AXIAL SKELETON
OSTEOLOGY AND
ARTHROLOGY
Dr. Michael P. Gillespie
HUMAN SKELETON: ANTERIOR
VIEW
Dr. Michael P. Gillespie
2
HUMAN SKELETON: POSTERIOR
VIEW
Dr. Michael P. Gillespie
3
RELATIVE LOCATION OR REGION
WITHIN THE AXIAL SKELETON
Synonym
Definition
Posterior
Dorsal
Back of the body
Anterior
Ventral
Front of the body
Medial
None
Midline of the body
Lateral
None
Away from the
midline of the body
Superior
Cranial
Head or top of the
body
Inferior
Caudal
Tail, or the bottom of
the body
Dr. Michael P. Gillespie
Term
The definitions assume a person is in the anatomic position.
4
COMPONENTS OF THE AXIAL
SKELETON
Cranium
 Vertebrae
 Ribs
 Sternum

Dr. Michael P. Gillespie
5
CRANIUM
The cranium encases and protects the brain.
 It houses several sensory organs.


Dr. Michael P. Gillespie

Eyes, ears, nose and vestibular system.
Only the temporal and occipital bones are
relevant to our study of kinesiology.
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OSTEOLOGIC FEATURES OF THE
CRANIUM

Temporal Bone

Dr. Michael P. Gillespie

Mastoid process
Occipital Bone






External occipital protruberance
Superior nuchal line
Inferior nuchal line
Foramen magnum
Occipital condyles
Basilar part
7
TEMPORAL BONES
The two temporal bones form part of the lateral
external surface of the skull immediately
surrounding and including the external acoustic
meatus.
 The mastoid process is just posterior to the ear
and serves as an attachment point to many
muscles (i.e. sternocleidomastoid and
longissimus).

Dr. Michael P. Gillespie
8
OCCIPITAL BONE






Dr. Michael P. Gillespie

The occipital bone forms the posterior base of the skull.
The external occipital protruberance (EOP) is a palpable
midline point. It is an attachment point for the ligamentum
nuchae and the medial part of the upper trapezius muscle.
The superior nuchal line extends laterally from the EOP to the
base of the mastoid process of the temporal bone. This line
serves as the attachment point for several muscles of the neck
(i.e. trapezius and splenius capitis).
The inferior nuchal line marks the anterior edge of the
attachment of the semispinalis muscle capitis muscle.
The foramen magnum is a large circular hole at the base of the
occipital bone. It serves as a passageway for the spinal cord.
Occipital condyles project from the anterior-lateral margins of
the foramen magnum forming the convex component of the
atlanto-occipital joint.
The basilar part of the occipital bone lies just anterior to the
anterior rim of the foramen magnum.
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LATERAL VIEW OF THE SKULL
Dr. Michael P. Gillespie
10
INFERIOR VIEW OF THE OCCIPITAL
AND TEMPORAL BONES
Dr. Michael P. Gillespie
11
VERTEBRAE
The vertebrae provide stability throughout the
trunk and neck. They protect the spinal cord,
ventral and dorsal roots, and exiting spinal nerve
roots.
 3 sections of the vertebra

Dr. Michael P. Gillespie
Vertebral body (anterior)
 Transverse and spinous processes (posterior) –
posterior elements (neural arch, vertebral arch)
 Pedicles – bridges that connect the body with the
posterior elements – transfer muscle forces applied to
the posterior elements forward across the vertebral
body and intervertebral discs.

