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Kines II > Exam 4: Lumbopelvic > Flashcards

Exam 4: Lumbopelvic Flashcards

1
Q

Define

Spondylosis

A

age related degeneration (DDD - degenerative disc disease and DJD - degenerative joint disease)

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2
Q

Define

Spondylolysis

A

defect/fracture in the pars interarticularis or arch of the vertebra

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3
Q

Define

Spondylolisthesis

A

forward displacement of one vertebra on another; aka slippage

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4
Q

Define

Retrolisthesis

A

backward displacement of one vertebra on another

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5
Q

Define

Peripheralization

A

pain is being referred distally toward or into a limb

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6
Q

Define

Centralization

A

pain is moving toward the spine or source

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7
Q

Define, example

Mechanical Low Back Pain

A
  • general term for back pain that does not refer distally
  • ex. hypermobility and core weakness
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8
Q

What does LBP stand for?

A

low back pain

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9
Q

Define

Lesion

A

offending structure/unhealthy tissue or pain generator

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10
Q

What percentage of weight bearing are the disc responsible for?

A

80%

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11
Q

What percentage of the weight bearing are facets responsible for?

A

20%

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12
Q

If discs were to wear down, what would that do to the distribution of weight bearing?

A

more weight bearing load would be placed on the facets

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13
Q

What is a spinal motion segment made up of?

A
  • inferior facets of superior vertebrae
  • disc (intervertebral joint)
  • superior facets of inferior vertebrae
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14
Q

Spinal Motion Segment

There is more potential for … and … in the lumbar area/segments.

A

nerve root impingement and mechanical stress

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15
Q

Facet Joints

L1-L5 is mainly oriented in the … plane to allow …. and resist …..

A
  • sagittal
  • flex/ext
  • rotation
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16
Q

Facet Joints

L1-L5 facets are oriented nearly …

A

vertically

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17
Q

Facet Joints

L1-L5 facets are oriented about … degrees from the … plane.

A
  • 25
  • sagittal
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18
Q

Facet Joints

L1-L5 has strong … plane bias.

A

sagittal

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19
Q

Facets Joints

L5-S1 is more oriented in the ….. plane to allow for …

A
  • oblique/frontal
  • rotation
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20
Q

Facet Joints

Most of the rotation of the lumbar spine occurs at the … level.

A

L5-S1

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21
Q

Facets Joints

Anatomical … is the norm. Facets may be … and/or more oriented in a different plane.

A
  • variation
  • asymmetrical
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22
Q

Lumbar Anatomy

The thoracolumbar junction marks an abrupt change in the orientation of the facets from the … to the … plane.

A
  • frontal
  • sagittal
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23
Q

Lumbar Anatomy

Transitional Zone of TL junction Significance

A
  • increased likelihood of mechanical instability
  • similar to lower cervical spine, it is susceptible to degenerative changes (spondylosis)
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24
Q

Look at image on slide 6.

A
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25
Q

Describe

Facet Joints

A

synovial joints with capsule around each facet pair

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26
Q

Facet joint Innervation?

A

multisegmental innervation by medial branch of dorsal ramus

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27
Q

Facet joints contain a … that can get locked in younger patients.

A

“meniscus”

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28
Q

What is the main job of facet joints?

A

guide osteokinematics

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29
Q

See image on slide 7.

A
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29
Q

L5-S1 (oblique orientation) shear forces resisted by:

A
  • disc
  • ZAJ
  • ZAJ capsule
  • ALL
  • iliolumbar ligaments

think about osteophytes and hypertrophy

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29
Q

Sacral orientation? results in?

A
  • post to ant, inclined ant/inf 40 degrees
  • shear force due to body weight
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30
Q

See images on slide 8.

A
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31
Q

Lordosis accentuates…

A

anterior shear forces

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32
Q

Normal Lordosis?

A

40-45 degrees

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33
Q

What helps contribute to lordosis?

A

disc shape

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34
Q

See images on slide 10.

