There are anatomical, physiological, and functional pivots.

Anatomical pivots are the atypical vertebrae. They force segments of the spine to behave in specific ways due to their special anatomical shape. Anatomical pivots are: C2-L5-sacrum.

Fig. 5.5 Force polygon according to Littlejohn.

Littlejohn associated the atlas with the head and therefore did not consider it as a pivot.

Physiological pivots are located in between curvatures. that is, where a lordosis transitions into a kyphosis: C5-T9-L5.

Functional pivots are vertebrae that gain special significance because of their mechanical function. These are: C2/T4/L3:

• C2 is a pivot for the head. The extremely sensitive suboccipital musculature connects the OAA complex.

• T4 is a pivot because the head rotation reaches toT4-T5. In addition, T4 is an important intersection for Littlejohn's force lines.

• L3 is the lowest lumbar vertebra that is not directly connected by ligaments to the pelvis.

Because of their connection through the iliolumbar ligaments, L4 and L5 belong to the pelvis (similar to the connection of CI and C2 to the head). In addition, L3 is the gravitational center of the whole body for Suther

Fig. 5.6 Arches, double arches, and pivot vertebrae.

land. Dysfunctions of these pivot vertebrae are extremely common. Only in very rare cases are they manipulated in isolation. The associated arches should always be treated in conjunction.

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