PT 1011: Back Region

VERTEBRAL COLUMN
Secondary curve

• Lordotic curve
• developed as the baby grows
• Lumbar curve
o Once the baby learns how to stand
at around 10-11 months
• Cervical curve
o Once the baby knows how to extend
their neck
o first to appear before lumbar
o develop around 1-2 months

• Central bony pillar of the body

• part of axial skeleton (basic framework
where appendicular skeleton attaches to;
skull, vertebral column, thoracic cage, and
pelvic)
• Supports the skull, pectoral girdle, upper
limb, thoracic cage and pelvic girdle
• Transmits body weight to lower limb
• Protects the spinal cord and spinal nerves
and meninges
• Attachment of muscles
• Starts from skull to tip of coccyx POSTURAL ANALYSIS
• Composed of 33 vertebrae (in adult)
o 7 cervical vertebrae • Exaggeration in the thoracic curve;
o 12 thoracic vertebrae kyphosis
o 5 lumbar • Exaggeration in lumbar area
o 5 sacral
o 4 coccyx (3-4 in some)
CURVATURES
Primary curve

• original curve at birth

• Kyphotic curve
o Single curve at birth (C-curve)
• Thoracic and sacral
o Area of maintained kyphotic curve in
adults
PT 1011: Back Region

ABNORMAL CURVES LORDOSIS

KYPHOSIS

• Exaggerated sagittal curvature on

thoracic area due to:
o muscle weakness/spasm
o compression fracture
o Pott's disease
▪ The bones are soften then
compressed
o Osteoporosis: most common
▪ Creates wedge in the
vertebra

• Exaggeration in sagittal curvature present in

lumbar region
• common in:
o obese patients
▪ there’s a tendency that the
COG moves forward, and
you follow it, making you
exaggerate your back
• hunchback or kuba o pregnant
• Most common in thoracic o congenital dislocation of hip
o wearing high heels
Gibbus
• swayback or liyad
• single bone that collapsed • pain in the back area
• sharper curve
SCOLIOSIS
• looks more angulated
Dowager’s hump

• subsequent bones/adjacent segments (2-

4)
• curve is diffused
• gradual but more rounded
• pain in the back area
PT 1011: Back Region

• Lateral deviation of vertebral column

common in the thoracic area
• look at patient in anteroposterior view
o asymmetry in the area of the
shoulder, waistline, pelvis,
prominences of the back
o use plumbline
• can develop an S-curve wherein curves are
developed at thoracic and lumbar region
• May be due to:
o muscle imbalance
o congenital defect (hemivertebra)
o compensation for short leg
▪ limb length discrepancy
o back pain
o 80% idiopathic (spontaneously
happening)
o can be inherited or genetically
transmitted
• Lateral deviation may be more evident if the MANAGEMENT OF SCOLIOSIS
examiner uses a plumb bob (plumbline)
• Mild (0 – 20 degrees)
from the C7 spinous process or external
o Exercise
occipital protuberance
o Go opposite to the convex side of
• X-ray of patient with scoliosis
the patient
• Moderate (21 – 40 degrees)
o Patients need bracing and must
wear it for 23 hours and 1 hour for
taking a bath
o cannot remove scoliosis, but can be
prevented from progressing
o Milwaukee brace; Boston brace
o Only stop wearing brace if the
patient stops growing because as
Levoscoliosis they grow, chances are the curve
will become bigger as well
• convexity faces the left; In the lumbar area
o Scoliosis cannot be corrected the
Dextroscoliosis same way before

• curve faces right; In the thoracic area (right

photo)
Cobb method

• the degree of curve will tell you its severity

• Cobb’s angle is measured by getting the
most titled vertebra • Severe (40+ degrees)
o Will need surgery
o Harrington rod
PT 1011: Back Region

• upper and lower surfaces are flattened and

rough, and give attachment to the
intervertebral fibrocartilages
• Above it is the intervertebral disc
o Fibrous cartilage

VERTEBRAE

• Is composed of 2 essential parts:

ANTERIOR
• Bigger portion
• Body

POSTERIOR
• vertebral arch
• vertebral foramen
• pedicles
• lamina
• process:
spinous process
transverse process
articulating facets

