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Before discussing the etiology and pathogenesis of postural disorders in preschool children, it is advisable to briefly characterize the anatomical and physiological features of the musculoskeletal system in this age period.

The skeleton of a preschooler consists mainly of cartilaginous tissue, which determines the possibility of its further growth. However, unlike children of preschool or early age, in this age period, ossification zones already appear, which makes the bones stronger. However, the bone tissue of children is poor in mineral salts and, on the contrary, rich in organic matter and water. As a result, it is characterized by softness, pliability, easily changes shape under the influence of loads. The ossification of the skeleton (replacement of cartilaginous tissue with bone) is uneven: ossification of the hands ends at 6-7 years old, and the feet - only by the age of 20, so intense manual work at preschool age, wearing uncomfortable shoes leads to curvature of the bones, disruption of the joints.

The spine of a preschool child is very elastic and easily subject to curvature in adverse developmental conditions. The spinal column consists of separate segments of the vertebrae, overlapping each other with a layer of cartilage - intervertebral discs, giving the spine flexibility and providing a certain resistance to the load on the spine. Intervertebral discs in children are relatively thicker than in adults. With age, the discs lose their elasticity, the nucleus pulposus between the vertebrae decreases in size and the thickness of the discs becomes smaller. To preschool age 4 physiological curves are already clearly visible throughout the entire spine. However, they are well visualized only when walking; when lying down, they are aligned, since the spine of children is very elastic. Thoracic kyphosis is finally formed at 6-7 years old, lumbar lordosis - at school age.

By the end of the preschool period, the formation of the bones of the hand is completed, the shape of the skull changes, and its facial part increases, which is associated with the already well-developed function of chewing and the function of speech (Kapitan T.V., 2006).

The muscular system in preschool age is also peculiar. Muscle fibers are rather short, thin, rich in water, indicators muscle strength very low. As the child grows, the development of the muscular system occurs, but this process occurs unevenly. So, in the first years of life, large muscles of the shoulders and forearms are formed, in connection with which, up to 5-6 years, basic motor skills develop, but fine motor skills suffer. The muscles of the hand develop slowly - as a result, only after 6-7 years do the abilities for writing, modeling, drawing develop. The muscles of the foot in preschool children are poorly developed, therefore, at this age, running and jumping from a height should be limited.

Preschool children are characterized by low endurance of the muscular system. Therefore, preschoolers are not able to perform the same movements, walk at a calm pace. In older preschoolers, muscles become stronger, endurance increases, but it is impossible to force physical activity under the influence of emotional influences, this can damage the health of the child.

At preschool age, the nature of the articulation of bones in the joints also changes. At the age of 6-10 years, there is a complication in the structure of the joint capsule, the number of villi and folds of the synovial membrane increases, and the formation of vascular networks of the nerve endings of the synovial membrane occurs. In the fibrous membrane of the joint capsule in children from 3 to 8 years old, the number of collagen fibers increases, which thicken greatly, providing its strength (Geppe N.A., Podchernyaeva N.S., 2009).

Analyzing the above anatomical and physiological features of the musculoskeletal system in children, it becomes obvious that they have a predisposition to bone deformities and, in particular, to a violation of posture.

Currently, the issues of the etiology and pathogenesis of posture disorders in children attract the close attention of researchers, due to the wide spread and problems in correcting this pathology.

Among the most important reasons for the formation of posture disorders in a child, the following are distinguished:

Anatomical and constitutional features of the structure of the spine;

visual disturbances;

Violations of the nasopharynx and hearing;

Frequent infectious diseases;

Lack of systematic education of the skill of correct posture and regular physical training (insufficient physical activity);

Weakly developed muscular system, especially hypotension of the muscles of the back and abdominals;

Poor nutrition;

Tables and desks that do not correspond to the height of the student;

Bed with soft mesh.

In addition, insufficient formation of the physiological curvature of the spine, the difference in the length of the legs, the skew of the pelvis are distinguished as causative factors (Nikiforova E.K. et al., 1963; Alstrue Vidal A., 1988).

Of no small importance in the development of deviations from the spine is the state of health of parents, the conditions for the course of pregnancy and childbirth, that is, a complex of neonatal and perinatal factors. So, M.A. Grigoriev (1996), who singled out 28 factors of perinatal pathology, proved that an increase in the number of factors directly proportionally affects the incidence of spinal defects in general and posture disorders, in particular.

Congenital posture disorders in children can be associated with intrauterine spinal formation disorders (the formation of additional vertebrae or their wedge-shaped deformity), myotonic syndrome, connective tissue dysplasia, etc. Birth injuries can also lead to postural disorders in children - for example, subluxation of the 1st cervical vertebra, torticollis.

However, disorders in the formation of the spinal column in children can also occur postnatally - this is the basis, in particular, for the osteopathic hypothesis of the development of postural disorders. Its supporters believe that for some reason the child has an asymmetric growth of the vertebrae, which leads to their wedge-shaped deformation. However, the contradiction lies in the fact that not all patients with congenital or acquired wedge-shaped deformities subsequently develop postural disorders or scoliosis.

A number of authors believe that functional asymmetry caused by uneven development of muscles, leading to relative discoordination of movements in children of preschool and primary school age, can lead to a violation of posture, which, of course, affects the electrical activity of muscles in general and paravertebral, in particular, being one of the causes of spinal defects. Muscle asymmetry is detected by electromyography, even in children with normal posture (Nikityuk B.A., 1989; McCarrollJ.R.etal., 1995). That is, in this case, we can talk about the presence of a hidden form of posture violation with its possible transition to an explicit form. However, in modern literature there is no convincing evidence that this asymmetry is not a cause, but a consequence of skeletal deformities.

The genetic theory of the development of postural deformities states that their formation occurs under the influence of genetically determined disorders in the development of the neural tube in embryogenesis. In addition, the role of some metabolic disorders is noted - for example, disorders of the metabolism of glucosaminoglycans.

As you know, the decisive factor in the formation of correct posture is the development of skills to maintain an upright position of the body and walking. In this regard, it is necessary to point out the obvious etiological role of the violation of the staging of the development of postural tonic reflexes of the brain. The natural ontogenesis of human motor skills is due to the incompleteness at the time of birth of the myelination of the pathways, the degree of which decreases from the trunk to the cortex. The motor development of a healthy child in the most general view It is characterized by the successive displacement of primitive cervical and vestibular tonic trunk reflexes, which ensure the intrauterine posture and optimal passage of the fetus through the birth canal, by midbrain adjusting reflexes that determine the normal position of the body or its elements in space and relative to each other. The latter serve as the basis for the formation of antigravitational striopallidar synergies of sitting, getting up and standing. Only with the beginning of the functioning of the pyramidal system does it become possible to move the segments of the trunk and limbs in isolation. Each successive transition to a higher level of movement construction is almost always accompanied by the suppression of a certain part of the motor skills of the previous level. If this process is disturbed for some reason, a conflict arises between reflexes of different phylogenetic age, giving rise to anomalous and often asymmetric muscular-tonic settings that form very typical deformations of the skeleton of a growing organism.

Studying posture disorders in children with the so-called "functional" pathology of the musculoskeletal system, V. Janda (1978) was one of the first to draw attention to the accompanying mild neurological symptoms, which he defined as "microspasticity" and poor motor stereotype. The movements of these patients were awkward and uncoordinated. The author came to the conclusion that these patients had dysneuro-ontogenetic disorders in childhood. He described several syndromes characteristic of such patients. Upper cross syndrome is characterized by an imbalance between the following muscle groups:

Shortening of the upper part of the trapezius muscle, the levator scapula muscle, and scalene muscles, one side; and relaxation of the lower part of the trapezius muscle, the anterior serratus muscle on the other;

Shortening of the pectoralis major and minor muscles, on the one hand, and relaxation of the interscapular muscles, on the other;

Shortening of the deep neck flexors (m. longus colli, m. longus capitis, m. omochyoideus, m. thireochyoideus) - on the one hand, and relaxation of its extensors (cervical m. erector spinae, upper part of the trapezius muscle) - on the other;

This causes the neck and shoulders to move forward, often with increased thoracic kyphosis and cervical lordosis.

