it is much earlier there will be more tendency to hyperorbism, if the sacrum is more posterior there will be a loss of the curvatures and of course the coccygeas. Many times people with pains referred to one side or both sides in a column come to our consultation, sometimes accompanied by previous irradiation at the visceral level, for this reason we must perform a physical examination in a fine way, for example;
SIGNS OF RADICULAR IRRITATION.
These signs are the derivatives of joint pain and we can think that, they are deeply related to the different minor intervertebral dysfunctions so called because it can only be observed through specific palpation, these minor intervertebral dysfunctions must be investigated in a particular way and specify the forms of realization is;
a) Flow pressure performed with the thumb.
b) Cephalic pressure performed with the thumb.
c) Lateral pressure (we evaluate rotation)
d) Ligament pressure (this is done with the edge of a 10-peso coin).
DIRECT PRESSURE ON THE SPINOUS APOPHYSIS.
This craft is performed on the spinous process, the thumbs are superimposed making a pressure which will give us the information of the type of injury that refers to us if it is ascending lesion in extension when the joint facets are separated, or descending when the veneers Articular approach will be in flexion, the lateral pressure will inform us of a rotation.
PRESSURE IN THE INTERESPINOUS LIGAMENT.
The pressure in the inter-spinous ligament will be done with a 10-peso coin, among the thorns, which will allow us to evaluate the commitment it has.
WHAT WE CAN DO TO LOWER THE INTENSITY OF PAIN FOR THIS LIGAMENT.
We will use a gentle friction maneuver for 10 to 20 minutes as an intervertebral massage from T12 to T 1, in a zigzag fashion. Also releasing vertebral bodies.
THE CAUSES
When the result of the particular physical examination throws punctual or group pain we will be facing a thoracic vertebral dysfunction or injury, in addition to performing this type of test we can incorporate another type of test such as the pinzado rodado.
THE IMPORTANCE OF MUSCLE SUSPENSION
MYOLOGY
1.- Muscles of the vertebral channels.
2.- Medium muscular plane.
3.- Surface muscular plane.
1.- MUSCLES OF THE VERTEBRAL CHANNELS:
The vertebral channels are wide and deep surfaces that are found on each side of the midline between the spinous processes and the ribs.
They are occupied by three important muscle formations (deep plane of the posterior region) that extend from the sacrum to the cervical region. These muscles are: iliocostal or lumbar sacrum, long dorsal and transverse spiny. The first two are located in a more superficial plane being the iliocostal: external and the long dorsal: external and the internal long dorsal.
The transverse spiny is below the previous ones in a deeper plane applied directly on the sheets. These muscles, separated at the dorsal level by adipose cell layers, are united in a single mass, partly fleshy and partly tendinous at lumbo sacral level, called the common mass that is considered the origin of the entire muscle mass.
COMMON MASS
It occupies the pelvis, the sacrum canal and the lumbar region, all the space between the spinous processes and the costophthal processes. Take insertion in:
Spinous processes of the last lumbar vertebrae.
Sacred Ridge.
Posterior tubers of the sacrum.
Major sciatic sacral ligament.
Tubal iliac.
Posterior fifth of the iliac crest.
ILIOCOSTAL OR SACRO LUMBAR.
It constitutes the superficial and external part of the common mass. From here it is directed upwards by inserting itself by twelve dorsal tendons in the angle of the twelve ribs and by five cervical tendons in the posterior tubers of the transverse processes of the last five cervical vertebrae.
As the tendons that are inserted in the ribs are detached from the outer edge, they in turn emit new beams at the inner edge (reinforcing beams) that prevent the weakening of the muscle.
DORSAL LONG:
It constitutes the superficial and internal portion of the common mass. It rises vertically occupying the entire dorsal region and stops in the cervical region without penetrating it. In its ascending path it crosses 16 or 17 vertebrae, providing three beams:
• Internal beam: it takes insertion in the corresponding spinous process (THORNY BEAM).
• Medium beam: it takes insertion in the cusp of the transverse processes (DO TRANSVERSE).
• External beam: insertion on the external side of the rib between the angle and the tuberosity (DO COSTAL).
ESPINOSO TRANSVERSE:
It extends from the apex of the sacrum to the second cervical vertebra.
• This is represented by a series of numerous muscle bundles that have the characteristic of extending all obliquely upwards and inwards from a transverse process to a spinous process, but they are differentiated by their situation, development and length in three groups:
SEMIESPINOSO:
There are two, located in the dorsal region and in the cervical region.
SEMIESPINOSO DORSAL:
• Made up of six bundles originating in the transverse processes of the last six dorsal vertebrae and ending in the spinous processes of the first four dorsal vertebrae and the last two cervical vertebrae.
SEMIESPINOSO DE LA NUCA:
• Located above the previous one, it has an analogous formation. It originates in the transverse process of the first six dorsal vertebrae and ends in the spinous process of the second, third, fourth and fifth cervical.
MULTIFIDO DEL RAQUIS:
It occupies the entire extension of the vertebral channels from the sacrum to the axis. Formed by a series of beams that take origin in:
• Sacral region: sacral canal and anterior aspect of spinal aponeurosis.
• Lumbar region: apophyseal tubers (transverse homologs).
• Dorsal region: transverse process.
• Cervical region: transverse and articular processes of the last four cervical vertebrae.
LATEST CERVICAL VERTEBRAS:
• They are directed upwards and inwards to end in the spinous processes of the fourth, third and second vertebrae located above.
• These bundles are directly applied against the vertebrae, except in the dorsal region, where they are separated by the rotators of the back or multifidus.
