AFAB II- Exam 1 Flashcards
3 divisions of a vertebrae:
The ______ ________ is anterior primary, weight-bearing component
vertebral body
3 divisions of a vertebrae:
The ________ _______ include the transverse/spinous processes, laminae, and articular processes
posterior elements
3 divisions of a vertebrae:
With the _________, the bridge connects to the body-posterior elements; they are also thick and strong
pedicles
3 divisions of a vertebrae:
The _________ transfer muscle forces applied to the posterior elements for dispersion across the body/disc
pedicles
The spinal curves provide ______ and ________ (spring like)
strength; resilience
Spinal curves are vulnerable to what???
shear forces at transitions
Spinal curves are involved with :
______ position
____ deposition
_______ strength & endurance
connective tissue __________
_______ supported by the body
_______ of facets, ________ bodies, and ________
limb
fat
muscle
extensibility
loads
shape; vertebral; discs
_________ ________ : ant lamina to posterior lamina, end ROM flexion, 80% elastin, posterior to spinal cord
A. Interspinous ligament
B. Ligamentum Flavum
C. ALL
B.
_________ ________: between adjacent spinous processes; blends with LF – more elastin; more superficial more collagen and blend with SS lig, fiber direction varies – L/S
A. Supraspinous ligament
B. PLL
C. Interspinous ligament
C.
_________ _________: between tips of spinous processes; resist separation – flexion; less developed in L/S
A. Supraspinous ligaments
B. ALL
C. Intertransverse ligaments
A.
__________ _____________: are thin, taut in contralateral flexion
A. PLL
B. Supraspinous ligaments
C. Intertransverse ligaments
C.
The ________ is long, strong strap, occiput to sacrum, fibers into and reinforce anterior disc
A. PLL
B. ALL
B.
Which ligament is on the posterior surfaces of vertebral bodies C2-sacrum (in canal) and blends with and reinforces posterior discs?
PLL
Which ligaments cover the entire rim of facets, connect and stabilize, and are reinforced by adjacent muscles (multifidus)?
Capsular ligaments
Which ligaments go with each Axis of Motion?
- ALL
- PLL
- Ligamentum Flavum
- Interspinous Lig.
- Supraspinous Lig.
- Intertransverse Lig.
- Facet (zygoapohysial) joint capsules
Label These
- Interspinous Lig.
- Capsular Lig.
- Ligamentum Flavum
- ALL
- PLL
- IAR
______ _______ is a loss of intervertebral stiffness that can lead to abnormal and increased intervertebral motion
spinal instability
The ________ ________ is The amount of intervertebral movement that occurs with the least passive resistance from the surrounding tissues (minimal stiffness zone)
neutral zone
With the neutral zone, chronic ________ can cause further injury
instability
Core stability can also be viewed from a _________ level as well as the whole spine
segmental
What happens when the neutral zone is larger than normal?
the spinal segments become unstable
*there will be more slide, glide, and rotation between the vertebrae
The neutral zone has been found to increase with ______ and _________ and decrease with ______ ______
injury; degeneration
muscle force
With injury (DDD) the _____ ______ pattern changes and influences the motion of the whole spine, potentially causing pain and _________
vertebral motion; hypermobility
Which of the 3 subsystems…. consists of the bony structures, ligaments, joint capsules, discs, and passive portion of the musculotendinous units. This system is thought to send feedback to the neural subsystem about joint positions and challenges to stability at the passive level
passive system
Which of the 3 subsystems….
is composed of the muscles and tendons and is the subject of the core exercises later
active system
Which of the 3 subsystems….
receives and transmits information from and to the other two systems to manage spinal stability. Neuromuscular control can be compromised in patients with LBP and must be considered in a core stabilization program
neural subsystem
Lumbopelvic Structure and Design is an example of what type of stability?
Passive
Neural Mediation is an example of what type of stability?
Neural
Muscular Force Transfer is an example of what type of stability?
Active
Marked or chronic instability causes further injury to where?
local ligaments
facets
discs
Marked or chronic instability can result in loss of P! free _____
ROM
Thoracic vertebrae: 2-9 Have a ________ pointing SP
downward
With the thoracic vertebrae 2-9, the sup/inf articular processes are oriented _________ and are aligned close to the ______ plane
vertically; frontal
With the thoracic vertebrae 2-9, the superior articular facets face ________
posterior
With the thoracic vertebrae 2-9, the inferior articular facets face ________
anterior
Thoracic vertebrae: 2-9 have a pair of ______ facets
costal
What are the atypical thoracic vertebrae?
