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The joint capsules are innervated by the dorsal rami of the spinal nerves. However, one particular ramus is not responsible for only one segmentally related joint capsule but sends out lateral branches connecting to the neighboring proximal and distal apophyseal (fa cet) joints as well. This plurisegmental innervation of the facet joints is of significant importance for the coordination of complex regional movement patterns. This may also explain the fact that the pain described by the patient often cannot be localized to one segment as it is per ceived over an area covering several segments (overlap of the der matomas).
Clinically, the spinous processes move towards the convexity that is in a direction opposite that of the side-bending (Fig. 20). Lumbar Spine • • • 18 The joint surfaces of the lumbar spinal facet joints are almost verti cal and rotated approximately 45° about the y-axis (Fig. 21). This rather vertical orientation prevents axial rotation in particular. In the spinal segment L5-S1, rotation of only 5° is possible. The primary movement in the lumbar spine is flexion and exten sion. 21 The facet joint inclinations and axes of motion of a lumbar vertebra (after White and Panjabi, 1990) Pelvic Girdle • • • The functional unit of the pelvic girdle consists of the sacrum, both ilia, the 5th lumbar vertebra connected through the sacroiliac joints on either side, and the symphysis pubis anteriorly.
The examiner fixates the patient's trunk laterally. The index and middle finger of the examiner's palpating hand are placed over the spinous processes of C2 and C3, respectively . With the opposite hand, the examiner fixates the patient's head over in the parietal region. The first step involves side-bending of the head to either side (Fig. 48) . In the second step, axial rotation to each side is introduced (Fig. 49) . r Fig. 48 Fig. 49 Note • • • With initiation of side-bending movement to one side, the axis im mediately starts to rotate towards the same side (the spinous pro cess moves in the opposite direction ) .