12
Dr. Michael P. Gillespie
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MAJOR PARTS OF A MIDTHORACIC
VERTEBRA
Table 9-2
 Major parts of a Midthoracic Vertebra
 Chapter 9 Page 311

Dr. Michael P. Gillespie
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ESSENTIAL CHARACTERISTICS OF A
VERTEBRA
Dr. Michael P. Gillespie
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ESSENTIAL CHARACTERISTICS OF A
VERTEBRA
Dr. Michael P. Gillespie
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RIBS
Twelve pairs of ribs enclose the thoracic cavity
forming a protective cage for the
cardiopulmonary organs.
 The rib head and tubercle articulate with the
thoracic vertebrae forming two synovial joints:

These joints anchor the posterior end of a rib to
its corresponding vertebra.
 The anterior end of a rib consists of flattened
hyaline cartilage.
Dr. Michael P. Gillespie
Costocorporeal (costovertebral)
 Costotransverse


17
TYPICAL RIB
Dr. Michael P. Gillespie
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STERNUM

Three parts
Manubrium (Latin – handle)
 Body
 Xiphoid process (Greek – sword)

Dr. Michael P. Gillespie
The manubrium fuses with the body of the
sternum at the manubriosternal joint (a
cartilaginous joint that often ossifies later in life).
 The xiphoid process is connected to the sternum
by fibrocartilage at the xiphisternal joint that
often fuses by 40 years of age.
 Sternoclavicular joints.
 Sternocostal joints.

19
OSTEOLOGIC FEATURES OF THE
STERNUM

Osteologic Features of the Sternum






Dr. Michael P. Gillespie

Manubrium
Jugular notch
Clavicular facets for sternoclavicular joints
Body
Costal facets for sternocostal joints
Xiphoid process
Intrasternal Joints
Manubriosternal joint
 Xiphosternal joint

20
STERNUM
Dr. Michael P. Gillespie
21
VERTEBRAL COLUMN

33 vertebral bony segments divided into five
regions.




Cervical
Thoracic
Lumbar
Sacral
Coccygeal
Dr. Michael P. Gillespie

22
CURVATURES WITHIN THE
VERTEBRAL COLUMN




Dr. Michael P. Gillespie

When viewed from the side, the vertebral column
shows four slight bends called normal curves.
Relative to the anterior aspect of the body, the
cervical and lumbar curves are convex (bulging out),
whereas the thoracic and sacral curves are concave
(cupping in).
The curves in the vertebral column increases its
strength, help maintain balance in the upright
position, absorb shocks during walking, and help to
protect the vertebrae from fracture.
Various conditions may exaggerate the normal curves
of the vertebral column, or the column may acquire a
lateral bend, resulting in abnormal curves.
The abnormal curves are kyphosis, lordosis, and
scoliosis.
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VERTEBRAL COLUMN
Dr. Michael P. Gillespie
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INCORRECT LABELING OF THE
NORMAL CURVES
Dr. Michael P. Gillespie
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EXTENSION AND FLEXION OF THE
VERTEBRAL COLUMN
Dr. Michael P. Gillespie
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LINE OF GRAVITY



Dr. Michael P. Gillespie

The line of gravity acting on a person with ideal
posture passes near the mastoid process of the
temporal bone, anterior to the second sacral vertebra,
just posterior to the hip, and anterior to the knee and
ankle.
In the vertebral column, the line of gravity typically
falls just to the concave side of the apex of each
region’s curvature.
Ideal posture allows gravity to produce a torque that
helps maintain the optimal shape of the spinal
curvatures.
The external torque attributed to gravity is the
greatest at the apex of each region: C4 and C5, T6,
and L3.
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LINE OF GRAVITY
Dr. Michael P. Gillespie
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COMMON POSTURAL DEVIATIONS
Dr. Michael P. Gillespie
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LIGAMENTOUS SUPPORT OF THE
VERTEBRAL COLUMN
The vertebral column has extensive ligament
support.
 These ligaments limit motion, help maintain
natural spinal curvatures, stabilize the spine,
and protect the spinal cord and nerve roots.