T1, T10-12
T1 has full ______ attachment and ______
costal; demifacets
T10-12 has a full _______ attachment
costal
With the thoracic vertebrae:
It is larger; ____ shaped; and contains the _____ facets
heart; costal
What shape is the thoracic vertebrae?
circular
The TP’s of the thoracic vertebrae are
short or long?
contain articular facets for ____
long; ribs
The SP’s of the thoracic vertebrae, are long and point ______
inferiorly
The lumbar region has massive wide _____ for support
bodies
With the lumbar region, the TP’s project ________
A. medially
B. laterally
C. anterior-lateral
B. laterally
With the lumbar region, 1-4 disc are ____ and 5 is _____ and _______
thin; strong; thick
With the lumbar region, the _______ processes are off the sup. articular surfaces (posterior side)
mamillary
In the lumbar region, the articular facets are oriented ______
vertically
The lumbar facets are…
superior or inferior?
convex or concave?
faces medial to medial posterior or lateral to anterior-lateral?
superior
concave
medial to medial posterior
The lumbar facets are oriented closest to what plane in the upper L/S?
sagittal
The lumbar facets are oriented midway between the ______and ______ plane in the lower L/S
sagittal; frontal
In the lumbar region, the inferior articular processes are
convex or concave?
lateral to anterior-lateral or medial to medial-posterior?
convex
lateral to anterior-lateral
Diurnal Fluctuations in the discs:
When supine, there is ____ pressure that attracts water and ________ slightly when sleeping
low; swells
With durnal fluctuations, ____ forces push water out of the ____
WB; disc
With diurnal fluctuations, there is ___% in height change
1
With diurnal fluctuations, relating to age: as _________ reduces, water retaining reduces
proteoglycans (GAGs)
With diurnal fluctuations:
There is less __________ pressure
and the patient can have a dx of _________ disc
hydrostatic
degenerative
With diurnal fluctuations,
______ ________ shows : loss of distinction AF/NP, nuclear bulging, and loss of disc space
MR Imaging
What is this called?
T1- weight MR image
anterior spondylolisthesis of L5 on S1
With vertebral endplates, they are relatively _____ cartilaginous ______ that cover most of sup/inf surface of vertebral bodies
thin; caps
With vertebral endplates, the surface facing disc is _________ that binds directly and strongly to collagen in the ______
A. articular cartilage; NP
B. fibrocartilage; AF
C. tissue; AF
B. fibrocartilage; AF
With vertebral endplates, the surface facing bone is _______ __________ and becomes what…?
calcified; cartilage
weakly affixated to bone
The outer rings of the AF have ________ supply; there is limited healing at the ______
vascular; disc
With vertebral endplates, there is diffusion of _____ and _____
O2; glucose
Name These
- iliolumbar ligament
- anterior sacroiliac ligament
- sacrospinous ligament
- sacrotuberous ligament
- anterior longitudinal ligament
- iliolumbar ligament (deep part)
- interosseus ligament
- anterior sacrococcygeal ligament
Know this chart
With spine forces, the highest force is what?
bending over and picking up a box
With spine forces, the lowest force is what?
supine position
Which force applies the most stress on the disc?
A. leaned back
B. straight sitting
C. slumped
C.
Which force applies the least stress on the disc?
A. straight sitting
B. leaned back
C. slumped
B.
With IVD as a hydrostatic pressure distributor:
80% of load carried on the ________ joint in standing at L/Spine, 20 % _______ elements
intervertebral; posterior
With IVD as a hydrostatic pressure distributor:
The disc are designed as _______ _______- can handle the forces of what?
shock absorbers; BW & muscle activation
With IVD as a hydrostatic pressure distributor:
_____ _____ _______: biomechanical interaction water-based NP & annular rings
Load sharing system
With IVD as a hydrostatic pressure distributor:
________ loads push endplates inward to the _______
Compressive, NP
With IVD as a hydrostatic pressure distributor:
The _____ slowly deforms radially vs _____
NP; AF
With IVD as a hydrostatic pressure distributor:
Stretched rings of _______ and ________ create tension to resist/balance force, this is uniformly transferred to the _______ ________, then return when the load is _____
colagen; elastin
vertebral bodies
off
With IVD as a hydrostatic pressure distributor:
_________ resists a fast/strongly applied load; less resistance to slow or light compression (flexible low loads/rigid at higher loads)
viscoelastic
With ____° of thoracolumbar flexion, there is _____° of thoracic flexion and ______° degrees of lumbar flexion
85; 35; 50
Flexion or Extension?