REVERSE ROTATORS OR SUB-SUBSIDIARIES OF RAQUIS:
• They are small muscle bundles, located below the multifidus.
• They extend from a transverse process to the lower edge of the lamina and base of the spinous process of the supra-rectal vertebra.
• The muscles of the vertebral channels are innervated by the posterior branches of the spinal nerves.
NOTE.
Description of the transverse spinous muscle according to:
TROLARD
It extends from the spinous process and lamina of four supra-rectal vertebrae to the transverse process of the fifth vertebra.
WINKLER
It extends from the spinous process and lamina of one vertebra to the transverse processes of four underlying vertebrae.
2.- MEDIUM MUSCLE PLANE:
SERRATE LATER POSTEROINFERIOR:
• It is located behind the muscles of the vertebral channels and covered by the latissimus dorsi. It extends from the spinous processes of the first three lumbar vertebrae and the last two dorsal vertebrae to the lower edge and outer face of the last four ribs through four fascicles. Innervated by the posterior roots of D9 D10 and D1 l.
3.-SUPERFICIAL MUSCLE PLANE:
WIDE DORSAL:
• It originates in the spinous processes of the last seven dorsal vertebrae, five lumbar vertebrae and corresponding supra-spiny ligament.
▫ Sacred crest.
▫ Posterior third of the last four ribs.
▫ External face of the last four ribs.
▫ From here it is directed upwards and outwards to take insertion in the bottom of the bicipital slide of the flue.
Inervated by the nerve of the large dorsal (C5).
There are other muscles to be taken into account due to the relationship established by their insertions, between the cervical and dorsal rachis, and they are important in the establishment of lesions in these regions.
MAJOR COMPLEX:
▫ Located outside the midline, it finishes filling the vertebral canal.
▫ It extends from the transverse processes of D1 to D6, C4 to C7 and spinous process of C7 and D1 to the area between innervated by the greater occipital nerve, and the posterior branches of C3, C4 and C5.
MAJOR COMPLEX:
▫ It extends from the transverse process of D1 to C4 to the mastoid process. Inervated by the greater occipital nerve, and the posterior branches of C3, C4 and C5.
ESPLENIO:
▫ From the head: Occipital curve line and mastoid process.
▫ From the neck: Transverse processes of C1, C2 and C3. From here they are directed towards the spinous processes of C2 to C7 and D1 to D4, innervated by the greater occipital nerve and posterior branches of the cervical nerves.
TRANSVERSE OF THE NECK:
▫ Located outside the smaller complex.
▫ It extends from the ends of the transverse processes from D5 to D1 to the end of the transverse processes of C7 to C3. Inervated by the posterior branches of the last cervical and first dorsal nerves.
DORSAL LONG:
▫ It is confused with the cervical portion of the lumbar sacrum. It is born at the upper edge of the first six ribs and ends at the transverse processes of the last five cervical vertebrae. Inervated by the posterior branches of the spinal nerves.
TRAPEZE:
▫ It is the most superficial of the posterior region of the trunk, it is a wide and triangular muscle that occupies the space between the occiput and the lower part of the dorsal column.
IT EXTENDS FROM:
▫ Internal third of the superior occipital curve.
▫ External occipital protuberance.
▫ Posterior cervical ligament.
▫ Vertex of the spinous processes of the dorsal vertebrae and corresponding supra-spiny ligament.
▫ From here it extends towards the shoulder region to end up inserting itself in the posterior edge of the clavicle, inner edge of the acromion and spine of the shoulder blade. Innervated by the external branch of the spinal, and the nerve of the trapezius (anterior branch of C3 C4).
NECK LENGTH:
▫ Located in the paravertebral region, it joins the first three dorsal vertebrae with the entire cervical spine. Innervated by anterior branches of the first four cervical nerves.
ARTICULAR PHYSIOLOGY
▫ The dorsal spine is the region with the least movement capacity, its morphology and physiology differentiates it from the rest of the spine. It is arranged dorsally protecting the thoracic cavity, and is later displaced with respect to the central axis of the body.
▫ This displacement is caused by the central organs of the mediastinum, especially the heart.
▫ In the diagram we can see the relationship that exists between each region of the column with respect to the line of gravity:
▫ Dorsal portion: It is located in the fourth part of the thickness of the thorax.
▫ Cervical portion: it is more central and is located in the third of the thickness of the neck. (It must support the weight of the head).
▫ Lumbar portion: It is truly central and is located in the middle of the thickness of the trunk. (It must support the weight of the entire upper part of the trunk).
We must not forget that, the lordotic curves in the column are the result of the adaptation of man in the step from the quadrupedal to the standing, we must also consider the anterior inclination of the sacrum which will produce the adaptation of the curvatures in the column. What led to the straightening and later to the inversion of the lumbar spine, initially concave forward (phylogeny).
It must also be borne in mind that at birth, man presents a kyphotic column at all levels and it will be from the year of life where lumbar lordosis begins to form in response to standing, which will consolidate around 10 years (ontogenesis) ).
▫ newborn.
▫ five months.
▫ one year.
▫ three years.
▫ eight years.
▫ Ten years.
It is demonstrated, from a mechanical point of view, that a straight column supports a compression less effectively than a column with curves. From this it was deduced that the resistance of a column is proportional to the square of the number of curves that presents plus one.
R = N2 + 1
(N = Number of curves)
To support the pressures the spine presents an architecture that obviously responds to the mechanical stresses to which it is subjected. The vertebral body has a short bone structure, with a cortical of dense bone surrounding the spongy tissue. The cortical of the vertebral faces is thicker in its center, where we find a cartilaginous portion and in its periphery form and a rim called marginal runner.
