E1- Low BAck Flashcards
what horn does the autonomic nerves run through
ventral
what horn does the somatic motor neuron run through and where does it go
ventral
nerves going out
what horn does the sensory neurons run through and where does it go
dorsal
nerves run to the spinal nerves
what are the posterior elements of the vertebrae
transverse/spinous process, laminae, articular process
what are the pedicles
bridge that connects the posterior elements to vertebral body
what affects spinal curves and LOG
limb position, fat deposition, muscle strength, connective tissue extensibility, loads, vertebral bodies, shape of facets
what is the purpose of spinal curves and LOG
provides strength and resilience but vulnerable to shear forces at transitions
where is the axis of rotation in flexion and extension in the vertebrae
vertebral body
where is the axis of rotation in SB in the vertebrae
vertebral body and disc
where is the axis of rotation during RT in the vertebrae
spinal canal
what is neutral zone
the amount of intervertebral movement that occurs with the least passive resistance
what happens when neutral zone is increased
increased with injury or weakness of surrounding tissues
Neutral zone is a better measurement of what
instability
what is core stability
viewed as a segmental level or as a whole
what is marked or chronic spinal instability
further injury to local ligaments
injury to facets, disc, and nerves
loss of ROM
may need surgery
describe T2-9
downward pointing spinous process
facets are vertical - frontal plane
pair of costal facets
describe T1
full costal attachment and demi
describe T10-12
full costal attachment
describe the lumbar region
massive wide bodies- support
TP project lateral- 1- 4 thin, 5 strong
SP broad
mammillary process off sup articular surface on posterior side
what plane are better for L1-4
sagittal
what plane are better for L5-S1
frontal
describe the sacrum
base - superior
apex - inferior
sacral promontory - anterior edge
ala are wings
what does the sacrum do
transmits weight of vertebral column to pelvis
what forms the the SI joint
large articular surface articulates with the ilium
sacrum moving on iliac
describe anterior sacrum
smooth concave
posterior wall of of pelvic cavity
4 ventral foramina
describe posterior sacrum
convex and rough - muscle attachment
spinal and lateral tubercle
transmit dorsi rami sacral spinal nerve roots
what is the cauda equina
at birth spinal cord= vertebral canal
adult spinal cord ends at L1
horse tail
what are the 3 functional components of intervertebral joints and their functions
T/SP- mechanical levers
apophyseal joints- guiding motion
interbody joint- absorb and distribute load
describe apophyseal joints
24 pairs
plane jt
lined with articular cartilage
mechanical barricades
m help control
where are intervertebral or interbody joints
C2-3 through L5-S1
disc, endplates, adjacent vb
describe the disc
hydraulic shock absorbing system
dissipates and transfers loads
GAGS, proteins, fibroblasts, chondrocytes, water
describe the annulus
15-25 concentric rings
prevent distraction/shear/torsion
connects to endplates
describe the endplate
cartilaginous cap
diffusion of O2 and glucose
vascular supply
what is the process for degenerated intervertebral discs
reduced permeability - reduced inhibits syntheses of proteoglycans
less proteoglycans- less water
less ability to absorb or transfer loads
not just with aging but with excessive or abnormal loads
what is viscoelastic
flexible low loads
rigid at high loads
what is the explanation for spinal coupling
muscle action, fact orientation, posture, ribs, stiffness, curve of spine
describe the thoracic region
stable base for musculature, protective organs, breathing
40-45 deg normal kyphosis
facets- frontal plane
all planes of motion
24 apophyseal joints
describe flexion in the thoracic region
30-40 deg
limited by ligs on posterior body
describe extension in the thoracic region
15-20 deg
limited by ALL and lamina of adjacent vb
what is the reason for more FLX/EXT in the lower thoracic region
free floating ribs and facets more sagittal
what is the breakdown of flexion in the thoracolumbar region
85 deg = 35 thoracic + 50 lumbar
tension on capsule of apophyseal jt, interspinous, supraspinous, PLL and compression of anterior annulus
what is the breakdown of extension in the thoracolumbar region
35 deg = 20 thoracic + 15 lumbar
tension on ALL, anterior annulus, capsule of apophyseal jt
what is the degrees for RT in the thoracolumbar
25-35
what is the degrees for SB in the thoracolumbar
25-30
what are the normal ranges for the lumbar regions
FLX- 45-55
EXT- 15-25
RT- 5-7
SB- 20
how does coupling compare the cervical and thoracic spine to lumabr
lumbar coupling is inconsistent compared to cervical and thoracic
what is the arthrokinematics of the ribs during exhalation
upper costotransverse jt - ant RT
lower costotransverse jt - sup glide
produces thoracic flexion