Dr. Michael P. Gillespie
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LIGAMENTS: LATERAL VIEW
Dr. Michael P. Gillespie
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LIGAMENTS: ANTERIOR VIEW
Dr. Michael P. Gillespie
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LIGAMENTS: POSTERIOR VIEW
Dr. Michael P. Gillespie
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MAJOR LIGAMENTS OF THE
VERTEBRAL COLUMN
Attachments
Function
Ligamentum
Flavum
Between the
Limits flexion
anterior surface
of one lamina and
the posterior
surface of the
lamina below.
High in elastin
Posterior to the
spinal cord
Supraspinous
and
interspinous
ligaments
Between adjacent Limits flexion
spinous processes
from C7 to
sacrum
Ligamentum
nuchae is the
cervical and
cranial extension
of the
supraspinous
ligaments
Intertransverse Between adjacent Limits
transverse
contralateral
ligaments
processes
flexion and
forward flexion
Comment
Few fibers in
cervical and
thoracic, thin in
lumbar
Dr. Michael P. Gillespie
Name
34
MAJOR LIGAMENTS OF THE
VERTEBRAL COLUMN
Attachments
Function
Comment
Anterior
longitudinal
ligaments
Between occipital
bone and anterior
vertebral bodies
including sacrum
Limits extension
Reinforces
anterior aspect of
IVDs
Most developed
in lumbar spine
Twice the tensile
strength of PLL
Posterior
longitudinal
ligaments
Posterior
surfaces of all
vertebral bodies
between C2 and
sacrum
Limits flexion
Reinforces
posterior sides of
IVDs
Lies within
vertebral canal
just anterior to
spinal cord
Capsules of the
apophyseal
joints
Margin of each
apophyseal joint
Strengthen the
apophyseal joint
Loose in the
neutral position,
but become taut
in the extremes
of other positions
Dr. Michael P. Gillespie
Name
35
STRESS STRAIN CURVE
LIGAMENTUM FLAVUM
Dr. Michael P. Gillespie
36
PROMINENT LIGAMENTUM
FLAVUM
Dr. Michael P. Gillespie
37
CERVICAL REGION
Smallest and most mobile of the vertebrae, which
facilitates the large range of motion of the head.
 Transverse foramina are located in the
transverse processes of the cervical spine through
which the vertebral artery travels.

Dr. Michael P. Gillespie
38
CERVICAL VERTEBRA: SUPERIOR
VIEW
Dr. Michael P. Gillespie
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CERVICAL VERTEBRA: ANTERIOR
VIEW
Dr. Michael P. Gillespie
40
TYPICAL CERVICAL VERTEBRAE (C3
TO C6)
Small rectangular bodies.
 The superior surfaces are concave side to side,
with raised lateral hooks called uncinate
processes (uncus means “hook”).
 These form the uncovertebral joints (a.k.a. “joints
of Luschka”).
 Osteophytes can form around the margins of
these joints which can reduce the size of the
intervertebral foramen (IVF) and impinge upon
exiting nerve roots.
 Superior articular facets face posterior and
superior, whereas the inferior articular facets
face anterior and inferior.

Dr. Michael P. Gillespie
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CERVICAL VERTEBRA: POSTERIORLATERAL VIEW
Dr. Michael P. Gillespie
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CERVICAL VERTEBRAL COLUMN:
LATERAL VIEW
Dr. Michael P. Gillespie
43
ATYPICAL CERVICAL VERTEBRAE
(C1, C2, & C7)
Atlas (C1)
 Axis (C2)
 “Vertebra Prominens” (C7)

Dr. Michael P. Gillespie
44
ATLAS (C1)
The primary function is to support the head.
 The atlas has large, palpable transverse
processes, usually the most prominent of the
cervical vertebrae.
 The transverse processes serve as attachment
points for muscles that move the cranium.

Dr. Michael P. Gillespie
45
ATLAS
Dr. Michael P. Gillespie
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ATLAS (C1)
Dr. Michael P. Gillespie
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AXIS (C2)

Dr. Michael P. Gillespie
The axis has an upwardly projecting dens
(odontoid process) which provides a vertical axis
of rotation for the atlas and head.
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AXIS (C2)
Dr. Michael P. Gillespie
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AXIS (C2)
Dr. Michael P. Gillespie
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ATLANTO-AXIAL ARTICULATION
Dr. Michael P. Gillespie
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“VERTEBRA PROMINENS” (C7)
C7 is the largest of all cervical vertebrae and has
many characteristics of thoracic vertebrae.
 This vertebra has a large spinous process,
characteristic of thoracic vertebrae.
 The hypertrophic anterior tubercle may sprout
an extra cervical rib, which may impinge on the
brachial plexus.