If we make a sagittal section we see that in the vertebral body the trabeculae of cancellous bone are distributed following the lines of force. This is how they are observed.
• Vertical lines: join the upper face with the lower face.
• Horizontal lines: unite the two lateral cortical.
• Oblique lines: arranged in a fan start:
From the superior side, to extend through the pedicles to the inferior articular process and the spinous process.
From the inferior side, to extend through the pedicles to the inferior articular processes and the spinous process.
The crossing of these three trabecular systems determines points of great resistance, as well as a point of least resistance located in the anterior part of the vertebral body, where there are only vertical trabeculae.
This explains why the fractures due to overload are fractures in the cradle, where the anterior part of the vertebra that has lower bone density yields. In general, the column is functionally divided into an anterior pillar that plays a static role and a posterior pillar with a dynamic role.
This is not entirely correct, since in fact the entire spine is dynamic. Most of the loads are transmitted through the vertebral bodies and the vertebral discs. The alternate arrangement of the bone pieces and the ligament binding elements determines two segments:
▫ Passive segment (I) formed by the vertebra.
▫ Motor segment (II) formed by the intervertebral discs, conjunction hole, interapofisary joints, yellow ligament and interspinous ligament.
Mobility at the level of this motor segment is responsible for the movements of the spine. If we consider the trabecular structure of the vertebral bodies and the posterior arches we can say that the vertebrae act as first degree levers with the point of support at the level of the articular processes. This system of lever allows to cushion the forces of axial compression on the column by two mechanisms.
DIRECT AND PASSIVE AMORTIGATION:
Through the intervertebral disc.
INDIRECT AND ACTIVE DAMPING
Through the muscles of the vertebral channels (its contraction causes the pressure to decrease at the level of the intervertebral disc) (3). The intervertebral disc is the most important element of the spine in the reabsorption of pressures, which is why its Indemnity is essential so that it can fulfill this function. As we already know it is formed by a central part Pulpy nucleus, (N), gelatinous substance that contains 88% of water and that lacks vascularization and innervation, and a peripheral part, Fibrous ring (A), constituted by oblique concentric fibrous layers alternating In the outermost layer the vertical fibers, increasing their obliquity towards the interior, becoming almost horizontal in the most central layer that is in contact with the nucleus pulposus. In this way we see how the nucleus is enclosed in an inextensible room between the vertebral faces and the ring. This results in an articulation that is called a kneecap where three kinds of movements can be developed:
INCLINE MOVEMENTS
In the sagittal plane: flexo-extension.
In the frontal plane: lateral inclination
ROTATION MOVEMENTS.
SLIDING OR SHEARING MOVEMENTS.
The pressures exerted on the intervertebral disc are considerable and increase the closer we get to the sacrum. Of 100% of a load 75% is supported by the core and 25% by the fibrous ring. The core acts as pressure distributions on the ring. The pressure is not zero in the center of the nucleus even when the disc does not bear any load. This is due to the state of hydrophilicity that makes it swell in its inextensible shelter.
This state is called Pretension and it is what allows the disc to more effectively resist the compression and inflection forces. When with age the nucleus loses its hydrophilic properties, its internal pressure decreases and therefore the state of pretension tends to disappear, which explains the loss of flexibility of the senile spine.
If a disc is subjected to an asymmetric axial pressure, inflection of the superior vertebra will occur to the side where the load falls, with an opening on the opposite side that will tighten the fibers of the ring. The nucleus will move towards that area of lower pressure causing greater tension of the disc, which will cause the vertebra to return to its neutral position.
A phenomenon of self-stability or author recovery is related to the state of pretension of the nucleus.
The fibrous ring and the nucleus form a functional pair whose efficacy depends on the integrity of both.
The intervertebral discs are not directly in contact with the surface of the vertebral bodies since they are covered with a layer of hyaline cartilage that have numerous microscopic pores.
When a pressure is exerted on the spine, for example the weight of the body in bipedal position (daily loading process) the water contained in the nucleus is directed towards the center of the vertebral bodies through the pores.
On the contrary, in the course of the night, in the position of dorsal decubitus, where the load is canceled and the muscular tone is reduced by sleep, the hydrophilicity of the nucleus again attracts the water that returns from the vertebral bodies.
With age, the nucleus loses the capacity for inhibition and hydrophilicity, which also translates into a decrease in the state of pretension, which explains the loss of height and flexibility of the elderly.
When a constant load is applied, the disc is deformed and it does so through an exponential process, that is, the dehydration is proportional to the volume of the nucleus.
When removing the load from the disk it recovers its thickness also in an exponential form, which will be Reverse. The total recovery requires some time, which means that the application of charges and discharges are repeated for a long time the disk does not have enough time to recover its state causing an aging phenomenon. The capacity of deformation of the disc in response to the solicitation of the loads is not equal according to this healthy or injured. It has been verified that for a load of 100 Kg a healthy disc and in rest this same load on a damaged disc, it will determine an Incomplete decrease. When the disc height decreases in a process
lesion, it will alter the interapofisary joint relationships, which constitutes a factor of osteoarthritis over time. We must bear in mind that the height of the disc is not the same in the different regions of the spine and this is in relation to the mechanical stresses to which each region is subject and to its movement capacity. The most important thing is not the absolute height of the intervertebral disc, but the ratio of the height of the disc to the height of the vertebral body, which will be related to the mobility of the spinal segment.
Greater proportion greater mobility. Thus we see how the cervical rachis that is more mobile has a discorporating ratio of 2/5. The lumbar spine has a discorporating ratio of 1/3 and the dorsal spine, which is the one with the least mobility, has a discorporating ratio of 1/5.