Vertebral arch

• found posteriorly, contains:

Pedicles
GENERAL CHARACTERISTICS OF A
VERTEBRA • cylindrical pair at side of arch

Body Laminae

• found anteriorly • flattened part on each side

• largest part of a vertebra Processes:
• more or less cylindrical in shape
o the bigger the load it carries, the • Spinous process (1)
bigger it is • Transverse process (2)
• carry weight of the vertebra above it • Articular process (4)
PT 1011: Back Region

Vertebral foramen CHARACTERISTICS OF A TYPICAL

VERTERBRA
• enclosed between body and arch
• significant because this is where spinal cord CERVICAL VERTEBRA
passes through and where spinal nerves
exit
3 PROCESSES

• Serves as levers and receive attachments

of muscle and ligaments
Spinous or spine

• Directed posteriorly
• Found between two lamina
Transverse process

• directed laterally from junction of lamina and

pedicle; attachment for muscles and
ligaments • Transverse process contains foramen
• in thoracic area, serve as attachment for transversarium for the passage of the
ribs vertebral artery and veins
Articular processes o The artery only passes through C1-
C6
• Vertically arranged and composed of 2 o C7 have a foramen but no artery
superior and 2 inferior processes passes through it
• Covered with hyaline cartilage
Spine small and bifid
• Two superior facets of the vertebra above
articulates with the two inferior facets of the
Body small and broad; oval shaped
vertebra below forming 2 synovial plane because it only carries the head
joint (zygapophyseal joint) Vertebral Large and triangular;
• The significance of the orientation is for the foramen accommodate fusiform shape of
movement of vertebra spinal cord
o Lumbar: SF is medial IF is lateral,
hence the movement is mostly for Superior face posteriorly and superiorly
flexion and extension facets

Intervertebral notch Inferior facet face anteriorly and inferiorly

• found on superior and inferior borders of
pedicles
• when these notches go together, it forms a THORACIC VERTEBRA
foramen
• Medium size because it will carry the head
Intervertebral foramen and cervical
• superior and inferior vertebral notches of Body medium size and heart shaped
adjacent vertebra form intervertebral Vertebral small and circular
foramen for exit of spinal nerve foramen
• contains the spinal nerve Spine long and inclined downward
PT 1011: Back Region

Costal facets sides of the body and

transverse processes (except
T11 and T12)
attachment of ribs; demifacets
Superior face posterolateral
articular facets
Inferior articular face anteromedial (T12 faces
facets laterally)

Body large and kidney shaped

Pedicles strong & directed
backwards
Laminae Short
Vertebral foramina triangular shape and large
Transverse long and slender
process
Spinous process short, flat & quadrangular
Superior articular faces medially
surface
Inferior articular faces laterally
surface

• 2 costal facets in the body

o Superior and inferior costal facet
• Costal facet in the transverse process as
IN SUMMARY
well
• No costal facets in T11 and T12 transverse • Both cervical and lumbar, have large
process because the rib 11-12 is short vertebral foramen because of the shape of
(floating ribs) the spinal cord
o However, costal facets are still seen • The spinal cord has 2 enlargements at the
in the body cervical and lumbar area
o Cervical: brachial plexus
LUMBAR VERTEBRA
o Lumbar: lumbosacral plexus
• Largest body because it has to carry more
weight (head, cervical, thoracic etc.)
PT 1011: Back Region

• baby will have a hard time having a normal

delivery if sacral promontory is very
prominent
• If the baby cannot pass through because
the sacral promontory is too prominent and
the passage is too small or narrow, they
baby will be delivered thru C- section
• Important in measuring the size of the pelvis
Sacral canal

• formed by the vertebral foramina

• Contains anterior and posterior roots of
sacral and coccygeal spinal nerves, filum
terminale (lower end of spinal cord where
most of the roots are there) & fibrofatty
material
• Also contains lower part of subarachnoid
space (space between roots up until end of
canal)
Sacral hiatus

• lamina of S5 (and sometimes S4); lamina

did not completely close
Dorsal and pelvic sacral foramina
SACRUM
• Anteriorly and posteriorly contains four
foramina for the passage of the anterior &
posterior rami of upper four sacral nerves
(usually 4 sacral nerves)
COCCYX