In the case of the lower cross syndrome, we are talking about an imbalance of the following paired muscle groups:

relaxation of the gluteus maximus muscle and shortening of the hip flexors (iliopsoas muscle, rectus quadriceps femoris muscle);

relaxation of the abdominal muscles and shortening of the lumbar part of the rectifier of the spine;

relaxation of the hip abductors and external rotators and shortening of the hip adductors and internal rotators.

The patient tends to have lumbar or lumbosacral hyperlordosis, bulging of the abdomen, and flaccid gluteal muscles.

The syndromes of posture disorder described by V. Janda K.B. Petrov adds the following observations of his own. If the process of formation of chain extensor (adjustment) reflexes is delayed or has a surrogate character, the muscles of the neck and upper body remain weak for a long time. The lack of timely conditions for setting the head in the correct physiological position (the plane of the oral cavity should be parallel to the horizon line) contributes to the formation of thoracic hyperkyphosis (“round back”) and “pterygoid scapulae”, which are characteristic only for postural disorders in childhood (Fig. one).

Rice. 1. Syndrome of pterygoid scapulae in a child, as a result of a “conflict” between stem tonic and midbrain adjusting reflexes

The inability to adequately hold the upper body in an upright position due to moderate labyrinth hypertonicity of the iliopsoas muscles leads to lumbar hypolordosis ("flat loin"). If the tone of the muscles surrounding the hip joints remains elevated for a long time due to the influence of the vestibular tonic reflex, during the formation of the walking skill, vicious compensation develops in the form of excessive movements in the trunk joint (“wagging gait”). In this case, the transfer phase of the step is performed not by flexing the hip in the hip joint, but by contralateral rotation of the entire pelvis and cranial displacement (lifting) of its corresponding half. As a rule, "flat loin" and "wagging gait" are steadily combined with each other and can be isolated as a separate syndrome.

The above neurological disorders, on the one hand, can influence the formation of physiological curves of the spine in childhood, on the other hand, they serve as a premorbid background that exacerbates the weakening of postural muscles in age-related and dyshormonal (for example, as a result of pregnancy or menopause) disorders in adults.

In addition, according to pediatricians, among the reasons that can lead to posture disorders, a significant place is given to inadequate muscle tone, which often occurs in a maladaptive state of the psyche. In the study of children with the initial stage of postural disorders, M.V. Kiseleva (1994) established a high level of personal anxiety, which reflects the presence of long-term stagnant foci of internal emotional stress.

A special group of children with posture disorders is represented by young athletes who develop spinal curvature depending on the type of sport and experience of training. Posture disorders in boxing children can occur in both the frontal and sagittal planes. The position taken by the rower, fencer, shooter, the predominance of the load on the jumping leg in jumpers, the attacking arm in volleyball players, the development of excessive flexibility in rhythmic gymnastics are factors contributing to the occurrence of various posture disorders.

Also, acquired posture disorders in children can be formed due to rickets, tuberculosis, poliomyelitis, spinal fractures, osteomyelitis, hallux valgus deformity, flat feet, osteochondropathy, deforming scars on the back, shortening of one limb, etc.

Quite often, children suffering from myopia, astigmatism, strabismus or hearing loss are forced to take the wrong posture during work in order to compensate for the defect in visual or auditory perception.

Predisposing factors for the formation of postural disorders in children are also weak physical development, improper regimen, malnutrition or obesity, somatic weakness of the child, lack of intake of microelements and vitamins into the body.

In 1962, a classification of types of posture disorders in children was adopted, taking into account changes in the frontal or sagittal planes, which is often used today. According to this classification, the following types of posture disorders are distinguished:

1. Violation of posture in the frontal plane.

2. Violation of posture in the sagittal plane: - stooped back;

Round back;

Rounded back;

Flat back;

Flat back.

The clinical picture of postural disorders varies depending on the plane of curvature.

Posture disorders in the frontal plane (scoliotic posture)

Clinically, scoliotic posture is manifested by a violation of the symmetry of the back: different levels shoulder girdle, unequal waist triangles, misalignment of the shoulder and pelvic girdle, deviation of the spine to the side. It is very important to identify all asymmetries in the early stages, as this may be a precursor to the development of scoliosis.

Posture disorders in the sagittal plane

Violations of posture in the sagittal plane consist in strengthening or smoothing of the normal curves of the spine.

Slouch - violation of posture, which is based on an increase in thoracic kyphosis (forward bending of the spine) with a simultaneous decrease in lumbar lordosis (backward bending of the spine). To compensate for projection deviation common center masses backwards, children stand and walk on slightly bent legs. The angle of inclination of the pelvis is reduced and this also contributes to the flexion of the hip relative to the midline of the body. Shoulders are raised. Shoulder joints are shown. Stoop is often associated with pterygoid scapulae, when the lower angles or inner edges of the scapulae lag behind the chest wall. Belly protrudes.

Round back - violation of posture associated with a significant increase in thoracic kyphosis. Head tilted forward, shoulders raised, shoulder joints are given, the chest sinks, the arms hang slightly in front of the body. The round back is often combined with pterygoid shoulder blades. Belly protrudes.

With a round back, the ligaments and muscles of the back are stretched, and the pectoral muscles are shortened. With a round back, stretched weak ligaments and muscles of the back do not provide maximum extension of the spine, which reduces the depth of inspiration and respiratory excursion chest. The shortened muscles of the abdominal wall are poorly stretched and make it difficult for the excursion of the diaphragm, and this, in turn, reduces the VC. Inadequate chest excursion and the associated shallow breathing lead to a decrease in the suction force of the chest and impede the work of the heart. Due to the adverse effect of the round back on the functional state of the internal organs, it is necessary to start fighting this postural defect as early as possible, using both prophylactic agents and physical exercises. The neglected forms of a round back can become stable and very difficult to correct.

Circular back - violation of posture, consisting in an increase in all physiological curves of the spine. The legs are slightly bent or in a position of slight hyperextension at the knees. The abdomen protrudes, or even hangs down. The shoulder girdle is raised, the shoulder joints are adducted, the head is pushed forward from the midline of the body. The round-concave back is often combined with pterygoid shoulder blades.

flat back - violation of posture, characterized by a decrease in all the bends of the spine, in the first place - lumbar lordosis and a decrease in the angle of the pelvis. The chest is moved forward. Bottom part stomach will hold up. The shoulder blades are often pterygoid. This violation of posture adversely affects the state of the central nervous system when running, jumping and other sudden movements, causing it to concussion and microtraumatization.

Flat back - a violation of posture, consisting in a decrease in thoracic kyphosis with normal or increased lumbar lordosis. The cervical lordosis is often also flattened. The pelvis is displaced backwards. The legs may be slightly bent or overbent at the knees. Often combined with pterygoid scapulae. Similar clinical picture typical for hyperlordosis– increase in lumbar deflection.

The main types of posture disorders in the sagittal plane are shown in Figure 2.

Rice. 2 Types of posture disorders in the sagittal plane

Note: a - scoliotic posture, b - round back, c - violation of posture by the type of round-concave back, d - violation of posture by the type of flat back, e - violation of posture by the type of flat-concave back.