EXT
Flexion or Extension
FLX
With ____° of thoracolumbar EXT, there is _____° of thoracic EXT and ______° degrees of lumbar EXT
35; 25; 10
Rotation is ____-_____° in the horizontal plane
25;35
Lateral Flexion to each side is ___-___°
25;30
Flexion or Extension?
FLX
FLX or EXT?
EXT
What motion is occuring?
Rotation to the left
What motion is occuring?
Lateral flexion to the right
What motion is occuring?
Rotation to the left
What motion is occuring?
Lateral flexion to the right
With increased lumbar spine lordosis, there will be excessive tilt in what direction?
anteriorly
With increased lumbar spine lordosis, an anterior tilt will cause excess stress on which muscles?
hip flexors (contractures) and back extensors
The AF has ___-____ concentric rings of ______ fibers and it is ____° from vertical
15; 25
collagen
65
The AF prevents _______, _______, and ________
distraction, shear, and torsion
With the AF, due to angulation @ ______% of ______ force to stretch ______ ; in the direction of the force
90
torsion
fibers
With the AF, it entraps/encases _____-______ nucleus
liquid; based
With the AF: it is ___-_____% collagen and (____-____%) in nucleus)
50;60
15;20
With the AF, the elastin is interspersed parallel to the rings of collagen, this is called _______ ________?
circumferential elasticity
With the AF, the outer layers disc is only ________ nerves, it binds to the _____/______
spinal; ALL; PLL
With the AF, the outer layer is more ______ and the inner layer is more ______
collagen; water
Flexion is a reversal of _______
lordosis
With flexion, the discs move _______
anteriorly
With extension, the disc move _______
posteriorly
With flexion, the inferior articular facets slide _____/______
superior/anterior
With flexion, there is compression on the _______ aspects of disc and bodies
anterior
With flexion, the ______ and _____ change size
foramina and canal
With flexion, this stretches the ______ ligaments and causes the _____ to migrate in a posterior direction
posterior; NP
With extension, the inferior articular facets slide _____/_______
inferior; posterior
Hyperextension can cause the tips of the inf articular process to contact the ______ _______…this can cause damage and compress the ________ ligaments
adjacent lamina
posterior
With extension, the size of the intervertebral foramina is ______ and the nucleus presses _______
reduced; anterior
Full ______ _______ has been shown to reduce pressure within the disc and reduced contact pressure between disc materials and neural tissues… this also known as what?
lumbar extension
centralization
Axial rotation is ___-___-° each side
5;7
With rot to the R , the _____ inferior facet _______ and R inf _____/______ from R sup. facet
left
approximates
gaps; distracts
With axial rotation, there is a bony rotation due to ________ of the facets
alignment
With LF, one side of the facets slide ______ and the other side ________
superiorly; inferiorly
Inspiration of the ribs move how??
This creates slight __________ in the T/S
upward/outward (bucket handle) or post/sup’
extension
Expiration of the ribs moves how??
This creates slight _______ in the T/S
down/inward or ant/inf
flexion
What is contracting or tight in posterior pelvic tilt?
Contraction of the hip extensors/abs
Lumbar spine kinematics
3 degrees of freedom:
Flexion: ___-____° ( )
Extension: ___-_____°
Axial Rotation: ___-___°
LF: ____°
45; 55
15; 25
5; 7
20
Structures that resist shear at L5/S1
1.
2.
3.
4.
5.