A
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35
Q

Consists of?

Pelvis

A
  • 2 innominates
  • sacrum
  • coccyx
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36
Q

Movement? Why?

Sacroiliac Joint

A
  • very little movement due to inherent stability (coarse texture, ridges, and depressions of joint surfaces - anatomical variation is the norm)
  • Consider Wolfe’s Law - bone adapts to mechanical stress placed on it, remodeling to become stronger - once we begin walking
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37
Q

Where is the iliac crest in relation to vertebral level?

A
  • can be anywhere from L3-L5 depending on gender
  • L4 is typically the standard answer
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38
Q

Properties of the nucleus pulposus?

A
  • hydrophilic
  • very reliant on water content
  • mainly type 2 collagen to resist compressive forces
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39
Q

Properties of the annulus fibrosis?

A
  • mainly type 1 collagen to resist tension forces
  • oblique angle of fibers perpendicular to one another = 50/50
  • inner annulus is monosegmentally innervated (early on in disease process, thumbprint, isolated pain)
  • outer annulus is polysegmentally innervated (diffuse pain, hand print pattern)
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40
Q
A
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41
Q

The outer annulus is … innervated.

A

polysegmentally

diffuse pain, handprint

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42
Q

The inner annulus is … innervated.

A

monosegmentally

isolated pain, thumb print

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43
Q

Disc

Define radial expansion.

A

dissipation of forces by the disc in a circumferential fashion

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44
Q

Radial expansion

When is the disc at an increased risk for damage?

A

with combined flexion and rotation/twisting

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45
Q

What is the main job of the disc?

A

resist compression and tension

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46
Q

Read Neumann’s special focus 9.8.

A

includes nuclear material and fragments of the vertebral endplate

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47
Q

See image on slide 15.

A
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48
Q

Better prognosis is available with … or … due to potential for resorption by macrophages.

A

extrusion and sequestration

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49
Q

Define, what does it resist

Anterior Longitudinal Ligament

A

thick ligament that resists anterior migration of the disc and lumbar extension

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50
Q

resists? thickness? recess?

Posterior Longitudinal Ligament

A
  • resists posterior migration of the disc centrally by provides very little support in lateral recess
  • very thin
  • posterolateral/lateral recess - problems with nerve roots
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51
Q

o

A
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51
Q

What is the significance of the posterolateral/lateral recess?

A

common site of disc herniation

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52
Q

resists? effect of hypertrophy?

Ligamentum Flavum

A
  • resists flexion
  • hypertrophy due to degeneration leads to compression in the lateral recess
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53
Q

Degenerated spines with loss of disc height will result in hypertrophy of these structures and lead to possible …

A

spinal cord or nerve root impingement

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54
Q

See images on slide 19.

A
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55
Q

Dura

What does the dura do?

A

encapsulate the spinal cord and part of the exiting nerve

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56
Q

What may become adhered in foramen or on PLL?

A

dura

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57
Q

The dura has what type of innervation?

A

multisegmental with diffuse pain pattern

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58
Q

Root is …sensitive.

A

chemo

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59
Q

Root is only mechanoreceptive when…

A

primed by chemical irritation

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60
Q

What does DRG stand for?

A

dorsal root ganglion

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61
Q

The DRG is … and … sensitive

A

mechanosensitive and chemosensitive

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62
Q

Roots follow…

A

dermatomal patterns

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63
Q

Spondylolisthesis is the condition in which one … is slipped forward over another.

A

vertebral body

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64
Q

Spondylolisthesis is most likely caused by an underlying condition of …

A

spondylolysis

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65
Q

What are the different kinds of spondylolisthesis?

A
  • degenerative
  • isthmic
  • dysplastic
  • traumatic
  • pathologic
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66
Q

Which condition is associated with the scotty dog sign and worsened by hyperextension?

A

spondylolisthesis

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67
Q

Spondylolysis is a condition in which there is a defect in a portion of the spine called the …

A

pars interarticularis

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68
Q

The pars interarticularis defect of spondylolysis leads to spondylolisthesis … percent of the time.