• Wedge shaped; used to be separate but

fuses in adults
• Concave anteriorly
• Base articulates with the L5 and
inferiorly with the coccyx
• Laterally articulates with the iliac bone • 4 vertebrae fused together
(sacroiliac joint) • Small triangular bone
• 1st coccygeal vertebra is usually
Sacral promontory (S1)
not/incompletely fused with 2nd
• posterior margin of the pelvic inlet
PT 1011: Back Region

o sometimes movable between 1st &

2nd
o rudimentary bone
ATYPICAL CERVICAL VERTRBRAE
C1 (atlas)

VARIATIONS IN THE VERTEBRAE

Sacrum

• 1st sacral may be completely separated

from sacrum and resemble sixth lumbar
vertebrae (lumbarization – sacrum became
• Does not have a body and a spinous
a part of lumbar)
process
• Has an anterior and posterior arch
• Superior articular facet (forms the atlanto-
occipital joint with occipital condyles)
• Articular surface on the inferior side

C2 (axis)

Coccyx
• Odontoid process (dens) projects from the
superior surface of the body • usually 4 fused but may have 3 – 5
• Atlantoaxial joint (articulate with the foramen
of atlas; pivot joint)
C7 (vertebra prominens)

• Longest spinous process and is not bifid

• Transverse process is large
• Foramen transversarium is small
• Know that this is C7 because it moves as
you move your head (Thoracic doesn’t)
PT 1011: Back Region

JOINTS IN THE VERTEBRAL COLUMN Alar odontoid to medial of occipital

condyle
Atlanto-Occipital Joints Cruciate Transverse: attaching odontoid to
anterior arch of atlas
Vertical parts: body to anterior
margin of magnum
Membrane continuation of posterior
tectoria longitudinal ligament up to
occipital bone in foramen
magnum
covers everthing

Zygapophyseal joint

• Condyloid joint
o Flex, extend, laterally bend
• Ligaments
o Anterior longitudinal ligament
o Posterior atlanto occipital membrane
o Ligamentum flavum
Atlantoaxial joint

• Pivot joint
o Rotation of neck • Between superior and inferior articular
• Needs to be support because if not and is processes
moved, the spinal cord might be impinged • covered by hyaline
• Plane synovial joint
o Glide with each other
• Ligaments:
o Suprapinous ligament
o Interspinous ligaments
o Intertransverse ligaments
o Ligamentum flavum
Joint between vertebral bodies

• Ligaments

Apical apex of odontoid to anterior margin

of foramen magnum
tip of odontoid to foramen magnum
PT 1011: Back Region

• Between two bodies is a fibrocartilage (disc)

• Cartilaginous joint
LIGAMENTS

Anterior Longitudinal ligament

Anterior Anterior located in the anterior • From base of the skull to anterior surface
longitudinalhalf annulus fibrosus of the sacrum.
ligament and vertebral body; • is attached to the vertebral bodies and
yellow intervertebral discs.
Middle Posterior covers posterior half
longitudinal annulus fibrosus and Posterior Longitudinal Ligament
ligament vertebral body;
• is on the posterior surfaces of the
tapering; thinner in
lumbar area than in vertebral bodies and lines the anterior
cervical area; green surface of the vertebral canal
Posterior Interspinous Osseous and • is attached along its length to the vertebral
ligaments ligamentous structures bodies and intervertebral discs.
posterior to the • The upper part from C2 to the intracranial
posterior longitudinal aspect of the base of the skull is termed
ligament (red) the tectorial membrane.
Ligamenta flava
• The anterior and posterior longitudinal
ligaments are on the anterior and posterior • runs between the posterior surface of the
surfaces of the vertebral bodies and extend lamina on the vertebra below to the anterior
along most of the vertebral column. surface of the lamina of the vertebra above
• connects one lamina to another
• resists separation of the laminae in
flexion and assist in extension back to
the anatomical position
Supraspinous ligament

• connects and passes along the tips of the

vertebral spinous processes from
vertebra CVII to the sacrum
Ligamentum nuchae

• From vertebra CVII to the skull, the

ligament becomes structurally distinct from
more caudal parts of the ligament
PT 1011: Back Region