Posture disorders in the horizontal plane

In the horizontal plane, pathological posture is assessed by the turn of the shoulder, pelvic girdle or general torso torsion. Often these violations lead to a pronounced external defect.

The main sign of a violation of posture is the appearance of a standing child. With stooping, the head is tilted forward, the shoulders also move forward, the shoulder blades protrude, the buttocks are flattened. In children with kyphotic posture, there is a forward tilt of the head, lowering of the shoulders, retraction of the chest, “wing-shaped” shoulder blades, legs half-bent at the knees, flattening of the buttocks, and weak muscle tone of the entire body. Kypholordotic posture disorder in children (round-concave back) is characterized by forward tilt of the head and upper shoulder girdle, protrusion and drooping of the abdomen (often visceroptosis due to weakness of the abdominal muscles), a large angle of the pelvis, maximum extension or overextension of the legs at the knees. In children with a flat back, the tilt of the pelvis is reduced, the chest is displaced anteriorly, “pterygoid shoulder blades” protrude, and the abdomen sags. Violation of posture in children according to the type of flat-concave back is accompanied by a narrow chest, an increase in the angle of the pelvis, protrusion of the abdomen and buttocks.

With an asymmetric posture in children, an arched deformity of the spine is noted with the apex facing left or right; head tilt to the side multi-level position of the shoulders, shoulder blades, nipples.

It should be noted that, in addition to spinal deformities, posture disorders in children to a large extent contribute to a change in the functioning of the lungs, heart, and digestive organs. So, a sunken flat chest and a stooped back limit the full excursion of the chest, make breathing superficial, which causes oxygen deficiency and a decrease in the level of metabolism. Children with impaired posture are lethargic, apathetic, suffer from poor memory, anemia, are prone to acute respiratory infections, bronchitis, pneumonia, and are prone to tuberculosis.

Due to excessive deflection in the lumbar spine, weakness of the abdominal muscles develops and, as a result, prolapse of the stomach and intestines, constipation. Children with posture disorders of various types may complain of back pain, fatigue, headaches, blurred vision. Posture disorders in children over time can lead to the development of degenerative changes in the spine (osteochondrosis), chest deformities, intervertebral hernias, scoliosis, deforming osteoarthritis.

Thus, when studying the most typical postural disorders, one should recognize the obvious etiological role of mild and moderately pronounced dysneuroembryological disorders, which entail underdevelopment of the vestibular apparatus, as well as other causes underlying developmental delay or distortion of adjusting reflexes in the first half of life. In addition, congenital pathologies of the vertebrae, sanitary and hygienic conditions, various diseases (rickets, tuberculosis, etc.), sports, etc. can play an important role. As a result, it can be summarized that posture disorders are polyetiological and, obviously, are characterized by different pathogenesis, depending on the leading cause. The clinical picture of a violation of posture depends on the plane of deformation. However, in addition to spinal deformity and impaired muscle tone, posture disorders lead to impaired functioning of internal organs, and may also predispose to the development of a number of diseases.

The development of the bone and joint system in preschool children

2.2 Development of the skeletal system in preschool children

The process of ossification. The skeleton of a child is laid down in the early uterine period and consists mainly of cartilage tissue. Even in the uterine period, cartilage tissue begins to be replaced by bone tissue. The process of ossification proceeds gradually, and not all bones of the skeleton ossify at the same time.

After the birth of the child, the process of ossification continues. The timing of the appearance of ossification points and the end of ossification are different for different bones. For each bone, these periods are relatively constant, so these periods can be used to judge the normal development of the skeleton in children and their age. The skeleton of a child differs from the skeleton of an adult in size, proportions, structure and chemical composition.

The development of the skeleton in children largely determines the development of the body, for example, the muscles develop more slowly than the skeleton grows.

There are two ways of bone development. Some bones develop directly from the mesenchyme (bones of the skull roof, face, and partly the clavicle, etc.) - this is primary ossification.

During primary ossification, skeletal mesenchymal syncytium is formed, in which osteoblast cells appear, turning into bone cells- osteocytes, and fibrils impregnated with lime salts and turning into bone plates. Therefore, bone develops from connective tissue. But most of the bones of the skeleton are first laid down in the form of dense mesenchymal formations, having approximately the outlines of future bones, which then turn into cartilage and are replaced by bones (bones of the base of the skull, trunk and limbs) - this is secondary ossification.

With secondary ossification, bone development occurs in place of cartilage outside and inside. Outside, the bone substance is formed by the osteoblasts of the periosteum. Inside the cartilage, an ossification nucleus arises, the cartilage resolves and is replaced by bone. The bone, as it grows, is resorbed from the inside by special cells called osteoclasts, and the bone substance is superimposed on the outside. The growth of the bone in length occurs due to the formation of bone substance in the cartilages, which are located between the epiphysis and the diaphysis, and these cartilages gradually shift towards the epiphysis. In humans, many bones are laid down in separate parts, which then merge into one bone, for example, the pelvic bone initially consists of three parts, which merge together by 14-16 years.

Tubular bones are also laid down in three main parts (not counting the ossification nuclei in the places of formation of bone protrusions), which then merge.

At the age of 4-5 years, bone beams appear in the upper epiphysis of the femur. After 7-8 years, bone trabeculae elongate and become homogeneous and compact. The thickness of the epiphyseal cartilage by the age of 17-18 reaches 2-2.5 mm. By the age of 24, the growth of the upper end of the bone ends and the upper epiphysis fuses with the diaphysis; the lower epiphysis grows to the diaphysis even earlier - by the age of 22.

By the end of puberty, the ossification of tubular bones is completed. With the end of ossification of tubular bones, their growth in length stops.

Lamellar bone develops from 5 months to 1.5 years, that is, when the child gets on his feet. During the 2nd year, most of the bone tissue has a lamellar structure, and by 2.5-3 years, the remnants of coarse fibrous tissue are no longer present.

Ossification is delayed with a decrease in the functions of the glands internal secretion(anterior part of the adiohypophysis, thyroid, parathyroid, thymus, genital), lack of vitamins, especially D. Ossification accelerates with precocious puberty, increased function anterior pituitary gland, thyroid gland and adrenal cortex. The delay and acceleration of ossification are especially clearly manifested before the age of 17-18 and can reach a 5-10-year difference between the "bone" and passport ages. Sometimes ossification occurs faster or slower on one side of the body than on the other.

Age features chemical composition and bone structure.

In children, the bones contain relatively more organic matter and less inorganic matter than those of adults. With age, the chemical composition of bones changes, the amount of salts of calcium, phosphorus, magnesium and other and other elements increases significantly, and the ratio between them changes. Calcium is retained in large quantities in the bones of young children, and phosphorus in older children.

With a change in the structure and chemical composition of bones, their physical properties change; in children they are more elastic and less brittle than in adults. Cartilage in children is also more plastic. Significant age-related differences are observed in the structure and composition of the bones, especially clearly in the number, location and structure of the Haversian canals. With age, their number decreases, and the location and structure change. How older child, the more dense the substance of the bone, and the younger, the more spongy. The structure of spongy bones by the age of 7 is similar to an adult. How younger child, the more the periosteum is fused with the bone, and the older it is, the more it is limited from the dense substance of the bone and by the age of 7 it is already limited from it.

Peculiarities of the skull in children.

The skull is the skeleton of the head. In accordance with the features of development, structure and functions, two sections of the skull are distinguished: cerebral and facial (visceral). The brain part of the skull forms a cavity inside which the brain is located. The facial region forms the bone base of the respiratory apparatus and the alimentary canal.