A

15

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69
Q

Is lumbar myeloopathy a thing?

A

no; at that point it’s typically called cauda equina syndrome; there is such thing as cervical myelopathy though

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70
Q

Wiltse Classification for Spondylolisthesis

Type I

A
  • dysplastic/congenital
  • translation is secondary to an abnormal neural arch
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71
Q

Wiltse Classification for Spondylolisthesis

Type II

A
  • isthmic
  • translation is secondary to a lesion involving the pars articularis
  • 3 subtypes: A (lytic), B (elongated pars), C (acute pars fx)
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72
Q

Wiltse Classification for Spondylolisthesis

Type III

A
  • degenerative
  • result of chronic instability and intersegmental degenerative changes
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73
Q

Wiltse Classification for Spondylolisthesis

Type IV

A
  • post traumatic
  • fracture in region other than pars leading to slippage
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74
Q

Wiltse Classification for Spondylolisthesis

Type V

A
  • pathological
  • diffuse or local disease compromising the usual structural integrity that prevents slippage
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75
Q

Wiltse Classification for Spondylolisthesis

Type VI

A
  • iatrogenic
  • related to illness caused by medical examination or treatment
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76
Q

See image on slide 23.

A
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77
Q

Facet movement with thoracolumbar flexion?

A
  • facets move anterior/superior
  • superior vertebra (inferior articular facets) sits inside of inferior vertebrae (superior articular facets)
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78
Q

Lumbar flexion makes more room for …

A

nerve roots

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79
Q

Lumbar flexion norm?

A

45-55 degrees

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80
Q

Lumbar flexion reverses …

A

lordosis

see image on slide 26

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81
Q

Describe disc movement in lumbar flexion.

A
  • nucleus moves posterior
  • annulus bulges anterior
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82
Q

During lumbar flexion, the facets/foramen … to result in up to a …% in foramen size.

A
  • open up
  • 19% increase
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83
Q

Lumbar flexion is a relative …. translation of vertebrae.

A

superior/anterior

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84
Q

Lumbar flexion tightens which ligament?

A

PLL

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85
Q

Extreme lumbar flexion stresses … and surrounding ligaments.

A

ZAJ capsule

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86
Q

During lumbar flexion the compressive load shifts from … to …

A

ZAJs to disc

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87
Q

Although the load is decreased on the ZAJ during lumbar flexion, the “…” may increase due to reduced surface area to distribute the load.

A

contact pressure

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88
Q

Know figure on slide 27.

A
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89
Q

What is a good treatment/exercise for disc rehydration? what condition is this typically treating?

A
  • supine 90/90 (supine w/ feet on chair)
  • stenosis
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90
Q

What is the typical directional preference in stenosis?

A

flexion

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91
Q

Facet movement with thoracolumbar extension?

A
  • facets slide posterior/inferior
  • translate on the inferior vertebra/its superior articular facets
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92
Q

Thoracolumbar extension tends to …

A

close things down

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93
Q

Normal lumbar extension?

A

15-25 degrees

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94
Q

Lumbar extension increases…

A

lordosis

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95
Q

Lumbar extension involves a relative … tilt of the pelvis.

A

anterior

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96
Q

Disc material movement during lumbar extension?

A
  • nucleus moves anterior
  • annulus bulges posterior
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97
Q

During lumbar extension, facets/foramen …. resulting in up to a …% in foramen size

A
  • close down
  • 11% decrease
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98
Q

During lumbar extension, it can close down on a nerve root; however, this is ok unless it is already …. in which case the mechanical stress can cause pain.

A

chemically irritated

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99
Q

Lumbar extension involves the relative … translation of vertebrae.

A

inferior/posterior

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100
Q

Lumbar extension tightens which ligament?

A

ALL

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101
Q

Relatively sharp tips of the facets contact the adjacent … in hyperextension.

