DIAPHRAGM, ABDOMINAL WALL & PELVIC FLOOR Flashcards

1
Q

2 sets of connective tissue

A

rectus sheath

tfl - 3 layers

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2
Q

ABDOMINOPELVIC CAVITY

A
Superiorly: Diaphragm
Inferiorly: Pelvic
Posterior abdominal wall:
Psoas major Quadratus lumborum
Anterolateral abdominal wall:
External oblique abdominals Internal oblique abdominals Transversus abdominis
Anterior: Rectus abdominis
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3
Q

Diaphragm: structure

A

• dome shape with a central tendon
• right higher than left
* direct connection to lumbar vertical column

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4
Q

Diaphragm: attachments etc

A
Attachments:
L1,2 & 3; lower 6 costal cartilages & ribs superiorly = central tendon
Openings:
inferior vena cava (T8)
oesophagus (T10)
descending aorta passes behind (T12)
Innervation:
Phrenic nerves C3,4,5
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5
Q

Pelvic floor:

A

• Levator ani & coccygeus
• Support contents of the pelvic cavity
* if increase IAP, must maintain tone the pelvic floor

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6
Q

Psoas major:

A

posterior abdominal wall
Primarily a hip flexor
attachments:
• Anterior = from vertebral bodies / iv discs
• Posterior = from transverse processes
• Insert onto lesser trochanter of femur
• vertical orientation & close to joint axis…
• = COMPRESSION of lumbar spine
• small moment arms for flexion or extension
VERTICAL LOA
BIG PCSA - ATTACHES TO TRANSVERSE PROCESSES

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7
Q

Quadratus lumborum:

A
posterior abdominal wall
Attachments:
12th rib
lumbar transverse processes posterior iliac crest
Moment arms:
• Sagittal movements (F/E) = minimal QL
• Coronal movements (LF) = large
   EMG activity:
Active during flexion & extension activities Active during axial loading activities
Innervation: thoracolumbar ventral rami
NO SIGNIFICANT MA FOR EITHER ACTION
- ACTIVE DURING FLX AND EXT. THEREFORE NOT MOVER BUT INSTEAD STABALISER
- LARGE MA FOR LAT. FLX
COMPRESS FOR STABILITY
- LARGE PSCA
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8
Q

Anterolateral abdominal wall:

A
  1. External oblique abdominal
  2. Internal oblique abdominal
  3. Transversus abdominis
    • Movements • Increase IAP
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9
Q

External oblique abdominal

A

anterolateral abdominal wall
POSTEROSuperior attachment: external surface lower 8 ribs
ANTEROInferior attachment: linea alba via aponeurosis & anterolateral iliac crest Free posterior border
Innervation: T7-12 ventral rami
Action:
B = trunk flexion & increase IAP;
U = contralateral rotation, ipsilateral LF

GOOD MA, LARGE PCSA
INCREASES IAP

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10
Q

Internal oblique abdominal

A

anterolateral abdominal wall
Posterior attachment: TLF
Inferior attachment: anterolateral iliac crest, inguinal ligament
Superior attachment: lower 4 ribs & cartilages,
Anterior attachment:linea alba via aponeurosis
Innervation: T7 – L1 ventral rami
Action:
B = trunk flexion & increase IAP;
U = ipsilateral rotation & LF

FIBRES ABOVE ASIS GO UPWARDS AND INWARDS
- WHEN GET TO ASIS AND BELOW ARE MORE TRANSVERSE

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11
Q

PURE AXIAL ROTATION

A

TO TURN TO RIGHT=
LFT. EXTERNAL OBLIQUE
RIGHT INTERNAL OBLIQUE
AND CONTRACT MULTIFIDUS CAUSE OBLIQUES ARE FLEXORS SO NEED EXTENSION COMPONENT

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12
Q

Transversus abdominis

A

Posterior attachment: thoracolumbar fascia
Superior attachment: internal aspect of lower ribs/cartilages
Inferior attachment: iliac crest & inguinal ligament
Insertion: linea alba (& lower fibres onto pubic crest)
Innervation: T7 – L1 ventral rami
Action: increase intra-abdominal pressure