The medulla of the skull consists of a roof (or vault of the skull) and a base. The parietal bone of the cranial vault is a quadrangular plate with four serrated edges. Two parietal bones connected by sutures form the parietal tubercle. Front of parietal bones lies the frontal bone, most of which is represented by scales.

The convex part of the facial part of the skull is formed by the frontal tubercles, below which are the bones that form the walls of the orbits. Between the eye sockets is the nasal part, adjacent to the nasal bones, below which are the cells of the ethmoid bone.

Behind the parietal bones is the occipital bone, thanks to which the base of the skull is formed and the skull is connected to the spine. On the sides of the roof of the skull are two temporal bones, also involved in the formation of the base of the skull. Each of them contains the corresponding sections of the organ of hearing and the vestibular apparatus. At the base of the skull is the sphenoid bone.

The bones of the base of the skull, developed from cartilage, are connected by cartilage tissue, which is replaced by bone tissue with age. The bones of the roof, developed from the connective tissue, are connected by connective tissue sutures, which become bony in old age. This also applies to the facial region of the skull.

The facial region of the skull consists of the upper jaw, zygomatic, lacrimal, ethmoid, palatine, nasal bones, inferior nasal concha, vomer, mandible and hyoid bone.

Age features of the skull. Brain and facial department The skulls are formed from mesenchyme. The bones of the skull develop in a primary and secondary way. The skull of children differs significantly from the skull of adults in its size compared to the size of the body, the structure and proportions of individual parts of the body. In a newborn, the cerebral region of the skull is six times larger than the facial region, in an adult - 2.5 times. In other words, in a newborn, the facial region of the skull is relatively smaller. brain department. With age, these differences disappear. Moreover, not only the shape of the skull and its constituent bones changes, but also the number of skull bones.

From birth to 7 years, the skull grows unevenly. Three waves of acceleration are established in the growth of the skull: 1) up to 3-4 years; 2) from 6 to 8 years; 3) from 11 to 15 years old.

At the age of 3 to 7 years, the base of the skull along with occipital bone grows faster than the vault. At the age of 6-7 years, the frontal bone is completely fused. By the age of 7, the base of the skull and the foramen magnum reach a relatively constant value, and there is a sharp slowdown in the development of the skull.

The development of the lower jaw is directly dependent on the work of the masticatory muscles and the condition of the teeth. Two waves of acceleration are observed in its growth: 1) up to 3 years; 2) from 8 to 11 years old.

Head sizes in schoolchildren increase very slowly. At all ages, boys have a larger average head circumference than girls. The largest increase in the head is observed between the ages of 11 and 17, i.e., during puberty (for girls - by 13-14 years, and for boys - by 13-15).

The ratio of head circumference to height decreases with age. If at 9-10 years old the head circumference is on average 52 cm, then at 17-18 years old it is 55 cm. In men, the capacity of the cranial cavity is approximately 100 cubic meters. see more than women.

There are also individual features of the skull. These include two extreme forms of skull development: long-headed and short-headed.

Features of the child's spine.

The spine consists of 24 free vertebrae (7 cervical, 12 thoracic and 5 lumbar) and 9-10 non-free (5 sacral and 4-5 coccygeal). Free vertebrae, articulated among themselves, are connected by ligaments, between which there are elastic intervertebral discs made of fibrocartilage. The sacral and coccygeal vertebrae are fused to form the sacrum and coccyx. The vertebrae develop from cartilage tissue, the thickness of which decreases with age.

There are four stages in the development of the epiphyses of the vertebrae: up to 8 years - the cartilaginous epiphysis; from 9 to 13 years - calcification of the epiphysis; from 14 to 17 years old - bone epiphysis; after 17 years - the fusion of the epiphysis with the vertebral body.

From 3 to 15 years, the size of the lower lumbar vertebrae increases more than the upper thoracic. This is due to an increase in body weight, its pressure on the underlying vertebrae.

From the age of 3, the vertebrae grow equally in height and width; from 5-7 years old - more in height.

At the age of 6-8 years, ossification centers are formed in the upper and lower surfaces of the vertebral bodies and at the ends of the spinous and transverse processes. Up to 5 years, the spinal canal develops especially rapidly. Since the vertebral bodies grow faster than the arches, the capacity of the canal decreases relatively, which corresponds to a decrease in the relative size of the spinal cord.

The length of the spine increases especially sharply during the first and second years of life, then the growth of the spine slows down and accelerates again from 7 to 9 years (more in girls than in boys).

The mobility of the spine depends on the height of the intervertebral cartilage discs and their elasticity, as well as on the frontal and sagittal size of the vertebral bodies. In an adult, the total height of the intervertebral discs is equal to one fourth of the height of the movable part of the spine. The higher the intervertebral discs, the greater the mobility of the spine. The height of the discs in the lumbar region is one third of the height of the body of the adjacent vertebra, in the upper and lower parts of the thoracic region - one fifth, in its middle part - one sixth, in the cervical region - one fourth, therefore, in the cervical and lumbar regions, the spine has the greatest mobility.

The flexion of the spine is greater than its extension. The greatest flexion of the spine occurs in the cervical region (70°), less in the lumbar, and the least in the thoracic region. Tilts to the side are greatest between the thoracic and lumbar regions (100°). Greatest Roundabout Circulation observed in the cervical spine (75°), it is almost impossible in the lumbar (5°). Thus, the cervical spine is the most mobile, the lumbar is less mobile, and the thoracic is the least mobile, because its movements are inhibited by the ribs.

The mobility of the spine in children, especially 7-9 years old, is much greater than in adults. It depends on the relatively larger size of the intervertebral discs and their greater elasticity.

Physiological curves of the spine. After birth, the spine acquires four physiological curves. At 6-7 weeks, when the baby's head is raised, an anterior bend (lordosis) occurs in the cervical region. At 6 months, as a result of sitting, backward bends (kyphosis) are formed in the thoracic and sacral regions. At 1 year old, with the onset of standing, lordosis is formed in the lumbar region. Initially, these physiological curves of the spine are held by the muscles, and then by the ligamentous apparatus, cartilage and bones of the vertebrae.

By the age of 3-4 years, the curves of the spine gradually increase as a result of standing, walking, gravity and muscle work. By the age of 7, cervical lordosis and thoracic kyphosis are finally formed.

Due to the spring movement of the spine, the magnitude of its bends can change. As a result of changes in the curvature of the spine and the height of the intervertebral discs, the length of the spine also changes: with age and during the day. During the day, a person's height varies within 1 cm, and sometimes 2-2.5 cm and even 4-6 cm. In the prone position, the length of the human body is 2-3 cm longer than in the standing position.

Features of the chest of the child.

The chest is made up of 12 pairs of ribs. true ribs(the first - seventh pairs) are connected with the sternum with the help of cartilages, from the remaining five false ribs, the cartilaginous ends of the eighth, ninth and tenth pairs are connected to the cartilage of the overlying rib, and the eleventh and twelfth pairs do not have costal cartilages and have the greatest mobility, as they end freely . The second - seventh pairs of ribs are connected to the sternum by small joints.

The ribs are connected to the vertebrae by joints, which, when the chest is raised, determine the movement of the upper ribs mainly forward, and the lower ribs to the sides.

The sternum is unpaired bone, in which three parts are distinguished: the handle, the body and the xiphoid process. The handle of the sternum articulates with the clavicle with the help of a joint containing an intracartilaginous disk (by the nature of the movements, it approaches the spherical joints).

The shape of the chest depends on age and gender. In addition, the shape of the chest changes due to the redistribution of the force of gravity of the body when standing and walking, depending on the development of the muscles of the shoulder girdle.

