The Global CTR Algorithms

And The Golden Ratio

By
PhD Staffan Norlander

2014 SEGMO GRAPGH AB

The Global CTR algorithms and the Golden Ratio

The Global CTR is a new application of the Cervico-Thoracic Ratio (CTR) and is used
to assess the upper thoracic sagittal balance by finding the rate of change of flexion
mobility between C7 and T5. This procedure is used to classify mobility distribution in relation to a perfect balanced spine. The upper thoracic spine is categorized as balanced
when the gravity line is intersected by an extension line, at level L5-S1 in the lumbar
spine and at level C3-4 in the cervical spine. The outcome is determined by a perfect
mobility distribution between C7-T3 versus T3-T5. A perfect balance is related to the
Golden ratio. Anomalies are defined as sagittal tension or sagittal compression syndromes,
respectively, depending on the distribution of mobility. The Global CTR graph shows the
measured balance as a superimposed graph, displayed on a stationary anatomical picture,
with a perfectly balanced spine. The graph can be altered between perfect and measured.

From Thieme Atlas of Anatomy,

General Anatomy and Musculoskeletal System,
Thieme 2005, Illustration by Karl Wesker

Figure 1. The Global CTR shows the measured balance compared to a theoretical perfect fit, in this case defined as a
sagittal tension syndrome and related to an increased segmental mobility C7-T3.

2014 SEGMO GRAPGH AB

Changes in posture, related to segmental mobility, are difficult to assess. A

measurement of the CTR presented as Global CTR and as the distribution of
segmental mobility, will provide a greater understanding of this difficult problem and also
aid in the choice of treatment. CTR holds great potential for the evaluation of spinal treatment effects to restore postural balance and to reduce neuro-musculoskeletal symptoms.

Figure 2. The CTR Graph shows the distribution of segmental mobility between C7- T5. This distribution corresponds
to a sagittal tension syndrome, mobility C7-T3 is increased mainly due to an extreme hypermobility at level T1-2.

In the following we will explain how the CTR measurements are related to the Golden Ratio
and how this relationship has lead us to develop the new Global CTR and also a treatment
strategy based on bio-tensegrity principles. This is described in the document, Balancing.
We will show how tensegrity principles are applied to proportions of spinal mobility and
how rate of mobility change relates to spinal arc length, thus function governs structure.

2014 SEGMO GRAPGH AB

Population mean value of upper thoracic mobility

In our measurements of the thoracic spine we use an algorithm based on distribution of
segmental mobility between C7-T5 and its close relationship to the Golden ratio. From the
measurement, referred to as a CTR measurement we calculate the derivative of mobility, and
from this outcome we will assess the relation to the gravity line at level L5-S1 and at level C3-4.
From our CTR measurements we have found an amazing concurrence to the Golden ratio
in the way mobility is distributed. The division of the whole segment C7-T5 into the larger
segment C7-T3 and a smaller segment T3-T5 results in an approximation of the Golden
ratio (C7-T3 )/(T3-T5 )=0.618/0.382=1.618. It seems to us that mobility distribution tends
to counterbalance the longer against the shorter segment. When this balance fails, motion
segment T2-3 may become dysfunctional and a thoracic sagittal imbalance has occurred.
This is evidently associated with pain and various other symptoms. We have also realized
that this measurable malfunction will influence the whole body in a number of practical ways.
Population mean values for CTR and CI 95% for male and female subjects.
Motion segment

Male

Female

C7-T3

0.619

0.612

T3-T5

(0.617-0.621)

0.381
(0.379-0.383)

(0.610-0.613)

0.388
(0.386-0.389)

Function governs structure

The geometric properties of the Global CTR operates with the fact that a biotensegrity structure
itself can control complex movements and also the opposite, as we have hypothetically stated;
mobility is related to uniform growth. Read more in the document, Geometric Organization.
In the new Global CTR graph the thoracic sagittal balance is assessed by using the small changes of central angles, in a unit circle, related to mobility. The outcome is enlarged by looking at the effect of these small changes of angles at a distant and also in relation to the function of the rectangular hyperbola 1/x. If you are
not familiar with the fundamentals of the original CTR method we recommend reading the document CTR, before continuing with details related to the Global CTR.

