A full-blown LEFT iliopsoas syndrome will cause: 1. ) A _____ pelvic shift 2. ) Rotation of sacrum on the _____ ______ axis 3. ) Right piriformis spasm 4. ) Pain in the _____ hip down the back of thigh to the knee. This is due to the ________.

1. ) RIGHT pelvic shift 2. ) Rotation of sacrum on the LEFT OBLIQUE AXIS 3. ) ______ piriformis spasm with tender point 4. ) Pain in RIGHT hip, due to SCIATIC NERVE

1. ) Where is the key lesion in acute psoas syndrome? 2. ) What type of treatment is contraindicated in acute psoas syndrome?

1. ) Upper-lumbar, approx. L1-L2, sometimes T12/L3 2. ) HVLA

Exam #2 (cont) Flashcards by Nathan Plaskett

Where does pain from the QL trigger points radiate?

Groin, lateral aspect of the leg

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What is the origin, insertion, and action(s) of the quadratus lumborum?

Origin: 12th rib and TPs of L1-L4
Insertion: Iliolumbar ligament and posterior iliac crest
Actions: Stabilizes 12th rib, lateral flexion of lumbar (unilaterally) and extension

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Give the origin, insertion, and action of the iliopsoas (psoas major) muscle

Origin: TPs and vertebral bodies of T12-L5
Insertion: Lesser trochanter
Action: Flexes thigh, some external rotation, flexes spine on pelvis.

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What are the referred pain patterns from the iliopsoas?

Lumbar spine and anterior thigh

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What visceral dysfunction(s) can be confused with iliopsoas spasm/strain?

Kidney stones, ovarian vessel disorder

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What affect does a shortened iliopsoas muscle have on the lumbar spine and pelvis?

increased LORDOSIS and ANTERIOR pelvic shift

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During which movement is the iliopsoas stressed?

Flexion

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What postural observation can be made to identify iliopsoas syndrome?

Flexion at hip and sidebending of lumbar spine to side of most hypertrophied psoas

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What three tests should be performed to diagnose iliopsoas syndrome, and rule out other pathologies (which?)

) Thomas test (positive)
) Straight leg raise (negative will rule out herniated disc)
) Well leg test (negative will rule out herniated disc)

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When evaluating iliopsoas syndrome, one should pay particular attention to what vertebral levels?

L1 and L2

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A full-blown LEFT iliopsoas syndrome will cause:

) A _____ pelvic shift
) Rotation of sacrum on the _____ ______ axis
) Right piriformis spasm
) Pain in the _____ hip down the back of thigh to the knee. This is due to the ________.

) RIGHT pelvic shift
) Rotation of sacrum on the LEFT OBLIQUE AXIS
) ______ piriformis spasm with tender point
) Pain in RIGHT hip, due to SCIATIC NERVE

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) Where is the key lesion in acute psoas syndrome?

2. ) What type of treatment is contraindicated in acute psoas syndrome?

) Upper-lumbar, approx. L1-L2, sometimes T12/L3

2. ) HVLA

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What is the origin, insertion, and action of the piriformis?

Origin: Anterolateral surface of S2-S4 at or near SI joint capsule
Insertion: Greater trochanter
External rotation of thigh at the hip, some thigh extension. If hip bent –> abduction of thigh at hip, and internal rotation of thigh.

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Extensive sitting indicates what pathology?

Piriformis syndrome

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Sciatica is a _____ rather than a _______

Sciatica is a SET OF SYMPTOMS rather than a DIAGNOSIS

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Give three observations associated with piriformis syndrome

) Altered, painful gait
) Leg externally rotated
3) Increased flexion of spine

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What diagnostic technique is used to differentiate piriformis from disc herniation?

Electromyography (EMG)

What technique are recommended in treatment of QL hypertonicity?

Treatment of QL trigger points: 12th rib technique AND passive myofascial release of the QL (both useful during acute stage)

Which Type-II somatic dysfunction is common in psoas syndrome?

L5 extended

Which OMM techniques are indicated for treatment of ACUTE psoas syndrome?

Passive extension, counterstrain, muscle energy, active and passive myofascial.

Define the temporal duration of symptoms in each of the following:

) Acute
) Subacute
) Chronic

Symptoms lasting…

) Acute = < 6 weeks
) Subacute = 6 - 12 weeks
) Chronic = > 3 months

What are the seven (7) possible causes of low back pain?

) Mechanical (disc herniation, compression fracture, DDD, etc.)
) Non-mechanical/Viscerogenic (renal disease, IBS, AAA, GI diseases)
) Neoplastic (myeloma, sarcoma, etc.)
) Infection (osteomyelitis)
) Somatic dysfunction (postural compensations)
) Psychosocial (seeking disability or drugs)
) Psychiatric (depression)

What etiology are the following complaints typically associated with?

