Cervical Articular Overview
v.07.21.01 (c) Jan Henry Sultan July 2001

When we study anatomy, and structure we see that the spine is not a discrete aggregation of bony elements. Rather we have to remember that the spine arises embryologically from the primitive notochord. The vertebrae form from ossification centers within the membrane. The intervertebral discs are specializations of notochordal tissue, and the bones are derived from those ossification centers.

This means that while we study biomechanics, we must never lose sight of the fact that the spine is primarily membranous, with denser, more mineralized tissues as the bones.

Having acknowledged that, we will look at the way the bones interact, and the concomitant softer tissue patterns, and come to have a working view of biomechanics that is fleshed out contextually. The bones become landmarks to be identified, as parts of larger patterns, and hence giving rise to appropriate and coherent treatment strategies. These observations indicate techniques that are consistent with soft tissue manipulation, and do not violate the professional covenants we all live with.

Spinal biomechanics 1-A

Spinal motion mechanics have a conventional language. The language presented here is largely consistent with the Osteopathic Lexicon. This was a professional choice, having examined the terminologies current in orthopedics, physical therapy, chiropractic, naturopathy, and osteopathy, we decided to align the Rolfing lexicon with the osteopathic convention. This is a reflection of our respect, and an acknowledgement that the osteopaths have pioneered physical medicine in America, making countless contributions to understanding the "nature of structure."

With all due respect to the pioneers, the presentation being made here is reflective of the Rolfing perspective of system wide integration. This presentation is the "cartoon version" of a complex and significant aspect of structure. It is ultra-simple by design, but fundamentally true to the most complex understanding of the region.

1. The primary movements of the spine:

A. Movements of the whole spine (as seen from behind) are described by the bend of the top half of the bend ON the bottom half. A person bending right at the waist is in a right sidebend (RSB) because the top half is RSB ON the lower half. Illustration #1

B. The spine is said to be in flexion when it is forward bent (FB) The upper part of the spine is FB ON the lower part. Illustration #2

C. Rotation of the spine is named for the way the front of the spine is rotating as seen from above. Illustration.#3

2. The primary movements of the vertebrae and the sacrum.

A. Individual vertebrae are named in their movement relative to the "inferior neighbor." ex: L3 moves anterior ON L4 in flexion (or forward bending; FB). L3 moves posterior ON L4 in extension (or back bending; BB). Illustration #4

Anatomically the paired facet joints between the vertebrae, are OPENING, going to their limit of flexion in forward bending (FB). The joint is said to be a "distracted" joint. Illustration #5

B In backbending (BB), or extension they are CLOSING to their limit. This is also called a "close packed" joint. Illustration #6

C. Rotational movements of vertebrae are described by the direction of rotation of the vertebral body, as seen from above. ex: Looking at the back....L3 rotates right ON L4 when the right transverse process (TP) is prominent and the left TP is deep. Illustration #7

Then in right rotation, the right facet joint of L3 has closed ON L4 in BB or extension, and the left facet joint has opened ON L4 in FB or extension.

D. Sidebending movements of the vertebrae are named, like FB and BB, for the action of the superior vertebrae on its "inferior neighbor." L3 sidebends ON L4. Illustration #8

Now here is the big secret. There are structural LAWS (or rules if that makes you more comfortable) that determine the normal interaction of the vertebral elements. Given the trait-driven body type of the individual, there will be predictable vertebral interactions that are part of combined patterns of BB, FB, SB, and RR-LR. Adaptations to the "strains of life" will show up, at the vertebral level, as interruptions of normal motion and subsequent positional irregularities. Within limits, adaptation to motion restriction is also LAWFUL. When adaptation is forced beyond the limits of the structure to accommodate, as in sudden deceleration from high velocity, then the patterns of interaction become very individualized, and are best referred to higher authority.

Laws of vertebral interaction:

A. In the cervical spine, the vertebrae rotate in the same direction that the neck (as a group) is sidebent. Right CERVICAL SB couples with right VERTEBRAL SB, and the cervical group goes into RR (right rotation). Illustration #9

B. In the thoracic and lumbar spine the vertebrae rotate in the opposite direction of sidebending. Ex: Lumbar spine is brought into RSB (as a group). The individual vertebrae RSB on each other, and the lumbar group rotates left, LR. Illustration #10

C. When a vertebrae sidebends and rotates there are corresponding motions of the associated joints (facets). On the side the vertebrae is rotating TOWARD, the facets close, reflection the bilateral movement of BB (extension). On the side the vertebrae is rotating AWAY from, the facets mirror the bilateral action of forward bending FB, and thus, open. Ex: In RSB of the lumbars, the vertebrae rotates left (LR), opening on the right, and closing on the left. Remember!!!!! "on its inferior neighbor." Illustration #11

D. Lawful adaptation to motion restriction. 1. when a vertebrae cannot return to easy neutral after a coupled SB/RR response to general sidebending of the spine, it is said to be motion restricted or FIXED. Although accepted terminology uses the term fixed, I prefer to call this motion restricted, as "fixed" also means "repaired," which the affected part is definitely not.

