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Fisiologia Articular Columna Cervical
Fisiologia Articular Columna Cervical
4
pensatory strategies that alter normal motion of the trunk, the
5 extremities, or the body as a whole. For example, the swayback
posture illustrated in Fig. 8.4C, is often associated with signif-
icant tightness of the lumbar extensor muscles and excessive
Sacrococcygeal kyphosis
stretch (and potentially weakness) of the abdominal muscles.
This posture can increase shear forces on the intervertebral
Fig. 8.1 Normal curvatures of the vertebral column. These curvatures discs and joints that interconnect the lumbar spine. Clini-
represent the normal resting posture of each region. (From Neumann DA: cians who treat people with back and neck pain often attempt
Kinesiology of the musculoskeletal system: foundations for physical reha- to correct faulty postures as a primary component of the reha-
bilitation, ed 2, St Louis, 2010, Mosby, Fig. 9.39.) bilitation process.!
Cervical
lordosis
Thoracic
kyphosis
Lumbar
lordosis
Sacrococcygeal
kyphosis
A B C
Fig. 8.2 Side view of the normal sagittal plane curvatures of the vertebral column. (A) Neutral position of the vertebral column during standing. (B) Ex-
tension of the vertebral column increases cervical and lumbar lordosis but decreases (straightens) thoracic kyphosis. (C) Flexion of the vertebral column
decreases cervical and lumbar lordosis but increases thoracic kyphosis. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for
physical rehabilitation, ed 2, St Louis, 2010, Mosby, Fig. 9.8.)
GENERALIDADES
• La columna cervical nos permite posicionar la
cabeza en el espacio
• Está sumamente dotada de propioceptores que
informarán pequeñas perturbaciones de la
postura de cabeza-cuello
• Colabora en la orientación de la mirada hacia la
horizontal
• Colabora en la estabilidad de cabeza, siendo
responsable del desarrollo ontogénico normal del
ser humano.
Rango de
Movimiento
180 CHAPTER 8 Structure and Function of the Vertebral Column
1
2
Line of Gravity
3
30–35! 4 Cervical lordosis Although highly variable, t
5 son with ideal posture pa
6
7
of the temporal bone, anter
1
slightly posterior to the hip
and ankle (Fig. 8.3). As ind
2
3
4 ity courses just to the conc
5 curvature. Consequently, i
6
7
torque that helps maintain
40!
8
Thoracic kyphosis curvature, allowing one to s
9 lar activation and minimal
10 tissues. These ideal biom
11
energy of maintaining post
12 Many persons exhibit po
1 tightness or weakness, tra
2 bution, disease, or heredit
45!
3
Lumbar lordosis observed abnormal or “faul
4
tures may significantly des
pensatory strategies that al
5 extremities, or the body as a
posture illustrated in Fig. 8
icant tightness of the lumb
Sacrococcygeal kyphosis
stretch (and potentially we
This posture can increase
Fig. 8.1 Normal curvatures of the vertebral column. These curvatures discs and joints that inter
represent the normal resting posture of each region. (From Neumann DA: cians who treat people with
Kinesiology of the musculoskeletal system: foundations for physical reha- to correct faulty postures a
bilitation, ed 2, St Louis, 2010, Mosby, Fig. 9.39.) bilitation process.!
CHAPTER 8 Structure and Function of the Vertebral Column 185
Ligamentum flavum
es two motion
and the other FIGURE 15.4 Posterior atlanto-occipital membrane.
MOVIMIENTOS CERVICALES:
OSTEOKINEMÁTICA
• Flexión/ extensión
• Rotaciones
• Inclinaciones
C2-C3 a la unión C6-C7. Posee discos intervertebrales y apófisis unciformes qu
modifican los movimientos del segmento.
C0-C1-C2
182 CHAPTER 8 Structure and Function of the Vertebral Column
Inferior view
External occipital protruberance
Trapezius
Superior nuchal line
Fig. 8.6 Inferior view of the skull. Distal muscular attachments are indicated in gray, proximal attachments in red. (From Neumann DA: Kinesiology of the
musculoskeletal system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Fig. 9.3.)
Lateral view
Superior articular facet Superior articular process
Transverse process Superior costal demifacet
Costal facet Superior view
Spinous process
Intervertebral foramen
T6 Laminae
Apophyseal joint Transverse process
Intervertebral
Reduca (Enfermería, Fisioterapia y Podol
Serie Biomecánica clínica. 3 (4): 45-64,
ISSN: 1989
a 2. Atlas: carillas articulares para los cóndilos del occipital (a); carillas para las masas late
xis (b) y carilla para la apófisis odontoides del axis (c).
