Forward bending cervical spine

FIG. 25-1 Gross motion testing of the cervical spine, forward bending,... 

FIG. 33-1 Exercise therapy for the cervical spine forward bending. 

When a force is applied to the posterosuperior quadrant of the head or when a crown impact is administered while the head is in flexion, the neck is subjected to a combined load of axial compression and forward bending. Anterior wedge frartures of vertebral bodies are commonly seen, but with increased load, burst fractures and fracture-dislocations of the facets can result. The latter two conditions are unstable and tend to disrupt or injure the spinal cord, and the extent of the injury depends on the penetration of the vertebral body or its fragments into the spinal canal. Recent experiments by Pin tar et al. [1989, 1990] indicate that burst fractures of lower cervical vertebrae can be reproduced in cadaveric specimens by a crown impact to a flexed cervical spine. A study by Nightingale et al. [1993] showed that fracture-dislocations of the cervical spine occur very early in the impact event (within the first 10 ms) and that the subsequent motion of the head or bending of the cervical spine cannot be used as a reliable indicator of the mechanism of injury. 

The thoracic spine is subject to many conditions that affect the cervical and lumbar spine including somatic dysfunction, herniation of an intervertebral disk, arthritis, and other bony and soft tissue injuries and degenerative processes. Osteoporosis coimnonly manifests in the thoracic spine, with vertebral compression fractures and formation of the dowager s hump, caused by micro fractures of the anterior bodies of the vertebrae leading to a forward bending of the upper thoracic spine. This chapter discusses some of the conditions most commonly affecting the thoracic spine. 

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