Dr. Michael P. Gillespie
52
THORACIC REGION

Typical Thoracic Vertebrae (T2 to T9)

Atypical Thoracic Vertebrae (T1 and T10 to T12)
T1 has a full costal facet the accepts the entire head
of the first rib.
 The spinous process of T1 is elongated and often as
prominent as C7.
 The bodies of T10 – T12 may have a single full costal
facet. These segments usually lack costotransverse
joints.

Dr. Michael P. Gillespie

The heads of ribs 2 – 9 typically articulate with a pair
of costal demifacets.
53
TYPICAL THORACIC VERTEBRAE
Dr. Michael P. Gillespie
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LUMBAR REGION
Massive wide bodies for supporting the entire
superimposed weight of the head, trunk, and
arms.
 The spinous processes are broad and rectangular
projecting horizontally (as opposed to the slant n
the thoracic region).
 Short mammillary processes project from the
posterior surface of each superior articular facet
for attachment of the multifidi muscles.

Dr. Michael P. Gillespie
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LUMBAR VERTEBRAE: SUPERIOR
VIEW
Dr. Michael P. Gillespie
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LUMBAR VERTEBRA: LATERALPOSTERIOR VIEW
Dr. Michael P. Gillespie
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SACRUM








Dr. Michael P. Gillespie

Triangular bone with the base facing superiorly and apex
inferiorly.
Transmits weight of the vertebral column to the pelvis.
In childhood, each of the five separate sacral vertebrae is
joined by a cartilaginous membrane.
By adulthood they fuse into a single bone.
Four paired ventral (pelvic) sacral foramina transmit the
ventral rami of spinal nerve roots that form the sacral
plexus.
Four paired dorsal sacral foramina transmit the dorsal
rami of sacral spinal nerve roots.
The sacral canal houses and protects the cauda equina.
A large auricular surface articulates with the ilium,
forming the sacroiliac joint.
The apex articulates with the coccyx.
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LUMBOSACRAL REGION: ANTERIOR
VIEW
Dr. Michael P. Gillespie
59
LUMBOSACRAL REGION:
POSTERIOR-LATERAL VIEW
Dr. Michael P. Gillespie
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SACRUM: SUPERIOR VIEW
Dr. Michael P. Gillespie
61
COCCYX
Small triangular bone consisting of four fused
vertebrae.
 Base of coccyx joins the apex of the sacrum at the
sacrococcygeal joint (which usually fuses late in
life).
 The joint has a fibrocartilaginous disc.

Dr. Michael P. Gillespie
62
CAUDA EQUINA






Dr. Michael P. Gillespie

At birth the spinal cord and vertebral column are nearly
the same length.
The vertebral column grows slightly faster than the spinal
cord.
The spinal cord terminates at around the level of L1 or L2.
The lumbosacral spinal nerve roots must travel a great
distance caudally before reaching their corresponding
intervertebral foramina.
The elongated nerves represent a horse’s tail, hence the
term cauda equina.
Severe fracture or trauma to the lumbosacral region can
damage the cauda equina but spare the spinal cord.
Damage to the cauda equina can result in muscle paralysis,
atrophy, altered sensation, and reduced reflexes.
63
TYPICAL INTERVERTEBRAL
JUNCTION

Three functional components:

1. Transverse and spinous processes

2. Apophyseal joints


Levers that increase the mechanical leverage of muscles
and ligaments.
Guiding intervertebral motion (like railroad tracks for a
train).
3. Interbody joints

Dr. Michael P. Gillespie

Connect an intervertebral disc with a pair of vertebral
bodies.
64
TYPICAL INTERVERTEBRAL
JUNCTION
Dr. Michael P. Gillespie
65
MOVEMENT IN THE VERTEBRAL
COLUMN
With a few exceptions, movement within any
given intervertebral joint is relatively small.
 When added across the entire vertebral column,
however, these small movements can yield
considerable angular rotation.