Another significant fact is that the position of the nucleus is not the same in the different segments of the spine.
In the cervical and lumbar spine it will be located at the level of the axis of movement, while in the dorsal spine it is located behind this axis.
OUR DAILY WORK TAKES US.
These times have brought a great advance in technology which has made our lives more comfortable and less demanding in the physical since, now we do not hunt to survive. This development has produced a change in people for example; where people spend a lot of time in front of the screen of their computer, where the screen of this one, is not according to the visual height provoking; poor posture (increased curvature of the dorsal kyphosis, lumbar lordosis) as well as other neuromusculoskeletal disorders in the upper extremity, for example; tendinitis, epicondylitis. The most worrisome is the use of smart phones or smart phones where people interact much of the day, writing and sending messages. The position that can often be observed of these people (usually young people) is the dorsal kyphosis, produced by the location to be able to write on the mobile, this when they are standing (stopped). It is also worrisome to see how little importance is given to this in Ed classes. Physics in schools or institutes where the teacher is responsible for making the anthropometric evaluation from basic to average, with the aim of preventing and recovering the dynamic functionality of the structures and march, only that this is not the case, I know that this is not contemplated in the educational plans and projects of the different governments, only that, a boy or girl with postural alteration will be an adult who, will have less quality of life will demand more attention from the state (kinesiology, osteopathy or others).
HOW CAN WE AND WHAT DO WE DO PARENTS?
From early ages we can see our children in the march, if you have a duck walking this indicates a flat foot (fall navicular) is there, we must acquire shoes with a slight inner arch so that, thus begin to work all the plantar muscles . By preventing this from happening, when we bathe our children in the tub, after this we perform a gentle massage starting with the sole of the right foot (favoring the circulatory return) we emphasize the area or plantar arch. When they are already at school, teach them to carry the weight of the backpack in an appropriate way, in addition to stretching exercises so we avoid annoying muscular contractures or lumbago.
WHAT DO WE HAVE TO DO THERAPISTS?
We have a variety of techniques to address the alteration or neuromuscular dysfunction, such as Jones inhibition techniques, deep massage, orthopedic massage, connective tissue massage, all this will depend on the professional's training.
JONES TECHNIQUE.
Painful points of diagnosis and treatment.
In joint dysfunctions there are usually painful points in the deep tissues, muscles, tendons, ligaments, fasciae, etc., which can be assimilated to the trigger points of TRAVEL, to the points of VALLEIX, to those of CHAPMAN, etc., which can be located with respect to the corporal planes in the anterior, lateral, posterior zones, as has been said before depending on the injury mechanism, there will be in each case more of them, in one area or both at the same time.
In a study carried out by J. Burnotte, S. Hautain, M. Bocksael and A. Saint Croix, it was possible to determine that the vertebral dysfunctions in the ERL block, there are many anterior and few posterior points, occurred upside down in the FRL lesion. and in vertebral dysfunction NLR, there were as many anterior and posterior points.
It is a gratifying experience for the therapist to appreciate under physical palpation the change that occurs towards a state of low tension in the muscle tone of the deep tissues, the patient is freed from the sensation of pain when the technique is correct.
The discovery of the existence of the previous points was another of the valuable contributions of Jones.
Curiously, the patient himself is surprised at its existence because until they were made patent by the pressure of the therapist, he had not been appreciated by the subject. The value of finding these points lies in their diagnostic nature and treatment and they disappear simultaneously with the normalization of the dysfunction.
According to Jones, the dysfunctions that are alleviated when performing a flexion have more posterior points than before, in which they are relieved with the extension the opposite occurs, if the points are close to the midline, more light positions will be necessary, both in Flexion as in extension for correction.
If the painful points are far from any of these two positions it will be necessary to add a greater degree of lateralization for normalization conveniently.
DEEP MASSAGE.
The techniques of deep massage is based on the good application of the anatomy and biomechanics of gait and posture, it is not only the application of massage techniques with elbow or forearm knuckles there will always be a good physical exploration of these aspects as it is the march and the posture in order to be able to apply with a clear and precise objective about the demand and corporal demand that is presented to us, for that reason the therapist must be a person that has to have a clarity in this objective.
The development and application of deep massage techniques will always be in accordance with what the evaluation throws at us or can not be that during the whole massage session we perform deep massage techniques there will be areas or areas where if we find tissues that require these applications for various reasons that the fascias are stuck or stuck as soil say product of poor circulation or trauma or stress, that is why we should always bear this in mind.
MASSAGE TO THE CONNECTIVE TISSUE.
This type of reflex massage technique that acts on the autonomic nervous system, will have a focus rather on regulation of the functions of the different organs that are stimulated, as well as in cases of neuromusculoskeletal alterations it is a less intense technique in pressure or drag of the tissues and it is more satisfying.
All this must be accompanied by a good training plan according to the demand and body requirement and the sport that is performed, in people who are more sedentary it will be convenient to perform a physical activity focused on preventing dysfunctions or muscle skeletal alterations. the lack of physical activity itself.
Author; Jaime Valenzuela C.
Chiromasajista and Osteopath
SUMMARY.
This article presents in practical form the physical evaluations and function that the different muscles of our back fulfill, in function to maintain a harmonic balance avoiding thus the dysfunctions or neuromusculoskeletal alterations. The 85 percent of our population, will suffer sometime in his life some incident in the lumbar spine or other area of the spine. Product for the lack of physical activity, focused on the general maintenance of the person, in addition to the work life that can develop, that is why you should address the rehabilitation and recovery in an integral way with application of various techniques or therapies.