• is a triangular, sheet-like structure in the MOVEMENTS OF THE VERTEBRAL COLUMN

median sagittal plane
Flexion
• supports the head
• resists flexion and facilitates returning • Anterior movement
the head to the anatomical position • Restricted in thoracic region
o extension of the neck • More extensive on cervical and lumbar
Interspinous ligaments • The movements in the thoracic are minimal
because of the restriction from the ribs
• between adjacent vertebral spinous • Atlanto-occipital joint
processes • Muscles:
• from the base to the apex of each spinous
process Cervical longus cervicis
scalenus anterior
• blends with the supraspinous ligament
sternocleidomastoid
posteriorly and the ligamenta flava
Lumbar rectus abdominis
anteriorly on each side. psoas

Extension

• Posterior movement
• Restricted in thoracic region
• Atlanto-occipital joint
• Muscles:

Cervical Postvertebral muscles

Lumbar Postvertebral muscles

Lateral flexion

• Sideward bending; abduction of the trunk

• Restricted in thoracic region
• Muscles:

Cervical scalenus anterior

medius
trapezius
sternocleidomastoid
Lumbar postvertebral muscles
quadratus lumborum
oblique muscles (sometimes psoas)

Rotation

• Twisting of the vertebral column

• prominent in cervical region (atlanto-axial
joint; pivot joint)
• Less extensive in the lumbar and thoracic
region
PT 1011: Back Region

o The rotational movement of the • Parts

lumbar area is more of
circumduction
• Atlantoaxial joint
• Muscles:

Cervical SCM
splenius
Thoracic Semispinalis
Rotatores (assisted by obliques)
Lumbar rotatores muscles
obliques
Anulus made of fibrocartilage
fibrosus most rigid
Circumduction protect nucleus
Collagen fibers arranged in
• Combination of all these movements concentric layers
Nucleus gelatinous material with large
pulposus amount of water
• Main reason for movement
Composed of collagen fiber
Situated in the center (nearer
posterior margin of disc)

• Does not have a blood supply and nerve

INTERVERTEBRAL DISC
• Functional unit of the vertebral column is 2
adjacent vertebrae and disc
• Fibrocartilage
• between 2 bodies
• Function
o intervertebral discs make up one
fourth of the spinal column's length
▪ if you remove them all, you
will lose 25% of the
vertebral height
o Serve as shock absorbers when
the load on the vertebral column is
increased
▪ Weight and pressure
o Thickest in cervical & lumbar
where movement is greatest
o Elasticity of disc allows
movement in the spine
supply hence there’s no pain when injured
• However, no blood supply = no source of
nutrition
o When you are lying down, the
water/nutrition goes to the disc by
diffusion
o Most swollen/ most water in the
morning
o At the end of the day, these are
compressed results to the squeezing
out of the fluid → discs become dry
because of pressure and age
• Dry = more prone to injury
o Tearing of anulus
CLINICAL NOTES
• When you do a forward movement, the
weight anteriorly pushes the disc
posteriorly
o there would be a chance that when
you stand, the disc will remain
bulging which can cause an
impingement
PT 1011: Back Region

• Sudden increase in compression load on SUPERFICIAL GROUP

the disc (as in bending) causes the nucleus
• Known as appendicular group
pulposus to thrust outward and back
• related to and involved in movements of the
Disc herniation upper limb
• Origin is from the axial skeleton (skull,
• No nerve supply however, the pain is from
vertebral column)
the impingement of the nerves exiting
• Insertion is to the superior part of UE
• Herniation of the nucleus pulposus at the
(clavicle, scapula, humerus)
posterior longitudinal ligament
• Herniation can cause impingement of the Muscles of upper limb
nerve root exiting between the vertebra; slip Trapezius
disc; present a shooting pain in the neck Latissimus dorsi
Levator scapulae
Rhomboids minor and major