Dr. Michael P. Gillespie
66
TERMINOLOGY DESCRIBING
MOVEMENT

Osteokinematics
Rotations within the three cardinal planes.
 Each plane, or degree of freedom, is associated with
one axis of rotation.
 Movement is described in a cranial-to-caudal fashion.

Arthrokinematics

Describes the relative movement between articular
facet surfaces within the apophyseal joints.
Dr. Michael P. Gillespie

67
OSTEOKINEMATICS OF THE
VERTEBRAL COLUMN
Dr. Michael P. Gillespie
68
APOPHYSEAL JOINTS






Dr. Michael P. Gillespie

24 pairs of apophyseal joints.
Each apophyseal joint is formed between opposing
articular facet surfaces.
Lined with articular cartilage and enclosed by a
synovial-lined, well innervated capsule.
The articular surfaces of most apophyseal joints are
flat.
Apophysis means “outgrowth” which emphasizes the
protruding nature of the articular process.
The facets act as barricades. They permit certain
movements, but block other movements.
The near vertical orientation of the apophyseal joints
in the lower thoracic, lumbar, and lumbosacral
regions block excessive anterior translation of one
vertebra on another.
69
ARTHROKINEMATICS APOPHYSEAL
JOINTS
Definition
Functional
Example
Approximation of
joint surfaces
An articular facet surface
tends to move closer to its
partner facet. Usually
caused by a compression
force.
Axial rotation between L1
and L2 causes
approximation
(compression) of the
contralateral apophyseal
joint.
Separation (gapping)
between joint
surfaces
An articular facet tends to
move away from its partner
facet. Usually caused by a
distraction force.
Therapeutic traction is a
way to decompress or
separate the apophyseal
joints.
Sliding (gliding)
between joint
surfaces
An articular facet
translates in a linear or
curvilinear direction
relative to another articular
facet. Sliding between joint
surfaces is caused by a
force directed tangential to
the joint surfaces.
Flexion-extension of the
mid to lower cervical spine.
Dr. Michael P. Gillespie
Terminology
70
APOPHYSEAL JOINT (OPENED)
Dr. Michael P. Gillespie
71
INTERBODY JOINTS
From C2-3 to L5-S1, 23 interbody joints are
present in the spinal column.
 Each interbody joint contains an intervertebral
disc, vertebral endplates, and adjacent vertebral
bodies.
 The joint is a cartilaginous synarthrosis.

Dr. Michael P. Gillespie
72
INTERVERTEBRAL DISCS






Dr. Michael P. Gillespie

Central nucleus pulposus surrounded by an annulus
fibrosus.
The nucleus pulposus is a pulplike gel in the mid to
posterior part of the disc.
In youth, the lumbar discs consist of 70% - 90% water.
The discs act as a hydraulic shock absorption system,
dissipating and transferring loads across vertebrae.
The annulus fibrosus consists of 15 to 25 concentric
layers or rings of collagen fibers.
Abundant elastin protein is also interspersed
conferring circumferential elasticity to the annulus
fibrosus.
If the disc is dehydrated and thin, a disproportionate
amount of compressive force is placed on the
apophyseal joints.
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INTERVERTEBRAL DISC
Dr. Michael P. Gillespie
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ANNULUS FIBROSIS
Dr. Michael P. Gillespie
75
VERTEBRAL ENDPLATES
The vertebral endplates are relatively thin
cartilaginous caps of connective tissue that cover
most of the superior and inferior surfaces of the
vertebral bodies.
 At birth they are thick, accounting for
approximately 50% of the height of each
intervertebral space.
 During childhood, the endplates function as
growth plates for the vertebrae.

Dr. Michael P. Gillespie
76
VERTEBRAL ENDPLATE
Dr. Michael P. Gillespie
77
INTERVERTEBRAL DISC AS A
HYDROSTATIC PRESSURE
DISTRIBUTER
The intervertebral discs act as shock absorbers to
protect the bone from excessive pressure.
 Compressive forces push the endplates inward
and toward the nucleus pulposus.
 The nucleus pulposus deforms radially and
outwardly against the annulus fibrosus.
 When the compressive force is removed from the
endplates, the stretched elastin and collagen
fibers return to their original preload length.