2014 SEGMO GRAPGH AB

However, we must start with describing the relationship between upper

thoracic mobility, the Golden ratio and the equation we use to calculate Global CTR
thoracic sagittal balance. If you are not interested in the mathematics you can continue your reading in the documents Interpretation, Clinical relevance and Balancing.

The rectangular hyperbola and Phi

The hyperbola is one of the conic sections, the curve represents the function f(x)=1/x. For
every x except 0, y represents its multiplicative inverse, xy=1. A CTR measurement is based on
the x-values of this function. The fact that mobility distribution within C7-T5 approximates the
Golden ratio has lead us to explore the quadratic equation related to Phi, an irrational number
1.618 represented by the Greek letter , Phi. Phi is a mathematical constant that describes a
continuous balanced proportionality or uniform growth. The same relationship is maintained
between different components no matter where they are in the structure. The Phi number is
commonly found in the structures of organic life. It is also linked to the principles of tensegrity.
The division of the whole spinal arc C7-T5 defined as (1) into a larger part C7-T3, defined
as (x), and a smaller part T3-T5 defined as (1-x), so that the smaller part forms the same
ratio with the larger part as the larger part does with the whole 1/x=x/(1-x) produces the
Golden ratio 1/0.618=0.618/(1-0.618)= 0.618/0.382=1.618. The Golden ratio is embedded in the Global CTR equation and reflects an erect posture. In simple terms, you can
say that proportions from flexion are reversed to the erect posture and shows the curvature of the spinal arc. This is done by using the reciprocal 1/x from our CTR x-values
in our equation. As 1/x is satisfied by the quadratic equation y-y-1=0 we have decided
to use x-x-1=0 and adding the reciprocals as mobility coefficients. Thus the mobility
coefficients included in the equation are: (C7-T5)/(C7-T3)=1/0.618=1.618 and (C7-T5)/
(T3-T5)= 1/0.382=2.618. This gives us the Global CTR equation and its relation to a perfect erect posture; 2.618x-1.618x-1=0. The roots of this equation is x=-0.382 and x=1.

2014 SEGMO GRAPGH AB

Figure 3. A CTR measurement relates to the flexion values on the x-axis of a rectangular hyperbola, while the erect Global
CTR values relates to the y-axis of the rectangular hyperbola.

If the measured proportion differs from the perfect Phi-proportion the positive root of the
equation will not equal one and the extension lines will not intersect the gravity line at the
exact levels, L5-S1 and C3-4. Thoracic sagittal imbalances will be shown as the measured
angular displacements and categorized as tension or compression syndromes, depending
on the outcome of C7-T3 versus T3-T5 mobility. Normal values with CI95% for female and
male subjects are presented. This will be explained in detail in the document Interpretation.

The Phi relationship of the spine

The Global CTR has explored the usefulness of the Golden ratio and we shall now have a
look at the secrets hiding within Phi. The derivation of our function gives d/dx=(2.618x1.618x-1)=5.236x-1.618. The root is x equals 0.309. The derivative is used to analyse
the rise and run relationship. Let us turn to the perfect derivative of the thoracic spine.

2014 SEGMO GRAPGH AB

Starting with C7-T1, the y-coordinate is defined as 1, so we plug in 1=5.236x-1.618 thereby

solving the equation where x equals 0.5. Level T5-T6 being defined as 0, plug in 0=5.236x1.618, thus x equals 0.309. Finally we look at the level were x intersects the y-axis at -1.618,
so plug in -1.618=5.236x-1.618 thus x equals 0, corresponding to motion segment T12-L1.
It is important to realize that the rate of change of mobility corresponds to uniform growth of the
spine, consequently the sagittal extent of the thoracic spine is harmonized with the rate of change
of thoracic mobility, i. e. function governs structure. You can also calculate the coordinates
for C0-1 (0.691, 2), the sagittal midpoint T8-T9 (0.191, -0.618) and S1-S2 (-0.309, -3.236).

From Thieme Atlas of Anatomy,

General Anatomy and Musculoskeletal System,
Thieme 2005, Illustration by Karl Wesker

Figure 4. The derivative y=5.236x-1.618 shows the rate of change of mobility between C7-T5. It also corresponds to
the uniform growth of the sagittal spinal arc length. The full spine is 2.618+1.618+1=5.236.