Craniocervical flexion
FL
45!-50! FLEXIÓN C0-C1
XI
5 Grados
ON
Ligamentum C3
E
FL
45 !- 50!
C2 nuchae
E
D
Interspinous
•SLI Los cóndilos occipitales ligament
se delizan hacia
Ligamentum
nuchae
C3
SLID
E
atrás y ruedan hacia delante en
Interspinous ligament relación a las masas laterales C4
S
C4 E
S LID
Anterior
External • Concha occipital se aleja del arco
longitudinal
External
auditory
C5 ID
E ligament C5 IDE
SL
auditory
LEXION FLEXION FLEXION SL FLEXION
meatus
meatus posterior del atlas
R O LL Styloid Compressed
ccipital bone process Atlas
R O LL
annulus fibrosus
E
C6
Styloid
ID
E
SLID Atlas
SL
anto- Occipital
Ligamentum bone T IL
T process
Capsule of
E
brane flavum apophyseal joint
C6
ID
psule
E
SLID
SL
Atlas Axis
Posterior atlanto- Ligamentum
C7 T IL
A occipital membrane B C T
flavum
and joint
Atlanto-occipital joint capsuleAtlanto-axial joint complex Intracervical region (C2-C7)
Atlas Axis
matics of craniocervical flexion. (A) Atlanto-occipital joint. (B) Atlanto-axial joint. (C) Intracervical region (C2-C7). Elongated and taut tissues
hin black arrows; slackened tissues are indicated by a wavy black arrow. (From Neumann DA: Kinesiology of the musculoskeletal system: C7
hysical rehabilitation, ed 2, St Louis, 2010, Mosby, Fig. 9.46.)
A B C
Atlanto-occipital joint Atlanto-axial joint complex Intracervical region (C2-C
Fig. 8.23
onal 150 to 160 degrees Kinematics of craniocervical
of total horizontal plane flexion.
these joints allows (A) Atlanto-occipital
about joint.
45 degrees of rotation (B) Atlanto-axial joint. (C) Intracervical region (C2-C
in either
eyes,
aretheindicated
visual field approaches
by thin black360 degrees
arrows;direction
slackened and is mechanically
tissues coupled with
are indicated by avery slight
wavy black arrow. (From Neumann DA: Kinesiology o
g the trunk. amounts of lateral flexion secondary to the orientation of
foundations
-axial for physical
joint is responsible rehabilitation,
for about half of the ed joints
the facet 2, St(Fig.
Louis, 2010,
8.24B). Mosby, Fig. 9.46.)
The arthrokinematic move-
occurs in the craniocervical region. The verti- ments involved with rotation to the right are illustrated in
CHAP TER 8 Structure and Function of the Vertebral Column 193
Craniocervical extension
80!
Extensión C0-C1
80!
SLIDE
10 Grados
SLIDE
C2
C2
E
SLID
E
N
Ant
C3
SLID
SI
erio
EN
IDE
r long
EXT
SL
Ant
C4
C3
O
itudinal li
EXTENSION
SI
ID
External acoustic
erio
SL
meatus EXTENSION C5
EN
E
LL Anterior capsule
gament
O
ID
Occipital bone of apophyseal
r long
R
EXT
joint
E
C6
SL
ID
Mastoid process membrane and
SLIDE as
SL
Atl
C4
joint capsule
T
TIL
itudinal li
C7
EXTENSION
Atlas
E
A B Axis C
ID
External acoustic
SL
Atlanto-occipital joint meatus
Atlanto-axial joint complex EXTENSION
Intracervical region (C2-C7) C5
Fig. 8.22 LL Anterior capsule
gament
Kinematics of craniocervical extension. (A) Atlanto-occipital joint. (B) Atlanto-axial joint. (C) Intracervical region (C2-C7). Elongated and taut
O of apophyseal
Occipital bone
tissues are indicated by thin black arrows. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2,
• Concha occipital se dirige hacia el
R
E
C6
arco
lt as posterior del atlas
ID
Mastoid process membrane and
SLIDE
SL
joint capsule A
T
TIL
degrees is pictured in Fig. 8.23. About 25% of the total sagit- Flexion and extension of the intracervical region (C2- C7
tal plane motion occurs through the combined motions of
Atlas C7) result in an arc of motion determined by the oblique
plane of the cervical facet joints. As described earlier, A xis
A
the atlanto-occipital and atlanto-axial joints; the remaining
motion occurs across the intracervical (C2-C7) region. B these
joints are oriented in a plane about 45 degrees between the C
The atlanto-occipital joints are well designed to produce horizontal and frontal planes. During extension, the inferior
flexion and extension because the convex occipital condyles facets of the superior vertebra slide posteriorly and inferi-
and corresponding concave facet surfaces of the atlas fit like orly—relative to the vertebra below it (see Fig. 8.22C). The
Atlanto-occipital joint
rockers on a rocking chair: The occipital condyles roll back- Atlanto-axial joint complex
mechanics of flexion are the reverse of the mechanics of Intracervical region (C2-C7)
ward during extension (see Fig. 8.22A) and forward during extension (Fig. 8.23C).!