Age-related changes in the formation of the chest. The ribs develop from mesenchyme, which transforms into cartilage in the second month of uterine life. Their ossification begins in the fifth - eighth week, and the sternum - in the sixth month. Ossification nuclei in the head and tubercle appear in the upper ten ribs at 5-6 years of age, and in the last two ribs at 15 years of age. The fusion of parts of the rib ends by the age of 18-25.

Up to 1-2 years, the rib consists of a spongy substance. From 3-4 years of age, a compact layer develops in the middle of the rib. From the age of 7, a compact layer grows along the entire rib

In the xiphoid process, the nucleus of ossification appears at the age of 6-12 years.

The shape of the chest. In humans, there are two extreme forms of the chest: long narrow and short wide. They also correspond to the shape of the sternum. Among the main forms of the chest, there are conical, cylindrical and flat shapes.

The shape of the chest changes significantly with age. After birth and for the first few years of life, the rib cage is cone-shaped with the base facing down. From the age of 2.5-3 years, the growth of the chest goes parallel to the growth of the body, in connection with this, its length corresponds to the thoracic spine. Then the growth of the body accelerates, and the chest becomes relatively shorter. In the first three years, there is an increase in the circumference of the chest, which leads to the predominance of the transverse diameter in the upper part of the chest.

Gradually, the chest changes its conical shape and approaches that of an adult, i.e., it acquires the shape of a cone with the base turned upward. The chest acquires its final shape by the age of 12-13, but is smaller than in adults.

Gender differences are also observed in the growth of the circumference of the chest. In boys, the circumference of the chest from 8 to 10 years old increases by 1-2 cm per year, by puberty (from 11 years old) - by 2-5 cm. In girls up to 7-8 years old, the chest circumference exceeds half the size of their growth. In boys, this ratio is observed up to 9-10 years, from this age half of the height becomes larger than the size of the chest circumference.

Exceeding half of the height above the circumference of the chest depends on the growth rate of the body, which is greater than the growth rate of the circumference of the chest. The growth of the circumference of the chest is inferior to the addition of body weight, so the ratio of body weight to the circumference of the chest gradually decreases with age. The chest circumference grows most rapidly during puberty and in the summer-autumn period. Normal nutrition, good hygienic conditions and physical exercise have a dominant influence on the growth of the chest circumference.

The parameters of the development of the chest depend on the development of skeletal muscles: the more developed skeletal muscle the more developed the chest

Improper seating of children at a desk can lead to chest deformity and, as a result, a violation of the development of the heart, large vessels and lungs.

Bone Development upper limbs.

The skeleton of the upper limbs includes the shoulder girdle and the skeleton of the hand. The shoulder girdle consists of the scapula and collarbone, the skeleton of the arm consists of the shoulder, forearm and hand. The hand is divided into the wrist, metacarpus and fingers.

The shoulder blade is a flat, triangular-shaped bone located on the back. The clavicle is a tubular bone, one end of which articulates with the sternum and ribs, and the other with the scapula. The costoclavicular joint appears in children from 11-12 years old; it reaches its greatest development in adults.

The arm skeleton consists of the humerus (shoulder skeleton), the ulna and radius (forearm skeleton), and the bones of the hand.

The wrist consists of eight small bones arranged in two rows, forming a groove on the palm and a bulge on its back surface.

The metacarpus consists of five small tubular bones, of which the shortest and thickest is the bone thumb, the longest is the second bone, and each of following bones less than the previous one. The exception is the thumb (first) finger, which consists of two phalanges. The other four fingers have three phalanges. The largest phalanx is proximal, the smaller is the middle, and the smallest is the distal.

On the palmar surface there are permanent sesamoid bones - inside the tendons between metacarpal bone the thumb and its proximal phalanx and inconstant - between the metacarpal bone and the proximal phalanx of the second and fifth fingers. The pisiform bone of the wrist is also a sesamoid bone.

The joints of the wrist, metacarpus and fingers are reinforced with a powerful ligamentous apparatus.

Age features of the development of the upper limbs. In a newborn, the clavicle is almost completely bone, the formation of a nucleus of ossification in its sternal region occurs at 16-18 years old, and merges with her body at 20-25 years old. Fusion of the nucleus of ossification of the coracoid process with the body of the scapula occurs at the age of 16-17 years. Synesthesia of the acromial process with her body ends at 18-25 years.

All long bones in a newborn, such as the humerus, radius, ulna, have cartilaginous epiphyses and bone diaphyses. There are no bones in the wrist, and cartilage ossification begins: in the first year of life - in the capitate and hamate bones; at 2-3 years old - in a trihedral bone; at 3-4 years - in the lunate bone; at 4-5 years old - in the navicular bone; at 4-6 years old - in a large polygonal bone; at 7-15 years old - in the pisiform bone.

Sesamoid bones in the first metacarpophalangeal joint appear at 12-15 years of age. At the age of 15-18, the lower epiphysis of the humerus merges with its body, and the upper epiphyses merge with the bodies of the bones of the forearm. In the third year of life, ossification of the proximal and distal epiphyses of the phalanges occurs. " Bone age» determine the centers of ossification of the hand.

Ossification of the bones of the upper limbs ends: at 20-25 years old - in the collarbone, scapula and humerus; at 21-25 years old - in the radius; at 21-24 years old - in the ulna; at 10-13 years old - in the bones of the wrist; at 12 years old - in the metacarpus; at 9-11 years old - in the phalanges of the fingers.

Ossification ends in men on average two years later than in women. The last centers of ossification can be found in the clavicle and scapula at 18-20 years old, in the humerus - at 12-14 years old, in the radius - at 5-7 years old, in the ulna - at 7-8 years old, in the metacarpal bones and phalanges fingers - in 2-3 years. Ossification of sesamoid bones usually begins during puberty: in boys - at 13-14 years old, in girls - at 12-13. The beginning of the fusion of parts of the first metacarpal bone indicates the beginning of puberty.

Features of the development of the pelvis and lower extremities. Skeleton of the lower extremities.

The pelvic girdle consists of the pubic, ilium, and ischium bones, which develop independently and merge with age to form a pelvis, posteriorly connected to the sacral spine. The pelvis serves as a support for internal organs and legs. Due to the mobility of the lumbar spine, the pelvis increases the range of motion of the leg.

The leg skeleton consists of the femur (thigh skeleton), the tibia and fibula (tibia skeleton) and the bones of the foot.

The tarsus is made up of the talus, calcaneus, navicular, cuboid, and three cuneiform bones. Metatarsus is formed by five metatarsal bones. The toes consist of phalanges: two phalanges in the first toe and three phalanges in the remaining fingers. Sesamoid ossicles are located, as in the hand, but are much better expressed. The largest sesamoid bone of the leg skeleton is the patella, located inside the tendon of the quadriceps femoris. It increases the shoulder strength of this muscle and protects the knee joint from the front.

Development of the pelvic bones. The most intensive growth of the pelvic bones is observed in the first three years of life. In the process of fusion of the pelvic bones, several stages can be distinguished: 5-6 years (the beginning of fusion); 7-8 years (pubic and ischial bones grow together);

The size of the pelvis in men is smaller than in women. Distinguish between the upper (large) pelvis and the lower (small) pelvis. The transverse size of the entrance to the small pelvis in girls changes abruptly in several stages: at 8-10 years old (it increases very quickly); at 10-12 years old (there is some slowdown in its growth); from 12 to 14-15 years (growth increases again). The anteroposterior size increases more gradually; from the age of 9 it is less than the transverse. In boys, both sizes of the pelvis increase evenly.