• intervertebral disc
• vertebral body Trapezius
• spinal cord
• prolapsed Origin Superior nuchal line, external
intervertebral disc protuberance, ligamentum nuchae,
spinous process of C7-T12
Insertion Lateral 1/3 of clavicle, acromion.
Spine of scapula
Nerve Spinal accessory (CN 11)
Action Upper: rotates scapula during
humeral abduction
MUSCLES OF THE BACK Middle: adduction
Lower: depression of scapula
• Muscles of the back are organized into
superficial, intermediate, and deep groups
• Muscles in the superficial and Latissimus dorsi
intermediate groups are extrinsic muscles Origin Spinous process T7-L5 and sacrum,
because they originate embryologically from iliac crest, ribs 1012
locations other than the back. Insertion Intertubercular sulcus of humerus
• innervated by anterior rami of spinal nerves Nerve Thoracodorsal n.
Action Extends, adducts, medially rotates
humerus
PT 1011: Back Region

Serratus posterior superior

Levator Scapulae • deep to the rhomboids
• fibers are descending
Origin Transverse process C1-4
• assist in inspiration
Insertion Upper medial border of scapula
Nerve Dorsal scapular n. Origin Ligamentum nuchae
Action Elevates scapula Spinous of C7 and T1-T3
Insertion Ribs 1-4, lateral to the angle of the
ribs
Rhomboid major
Nerve Branches of ventral anterior primary
Origin Spinous process T2-5 rami of spinal nerves of T1-4
Insertion Medial border of scapula between Action Elevates upper rib
spine and inferior angle
Nerve Dorsal scapular n
Serratus posterior inferior
Action Adducts and elevates scapula
• deep to latissimus dorsi
Rhomboid minor • fibers are ascending
• assist in expiration
Origin Lower part of ligamentum nuchae,
spinous process of C7-T1 Origin Thoracolumbar fascia, spines of
Insertion Medial border of scapula at spine vertebrae T11-T12 and L1-L
Nerve Dorsal scapular n. Insertion Ribs 9-12, lateral to the angle
Action Adducts and elevates scapula Nerve Branches of the ventral primary rami
of spinal nerves T9-12
Action Pulls down lower ribs
INTERMEDIATE GROUP

• Referred as respiratory group DEEP GROUP

• consists of muscles attached to the ribs
• Called intrinsic muscles because they
• serve as a respiratory function
develop in the back; Extends from pelvis to
skull
• Innervated by posterior rami of spinal
nerves
• Directly related to movements of the
vertebral column and head.
Deep muscles of the back (Postvertebral)

Superficial vertically Iliocostalis

running muscles Longissimus
spinalis
Intermediate oblique Semispinalis
running muscles Multifidus
rotatores
Deepest muscles Interspinales
intertransversarii
PT 1011: Back Region
SUPERFICAL DEEP MUSCLES
Erector Spinae
• Superficial vertically running muscle
• Largest group of intrinsic muscle
• Divides into 3 vertical columns spinalis,
longissimus and iliocostalis (SILo) further
subdivided regionally (lumborum, thoracis, Longissimus
cervicis and capitis)
Action
Bilateral • Extension of vertebral column
• Maintenance or erect posture
• Stabilization of vertebral
column during flexion, acting
in contrast to abdominal
muscles and action of gravity
Unilateral • Lateral bend to same side
• Rotation to same side; if
attached to head
(cervis/capitis) rotates head
• Opposite muscles contract
eccentrically for stabilization Spinalis
Splenius
Iliocostalis
• outer or most lateral associated with costal
elements (ribs)
• common tendon of origin but multiple
insertion at angles of ribs and transverse
processes of the lower cervical vertebrae
Origin Iliac crest and sacrum
Insertion Angle of ribs
Nerve Dorsal primary rami of spinal nerves
C4-S5
Action Extends and laterally bends the trunk
and neck
• middle or intermediate column
• largest of the erector spinae subdivisions
from tendon of origin to base of skull
Origin Transverse process at inferior
vertebral levels
Insertion Transverse process at superior
vertebral level and mastoid
Nerve Dorsal primary rami of spinal nerves
C1-S1
Action Extends and laterally bends the trunk,
neck and head
• most medial; Smallest of subdivisions and
interconnects spinous process of adjacent
vertebrae
• Mostly constant in the thoracic but absent
generally in the cervical
Origin Spinous processes at inferior
vertebral levels
Insertion Spinous processes at superior
vertebral level and base of skull
Nerve Dorsal primary rami of spinal nerves
2-L3
Action Extends and laterally bends the trunk
and neck and head
INTERMEDIATE DEEP MUSCLES
• Detached part of the deep muscles of back
• Come from spinous process and
ligamentum nuchae going to head/skull
• 2 muscles: splenius capitis and splenius
cervicis
• Both extend neck(head) and individually,
rotates head to one side
PT 1011: Back Region

