Normal Frontal Plane Spinal Alignment

1
Normal Frontal Plane Spinal Alignment?
Kendall claims, and Grays agrees, that it is
normal for a right-handed individual to have a
right thoracic lateral curvature.
2
Handedness and curvature
3
The sagittal spinal curves
Harrison spinal model
Generic spine
4
Lovett relationships
A Lovett-positive B Lovett-in-excessC
Lovett-static D Lovett-negativeE
Lovett-failure F Lovett-in-reverse
Not all the sacral-spinal relationships are
equally likely. The Lovett-positive is especially
well-behaved, and the Lovett-in-reverse is
especially poorly-behaved.
5
Lovett-in-Excess
6
Lovett-in-Reverse
7
Lovett-reverse or x-ray positioning?
8
Lovett-negative
Note symmetric pelvis, listing spine ? L4 often
9
Lovett-failure
Note asymmetric pelvis, straight spine ? L4 often
10
L4 cases
11
Tortipelvis (after Barge)
There is an anomalous open wedge on the concave
side of a spinal curvature.
12
PLS L4 / disc block
13
Radiological Confirmation of the Basic Distortion
The statics of postural pelvic tilt scoliosis a
radiographic study on 288 consecutive chronic LBP
patients (Friberg, Ora. Clinical Biomechanics
1987 (2) 211-219
14
The Helical Natureof the Distortion
SEGMENT MEAN TORSION
L1-L2 0.790 L2-L3 0.970 L3-L4 1.060 L4-L5 1.35
0 L5-S1 5.390
PI/short leg side
Calculated mean torsion of L1-S1 segments in 170
patients with lumbar scoliosis convex to the
short leg side. (Friberg, Clinical Biomechanics
1987 2211-219)
15
Million Dollar Roll Prescribed
16
Self-manipulationBAD
17
Why the lumbar vertebra rotate toward convexity

• Special anatomy of the iliolumbar ligament
• Illustration to follow
• the law of gravity
• Logan wrote that the fifth lumbar vertebra
  rotates to the low side of the sacral base

18
Janse-Illi Lumbosacral Torsional Effect
note role of iliolumbar ligament
19
Basic Distortion Seen from above
SP rotation to concavity
short leg side
long leg side
right anterior pelvis not to be confused with
AS ilium
20
Distinguishing Functional from Lateral Curvatures
RIGHT THORACIC PRIMARY CURVE
21
Thoraco-Lumbar Curvature
IT IS NOT OBVIOUS WHICH OF THE TWO CURVES IS MORE
PRIMARY
22
Dynamic Thoracic Spinal Analysis left
23
Lumbar sclerotogenous pain maps
24
Lumbar blockingthe extension sign
25
Lumbar BlockingThe Extension Sign
26
Which side up for side-posture manipulation?
27
Which side up for side-posture manipulation?