flexion (Fig. 8.23A). In accordance with the arthrokinematic
Fig. 8.22 Kinematics of craniocervical extension. (A) Atlanto-occipital joint. (B) Atlanto-axial joint. (C) Intracervical region (C2-C7). Elongated an
Axial Rotation
rules described in Chapter 1, the roll and the slide occur in
opposite directions. Rotation of the head and neck in the horizontal plane is an
tissues are indicated by thin black arrows. (Fromimportant
Neumann
The atlanto-axial joint, although primarily designed for DA:toKinesiology
motion, integral ofshown
vision and hearing. As the inmusculoskeletal system: foundations for physical rehabilitation,
horizontal plane motion, allows about 10 degrees of extension
Fig. 8.24, the craniocervical region rotates about 90 degrees
St Louis, 2010, Mosby, Fig. 9.45.)
and 5 degrees of flexion (see Figs. 8.22B and 8.23B).
to each side, allowing nearly 180 degrees of rotational motion.
Inclinación C0-C1
5 grados
i. Los cóndilos occipitales se
deslizan contralateral y
ruedan en sentido
ipsilateral
Rotación C0-C1
Se considera Despreciable
Figura 2. Atlas: carillas articulares para los cóndilos del occipital (a); carillas para las masas laterales
del axis (b) y carilla para la apófisis odontoides del axis (c).
Figura 3. Axis: carilla articular para el arco anterior del atlas (1) y carillas articulares para las masas
laterales del atlas (2).
80°
rotation
C2
SLIDE
Capsule of
apophyseal joint C3
SLIDE
Alar ligament
(taut) C4
Inferior facet Transverse ligament SLIDE
of atlas of atlas
Superior facet
IDE
Capsule of of axis C5
SLIDE
SL
Se considera Despreciable
C3-C7
Craniocervical extension
Extensión: C3-C7
80!
CHAPTER 8 Structure and Function of the Vertebral Column 193
SLIDE
Craniocervical extension
C2
E
SLID
N
Ant
C3
O
SI
erio
EN
IDE
r long
EXT
SL
C4
itudinal li
EXTENSION
E
ID
External acoustic
SL
meatus EXTENSION C5
LL Anterior capsule
gament
Occipital bone O of apophyseal
R
Atlanto-occipital joint
E
80! C6
ID
Mastoid process membrane and
SLIDE as
SL
joint capsule Atl
T
TIL
SLIDE
C7
Atlas C2 s
A B Axi C
E
SLID
N
Ant
C3
O
SI
Atlanto-occipital joint Atlanto-axial joint complex Intracervical region (C2-C7)
erio
EN
IDE
Fig. 8.22
r long
EXT
Kinematics of craniocervical extension. (A) Atlanto-occipital joint. (B) Atlanto-axial joint. (C) Intracervical region (C2-C7). Elongated and taut
SL
C4
tissues are indicated by thin black arrows. (From Neumann DA: Kinesiology of the musculoskeletal system: foundations for physical rehabilitation, ed 2,
itudinal li
EXTENSION
E
St Louis, 2010, Mosby, Fig. 9.45.)
ID
External acoustic
SL
meatus EXTENSION C5
LL Anterior capsule
gament
Occipital bone O of apophyseal
R
55-60º grados
Atlanto-occipital joint E
C6
ID
A t l
joint capsule
T
TIL
C7
Atlas i s
A degrees is pictured B in Fig. 8.23. About A 25% of the total sagit-
x
C Flexion and extension of the intracervical region (C2-
tal plane motion occurs through the combined motions of C7) result in an arc of motion determined by the oblique
the atlanto-occipital
Atlanto-occipital joint
and atlanto-axial joints;
Atlanto-axial joint complex
the remaining plane of the cervical facet joints. As described earlier, these
Intracervical region (C2-C7)
motion occurs across the intracervical (C2-C7) region. joints are oriented in a plane about 45 degrees between the
Fig. 8.22 Kinematics of craniocervical extension. (A) Atlanto-occipital joint. (B) Atlanto-axial joint. (C) Intracervical region (C2-C7). Elongated and taut
Flexión: C3-C7
35-40º grados
Flexion and Extension and the Effect on the Diameter of the Intervertebral Foramina
Cervical
Flexion increases the diameter of the intervertebral foramen; spinal nerve roots. The flexed position of the lower cervical ver-
extension, in contrast, decreases it (Fig. 8.26). This has clinical tebrae increases the space of the intervertebral foramen, allow-
relevance in cases of a stenosed (narrowed) intervertebral fora- ing the nerves to exit with less chance of impingement.
men. For example, osteophyte formation within the interverte- Treatment of cervical nerve root compression often includes
bral foramen may cause compression of a spinal nerve as it cervical traction with the neck in partial flexion to decompress
passes through this space. This can result in symptoms such the irritated nerve root and reduce painful symptoms.