) Pain worse when sitting
) Pain relieved with forward flexion
) Radiation below the knee

) Disc herniation
) Spinal stenosis
) Sciatica

List which structures correspond with the following sympathetic levels:

) T1-T4
) T1-T6
) T5-T9 (right and left)
) T10-T11
) T12-L2

) Sympathetics to head and neck
) Heart and lungs
) Upper abdominal viscera (celiac plexus) –> Right: Liver, gallbladder, duodenum, head of pancreas. Left: Stomach, spleen, tail of pancreas.
) Superior mesenteric plexus: Remainder of small intestine, kidneys (R&L), upper part of the ureters (R&L), gonads (ovaries and testes) – RIGHT: Appendix, cecum, ascending to mid-transverse colon.
) Inferior mesenteric plexus: Colon from mid-transverse to rectum and pelvic organs (bladder, uterus, prostate).

Herniation at disc X affects nerve root ________. Why?

Affects nerve root X+1, because nerve root X will have already exited the foramina and will be unaffected.

Give a description of the following: 1. ) Sacralization 2. ) Lumbarization

1. ) 5th lumbar fused with S1 | 2. ) S1 independent of rest of sacrum

1. ) Describe spondylolisthesis 2. ) On which diagnostic imaging tests is it best seen (2)? 3. ) What is a typical compensatory symptom?

1. ) Forward slippage of a vertebral body on the one BELOW 2. ) Lateral X-ray, MRI 3. ) Pelvic rotation and tight hamstrings

1. ) What is spinal stenosis? | 2. ) What are three relieving postures for patients with spinal stenosis?

1. ) Narrowing of the spinal canal, i.e. vertebral canal narrowing that compresses nerve roots, thus causing ischemia. 2. ) a. ) Flexion b. ) Sitting c. ) Bringing knees to chest

What types of exercises would be useful in treating spinal stenosis?

Exercises that tilt the pelvis and flatten or decrease lordosis, and initiate lumbar kyphosis.

Patients with what TWO conditions are more prone to compression fractures?

Hypocalcemia or osteoporosis

Where are the weak portions of the lumbar spine?

"Weak" spot on the ANTERIOR PORTION.

What are symptoms of Cauda Equina Syndrome (3)?

1. ) Progressive low back pain 2. ) Sphincter (anal/urinary) weakness 3. ) Ascending paralysis of lower extremities

1. ) What is Meralgia Paresthetica? | 2. ) Describe its pain pattern.

1. ) A compression of lateral cutaneous nerve of the thigh. | 2. ) It causes pain to the lateral anterior aspect of the thigh.

Which nerve root is associated with the following, and how would you test: 1. ) Great toe extension, dorsal foot sensation 2. ) Foot inversion, patellar reflex, medial foot sensation 3. ) Foot eversion, Achilles reflex, lateral foot sensation

1. ) L5 --> Walk on heels, ABduct hip 2. ) L4 --> Walk on heels with foot inverted 3. ) S1 --> Walk on toes

Osteoarthritis of the hip joint is characterized by decreases in what TWO ranges of motion?

1. ) Decreased extension | 2. ) Decreased internal rotation

The innominate bone can rotate around a ______ axis, its direction of rotation is named for the direction that the _____ moves.

- Transverse | - Superior iliac crest

A posteriorly rotated innominate will make the ipsilateral leg functionally ________. Anteriorly rotated?

Posterior rotation = functionally SHORTER | Anterior rotation = functionally LONGER

1. ) If a patient has level iliac crests and significant anterior rotation of right innominate, which came first: Short right leg or rotated innominate? 2. ) What, if any, compensation will occur in the contralateral innominate bone?

1. ) Right short leg came first (likely) | 2. ) Contralateral innominate will rotate POSTERIORLY to compensate

An anterior innominate rotation on the LOW PELVIC side suggests what about a leg length discrepancy?

It suggests that the anteriorly rotated innominate is compensating (by functionally lengthening) for an ANATOMICALLY SHORTENED LEG. *While a POSTERIOR ROTATION on the CONTRALATERAL side suggests compensation (functionally shortening) for the shortened right side*

If iliac crests are unlevel and the innominate on the lower side is POSTERIORLY rotated, what does this suggest?

That the innominate rotation is causing the pelvic unleveling, and thus a functionally shorter leg. While the opposite side rotated anteriorly is causing a functionally longer leg.

The _____ is the key muscle in stabilizing the spine in a side-to-side direction