1. The Spine

2. Structure and Function of the Spine

3. Motions of the Spinal Column
Flexion approximates the anterior vertebral bodies and separates the spinous processes
Extension approximates the spinous processes and the anterior vertebral bodies separate
Side bending
Rotation
Compression/ Distraction
Anterior/Posterior/Lateral Shear

4. Disk Disease A: breakdown of the annulus (Herniation)
B: nucleus pressing against outer annulus (Protrusion)
Protrusion=
C: extrusion of nuclear material, but still in contact with the disk (Extrusion)
D: free sequestration of the nuclear material (nuclear material has separated from the disk)
-different texts may describe the terms for disk disease slightly differently
1.Herniation= any change in the shape of the annulus that causes it to ‘bulge’
beyond normal parameters
2.Protrusion= nuclear material is contained by the outer layers of the
annulus
3.Prolapse: rupture of nuclear material into the vertebral canal
a. Extrusion= movement of the nuclear material beyond the disk space
b. Free Sequestration= extruded nucleus that has separated from the disk

5. Effects of Posture/Position on Intervertebral Disk Pressure

6. Passive Lumbar Extension
May have to start with pillows under the abdomen
Allow 5-10 mins. within each position before progressing
Symptoms should decrease and/or centralize, if they increase…STOP!

7. Lateral Shift Correction
Perform lateral glide slowly to ensure no over-correction, patient should extend once they are in neutral. Have patient progress to prone passive extine (propping up on elbows or push up as previously described)

8. Self Correction of Lateral Shift Standing Back Bend
Only do the standing back bend if there is not lateral shift

9. Self Correction of a Lateral Shift (when there is deviation of the trunk as it flexes)
Patient flexes the lower extremity opposite the side of the shift and places it on a chair with about 90˚of hip flexion
They flex their trunk over the raised thigh and apply pressure by pulling up on the ankle