The development of the bones of the lower extremities. By the time of birth, the femur consists of cartilage, only the diaphysis is bone. Synostosis in long bones ends at the age of 18 to 24 years. The kneecap acquires the shape characteristic of an adult by the age of 10.

The development of the bones of the tarsus occurs much earlier than the bones of the wrist, the ossification nuclei in them (in the calcaneus, talus and cuboid bones) appear even in the uterine period. In the sphenoid bones, they occur at 1-3-4 years, in the scaphoid - at 4.5 years. At the age of 12-16, the ossification of the calcaneus ends.

The bones of the metatarsus ossify later than the bones of the tarsus, at the age of 3-6 years.

From the age of 7, the legs grow faster in boys. The greatest ratio of leg length to body is achieved in boys by the age of 15, in girls - by 13 years.

The human foot forms an arch that rests on the calcaneus and the anterior ends of the metatarsal bones. The general arch of the foot is made up of the longitudinal and transverse arches. The formation of the arch of the foot in humans occurred as a result of upright walking.

2.3 Formation of joints in children and their age characteristics

By the time of birth, the articular-ligamentous apparatus is anatomically formed. Newborns already have all the anatomical elements of the joints, but the epiphyses of the articulating bones consist of cartilage. The capsules of the joints of the newborn are tightly stretched, and most of the ligaments are characterized by insufficient differentiation of the fibers that form them, which determines their greater extensibility and lower strength than in adults. These features determine the possibility of subluxations, for example, the heads of the radial and humerus. The development of the joints most intensively occurs before the age of 3 years and is due to a significant increase in the motor activity of the child.

For the period from 3 to 8 years, the amplitude of movements in the joints gradually increases in children, the process of restructuring the fibrous membrane of the joint capsule and ligaments actively continues, and their strength increases.

At the age of 6-10 years, the structure of the joint capsule becomes more complicated, the number of villi and folds of the synovial membrane increases, and the formation of vascular networks and nerve endings of the synovial membrane occurs.

Chapter 3. Diseases of the bone and joint systems in preschool children and their prevention

As the child grows, the proportions of his body change, the skeleton is aligned. This long process begins in the womb and ends by 20-25 years.

A great influence on the formation of the musculoskeletal system is exerted by congenital features, external conditions, daily routine, nutrition, physical overload during sports activities, past illnesses and everything that introduces an imbalance into the balanced state of the muscular-ligamentous frame and spine.

Pathologies of the musculoskeletal system in preschool children.

In children of the first years of life there are congenital anomalies skeletal structures. Problems with the limbs are easily detected by a pediatrician during examination, but anomalies in the structure of the hip and spine are not always diagnosed on time, since in the first year of life they are still outwardly invisible.

About one in 60 newborns has some degree of hip instability. That is why screening of the hip joints in newborns is of great importance. Ideally, all children should be examined at birth, at 6–8 weeks, 6–8 months of age, and when the child begins to walk. This will reduce the number of late detections of hip dysplasia. Risk factors are family history, breech presentation.

If the hip is displaced long enough, it will eventually lock into that position. Clinically, it looks like this: the leg is shortened, turned outward, the femoral and gluteal folds are asymmetrical. On examination, there is a limitation of hip abduction during leg flexion. When walking, the child limps painlessly.

Transient synovitis, an acquired, rapidly transient inflammatory disease of the hip joint, occurs in children aged 3-8 years. Typically occurs due to viral infection and is the most common cause acute lameness in children of this age. More dangerous at this age (in 4-10-year-old children) is idiopathic aseptic necrosis of the epiphyseal part of the femoral head (Perthes' disease), in 10% of cases the lesion is bilateral. Boys get sick four times more often than girls. The child complains of pain in the hip or knee joints, lameness. Examination reveals flexion deformity of the joint and limited abduction. The diagnosis is confirmed radiologically, but in the early stages of the disease, there may be no changes on radiographs.

In children 4-11 years old, a painless cystic swelling sometimes occurs in the popliteal fossa, while the range of motion of the knee remains almost unchanged. cystic formation due to a semi-membranous bag, often communicating with the knee joint. This benign cyst disappears on its own, although occasionally if it causes concern or reaches large sizes requiring surgical treatment.

Minor foot deformities may be associated with other congenital malformations, especially of the hip or spine. In one of the most common types of deformity (1:100), the front surface of the foot is in a varus position (adduction) with simultaneous supination (flexion). The sole of such a foot looks like a bean, but in this case there is no horse foot, in which the child focuses only on the toes while walking. The foot is flexible and lends itself to passive correction. Most children recover without treatment. For more severe deformities, traction or splinting is sometimes required. The need for surgical correction is rare.

Clubfoot occurs in one in a thousand newborns, and boys are predominantly affected. Half of the cases are bilateral lesions. A clumsy child needs early specialized treatment with traction and bandaging from a sticky plaster or plaster, and a course of physiotherapy. About half of the cases (mainly when there is no fixed deformity) are treatable, in the rest - children require surgical correction in the first year of life.

Flat feet. Up to three years, all children have a flattened medial arch of the foot. A painless, flexible foot at an older age is also considered physiological norm. If flat feet are accompanied by pain, stiffness, and spasm, especially of the peroneal muscles, seek pathological cause this state. Congenital platypodia, as a rule, is expressed by a flat-valgus foot, later a calcaneal foot may develop when the child, while walking, focuses on the calcaneus with an elevated forefoot. This condition is determined even in the neonatal period, therefore, it requires the earliest possible correction. Acquired flat feet may be the result of rickets, sometimes combined with rachitic curvature of the lower extremities (valgus and varus deformities of the knee joints).

Posture disorders. By posture is understood the habitual posture of a person at rest and during movement. According to the classification of types of posture disorders (1962), there are: posture disorders in the frontal plane and posture disorders in the sagittal plane: flat back, flat-concave back, stooped back, round back, round-concave back.

Preschoolers often have a flaccid posture. One of the main reasons for the formation of a sluggish posture is the poor development of the child's muscles, his lack of physical activity, frequent or prolonged illness. A child with a sluggish posture can hardly maintain static postures, often changes the position of individual parts of the body. Such a child gives the impression of being tired, weak or ill. Signs of a sluggish posture: an increase in the cervical and thoracic curves of the spine; head slightly lowered; shoulders are lowered and moved forward; shoulder blades behind the back ("pterygoid" shoulder blades); the stomach sags; legs slightly bent at the knees.

For children of preschool age, normally developing, but poorly nourished, a slightly increased roundness of the abdomen and shoulder blades slightly behind the back are also characteristic. Often, sluggish posture is combined with various defects in the lower extremities, which is explained by the general weakness of the entire musculo-ligamentous apparatus. In the absence of correction, flaccid posture leads to more stable forms of deformities of the musculoskeletal system.

Prevention of diseases in preschool children of the bone and articular systems.

For the correct formation of the musculoskeletal system, great attention should be paid to the overall physical development of the child. Moreover, from the first months of life, when the spine and its physiological curves are formed.

For the development of the muscular corset, a child over three years old should be taught to regular physical education: teach them to swim, play football, jump rope, ski and skate. It is not recommended to send the child to sports sections early. As a rule, children over 5-6 years old are taken to sports, because at this age it is already possible to assess the level of physical fitness of the child and the presence of pathologies.

The state of the bone articular system throughout a person's life depends to a large extent on adequate physical activity. It is known that the vibration of the bone, which occurs during movement, promotes the absorption of calcium by osteoblasts - bone-forming cells. Systematic physical exercises contribute to the growth and strengthening of bones, increase the elasticity of ligaments and muscle tendons, and increase joint flexibility. Hypodynamia or a lack of motor activity lead to a slowdown in bone metabolism, impair the absorption of calcium and phosphorus, bone growth slows down, its structure is disturbed, and conditions are created for shape distortion under the influence of static loads. The lack of sufficient motor activity also negatively affects the state of the joints: it leads to loosening of the articular cartilage and changes articular surfaces bones, reduced synovial fluid, the appearance of pain during movement.