CAPITIS turn or rotate to the opposite

direction
Origin Ligamentum nuchae & spines of C7 –
T6 vertebrae
Insertion Mastoid process and lateral end of
superior nuchal line
Nerve Dorsal rami of spinal nerves C2-6
Action Extends and laterally bends the neck
and head, rotates head to the same
side

CERVICIS

Origin Ligamentum nuchae & spines of C7 –

T6 vertebrae
Insertion Posterior tubercles of transverse
processes of C1-C3 vertebrae
Nerve Dorsal rami of spinal nerves C2-6
Action Extends and laterally bends the neck
and head, rotates head to the same
side

Semispinalis

• The semispinalis is the most superficial of

the deep intrinsic muscles
• can be divided by its superior attachments
into thoracic, cervicis, and capitis

Origin Transverse process of C7-T12

INTERMEDIATE OBLIQUE RUNNING MUSCLES
• Run oblique up and medial from transverse
process to spinous process
• Divided to 3 major subgroups:
o Semispinalis
o Multifidus
o Rotatores
• Transversospinales group
Action
Bilateral • extends the vertebral column
Unilateral • pull the spinous process
towards transverse process
on same side causing trunk to
Insertion Capitis- back of skull between nuchal
lines
Cervicis & thoracic – spines 4-6
vetrebrae above origin
Nerve Dorsal primary rami of spinal nerves
C1-T12
Action Extends the trunk and laterally bends
the trunk; rotates the trunk to the
opposite side
Multifidus
• Second group
• Present throughout the length of the
vertebral column but best developed in the
lumbar
• Pass from a lateral point of origin up and
medial attaching the spinous processes
PT 1011: Back Region

Action Insertion lower border of spinous process

above
Bilateral • extends the vertebral column Nerve dorsal primary rami of spinal nerves
• Controls lateral flexion to side opposite C1-L5
contraction (eccentric for stability) Action extend trunk and neck
Unilateral • rotate vertebral bodies
(column) to opposite side
INTERTRANSVERSARII

Origin Sacrum, transverse processes of C3- Origin upper border of transverse process
L5 Insertion lower border of transverse process
Insertion Spinous processes 2- 4, vertebral above
levels superior to their origin Nerve dorsal primary rami of spinal nerves
Nerve Dorsal primary rami of spinal nerves C1-L5
C1-L5 Action laterally bend trunk and neck
Action Extends and laterally bends trunk and
neck, rotates to opposite side

Rotators

• Deepest of transverse spinales group

• Found throughout the vertebral column but
best developed in the thoracic region
• Small & quadrilateral
• Divided into:
o Rotatores longi (long)
o Rotatores brevis (short)

Origin Transverse process

Insertion Long rotatres: spines 2 vertebrae
above origin; short rotatores: spines 1
vertebrae above origin
Nerve Dorsal primary rami of spiinal neves
C1-L5 Subocciptal muscles
Action Rotates the vertebral column to the
opposite side

DEEPEST SEGMENTAL MUSCLES

• Deeply placed
• Innervated by posterior rami of spinal
nerves
Interspinales and intertransversii

• both muscles are postural muscles that

stabilize adjoining vertebra during
movements of vertebral column
INTERSPINALES
Origin upper border of spinous process
Obliquus capitis inferior
Origin spinous process of axis
Insertion transverse process of atlas
Nerve suboccipital nerve (DPR of C1)
Action rotates the head to the same side
PT 1011: Back Region

INTERMEDIATE GROUP
Obliquus capitis superior

Origin Transverse process

Insertion occipital bone above inferior nuchal
line
Nerve suboccipital nerve (DPR of C1)
Action extends the head, rotates the head to
the same side