C3
C3
C4
C4
A B
Fig. 8.26 Comparison of the intervertebral foramen in a neutral position (A) and in a fully flexed position (B). Flexion significantly increases the space
within the intervertebral foramen, allowing greater room for passage of a spinal nerve root. (From Neumann DA: Kinesiology of the musculoskeletal
system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Fig. 9.50.)
CHAPTER 8 Structure and Function of the Vertebral Column 195
Rotación: C3-C7
Craniocervical axial rotation
C2
SLIDE
80°
rotation
Capsule of
apophyseal joint C3
SLIDE
Alar ligament
(taut) C4
Inferior facet Transverse ligament SLIDE
of atlas of atlas
Superior facet
IDE
Capsule of of axis C5
SLIDE
SL
C2
SLI
SLIDE
Capsule of C6 DE
apophyseal joint C3 SLI
SLIDE
30-35º grados
s (taut) C4
Inferior facet Transverse ligament SLIDE
of atlas of atlas
of axis
Capsule of Vertebral artery C5
SLIDE
SL
T ATI
O
SLI
N
A B C6
SLI
DE
Superior
Atla
s
view
Atlanto-axial jointAxis
complex (C1-C2) Intracervical region (C2-C7)
C7
Vertebral artery
RO
T
nematics of craniocervical
A axial rotation.
ATI
ON (A) Atlanto-axial joint. (B) Intracervical region (C2-C7). (From Neumann DA: Kinesiology of the mus-
B
Inclinación: C3-C7
Craniocervical lateral flexion
L
40° fle a
x
te o n
ra
i
l
Capsule of
apophyseal joint C2
C3
L
40° RO fle a
LL x
te o n
C4
ra
i
l
Capsule of
apophyseal joint C2
Cranium
C5
C3
RO
LL C4
C6
astoid process 30-35º grados
Cranium
Lateral
flexion C5
ROTA E INCLINA AL
MISMO LADO
COPLA DIRECTA
CERVICAL BAJA: C3-C7
Articulaciones Uncovertebrales
• Guían flexoextension
Protracción de Cabeza
the upper craniocervical region (Fig. 8.27A). Over time,
cles and ligaments of the upper cervical region shorten,
to the close proximity of the bony structures in this
and the upper craniocervical region into greater flexio
performed regularly, chin tucks often yield good resu
recting a forward head posture.
Protraction Retraction
Flexion
Extension
Extension
Flexion
A B
7 Protraction and retraction of the head. (A) During protraction, the lower cervical spine flexes as the upper craniocervical regio
retraction, in contrast, the lower cervical spine extends as the upper craniocervical region flexes. (From Neumann DA: Kinesio
puter screen for extended periods of time), the muscles of this begins, it may continue, eventually resulting in headaches and
region can become excessively shortened or lengthened, result- pain radiating to the scalp and temporomandibular joints.
ing in muscular imbalance. Regardless of the factors that cause Treatment for chronic forward head posture involves restor-
an individual to adopt a forward head posture, the posture itself ing a more optimal craniocervical posture. This is accomplished
stresses many of the muscles in the region. Extensor muscles through improved postural awareness, ergonomic workplace
such as the levator scapula and the semispinalis capitis will likely design, stretching and strengthening of the appropriate muscu-
become over-stretched and fatigued (Fig. 8.49B). Suboccipital lature, and specific manual therapy techniques.
muscles such as the rectus capitis posterior major may become
Rectus capitis
posterior major
Semispinalis
capitis
Levator scapula Sternocleidomastoid
Scalenus anterior
A B
Fig. 8.49 (A) Four muscles of the craniocervical region acting as guy wires to help maintain ideal posture. (B) Forward head posture places stress
on the levator scapula and semispinalis capitis muscles. The rectus capitis posterior major (a suboccipital muscle) is shown actively extending the up-
per craniocervical region. The highly active and stressed muscles are depicted in brighter red. (From Neumann DA: Kinesiology of the musculoskeletal
system: foundations for physical rehabilitation, ed 2, St Louis, 2010, Mosby, Fig. 10.31.)
CONSULTAS?