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Back pain can be experienced not only by the elderly, but also by teenagers and even infants. This pain can be caused by many reasons: both fatigue and all kinds of diseases that could develop over time or be from birth.

In order to better understand where pain sensations come from and what they can mean, as well as to know how to get rid of them correctly, information about the structure of the spine, its departments and functions will help. In the article we will consider the anatomy of this department, we will tell you in detail what functions the spine performs and how to keep it healthy.

The vertebral column has S-shape, thanks to which it has elasticity - therefore a person is able to take various poses, bend down, turn around and so on. If the intervertebral discs did not consist of cartilaginous tissue, which is capable of being flexible, then the person would be constantly fixed in one position.

The shape of the spine and its structure ensure balance and upright posture. The entire human body, its limbs and head “holds” on the spinal column.

The spine is a chain of vertebrae articulated by intervertebral discs. The number of vertebrae varies from 32 to 34 - it all depends on individual development.

Departments of the spine

The spinal column is divided into five sections:

Video - A visual representation of the structure of the spine

Functions of the spine

The spinal column has several functions:

• Support function. The spinal column is the support for all limbs and the head, and it is on it that greatest pressure of the whole body. The supporting function is also performed by discs and ligaments, however, the spine takes on the largest weight - about 2/3 of the total. This weight he moves to the legs and pelvis. Thanks to the spine, everything is combined into one whole: the head, and the chest, and the upper and lower limbs, as well as the shoulder girdle.
• Protective function. The spine performs the most important function - it protects the spinal cord from various injuries. It is the "control center" that provides correct work muscles and skeleton. The spinal cord is under the strongest protection: it is surrounded by three bone membranes, reinforced with ligaments and cartilage tissue. The spinal cord controls the work of the nerve fibers that depart from it, so we can say that each vertebra is responsible for the work of a certain part of the body. This system is very well coordinated, and if any of its components is violated, the consequences will reverberate in other areas of the human body.

• motor function. Thanks to the elastic cartilaginous intervertebral discs located between the vertebrae, a person has the ability to move and turn in any direction.
• damping function. The spine, due to its curvature, dampens the dynamic loads on the body when walking, jumping or traveling in transport. Thanks to such depreciation, the spinal column creates pressure opposite to the support, and the human body does not suffer. Muscles also play an important role: if they are in a developed state (for example, thanks to regular sports or physical education), then the spine experiences less pressure.

Detailed structure of the vertebrae

The vertebrae have a complex structure, with different parts spine, they may differ.

If you want to know in more detail what their functions are, you can read an article about it on our portal.

The vertebra consists of a bony bar, composed of an internal spongy substance, and an external substance, which is a lamellar bone tissue.

Each substance has its own function. Spongy substance is responsible for strength and good resistance, and compact, external, is elastic and allows the spine to withstand various loads. Inside the vertebra itself is the red brain, which is responsible for blood formation. Bone tissue is constantly renewed, due to which it does not lose strength for many years. If the metabolism is established in the body, then there are no problems with the musculoskeletal system. And when a person is constantly engaged in moderate physical activity, tissue renewal occurs more rapidly than with a sedentary lifestyle - this is also a guarantee of spinal health.

The structure of the vertebra

The vertebra consists of the following elements:

• vertebral body;
• legs, which are located on both sides of the vertebra;
• two transverse and four articular processes;
• spinous process;
• spinal canal in which the spinal cord is located;
• vertebral arches.

The vertebral body is in front. The part on which the processes are located is behind. The back muscles are attached to them - thanks to them, the spine can bend and not collapse. In order for the vertebrae to be mobile and not erased against each other, intervertebral discs are located between them, which consist of cartilage tissue.

The spinal canal, which is a conductor for the spinal cord, is made up of vertebral foramina, which are created due to the arches of the vertebrae attached to them from behind. They are necessary in order for the spinal cord to be as protected as possible. It stretches from the very first vertebra to the middle of the lumbar region, and then the nerve roots extend from it, which also need protection. There are 31 such roots in total, and they spread throughout the body, which provides the body with sensitivity in all departments.

The arc is the basis for all processes. The spinous processes extend backward from the arch and serve to limit the range of motion and protect the spine. The transverse processes are located on the sides of the arc. They have special openings through which veins and arteries pass. The articular processes are located two above and below the vertebral arch, and are necessary for the proper functioning of the intervertebral discs.

It is organized in such a way that the veins and arteries passing in the region of the spine, and most importantly, the spinal cord and all the nerve endings extending from it, are protected as much as possible. To do this, they are in such a dense bone shell, which is not easy to destroy. Nature has done everything to protect the vital parts of the body, and man can only keep the spine intact.

What are intervertebral discs?

Intervertebral discs are made up of three main parts:

• fibrous ring. This is a bone formation, consisting of many layers of plates, which are connected using collagen fibers. It is this structure that provides it with the highest strength. However, with impaired metabolism or insufficient mobility, tissues can become thinner, and if the spine is strong pressure, the annulus fibrosus is destroyed, which leads to various diseases. It also provides communication with neighboring vertebrae and prevents their displacement.
• Pulpous nucleus. It is located inside the fibrous ring, which tightly surrounds it. The core is a formation similar in structure to jelly. It helps the spine withstand pressure and supplies it with all the necessary nutrients and liquid. Also, the nucleus pulposus creates additional shock absorption due to its function of absorbing and releasing fluid.
  With the destruction of the fibrous ring, the nucleus can protrude - such a process in medicine is called an intervertebral hernia. Man experiencing severe pain, since the protruding fragment presses on the nerve processes passing nearby. The symptoms and consequences of a hernia are described in detail in other publications.
• The disc is covered from below and from above end plates, which provide additional strength and resilience.

If a intervertebral disc is destroyed in any way, then the ligaments located next to the spine and included in the spinal segment try in every possible way to compensate for the disruption of work - a protective function is triggered. Because of this, hypertrophy of the ligaments develops, which can lead to compression of the nerve processes and the spinal cord. This condition is called spinal stenosis, and the only way to get rid of it is through surgical treatment.

Facet joints

Between the vertebrae, in addition to the intervertebral discs, there are also facet joints. Otherwise, they are called arcuate. Neighboring vertebrae are connected using two such joints - they lie on both sides of the vertebral arch. The cartilage of the facet joint is very smooth, thanks to which the friction of the vertebrae is significantly reduced, and this neutralizes the possibility of injury. The facet joint includes in its structure the meniscoid - these are processes enclosed in the joint capsule. The meniscoid is the conductor of blood vessels and nerve endings.

Facet joints produce a special fluid that nourishes both the joint itself and the intervertebral disc, and also “lubricates” them. It's called synovial.

Thanks to such a complex system, the vertebrae can move freely. If the facet joints are destroyed, then the vertebrae will come together and undergo abrasion. Therefore, the importance of these articular formations is difficult to overestimate.

Possible diseases

The structure and structure of the spine is very complex, and if at least something in it stops working correctly, then all this affects the health of the whole organism. There are many different diseases that can occur in the spine.

Spine Health

Reading about numerous diseases, people are wondering: how to keep your spine in healthy condition? For this, there are certain preventive measures that are advised to adhere to people of any age.

• Take care of your posture: for this you can walk for 5-10 minutes a day with a book on your head, and outside the home just control the position of your back. You can set yourself a reminder on your smartphone in order to never forget about a straight back.
• Exercise. Going to the gym a couple of times a week or exercising at home will be beneficial if done correctly and in moderation.