what is the arthrokinematics of the ribs during inhalation
upper costotransverse jt - post RT
lower costotransverse jt - inf glide
produces thoracic ext
what happens when the pelvis has too much of an anterior tilit
increase in lumbar lordosis (extension)
contraction of hip flexors and back extensors
how do we do a posterior tilt
contraction of hip extensors and abs
what structures resist tension at L5/S1
disc
capsule of facets
ALL
facets - frontal plane
iliolumbar lig
create resistance force compression at L5/S1
what is the iliolumbar lig
inf aspect of L4-5 and quadratus lumborum
firm anchor between L5 and ilium/sacrum
what is lumbar spine kinematics
3 DOF
flexion 45-55
extension 15-25
RT 5-7
SB 20
what happens during flexion of the lumbar spine
inf facets slide sup and ant
compression forces shift away from facets
how does the disc change in flexion
disc goes posterior
what happens during extension of the lumbar spine
inf facets slide inf and post
increased contact and load on facets
how does the disc and foramina change with extension of lumbar spine
foramina size reduced and disc moves anterior
what is the normal lumbar flexion to hip flexion ratio
45 deg lumbar flexion to 60 deg hip flexion
what compensation happens there is limited hip flexion
greater flexion is required of lumbar and thoracic spine
what compensation happens when there is limited lumbar flexion
greater flexion is required of the hips
why is there a limited RT in the lumbar region
bony resistance due to facet alignment
more than 3 deg per segment would damage facet surface and tear AF
what is the sacroiliac joint
junction between auricular surfaces of the sacrum and ilium, tight fitting for stability
what is the keystone of the pelvic ring
sacrum
what is the function of the SI jt
transfer weight of the upper body
shock absorber
what is the SI jt innervation and pain locations
L5-S3
lower lumbar region, medial buttock, PSIS and SI jt ligs
what is the role of the thoracolumbar fascia
mechanical stability of low back and SI jt
how is the cartilage of the SI jt on the ilia side
fibrocartilage 1-2 mm thickness
what is the purpose of of the grooves and ridges on SI jt as we age
enhances stability
what is the innominate motion
iliac crests move on sacrum
what is sacroiliac motion
sacrum moves on innominate
what is nutation
anterior or forward motion of sacrum (flexion)
what is counternutation
posterior or backward motion of sacrum (extension)
what causes bilateral motion of sacrum
forward and backward bending of the trunk
nutation and counternutation
what causes unilateral motion of sacrum
flexion and extension of LE (walking)
one side nutates and induces RT
what motions can happen within the pelvis of the innominates in NWB
10-12 deg post RT with 6 mm ant translation
2 deg ant RT with 8 mm ant translation
what motions can happen within the pelvis of the innominates in WB
2.5 deg RT with .5-1.6 mm translation
what motions can happen within the pelvis of the sacrum
FLX/EXT
Lat RT
RT - 1 to 4 deg and 1-2 mm translation
what is the closed packed position of the sacrum
standing when loaded
full nutation
when is the sacrum unloaded and what happens
supine
return to counternutation
less stable
what is happening to the sacral promontory in nutation
anterior and inferior
what is the arthro of the sacrum with nutation
glides inferior down the short arm and posterior along the long arm
what resist the motion of nutation
wedge shape of sacrum
ridges/depression
interosseous and sacrotuberous leg
what is happening to the sacral promontory in counternutation
sacral base moves posterior and superior
what is the arthro of the sacrum with counternutation
glides anterior along long arm and superior along short arm
what resist the motion of counternutation
long dorsal ligament
less stable because sacrotuberous and interosseous are lax
what is sacral torsion
the coupling of RT and SB
what happens to the sacrum and pelvis when the lumbar flexes
sacrum extends (counternutation)
pelvis post tilt
what happens to the sacrum and pelvis when the lumbar extends
sacrum flexes (nutates)
pelvis ant tilt
what is the oblique axis
where the motion starts
what is done on the superior axis
breathing - inhale base forward and coccyx/ILA, posterior
what is the middle axis
nutation and counternutation
postural
what is the inferior transverse axis
ilia on sacrum
what is the vertical axis
unilateral RT
what is physiological motion
anterior motion fixation/nutation
what is non-physiological motion
posterior motion fixation/counternutation
how is the sacrum positioned with L on L physiological
R nutated
L RT and FLX
on L oblique axis
how is the sacrum positioned with R on R physiological
L nutated
R RT and FLX
on R oblique axis
how is the sacrum positioned with L on R non-physiological
L RT and EXT
R counternutated
on R oblique axis
how is the sacrum positioned with R on L non-physiological
R RT and EXT
L counternutated
on L oblique axis