The Golden ratio keeps parts in proportion with the whole

So if we look at the derivative of mobility change versus height we find it corresponding to the height of cervical lordosis 1, kyphosis of the thoracic spine 2.618 and lumbar lordosis 1.618 for perfect spinal balance. Height of the spinal arcs governs the
curvature of the spinal column and the height is related to distribution of mobility.

2014 SEGMO GRAPGH AB

So the derivative of mobility will tell us if the spine is subjected to sagittal tension forces or sagittal compression forces, respectively. The total height of spinal column
is 5.236. The change on the x-axis is 1, so 1/(5.236 )=0.191. That is the reciprocal of (C7-T5)/T5= 1/0.191= 5.236. Proportionality between parts is maintained. The
neck is to the thoracic spine 1/2.618=0.382 and the lumbar spine is to the thoracic
spine 1.618/2.618=0.618, compare with the measured relationships within C7-T5.
The Golden ratio maintains a continuous relationship between different parts of the body
in a self-similar way and change of mobility is harmonized with the size of the structure.

The equilateral triangle of the thoracic inlet

The thoracic inlet is the superior opening of mediastinum. Together with the radius of our
unit circle at T5C7 and a radius at the firs rib, respectively, a perfect equilateral triangle can be fitted. The assessment of this region has significant clinical value and some
of our observations regarding symptoms in the arms and also forward head posture
will be discussed in the document Clinical relevance and in the document Balancing.
If we look at some bio-tensegrity characteristics we know that the Golden ratio allows rescaling and keeping proportions unchanged. So if we rescale the radius of our unit circle so the
side of our equilateral triangle is 5.236, the angel in the big triangle will subtend five smaller
equilateral triangles, corresponding to the radius of an upright posture, the starting position
of a CTR measurement C7-T5. Dividing this distance in five smaller segments will gives us
5.236/5 = 1.0472. This is the radian measure corresponding to the angel of 60 (1.0472 x
180)/. Consequently you can fit five smaller equilateral triangles along the side of the big.
If you look at thoracic inlet as a stable tensegrity structure you can state, that it is not
because of the individual vertebrae C7-T5 that the structure is stable. The compression
elements do not touch. It is rather the way the intervertebral disc together with the rib
cage and soft tissue, distributes and balances the mechanical stress within its tension
network that makes it stable. However if you change the mobility proportions within C7-T5
a change in compression-tension force will be spread within the icosahedral structure of
the thoracic inlet and we know that motion segment T2-3 has an important balancing role
in the C7-T5 arc, just like a key stone that locks the other pieces in place . The thoracic
cavity shows icosahedral properties. In the document Geometric Organization you can
read about how we hypothetically placed a regular icosahedron within the thoracic cavity.

2014 SEGMO GRAPGH AB

From Thieme Atlas of Anatomy,

General Anatomy and Musculoskeletal System,
Thieme 2005, Illustration by Karl Wesker

Figure 5. The equilateral triangle of the thoracic inlet is a tensegrity structure showing icosahedral properties. Motion
segment T2-3 plays an important balancing part.

The rate of change

The Global CTR function y=5.236x -1.618 = 0 describes the rate of change for the
measured mobility within C7-T5. This function seem to be valid to the uniform growth of
the whole body. If the line is extended to the whole body it tangents the back of the skull
superiorly and the big toe inferiorly. It passes through the centre of gravity at (-0.309, -3.236).
The rate of change of mobility relates to the size of the structure, through the golden ratio and
the rectangular hyperbola. It is this relationship that will be used in clinical practice to evaluate the thoracic sagittal balance. The angel between the horizontal line and the derivative is
79.2 or 1.382 radians. We have realized that when the slope of the line changes the compensation patterns in the human body takes place above and under the center of gravity. You can
continue your reading in the document Interpretation where these issues will be further discussed.

2014 SEGMO GRAPGH AB

Figure 6. The rate of change of mobility relates to the size of the structure, through the golden ratio and the rectangular
hyperbola.

2014 SEGMO GRAPGH AB