Dr. Michael P. Gillespie
78
FORCE TRANSMISSION THROUGH
DISC
Dr. Michael P. Gillespie
79
INTRADISCAL PRESSURE DURING
COMMON POSTURES AND
ACTIVITIES
Dr. Michael P. Gillespie
80
DIURNAL FLUCTUATIONS IN WATER
CONTENT WITHIN THE
INTERVERTEBRAL DISCS
When a healthy spine is unloaded (i.e. bed rest)
the pressure within the nucleus pulposus is
relatively low.
 This low pressure attracts water to the disc and
the disc swells slightly while sleeping.
 When we are awake and upright, weight bearing
produces compressive forces that push water out
of the disc.
 The water retaining capacity of the disc declines
with age.
 With less water and a lower hydrostatic pressure,
the disc can bulge outward when compressed
(like a flat tire).

Dr. Michael P. Gillespie
81
SPINAL COUPLING
Movement performed within any given plane
throughout the vertebral column is coupled with
automatic and usually imperceptible movement
in another plane.
 This is referred to as spinal coupling.

Dr. Michael P. Gillespie
82
NORMAL SAGITTAL PLANE
CURVATURES ACROSS REGIONS OF
THE SPINAL COLUMN
Dr. Michael P. Gillespie
83
CONNECTIVE TISSUES THAT MAY
LIMIT MOTIONS OF THE
VERTEBRAL COLUMN
Connective Tissues
Flexion
Ligamentum nuchae
Interspinous and supraspinous
ligaments
Ligamentum flava
Apophyseal joints
Posterior annulus fibrosis
Posterior longitudinal ligament
Beyond neutral extension
Apophyseal joints
Cervical viscera (esophagus and
trachea)
Anterior annulus fibrosis
Anterior longitudinal ligament
Dr. Michael P. Gillespie
Motion of the Vertebral
Column
84
CONNECTIVE TISSUES THAT MAY
LIMIT MOTIONS OF THE
VERTEBRAL COLUMN
Connective Tissues
Axial rotation
Annulus fibrosis
Apophyseal joints
Alar ligaments
Lateral flexion
Intertransverse ligaments
Contralateral annulus fibrosus
Apophyseal joints
Dr. Michael P. Gillespie
Motion of the Vertebral
Column
85
CRANIOCERVICAL REGION
“Craniocervical region” and “neck” are used
interchangeably.
 Three articulations

Dr. Michael P. Gillespie
Atlanto-occipital joint
 Atlanto-axial joint complex
 Intracervical apophyseal joints (C2 to C7)

86
ATLANTO-OCCIPITAL JOINTS

The atlanto-occipital joints provide independent
movement of the cranium relative to the atlas.
Dr. Michael P. Gillespie
87
ATLANTO-OCCIPITAL JOINTS:
POSTERIOR - EXPOSED
Dr. Michael P. Gillespie
88
ATLANTO-OCCIPITAL JOINTS:
ANTERIOR
Dr. Michael P. Gillespie
89
ATLANTO-OCCIPITAL JOINTS:
POSTERIOR
Dr. Michael P. Gillespie
90
ATLANTO-AXIAL JOINT COMPLEX




Dr. Michael P. Gillespie

The atlanto-axial joint complex has two articular
components: a median joint and a pair of laterally
positioned apophyseal joints.
The median joint is formed by the dens of the axis
(C2) projecting through an osseous-ligamentous ring
created by the anterior arch of the atlas and the
transverse ligament.
The transverse ligament of the atlas stabilizes the
atlanto-axial articulation and prevents anterior
slippage.
The two apophyseal joints are formed by the
articulation of the inferior areticular facets of the
atlast with the superior articular facets of the axis.
Two degrees of freedom are allowed by this joint
complex: horizontal plane rotation and flexionextension.
91
ATLANTO-AXIAL JOINT COMPLEX:
SUPERIOR
Dr. Michael P. Gillespie
92
ATLANTO-AXIAL JOINT COMPLEX:
POSTERIOR
Dr. Michael P. Gillespie
93
INTRACERVICAL APOPHYSEAL
JOINTS (C2 TO C7)
The facet surfaces within the apophyseal joints of
C2 to C7 are oriented like shingles on a 45-degree
sloped roof.
 This orientation enhances the freedom of
movement in all three planes.