It should also be noted that "fixed" is a relative term, as motion restricted can be a matter of degree as well as absolute. Ex: If the vertebrae is LR when the spine returns to neutral after RSB, it is said to be "fixed" in LR. The transverse process on the left will be prominent, and the facet closed (extended). The corresponding transverse process, on the right ,will be deep to its inferior neighbor, and open, FB, flexed.

You see by now that within this lexicon open, FB, and flexed are synonymous, as are closed, BB, extended. From here forward FB-BB, RR-LR, RSB-LSB, and motion restricted MR will be used in description.

Outline for the exercise in Cervical Articular Pattern Recognition:

1. Sit at the head of the table and bring your hands along side the neck. Palpate (feel) with broad finger contact the two sides of the neck. The densest tissues under your fingers are the transverse processes. Now come into them from posterior to their lateral mass. You are feeling the TP's from the posterior quarter, typically just deep to the lateral border of the trapezius. You are not interested in the soft tissues now, but are sounding thru them to the bone. In a well muscled individual, the bones are inferred thru the soft tissues, as the overlying tissues will be between your fingers and the bones.

2. A rotated and MR vertebrae, or group of vertebrae, will be identified as a lump or dense mass in the surrounding tissue. You know then that the lump side is a vertebrae rotated toward the lump side. By extension you also know that the associated facet joint is BB closed on the lump side. By further extension you also know that the opposite side of that vertebrae is FB and open.

You will feel a space where the transverse process has gone deep. If this pattern occurs with the neck in relative neutral, you have a MR vertebrae. If there are 2 or 3 vertebrae in this pattern, you have a group MR. Illustration #12-13

It is common in the cervical region to find vertebrae that are alternately RR and LR. This is like the proverbial "train wreck" as in a rail accident, viewed from above, with the boxcars alternately off the tracks in a zig-zag pattern.

Practically speaking you will begin to reestablish normal motion by decompressing the soft tissues at the occiput first, to relieve the contraction you will usually find there as a part of the pattern. You will then work with the soft tissue patterns of the scalenes and the cervical erectors, again to relieve the holding pattern. Once the soft tissue tone has eased, you can then address the bones, starting with the most prominent MR and working your way thru the group above and below the prominent vertebrae.

There are sophisticated "tests" to discriminate more accurately which side of the vertebrae is more restricted, but for the purpose of this exercise, we will perform a simple "go-no go" approach.

3. With each lump, which represents a BB-MR put the neck in a moderate forward bend by lifting the head and flexing the neck. With the head held in one hand, put your fingers on the lump and steadily push forward and slightly superior from behind the transverse process.. This will encourage the BB side to open, in its normal response to FB motion. You may have to wait a bit, as the ligaments and intra vertebral muscles need time to respond to the pressure. You may also vary the degree of FB by adding or releasing pressure on the head. The movement of the vertebrae toward normal may be very small, and you must pay attention to any movement of the "lump" away from your finger pressure. If you get this release, return the head to the table, and feel the lump pattern in neutral. If it has become less prominent, move on to the next most prominent lump TP, and repeat the process.

If there is no response to the FB technique, you may have to move to the other side of the vertebrae. Here, we bring the neck into an extension or BB, by tilting the head back. Now feel into the space where the transverse process has gone deep. The BB puts pressure on the joint to close, expressing its normal response to BB motion. To encourage this we put our finger into the space where the TP has gone deep to release the ligaments and muscles associated with the MR. If this works, you will feel a softening of the tissues under your finger pressure. At this point you must return the head to the table, bringing the neck into neutral. As a final step for resolving the FB-MR, you have to go back to the lump side, FB the neck,. and push the TP of the affected vertebrae forward to resolve the positional element of the MR.

This simple sequence of interaction will restore normal motion and position to most restricted cervical elements. It is always done in conjunction with the soft tissue techniques discussed earlier. Without the attendant work with the muscles and ligament of the region, the bony patterns tend to return to their MR patterns.

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