Biomechanical Low Back Pain Flashcards
Most people (%) will have resolution within … weeks of onset
90% and 6
musculotendinous
strains
ligamentous/capsular
sprains
primary afferent nociceptors
Group III nociceptors = thinly myelinated axons (Aδ-fibers)
Group IV nociceptors = unmyelinated axons (C-fibers)
Where are some places nociceptors are located?
in fascia around muscles, periphery of annulus fibrosus, longitudinal ligament, capsule joints, paraspinial ligaments, sacroiliac ligaments, periosteum
where are nociceptors not found
cartilage
How does strain/sprain activate mechanical nociceptors?
Broken fibers cause leaking potassium into the interstitial fluid. Blood extravasation from damaged blood vessels release bradykinin from plasma proteins, which then release PGs
Neuropeptides (calcitonin-gene-related peptide substance P) are liberated at the nerve endings
Vasodilation causing mechanical compartment pressure
Terminal ‘link’ (body part) moving is loose in space, free to move, NOT FIXED against a surface; (waving the hand; foot during swing phase of gait ex. leg curl lat pull down
Open kinetic chain
Terminal (distal) joint meets with some considerable external resistance which prohibits or restrains its free motion (feet planted on ground or solid object) ex. squat, pushup
closed kinetic chain
Connective tissue composed of irregularly arranged collagen fibers, distinctly unlike the regularly arranged collagen fibers seen in tendons, ligaments or aponeurotic sheets
fascia
5 functions of fascia
package, passage, power, protect, proprioception
What is function of thoraco lumbar fascia?
locomotion of the body meaning that it facilitates stabilizing the body, generating and releasing the forces required by the body to move effectively such that an individual is able to ambulate normally without falling.
What are three layers of thoracolumbar fascia?
Superficial = aponeurosis of lats/serratus
Deep = paraspinal reticular sheath surrounds erector spinae & multifidus; aponeurosis adheres to PSIS, border of sacrum
Middle = Passes between the paraspinal muscles and the QL resulting in formation of the Transverse Abdominis Muscle.
Anterior = anterior of the transverse processes of the lumbar spine and the anterior surface of the quadratus lumborum muscle
rhomboid of michaelis
Which muscles move the lumbar spine?
Latissimus Dorsi
External Oblique/Internal oblique
Serratus Posterior Inferior
Erector spinae: Iliocostalis; Longissimus; Spinalis
Tranversospinalis: Multifidus, Semispinalis
Deep Segmental: Interspinales, Intransversarii
Quadratus Lumborum
Psoas major
Origin, Insertion, Function, Innervation of lats
Origin: spinous process T7-12, L1-5, ribs 9-12, sacrum, posterior iliac crest, and inferior scapula
Insertion: intertubercular groove of humerus
Function: internal rotate, adduct, extend, respirate
Innervate: thoracodorsal (C6-C8_
Origin, Insertion, Function, Innervation of external oblique
origin: inferolateral ribs 5-12
insertion: anterior rectus sheath, linea alba, anterior iliac crest
Function - trunk flexion, rotate and breathing
Origin, Insertion, Function, Innervation of internal oblique
Origin: Deep layer T/L fascia, anterior/lateral surface of Iliac crest, ASIS, iliopsoas fascia
Insertion: Inferior borders of 10th to 12th ribs, Anterior & posterior layers of rectus sheath, linea alba
Function: same as external
Origin, Insertion, Function, Innervation of serratus posterior inferior
Origin: T11-L2 spinous processes & their supraspinous ligaments/thoracolumbar fascia
Insertion: Inferior aspect of Ribs 9-12
Function: inspiration
Origin and insertion sacrospinalis
Origin: Dorsal surface of sacrum, spinous processes of lumbar vertebrae, and iliac crest
Insertion: Divides into iliocostalis and longissimus muscles
Origin, insertion, function Iliocostalis Lumborum
Origin: Sacrum, iliac crest, superficial layer of T/L fascia
Insertion: 6th -12th ribs, deep layer of T/L fascia, transverse processes of upper lumbar
Action extends spine, SB spine to same side
Origin, Insertion, action longissimus lumborum
Origin: Sacrum, iliac crest common tendon from sacrospinalis, Lumbar spinous processes
Insertion: Transverse processes of lumbar vertebrae
Action: extends spine, SB spine to same side
origin, insertion, and action of Multifidus
Origin: Sacrum, ilium, mammillary processes L1-5
Insertion: Super medially to spinous process of vertebra 2-4 levels higher
Action: Side bends superior vertebrae to same side, Rotates to opposite side, Extends the spine
origin and action of interspinalis
Origin/ Insertion: spinous process of adjacent lumbar vertebrae
Action: extend the spine
Origin and action of intertransversarii
Origin/Insertion:
between adjacent transverse processes of ALL lumbar vertebrae
Action: Side bends superior vertebrae to same side , Stabilizes & Extends the spine
Origin, insertion, action quadratus lumborum
Origin: Iliac crest
Insertion: 12th rib, Transverse processes of L1-4
Action: Side bends the trunk to the same side
Elevates iliac crest, HIP HIKER ’
Iliopsoas
the joined psoas major and iliacus muscles where they insert on the lesser trochanter of the femur
Acts as the STRONGEST flexor of the hip
Psoas Major
Origin: Lateral surfaces of T12-L4 & the assoc. discs
Deep: L1-L5 transverse processes
Insertion: Lesser trochanter of femur
Action: Hip flexion; External rotation
Side bends Lumbar spine to same side
Forms the major connection between the sacrum and the ilium, Receives the greatest stresses of the ligaments associated with the sacroiliac joint
Prevents forward and downward movement of the sacrum, Protects the sacroiliac joint by preventing excessive backward movement
interosseous sacroiliac ligaments
connects the posterior-superior iliac spine and iliac crest to the sacrum.
provides considerable stability to the sacroiliac joint
posterior sacroiliac ligaments
calcification of anterior longitudinal ligament
DISH
this ligament has pain that can radiate towards groin
anterior longitudinal ligament
where does Dish usually start
thoracic spine
Illiolumbar Ligament
has no nerve fibers within, connects iliac crest to transverse processes of L5, stabilizes lumbosacral junction and SIJ