Dr. Michael P. Gillespie
94
APPROXIMATE ROM FOR THE
THREE PLANES OF MOVEMENT
CRANIOCERVICAL
Flexion &
Extension
(Sagittal Plane,
Degrees)
Axial Rotation
(Horizontal
Plane, Degrees)
Lateral Flexion
(Frontal Plane,
Degrees)
Atlanto-occipital
joint
Flexion: 5
Extension: 10
Total: 15
Negligible
About 5
Atlanto-axial
joint complex
Flexion: 5
Extension: 10
Total: 15
35-40
Negligible
Intracervical
region (C2-C7)
Flexion: 35-40
Extension: 55-60
Total: 90-100
30-35
30-35
Total across
craniocervical
region
Flexion: 45-50
Extension: 75-80
Total: 120-130
65-70
35-40
Dr. Michael P. Gillespie
Joint or Region
95
KINEMATICS OF CRANIOCERVICAL
EXTENSION
Dr. Michael P. Gillespie
96
KINEMATICS OF CRANIOCERVICAL
FLEXION
Dr. Michael P. Gillespie
97
PROTRACTION AND RETRACTION
OF THE CRANIUM
Dr. Michael P. Gillespie
98
KINEMATICS OF CRANIOCERVICAL
AXIAL ROTATION
Dr. Michael P. Gillespie
99
KINEMATICS OF CRANIOCERVICAL
LATERAL FLEXION
Dr. Michael P. Gillespie
100
THORACIC REGION
The thorax consists of a relatively rigid rib cage,
formed by ribs, thoracic vertebrae, and sternum.
 The rigidity provides a stable base for muscles to
control the craniocervical region, protection for
intrathoracic organs, and a mechanical bellows
for breathing.

Dr. Michael P. Gillespie
101
COSTOTRANSVERSE &
COSTOCORPOREAL JOINTS:
SUPERIOR-LATERAL VIEW
Dr. Michael P. Gillespie
102
COSTOTRANSVERSE &
COSTOCORPOREAL JOINTS:
SUPERIOR VIEW
Dr. Michael P. Gillespie
103
APPROXIMATE ROM FOR THE THREE
PLANES OF MOVEMENT THORACIC
REGION
Axial Rotation
(Horizontal Plane,
Degrees)
Lateral Flexion
(Frontal Plane,
Degrees)
Flexion: 30-40
Extension: 20-25
Total: 50-65
30-35
25-30
Dr. Michael P. Gillespie
Flexion & Extension
(Sagittal Plane,
Degrees)
104
KINEMATICS OF THORACOLUMBAR
FLEXION
Dr. Michael P. Gillespie
105
KINEMATICS OF THORACOLUMBAR
EXTENSION
Dr. Michael P. Gillespie
106
KINEMATICS OF THORACOLUMBAR
AXIAL ROTATION
Dr. Michael P. Gillespie
107
KINEMATICS OF THORACOLUMBAR
LATERAL FLEXION
Dr. Michael P. Gillespie
108
LUMBAR REGION

L1 to L4
The facet surfaces of most lumar apophyseal joints
are oriented nearly vertically.
 This orientation favors sagittal plane motion at the
expense of rotation in the horizontal plane.