REMINDER ASPECTS.
The Vertebral column is composed of 7 cervical, 12 thoracic are protected by the rib cage, responsible for protecting the internal organs, this area of the spine is with limited movements in the turns. The 5 lumbar, which have limited movements in lateral inclination, the sacrum, which has a preponderance in its inclination as an example; if it is much earlier there will be more tendency to hyperorbism, if the sacrum is more posterior there will be a loss of the curvatures and of course the coccygeas. Many times people with pains referred to one side or both sides in a column come to our consultation, sometimes accompanied by previous irradiation at the visceral level, for this reason we must perform a physical examination in a fine way, for example;
SIGNS OF RADICULAR IRRITATION.
These signs are the derivatives of joint pain and we can think that, they are deeply related to the different minor intervertebral dysfunctions so called because it can only be observed through specific palpation, these minor intervertebral dysfunctions must be investigated in a particular way and specify the forms of realization is;
a) Flow pressure performed with the thumb.
b) Cephalic pressure performed with the thumb.
c) Lateral pressure (we evaluate rotation)
d) Ligament pressure (this is done with the edge of a 10-peso coin).
DIRECT PRESSURE ON THE SPINOUS APOPHYSIS.
This craft is performed on the spinous process, the thumbs are superimposed making a pressure which will give us the information of the type of injury that refers to us if it is ascending lesion in extension when the joint facets are separated, or descending when the veneers Articular approach will be in flexion, the lateral pressure will inform us of a rotation.
PRESSURE IN THE INTERESPINOUS LIGAMENT.
The pressure in the inter-spinous ligament will be done with a 10-peso coin, among the thorns, which will allow us to evaluate the commitment it has.
WHAT WE CAN DO TO LOWER THE INTENSITY OF PAIN FOR THIS LIGAMENT.
We will use a gentle friction maneuver for 10 to 20 minutes as an intervertebral massage from T12 to T 1, in a zigzag fashion. Also releasing vertebral bodies.
THE CAUSES
When the result of the particular physical examination throws punctual or group pain we will be facing a thoracic vertebral dysfunction or injury, in addition to performing this type of test we can incorporate another type of test such as the pinzado rodado.
THE IMPORTANCE OF MUSCLE SUSPENSION
MYOLOGY
1.- Muscles of the vertebral channels.
2.- Medium muscular plane.
3.- Surface muscular plane.
1.- MUSCLES OF THE VERTEBRAL CHANNELS:
The vertebral channels are wide and deep surfaces that are found on each side of the midline between the spinous processes and the ribs.
They are occupied by three important muscle formations (deep plane of the posterior region) that extend from the sacrum to the cervical region. These muscles are: iliocostal or lumbar sacrum, long dorsal and transverse spiny. The first two are located in a more superficial plane being the iliocostal: external and the long dorsal: external and the internal long dorsal.
The transverse spiny is below the previous ones in a deeper plane applied directly on the sheets. These muscles, separated at the dorsal level by adipose cell layers, are united in a single mass, partly fleshy and partly tendinous at lumbo sacral level, called the common mass that is considered the origin of the entire muscle mass.
COMMON MASS
It occupies the pelvis, the sacrum canal and the lumbar region, all the space between the spinous processes and the costophthal processes. Take insertion in:
Spinous processes of the last lumbar vertebrae.
Sacred Ridge.
Posterior tubers of the sacrum.
Major sciatic sacral ligament.
Tubal iliac.
Posterior fifth of the iliac crest.
ILIOCOSTAL OR SACRO LUMBAR.
It constitutes the superficial and external part of the common mass. From here it is directed upwards by inserting itself by twelve dorsal tendons in the angle of the twelve ribs and by five cervical tendons in the posterior tubers of the transverse processes of the last five cervical vertebrae.
As the tendons that are inserted in the ribs are detached from the outer edge, they in turn emit new beams at the inner edge (reinforcing beams) that prevent the weakening of the muscle.
DORSAL LONG:
It constitutes the superficial and internal portion of the common mass. It rises vertically occupying the entire dorsal region and stops in the cervical region without penetrating it. In its ascending path it crosses 16 or 17 vertebrae, providing three beams:
• Internal beam: it takes insertion in the corresponding spinous process (THORNY BEAM).
• Medium beam: it takes insertion in the cusp of the transverse processes (DO TRANSVERSE).
• External beam: insertion on the external side of the rib between the angle and the tuberosity (DO COSTAL).
ESPINOSO TRANSVERSE:
It extends from the apex of the sacrum to the second cervical vertebra.
• This is represented by a series of numerous muscle bundles that have the characteristic of extending all obliquely upwards and inwards from a transverse process to a spinous process, but they are differentiated by their situation, development and length in three groups:
SEMIESPINOSO:
There are two, located in the dorsal region and in the cervical region.
SEMIESPINOSO DORSAL:
• Made up of six bundles originating in the transverse processes of the last six dorsal vertebrae and ending in the spinous processes of the first four dorsal vertebrae and the last two cervical vertebrae.
SEMIESPINOSO DE LA NUCA:
• Located above the previous one, it has an analogous formation. It originates in the transverse process of the first six dorsal vertebrae and ends in the spinous process of the second, third, fourth and fifth cervical.
MULTIFIDO DEL RAQUIS:
It occupies the entire extension of the vertebral channels from the sacrum to the axis. Formed by a series of beams that take origin in:
• Sacral region: sacral canal and anterior aspect of spinal aponeurosis.
• Lumbar region: apophyseal tubers (transverse homologs).