• Watch your weight. Excess weight creates a strong load on the spine, and, in addition, brings a lot of other problems. It is better to get rid of it in time and control nutrition.
• Follow the removal of toxins. To do this, you need to drink plenty of water, as well as eat right. Due to the accumulation of toxins, the metabolism can slow down, which will lead to diseases of the spine.
• Avoid unnecessary weight lifting. It's best not to carry heavy objects unless you're prepared to do so.

Summing up

The structure of the spine is the most complex formation. Nature created musculoskeletal system so that all important parts of the body are protected. It remains for a person to maintain the health of the spine throughout life.

If you want to know in more detail, namely the lumbar region, you can read an article about this on our portal.

One of the most important structures of the human body is the spine. Its structure allows it to perform the functions of support and movement. The spinal column has an S-shaped appearance, which gives it elasticity, flexibility, and also softens any shaking that occurs when walking, running and other physical activities. The structure of the spine and its shape provide a person with the ability to walk upright, maintaining the balance of the center of gravity in the body.

Anatomy of the spinal column

The spinal column is made up of small bones called vertebrae. In total, there are 24 vertebrae connected in series to each other in a vertical position. The vertebrae are divided into separate categories: seven cervical, twelve thoracic and five lumbar. In the lower part of the spinal column, behind the lumbar region is the sacrum, consisting of five vertebrae fused into one bone. Below the sacral region there is a coccyx, which is also based on fused vertebrae.

Between two vertebrae adjacent to each other is an intervertebral disc of a rounded shape, which acts as a connecting seal. Its main purpose is to soften and absorb the loads that regularly appear during physical activity. In addition, discs connect the vertebral bodies to each other. Between the vertebrae there are formations called ligaments. They perform the function of connecting the bones to each other. The joints located between the vertebrae are called facet joints, which are similar in structure to the knee joint. Their presence provides mobility between the vertebrae. In the center of all vertebrae are openings through which the spinal cord passes. It contains nerve pathways that form a connection between the organs of the body and the brain. The spine is divided into five main sections: cervical, thoracic, lumbar, sacral and coccygeal. The cervical region has seven vertebrae, the thoracic region has twelve vertebrae, and the lumbar region has five. The bottom of the lumbar region is attached to the sacrum, which was formed from five vertebrae fused into a single whole. The lower part of the spinal column - the coccyx, has from three to five fused vertebrae in its composition.

Vertebrae

The bones involved in the formation of the spinal column are called vertebrae. The vertebral body has a cylindrical shape and is the most durable element that bears the main support load. Behind the body is the vertebral arch, which has the form of a semicircle with processes extending from it. The vertebral arch and its body form the vertebral foramen. The collection of holes in all the vertebrae, located exactly one above the other, forms the spinal canal. It serves as a receptacle for the spinal cord, nerve roots and blood vessels. Ligaments also participate in the formation of the spinal canal, among which the yellow and posterior longitudinal ligaments are the most important. The yellow ligament connects the proximal vertebral arches, and the posterior longitudinal connects the vertebral bodies behind. The vertebral arch has seven processes. Muscles and ligaments are attached to the spinous and transverse processes, and the superior and inferior articular processes appear in the creation of the facet joints.


The vertebrae are spongy bones, so they have a spongy substance inside, covered on the outside with a dense cortical layer. The spongy substance consists of bony crossbars that form cavities containing red bone marrow.

intervertebral disc

The intervertebral disc is located between two adjacent vertebrae and looks like a flat, rounded gasket. In the center of the intervertebral disc is the nucleus pulposus, which has good elasticity and performs the function of damping the vertical load. The nucleus pulposus is surrounded by a multilayer fibrous ring, which keeps the nucleus in central position and blocking the possibility of displacement of the vertebrae to the side relative to each other. The fibrous ring consists of a large number of layers and strong fibers intersecting in three planes.

Facet joints

The articular processes (facets) that participate in the formation of facet joints depart from the vertebral plate. Two adjacent vertebrae are connected by two facet joints located on both sides of the arch symmetrically with respect to the midline of the body. The intervertebral processes of neighboring vertebrae are located towards each other, and their ends are covered with smooth articular cartilage. Thanks to the articular cartilage, friction between the bones that form the joint is greatly reduced. Facet joints allow for various movements between the vertebrae, giving the spine flexibility.

Foraminal (intervertebral) foramen

In the lateral parts of the spine, there are foraminal openings created with the help of the articular processes, pedicles, and bodies of two adjacent vertebrae. The foramina serve as the exit point for nerve roots and veins from the spinal canal. Arteries, on the contrary, enter the spinal canal providing blood supply to the nerve structures.

Paravertebral muscles

Muscles adjacent to spinal column commonly referred to as vertebrae. Their main function is to support the spine and provide a variety of movements in the form of tilts and turns of the body.

Spinal motion segment

The concept of the spinal motion segment is often used in vertebrology. It is a functional element of the spine, which is formed from two vertebrae connected to each other. intervertebral disc, muscles and ligaments. Each spinal motion segment includes two intervertebral foramina, through which the nerve roots of the spinal cord, veins and arteries are removed.

cervical spine

The cervical region is located in the upper part of the spine, it consists of seven vertebrae. The cervical region has a forward convex bend, which is called lordosis. Its shape resembles the letter "C". The cervical region is one of the most mobile parts of the spine. Thanks to him, a person can perform tilts and turns of the head, as well as perform various neck movements.

Among the cervical vertebrae, it is worth highlighting the top two, bearing the name "atlas" and "axis". They received a special anatomical structure, unlike other vertebrae. The atlas (1st cervical vertebra) lacks a vertebral body. It is formed by the anterior and posterior arch, which are connected by bone thickenings. Axis (2nd cervical vertebra) has an odontoid process formed from a bony protrusion in the front. The odontoid process is fixed by ligaments in the vertebral foramen of the atlas, forming an axis of rotation for the first cervical vertebra. This structure makes it possible to carry out rotational movements of the head. The cervical region is the most vulnerable part of the spine in terms of the possibility of injury. This is due to the low mechanical strength of the vertebrae in this section, as well as a weak corset of the muscles located in the neck.

Thoracic spine

The thoracic spine contains twelve vertebrae. Its shape resembles the letter "C", located in a convex curve back (kyphosis). The thoracic region is directly connected to the posterior chest wall. The ribs are attached to the bodies and transverse processes of the thoracic vertebrae through the joints. With the help of the sternum, the anterior sections of the ribs are combined into a strong integral frame, forming the chest. The mobility of the thoracic spine is limited. This is due to the presence of the chest, low altitude intervertebral discs, as well as a significant long spinous processes of the vertebrae.

Lumbar spine

The lumbar region is formed from the five largest vertebrae, although in rare cases their number can reach six (lumbarization). The lumbar spine is characterized by a smooth forward curvature (lordosis) and is the link connecting the thoracic region and the sacrum. The lumbar region has to experience considerable stress, as it is under pressure top part body.

sacrum (sacral region)

The sacrum is a triangular bone formed by five fused vertebrae. The spine is connected to the two pelvic bones through the sacrum, located like a wedge between them.

Coccyx (coccygeal region)

Coccyx - lower section spine, which includes from three to five fused vertebrae. Its shape resembles an inverted curved pyramid. The anterior sections of the coccyx are designed to attach muscles and ligaments related to the activity of the organs of the genitourinary system, as well as remote sections of the large intestine. The coccyx is involved in the distribution of physical load on the anatomical structures of the pelvis, being important point supports.