NO VERTICAL COMPONENT SO NO FLX., EXT. OR LAT FLX

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13
Q

Rectus abdominis

A

Superior attachment: xyphoid process & adjacent rib cartilages Inferior attachment: pubic crest & symphysis Innervation:T7 – 12 ventral rami
Action:
trunk flexion
Midline linea alba & 3 tendinous intersections

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14
Q

Rectus sheath: layering of aponeuroses of the anterolateral abdominal muscles

A

upper 3⁄4
anterior = aponeuroses of: external oblique abdominal 1⁄2 internal oblique abdominal
posterior = aponeuroses of: 1⁄2 internal oblique abdominal transversus abdominis

Below arcuate line: lower 1⁄4
aponeuroses all anterior posterior = transversalis fascia

FUNCTION = IMPROVES EXT. OBLIQUE MA
LOA IS REDIRECTED = ENHANCES ACTION

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15
Q

Thoracolumbar fascia (TLF)

A
3 layers:
Anterior & middle layers:
• attach to lumbar t.p’s
• envelope Quadratus lumborum
• posterior attachment for
transversus abdominis & internal oblique abdominal
Posterior Layer:
• attaches to T/L/S sp processes
• encloses erector spinae group
• laterally fuses with middle layer
Blends with (CROSSING OF FIBRES):
• erector spinae aponeurosis
• latissimus dorsi
• gluteus maximus
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16
Q

Thoracolumbar fascia (TLF) - 2

A

STRONGEST AND MOST DEFINITE IN LUMBAR REGION AND BECOMES LESS IN THORACIC
- EXTERNAL OBLIQUE HAS NO INFLUENCE ON SPINAL CORD VIA TFL
FUNCTION = MUSCLE ATTACH. AND SPINAL STABILITY

17
Q

ESA

A

FLAT TENDONS OF 2 PARS THORACIC MUSCLES

18
Q

Do the muscles of the abdominopelvic cavity play a role in spinal stability?

A

What is “stability”?????
• not only at end of range
• control of the motion segment
Experimentally:
the force required to buckle the vertebral column or displace the vertebra
GAIN CONTROL VIA:
• Bony
• Ligamentous / intervertebral disc • Muscular (VERTICAL LOA ACROSS JOINT, WHEN CONTRACTS CREATES COMPRESSION)
• Intra-abdominal pressure (WHEN INCREASES SUPPORTS VERTICAL COLUMN)

19
Q

Muscular co-contraction

A

Muscular co-contraction can “stiffen” the vertebral motion segment
- PM, MULTIFIUS, RECTUS AB WHEN CONTRACT = COMPRESS JOINT

20
Q

Extensive muscular attachments into the thoracolumbar fascia

A

Extensive muscular attachments into the thoracolumbar fascia which, in turn, attach to lumbar transverse & spinous processes - possible contributions to motion segment stability

OBLIQUE FIBRES THEREFORE WHEN STRETCH, INCREASE COMPRESSION AND TRANSVERSE PROCESSES TOGETHER
- WHEN CONTRACT PULLS TFL TIGHT

21
Q

Diaphragm: function

1. Respiration

A

contraction pulls central tendon inferiorly
increases intra-thoracic volume / decreases intra-abdominal volume
if abdominal muscles are relaxed – abdominal viscera pushed anteriorly if abdominal muscles are contracted – increase intra-abdominal pressure

  • FAVOURS RESPIRATION OVER STABILITY
22
Q

Diaphragm: function

2. Trunk posture:

A

Standing at rest:
diaphragm relaxed during expiration
Sitting / standing + repetitive fast UL movements: diaphragm active throughout expiration
78 +/- 17%
“support the argument that diaphragm contraction is related to trunk control”
“postural activity of diaphragm changed
when respiratory drive increased”

23
Q

Increased intra-abdominal pressure

A
  • INCREASES STIFFNESS OF THE LUMBAR SPINE
  • creates an extension moment
    Increased IAP…
    • increased extensor moment & increased the force required to flex the lumbar spine
    • contributes to spinal stability
    ** “the net effect of this extensor torque in functional tasks would be dependent on the muscles used to increase the IAP and their associated flexion torque”