Shear
- Disc
- Capsule of facets
- ALL
- Wide and sturdy facets (frontal plane)
- Iliolumbar ligaments
With structures that resist shear at L5/S1:
The iliolumbar ligaments- inf aspect of __-__ AND _______ _________—> inf. to the _____/anterior to ______ and upper lat. sacrum- is a firm anchor between ____ and _____/sacrum
L4; 5
quadratus lumborum
ilium
SIJ
L5
ilium
__________ refers to symptoms returning toward the origin of pain or resolving completely
centralization
__________ refers to symptoms of pain or numbness/tingling traveling away from the pain
peripheralization
_______ ________ is the The kinematic relationship between the spine and hips during sagittal plane motions
lumbopelvic rhythm
With lumbopelvic rhythm, pay attention to the pattern and _______ ______ recruitment pattern- this could help address dysfunctions
trunk extensor
Variations for lumbopelvic rhythm:
____° lumbar/ ____° hip (pelvic-on-femoral)
Usually 3 phases: ________ flexion; ________ flexion and ______ flexion- mostly hip flexion
Limited hip _______ and limited _______ flexion
45; 60
lumbar; lumbar; hip
flexion; lumbar
With lumbopelvic rhythm:
A normal kinematic strategy used to flex the trunk from a standing position, incorporating a near simultaneous ____ degrees of flexion of the _____ spine and ___ degrees of hip (______-on-______) flexion
45; lumbar; 60
pelvic; femoral
With lumbopelvic rhythm:
With limited flexion in the hips (for example, from tight ________), greater flexion is required of the ______and ______ thoracic spines
hamstrings
lumbar; thoracic
With lumbopelvic rhythm:
With limited lumbar mobility, greater flexion is required of the _____ ______
hip joints
What are the regions SIJ pain can occur?
L5-S3 spinal n.
less often L4-S2
Pain with SIJ can occur in the
ipsilateral _____ _____
medial ________
________
long _______ ligaments
lower lumbar
buttocks
PSIS
SIJ
Thoracolumbar fascia plays an important in _______ ________ of the low _____ and _______
mechanical stability
back; SIJ
Thoracolumbar fascia is most extensive in the ______ _______
lower back
With the thoracolumbar fascia, the anterior and middle layers are anchored to the _______
TPs
The posterior layers of the thoracolumbar fascia are attched to the _____, ______, lat, and _______
SP; L/S; PSIS
The sacral joint surface is ____-shaped or ____-shaped; vertical, ______, and horizontal long arm
Ear; L
short
Sacral articular cartilage is normally ____ and _____
white; smooth
Hyaline cartilage is ___-___ mm
1; 3
With the sacral joint surface, interlocking contours prevent _______ ________ of the scarum
downward gliding
The sacral joint surface has ________ ridges and ______ that are matched by reciprocal shapes on the ______-
irregular; depressions; ilium
The articular surface of the sacrum is twisted _____ _____ _____
from above downwards
The SIJ- ilia side is mainly ____________
fibrocartilage
The SIJ is a ________ joint
synovial
SIJ- the joint capsule has 2 layers, external _____ layer, and inner ______ layer
fibrous; synovial
When the iliac crests move on scarum = ________ motion/ ________
innominate motion; iliosacral
When the sacrum moves on the iliac crests (innominates) = _______ ________
sacroiliac motion
SIJ-sacrum 3 planes of motion: ____/____/____/____
FLX
EXT
LF
ROT
Motion occuring within the pelvis:
______ _____ is full nutation, standing when ______- gravity/ligs/muscles
close packed
loaded
Motion occuring within the pelvis:
When _____- it is unloaded or ______ ______ the sacrum tends to return to ____________ or less stable
supine; open packed
counternutation
Anterior/forward motion or ________ causes _______ of the sacrum
nutation; flexion
Posterior; backward motion or __________ causes _________ of the sacrum
counternutation; extension
Bilateral motion of the sacrum occurs with ______/_______ bending of the trunk
forward; backward
Unilateral motion of the sacrum occurs with _______/_________ of the LE’s
flexion; extension
Sacral _________ :is when the sacral base moves posteriorly and superiorly; glides _______ along the long arm and _______ up the short arm
counternutation
anteriorly
posteriorly
With counternutation of the sacrum, the motion is resited by the _____ ______ ______
long dorsal ligament
Sacral ________: is forward motion of the sacral promontory into the pelvis- coronal axis…________ and ________
nutation
anteriorly; inferiorly
With nutation of the sacrum, it glides ________ down the ______ arm and __________ along the ______ arm
inferiorly
short
posteriorly
short
With nutation of the sacrum, the motion is resisted by ______ shape of sacrum, ______/depressions in joint surface, ________ and sacrotuberous ligaments
wedge
ridges
interosseous
The _____ ramus forms nerves that innervate muscles/joints/skin of the posterior trunk and neck
dorsal
The _______ ramus generally forms nerves to innervate muscles/joints/skin of ant/lat neck, and extremities
ventral
Trunk motion bilaterally is pure _____/______
FLX; EXT
Trunk motion unilaterally adds a component of _____ ______/_____
lat FLX; ROT
3 layers of musculature trunk?
Superficial
Intermediate
Deep
What are the 5 superficial back muscles?