• Dorsal region: transverse process.
• Cervical region: transverse and articular processes of the last four cervical vertebrae.
LATEST CERVICAL VERTEBRAS:
• They are directed upwards and inwards to end in the spinous processes of the fourth, third and second vertebrae located above.
• These bundles are directly applied against the vertebrae, except in the dorsal region, where they are separated by the rotators of the back or multifidus.
REVERSE ROTATORS OR SUB-SUBSIDIARIES OF RAQUIS:
• They are small muscle bundles, located below the multifidus.
• They extend from a transverse process to the lower edge of the lamina and base of the spinous process of the supra-rectal vertebra.
• The muscles of the vertebral channels are innervated by the posterior branches of the spinal nerves.
NOTE.
Description of the transverse spinous muscle according to:
TROLARD
It extends from the spinous process and lamina of four supra-rectal vertebrae to the transverse process of the fifth vertebra.
WINKLER
It extends from the spinous process and lamina of one vertebra to the transverse processes of four underlying vertebrae.
2.- MEDIUM MUSCLE PLANE:
SERRATE LATER POSTEROINFERIOR:
• It is located behind the muscles of the vertebral channels and covered by the latissimus dorsi. It extends from the spinous processes of the first three lumbar vertebrae and the last two dorsal vertebrae to the lower edge and outer face of the last four ribs through four fascicles. Innervated by the posterior roots of D9 D10 and D1 l.
3.-SUPERFICIAL MUSCLE PLANE:
WIDE DORSAL:
• It originates in the spinous processes of the last seven dorsal vertebrae, five lumbar vertebrae and corresponding supra-spiny ligament.
▫ Sacred crest.
▫ Posterior third of the last four ribs.
▫ External face of the last four ribs.
▫ From here it is directed upwards and outwards to take insertion in the bottom of the bicipital slide of the flue.
Inervated by the nerve of the large dorsal (C5).
There are other muscles to be taken into account due to the relationship established by their insertions, between the cervical and dorsal rachis, and they are important in the establishment of lesions in these regions.
MAJOR COMPLEX:
▫ Located outside the midline, it finishes filling the vertebral canal.
▫ It extends from the transverse processes of D1 to D6, C4 to C7 and spinous process of C7 and D1 to the area between innervated by the greater occipital nerve, and the posterior branches of C3, C4 and C5.
MAJOR COMPLEX:
▫ It extends from the transverse process of D1 to C4 to the mastoid process. Inervated by the greater occipital nerve, and the posterior branches of C3, C4 and C5.
ESPLENIO:
▫ From the head: Occipital curve line and mastoid process.
▫ From the neck: Transverse processes of C1, C2 and C3. From here they are directed towards the spinous processes of C2 to C7 and D1 to D4, innervated by the greater occipital nerve and posterior branches of the cervical nerves.
TRANSVERSE OF THE NECK:
▫ Located outside the smaller complex.
▫ It extends from the ends of the transverse processes from D5 to D1 to the end of the transverse processes of C7 to C3. Inervated by the posterior branches of the last cervical and first dorsal nerves.
DORSAL LONG:
▫ It is confused with the cervical portion of the lumbar sacrum. It is born at the upper edge of the first six ribs and ends at the transverse processes of the last five cervical vertebrae. Inervated by the posterior branches of the spinal nerves.
TRAPEZE:
▫ It is the most superficial of the posterior region of the trunk, it is a wide and triangular muscle that occupies the space between the occiput and the lower part of the dorsal column.
IT EXTENDS FROM:
▫ Internal third of the superior occipital curve.
▫ External occipital protuberance.
▫ Posterior cervical ligament.
▫ Vertex of the spinous processes of the dorsal vertebrae and corresponding supra-spiny ligament.
▫ From here it extends towards the shoulder region to end up inserting itself in the posterior edge of the clavicle, inner edge of the acromion and spine of the shoulder blade. Innervated by the external branch of the spinal, and the nerve of the trapezius (anterior branch of C3 C4).
NECK LENGTH:
▫ Located in the paravertebral region, it joins the first three dorsal vertebrae with the entire cervical spine. Innervated by anterior branches of the first four cervical nerves.
ARTICULAR PHYSIOLOGY
▫ The dorsal spine is the region with the least movement capacity, its morphology and physiology differentiates it from the rest of the spine. It is arranged dorsally protecting the thoracic cavity, and is later displaced with respect to the central axis of the body.
▫ This displacement is caused by the central organs of the mediastinum, especially the heart.
▫ In the diagram we can see the relationship that exists between each region of the column with respect to the line of gravity:
▫ Dorsal portion: It is located in the fourth part of the thickness of the thorax.
▫ Cervical portion: it is more central and is located in the third of the thickness of the neck. (It must support the weight of the head).
▫ Lumbar portion: It is truly central and is located in the middle of the thickness of the trunk. (It must support the weight of the entire upper part of the trunk).
We must not forget that, the lordotic curves in the column are the result of the adaptation of man in the step from the quadrupedal to the standing, we must also consider the anterior inclination of the sacrum which will produce the adaptation of the curvatures in the column. What led to the straightening and later to the inversion of the lumbar spine, initially concave forward (phylogeny).
It must also be borne in mind that at birth, man presents a kyphotic column at all levels and it will be from the year of life where lumbar lordosis begins to form in response to standing, which will consolidate around 10 years (ontogenesis) ).
▫ newborn.
▫ five months.
▫ one year.
▫ three years.
▫ eight years.
▫ Ten years.