Rectus capitis posterior major

DEEP GROUP
Origin spinous process of axis
A. SUPERFICIAL VERTICALLY RUNNING
Insertion inferior nuchal line
MUSCLES
Nerve suboccipital nerve (DPR of C1)
Action extends the head, rotate to same side

Rectus capitis posterior minor

Origin posterior tubercle of atlas
Insertion inferior nuchal line medially
Nerve suboccipital nerve (DPR of C1)
Action extends the head

SUMMARY OF THE MUSCLES

SUPERFICIAL GROUP

B. INTERMEDIATE OBLIQUE MUSCKES

PT 1011: Back Region

C. DEEPEST MUSCLES THORACOLUMBAR FASCIA

• Deep fascia situated between iliac crest and

12th rib
• Is origin of the middle fibers of the
transversus and upper fibers of internal
oblique muscle (of the abdominal wall)
• Parts:

LINE OF GRAVITY

• Line of gravity passes (when standing) Posterior lamella

1. Odontoid process of axis • covers deep back muscle, attached to
• posterior to cervical lordosis then passes lumbar spine
T1, pass anterior to vertebra, goes to body
of L1 and pass posterior to the lumbar Middle lamella
• 2 inches in front of S2
• attached to tips of lumbar transverse
2. Behind the center of hips
process
3. In front of center of knee and ankle
• anterior to deep muscles but posterior
• Normal curves of back are maintained by
quadratus lumborum
the tone of the muscles of the back
• Body has a tendency to move forward Anterior lamella
when a person is obese or pregnant which
causes muscle imbalance and may be • passes medially
cause of pain • attached to transverse process of lumbar
• anterior to quadratus lumborum
MUSCULAR TRIANGLE OF THE BACK
Auscultatory Triangle
PT 1011: Back Region

• Best site on back where breath sounds may BLOOD SUPPLY OF THE BACK
be most easily heard with a stethoscope
ARTERIES
• Boundaries:
o Latissimus dorsi Cervical region
o Trapezius
o Medial border of scapula • occipital artery (branch of external carotid)
• vertebral artery (from subclavian)
Lumbar Triangle • deep cervical (costocervical),
• Site where pus may emerge from the • branch of subclavian, ascending cervical a.
abdominal wall (branch of inferior thyroid a.)
• If there is an infection in the lumbar area, it Thoracic region
can be drained from here
• Boundaries: • posterior intercostal a.
o Latissimus dorsi (posterior) Lumbar region
o Posterior border of external oblique
muscle (anterior) • subcostal and lumbar a.
o Iliac crest (inferior)
Sacral region

• iliolumbar and lateral sacral a. of internal

iliac a.
VEINS

• These plexuses communicate with the veins

in the neck, thorax, abdomen and pelvis
external vertebral venous plexus

• surrounding vertebral column

internal vertebral venous plexus
Suboccipital triangle
• found within vertebral canal
• Contains suboccipital nerve (posterior
ramus of spinal nerve C1) and vertebral LYMPHATIC DRAINAGE
artery and vein
cervical nodes
• Boundaries:
o Rectus capitis posterior major • Lymph drainage from skin of neck
o Obliquus capitis inferior
o Obliquus capitis superior axillary node

• Trunk above iliac crest

superficial inguinal nodes

• From below iliac crest

Deep lymph vessels

• follow veins and drain to deep cervical,

posterior mediastinal, lateral aortic and
sacral nodes
PT 1011: Back Region

SPINAL NERVES

• There are 31 pairs of spinal nerves which

branch off from the spinal cord.
• In the cervical region of the spinal cord, the
spinal nerves exit above the vertebrae.
o E.g. between C4-C5 is C5; C1 exits
between occiput and C1
• A change occurs with the C7 vertebra
however, where the C8 spinal nerve exits
the vertebra below the C7 vertebra.
o E.g. between C7 - T1 is C8
o between T1 – T2 is T1
• Lumbar root will exit at the lumbar area and
sacral root will exit at the sacral area
despite the sacral cord being in the same
level of L1
Cervical

Lumbosacral root syndrome

Sacral root syndrome