Trapezius
Latissimus Dorsi
Rhomboids
Levator Scapula
Serratus Anterior
What are the 2 intermediate muscles?
Serratus posterior superior
Serratus posterior inferior
What are the 3 muscle groups within the deep layer of the muscles?
Erector Spinae Group (spinalis, longissimus, iliocostalis)
Transversospinal group (semispinalis muscles, multifidi, rotatores)
Short segments group (interspinalis muscles, intertransversarius muscles)
Multifidi Muscle Origin?
Posterior sacrum to C2
Multifidi Muscle insertion?
TP to SP 1 or 2-4 vertebrae above
The multifidi is the ________ and most developed in the _______ region, ___/____ of muscular ________ capacity
thickest
lumbar
2/3
stabilizing
The multifidi muscle fills the space between ____/_____
TP; SP
The multifidi muscle has a relatively large ____-_________ area
cross; sectional
The _______ muscles atrophy quickly with injury and P!
A. extensor
B. flexor
C. multifidi
C.
With the multifidi, the ______ and ______ ________ surround them
TA; thoracolumbar fascia
The intermediate layer: is deep to the ________ and _________; it is _____ and helps with __________
rhomboids; lats
thin
respiration
All superficial and intermediate muscles are considered _________
extrinsic
All superficial and intermediate muscles are innervated by the ______ rami/______
ventral; plexi
The superficial muscle group has bilteral help with _____ AND unilateral with ______ ________/________
EXT
Lat Flexion; ROT
The deep muscle group is innervated by the ________ rami and are considered _______
dorsal; intrinsic
The deep layer of muscles become progressively ______ and more ________
shorter; angulated
The ______ _______ experiences a number of morphological and neurophysiological changes following a ____ _____ injury
lumbar multifidus
low back
The lumbar multifidus experiences a number of morphological and neurophysiological changes following a low back injury
One of these changes is?????
segmental atrophy at the level of pathology
*more on the symptomatic side (as quickly as 24hrs. after injury)
With a disc injury, it is called ______ and it’s either ______ or ______ _______
HNP; posterior; posterior lateral
With a disc injury, it involves the ______ and fragments of dislodged ______
nucleus; endplates
With a disc injury, the _____ can stay inside ______
NP; AF
With a disc injury, it can _______ or ________ beyond the posterior rim of the ______ _______
bulge; protrude
vertebral body
With a disc injury, it can _______ through the ____ (and PLL)
herniate
AF
With a disc injury, it can _______ into the ______ space
extrude; epidural
With a disc injury, it can become lodged or break off and that is called _________
sequestration
The greatest injury risk during the sit-up arises if hip flexion occurs without….?
This may happen because of lack of _______ _______, ______ ______ dominance, or an inability to flex the ______ _______ (stiff spine)
trunk curl
abdominal strength; hip flexor; lumbar spine
When doing a sit-up…
Hip flexor without a trunk curl (lumbar flexion) causes dangerous ______ ______ forces from __________ of the lumbar spine
anterior shear
hyperextension
Fill in the blanks
abdominal
rectus abdominis
hip flexor
pelvic; femoral
Fill in the blanks
discs; spinal flexion
hip flexion
Fill in the blanks
trunk flexion; axial rotation
IO
rectus abdominis
axial rotation
_______ _______: is a separation in the abdomen that occurs when the tissue between the rectus abdominis muscles—the two sides of your “six pack”—stretches or tears at the central vertical line.
It’s most common in….?
Diastasis Rectus
pregnant women
______ _________ is when the portion of the whole movement segment is stabilized
Relative stabilization
Which group of muscles:
- Control precise alignment and stiffness
- High density muscle spindles
- Varying angles act as guidewires
short deep local muscles
Which group of muscles:
- Longer muscles
- Important torque generators
- Provide strong links between regions (cranium/spine/pelvis/legs)
global or extrinsic muscles
When the UE is lifted, it is preceded by ___ ____________
TA contraction
A _______ is when the nucleus migrates but remains contained in annulus
bulge
________ is when the nucleus migrates through the outer annulus
extrusion
_____ ______ is when the nucleus migrates and breaks away from the annulus
free sequestration
The ________ and ________ muscles:
-Extremely short length
- Crosses only 1 intervertebral junction
- Most developed in the cervical region
- Bilateral and blends with interspinous ligament
- Extension (IS) and lateral flexion (IT)
- Rich in muscles spindles – sensory feedback
interspinalis; intertransversarius