It is demonstrated, from a mechanical point of view, that a straight column supports a compression less effectively than a column with curves. From this it was deduced that the resistance of a column is proportional to the square of the number of curves that presents plus one.
R = N2 + 1
(N = Number of curves)
To support the pressures the spine presents an architecture that obviously responds to the mechanical stresses to which it is subjected. The vertebral body has a short bone structure, with a cortical of dense bone surrounding the spongy tissue. The cortical of the vertebral faces is thicker in its center, where we find a cartilaginous portion and in its periphery form and a rim called marginal runner.
If we make a sagittal section we see that in the vertebral body the trabeculae of cancellous bone are distributed following the lines of force. This is how they are observed.
• Vertical lines: join the upper face with the lower face.
• Horizontal lines: unite the two lateral cortical.
• Oblique lines: arranged in a fan start:
From the superior side, to extend through the pedicles to the inferior articular process and the spinous process.
From the inferior side, to extend through the pedicles to the inferior articular processes and the spinous process.
The crossing of these three trabecular systems determines points of great resistance, as well as a point of least resistance located in the anterior part of the vertebral body, where there are only vertical trabeculae.
This explains why the fractures due to overload are fractures in the cradle, where the anterior part of the vertebra that has lower bone density yields. In general, the column is functionally divided into an anterior pillar that plays a static role and a posterior pillar with a dynamic role.
This is not entirely correct, since in fact the entire spine is dynamic. Most of the loads are transmitted through the vertebral bodies and the vertebral discs. The alternate arrangement of the bone pieces and the ligament binding elements determines two segments:
▫ Passive segment (I) formed by the vertebra.
▫ Motor segment (II) formed by the intervertebral discs, conjunction hole, interapofisary joints, yellow ligament and interspinous ligament.
Mobility at the level of this motor segment is responsible for the movements of the spine. If we consider the trabecular structure of the vertebral bodies and the posterior arches we can say that the vertebrae act as first degree levers with the point of support at the level of the articular processes. This system of lever allows to cushion the forces of axial compression on the column by two mechanisms.
DIRECT AND PASSIVE AMORTIGATION:
Through the intervertebral disc.
INDIRECT AND ACTIVE DAMPING
Through the muscles of the vertebral channels (its contraction causes the pressure to decrease at the level of the intervertebral disc) (3). The intervertebral disc is the most important element of the spine in the reabsorption of pressures, which is why its Indemnity is essential so that it can fulfill this function. As we already know it is formed by a central part Pulpy nucleus, (N), gelatinous substance that contains 88% of water and that lacks vascularization and innervation, and a peripheral part, Fibrous ring (A), constituted by oblique concentric fibrous layers alternating In the outermost layer the vertical fibers, increasing their obliquity towards the interior, becoming almost horizontal in the most central layer that is in contact with the nucleus pulposus. In this way we see how the nucleus is enclosed in an inextensible room between the vertebral faces and the ring. This results in an articulation that is called a kneecap where three kinds of movements can be developed:
INCLINE MOVEMENTS
In the sagittal plane: flexo-extension.
In the frontal plane: lateral inclination
ROTATION MOVEMENTS.
SLIDING OR SHEARING MOVEMENTS.
The pressures exerted on the intervertebral disc are considerable and increase the closer we get to the sacrum. Of 100% of a load 75% is supported by the core and 25% by the fibrous ring. The core acts as pressure distributions on the ring. The pressure is not zero in the center of the nucleus even when the disc does not bear any load. This is due to the state of hydrophilicity that makes it swell in its inextensible shelter.
This state is called Pretension and it is what allows the disc to more effectively resist the compression and inflection forces. When with age the nucleus loses its hydrophilic properties, its internal pressure decreases and therefore the state of pretension tends to disappear, which explains the loss of flexibility of the senile spine.
If a disc is subjected to an asymmetric axial pressure, inflection of the superior vertebra will occur to the side where the load falls, with an opening on the opposite side that will tighten the fibers of the ring. The nucleus will move towards that area of lower pressure causing greater tension of the disc, which will cause the vertebra to return to its neutral position.
A phenomenon of self-stability or author recovery is related to the state of pretension of the nucleus.
The fibrous ring and the nucleus form a functional pair whose efficacy depends on the integrity of both.
The intervertebral discs are not directly in contact with the surface of the vertebral bodies since they are covered with a layer of hyaline cartilage that have numerous microscopic pores.
When a pressure is exerted on the spine, for example the weight of the body in bipedal position (daily loading process) the water contained in the nucleus is directed towards the center of the vertebral bodies through the pores.
On the contrary, in the course of the night, in the position of dorsal decubitus, where the load is canceled and the muscular tone is reduced by sleep, the hydrophilicity of the nucleus again attracts the water that returns from the vertebral bodies.
With age, the nucleus loses the capacity for inhibition and hydrophilicity, which also translates into a decrease in the state of pretension, which explains the loss of height and flexibility of the elderly.
When a constant load is applied, the disc is deformed and it does so through an exponential process, that is, the dehydration is proportional to the volume of the nucleus.
When removing the load from the disk it recovers its thickness also in an exponential form, which will be Reverse. The total recovery requires some time, which means that the application of charges and discharges are repeated for a long time the disk does not have enough time to recover its state causing an aging phenomenon. The capacity of deformation of the disc in response to the solicitation of the loads is not equal according to this healthy or injured. It has been verified that for a load of 100 Kg a healthy disc and in rest this same load on a damaged disc, it will determine an Incomplete decrease. When the disc height decreases in a process
lesion, it will alter the interapofisary joint relationships, which constitutes a factor of osteoarthritis over time. We must bear in mind that the height of the disc is not the same in the different regions of the spine and this is in relation to the mechanical stresses to which each region is subject and to its movement capacity. The most important thing is not the absolute height of the intervertebral disc, but the ratio of the height of the disc to the height of the vertebral body, which will be related to the mobility of the spinal segment.