L5-S1

The facet surfaces of the L5-S1 apophyseal joints are
usually oriented in a more frontal plane than those of
other lumbar regions.
Dr. Michael P. Gillespie

109
APPROXIMATE ROM FOR THE
THREE PLANES OF MOVEMENT
LUMBAR REGION
Axial Rotation
(Horizontal Plane,
Degrees)
Lateral Flexion
(Frontal Plane,
Degrees)
Flexion: 40-50
Extension: 15-20
Total: 55-70
5-7
20
Dr. Michael P. Gillespie
Flexion & Extension
(Sagittal Plane,
Degrees)
110
SPONDYLOLISTHESIS
Dr. Michael P. Gillespie
111
HERNIATED NUCLEUS PULPOSUS
Dr. Michael P. Gillespie
112
LUMBOPELVIC RHYTHM DURING
TRUNK FLEXION
Dr. Michael P. Gillespie
113
LUMBOPELVIC RHYTHM DURING
TRUNK EXTENSION
Dr. Michael P. Gillespie
114
ANTERIOR PELVIC TILT
Dr. Michael P. Gillespie
115
POSTERIOR PELVIC TILT
Dr. Michael P. Gillespie
116
KINESIOLOGIC EFFECTS OF
LUMBAR FLEXION & EXTENSION
Effect of Flexion
Effect of Extension
Nucleus Pulposus
Deformed or pushed
posteriorly
Deformed or pushed
anteriorly
Annulus Fibrosus
Posterior side
stretched
Anterior side
stretched
Apophyseal Joint
Capsule stretched
Articular loading
decreased
Capsule slackened
Articular loading
increased
Intervertebral
Foramen
Widened
narrowed
Posterior
Increased tension
longitudinal ligament (elongated)
Dr. Michael P. Gillespie
Structure
Decreased tension
(slackened)
117
KINESIOLOGIC EFFECTS OF
LUMBAR FLEXION & EXTENSION
Effect of Flexion
Effect of Extension
Ligamentum flavum
Increased tension
(elongated)
Decreased tension
(slackened)
Interspinous
ligament
Increased tension
(elongated)
Decreased tension
(slackened)
Supraspinous
ligament
Increased tension
(elongated)
Decreased tension
(slackened)
Anterior longitudinal
ligament
Decreased tension
(slackened)
Increased tension
(elongated)
Spinal cord
Increased tension
(elongated)
Decreased tension
(slackened)
Dr. Michael P. Gillespie
Structure
118
SITTING POSTURE & EFFECTS ON
ALIGNMENT
Dr. Michael P. Gillespie
119
SACROILIAC JOINTS
The sacroiliac joints mark the transition between
the caudal end of the axial skeleton and the lower
appendicular skeleton.
 The tight fitting SI joint is designed for stability,
ensuring effective transfer of potentially large
loads between the vertebral column, the lower
extremities, and ultimately the ground.

Dr. Michael P. Gillespie
120
SACROILIAC JOINTS: EXPOSED
SURFACES
Dr. Michael P. Gillespie
121
LIGAMENTS OF THE SACROILIAC
JOINT

Primary
Anterior sacroiliac
 Iliolumbar
 Interosseous
 Short and long posterior sacroiliac

Secondary
Sacrotuberous
 Sacrospinous
Dr. Michael P. Gillespie


122
LUMBOSACRAL REGION: ANTERIOR
VIEW
Dr. Michael P. Gillespie
123
LUMBOSACRAL REGION:
POSTERIOR VIEW
Dr. Michael P. Gillespie
124
NUTATION & COUNTERNUTATION

Nutation
Nutation means to nod.
 Nutation is the anterior tilt of the base (top) of the
sacrum relative to the ilum.

Counternutation

Counternutation is a reverse motion defined as the
relative posterior tilt of the base of the sacrum
relative to the ilium.
Dr. Michael P. Gillespie

125
KINEMATICS OF THE SACROILIAC
JOINTS
Dr. Michael P. Gillespie
126
FUNCTIONS OF THE SACROILIAC
JOINTS
Stress relief mechanism within the pelvic ring.
 A stable means of load transfer between the axial
skeleton and lower limbs.

Dr. Michael P. Gillespie
127
MUSCLES THAT REINFORCE AND
STABILIZE THE SACROILIAC JOINT
Erector Spinae
 Lumbar multifidi
 Abdominal muscles

Dr. Michael P. Gillespie
Rectus abdominis
 Obliquus abdomninis internus and externus
 Transversus abdominis

Hip extensor muscles
 Latissimus dorsi
 Iliacus and piriformis

128