Greater proportion greater mobility. Thus we see how the cervical rachis that is more mobile has a discorporating ratio of 2/5. The lumbar spine has a discorporating ratio of 1/3 and the dorsal spine, which is the one with the least mobility, has a discorporating ratio of 1/5.
Another significant fact is that the position of the nucleus is not the same in the different segments of the spine.
In the cervical and lumbar spine it will be located at the level of the axis of movement, while in the dorsal spine it is located behind this axis.
OUR DAILY WORK TAKES US.
These times have brought a great advance in technology which has made our lives more comfortable and less demanding in the physical since, now we do not hunt to survive. This development has produced a change in people for example; where people spend a lot of time in front of the screen of their computer, where the screen of this one, is not according to the visual height provoking; poor posture (increased curvature of the dorsal kyphosis, lumbar lordosis) as well as other neuromusculoskeletal disorders in the upper extremity, for example; tendinitis, epicondylitis. The most worrisome is the use of smart phones or smart phones where people interact much of the day, writing and sending messages. The position that can often be observed of these people (usually young people) is the dorsal kyphosis, produced by the location to be able to write on the mobile, this when they are standing (stopped). It is also worrisome to see how little importance is given to this in Ed classes. Physics in schools or institutes where the teacher is responsible for making the anthropometric evaluation from basic to average, with the aim of preventing and recovering the dynamic functionality of the structures and march, only that this is not the case, I know that this is not contemplated in the educational plans and projects of the different governments, only that, a boy or girl with postural alteration will be an adult who, will have less quality of life will demand more attention from the state (kinesiology, osteopathy or others).
HOW CAN WE AND WHAT DO WE DO PARENTS?
From early ages we can see our children in the march, if you have a duck walking this indicates a flat foot (fall navicular) is there, we must acquire shoes with a slight inner arch so that, thus begin to work all the plantar muscles . By preventing this from happening, when we bathe our children in the tub, after this we perform a gentle massage starting with the sole of the right foot (favoring the circulatory return) we emphasize the area or plantar arch. When they are already at school, teach them to carry the weight of the backpack in an appropriate way, in addition to stretching exercises so we avoid annoying muscular contractures or lumbago.
WHAT DO WE HAVE TO DO THERAPISTS?
We have a variety of techniques to address the alteration or neuromuscular dysfunction, such as Jones inhibition techniques, deep massage, orthopedic massage, connective tissue massage, all this will depend on the professional's training.
JONES TECHNIQUE.
Painful points of diagnosis and treatment.
In joint dysfunctions there are usually painful points in the deep tissues, muscles, tendons, ligaments, fasciae, etc., which can be assimilated to the trigger points of TRAVEL, to the points of VALLEIX, to those of CHAPMAN, etc., which can be located with respect to the corporal planes in the anterior, lateral, posterior zones, as has been said before depending on the injury mechanism, there will be in each case more of them, in one area or both at the same time.
In a study carried out by J. Burnotte, S. Hautain, M. Bocksael and A. Saint Croix, it was possible to determine that the vertebral dysfunctions in the ERL block, there are many anterior and few posterior points, occurred upside down in the FRL lesion. and in vertebral dysfunction NLR, there were as many anterior and posterior points.
It is a gratifying experience for the therapist to appreciate under physical palpation the change that occurs towards a state of low tension in the muscle tone of the deep tissues, the patient is freed from the sensation of pain when the technique is correct.
The discovery of the existence of the previous points was another of the valuable contributions of Jones.
Curiously, the patient himself is surprised at its existence because until they were made patent by the pressure of the therapist, he had not been appreciated by the subject. The value of finding these points lies in their diagnostic nature and treatment and they disappear simultaneously with the normalization of the dysfunction.
According to Jones, the dysfunctions that are alleviated when performing a flexion have more posterior points than before, in which they are relieved with the extension the opposite occurs, if the points are close to the midline, more light positions will be necessary, both in Flexion as in extension for correction.
If the painful points are far from any of these two positions it will be necessary to add a greater degree of lateralization for normalization conveniently.
DEEP MASSAGE.
The techniques of deep massage is based on the good application of the anatomy and biomechanics of gait and posture, it is not only the application of massage techniques with elbow or forearm knuckles there will always be a good physical exploration of these aspects as it is the march and the posture in order to be able to apply with a clear and precise objective about the demand and corporal demand that is presented to us, for that reason the therapist must be a person that has to have a clarity in this objective.
The development and application of deep massage techniques will always be in accordance with what the evaluation throws at us or can not be that during the whole massage session we perform deep massage techniques there will be areas or areas where if we find tissues that require these applications for various reasons that the fascias are stuck or stuck as soil say product of poor circulation or trauma or stress, that is why we should always bear this in mind.
MASSAGE TO THE CONNECTIVE TISSUE.
This type of reflex massage technique that acts on the autonomic nervous system, will have a focus rather on regulation of the functions of the different organs that are stimulated, as well as in cases of neuromusculoskeletal alterations it is a less intense technique in pressure or drag of the tissues and it is more satisfying.
All this must be accompanied by a good training plan according to the demand and body requirement and the sport that is performed, in people who are more sedentary it will be convenient to perform a physical activity focused on preventing dysfunctions or muscle skeletal alterations. the lack of physical activity itself.
Author; Jaime Valenzuela C.
Chiromasajista and Osteopath
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