102
Q

Hyperlordosis has the potential to cause …

A

long-term degenerative changes and result in pain

103
Q

What athlete population tends to have hyperlordosis?

A

gymnasts; they adapt but often have back pain

104
Q

Full sustained lumbar extension can reduce…
How can this be reduced?

A
  • pressure on the disc
  • centralize sypmtoms, repeated motions, McKenzie exercises
105
Q

What are McKenzie exercises?

A

use directional preference and repeated movement to improve symptoms

see slide 32 image

106
Q

Differential diagnosis is key - Most pain with sagittal plane motions is likely from the …

107
Q

T or F: Discs can slip.

108
Q

…ing water content can relieve pressure with pain in lumbar extension.

A

decreasing

109
Q

Disc dehydration exercises?

A
  • prone press ups
  • double knee to chest (lumbar flexion stretch)
110
Q

During lumbar SB, one side … and the other side …

A
  • closes down
  • opens up
111
Q

If you SB to the R, the R facet… and the L facet…
What ligament tightens?

A
  • R closes
  • L opens
  • L intertransverse ligament
112
Q

If you SB left what happens at the facets? which ligament tightens?

A
  • L facet closes
  • R facet opens
  • R intertransverse ligament
113
Q

What happens with the disc material during lumbar SB?

A
  • Nucleus moves L
  • Annulus bulges R
114
Q

What ligament tightens/resists motion with lumbar SB?

A

intertransverse ligament

115
Q

See images on slides 34-35

116
Q

Normal lumbar SB ROM?

A

20 degrees

117
Q

See image on slide 36.

118
Q

Norm lumbar rotation ROM?

A

5-7 degrees

119
Q

What is the norm for combined thoracolumbar rotation?

A

about 40 degrees

120
Q

When rotating to the R, what happens with facets and what ligament tightens?

A
  • L facet closes
  • R facet opens
  • interspinous ligament tightens
121
Q

During lumbar rotation, disc movement is dependent on …

122
Q

During L lumbar rotation, what happens at facets, what ligament is tightened?

A
  • R closes
  • L opens
  • interspinous ligament
123
Q

See image on slide 37.

124
Q

Lumbar rotation is limited by the … and its … fiber orientation.

A
  • annulus
  • oblique
125
Q

“In theory, an axial rotation of … degrees at any lumbar vertebral junction would damage the … and tear the … fibers in the annulus fibrosis”. -Neumann

(normal motion does not reach these levels)

A
  • 3 degrees
  • articular facet surfaces
  • collagen
126
Q

Differential diagnosis is key - Most pain with 3D motions is likely from the …

127
Q

Lumbar Rotation

Extension and SB is possible (in context of 3D motions) with ….

A

joint approximation

128
Q

Example

L4 … articular facets sit inside of L5 … articular facets

A
  • inferior
  • superior
129
Q

Differential Dx of Mechanical LBP

Muscle strain: age, pain pattern (location, onset, standing, sitting, bending stress), SLR test, plain x-ray?

A
  • 20-40 years old
  • unilateral back
  • acute
  • increased stress standing
  • decreased stress sitting
  • increased stress bending
  • negative SLR and xray
130
Q

Differential Dx of Mechanical LBP

Herniated nucleus pulposus: age, pain pattern (location, onset, standing, sitting, bending stress), SLR test, plain x-ray?

A
  • 30-50 years old
  • unilateral back, leg
  • acute (prior episodes)
  • decreased stress standing
  • increased stress sitting
  • increased stress bending
  • positive SLR
  • negative xray
131
Q

Differential Dx of Mechanical LBP

Osteoarthritis: age, pain pattern (location, onset, standing, sitting, bending stress), SLR test, plain x-ray?

A
  • > 50 years old
  • unilateral back
  • insidious
  • increased stress standing
  • decreased stress sitting
  • decreased stress bending
  • negative SLR
  • positive xray
132
Q

Differential Dx of Mechanical LBP

Spinal Stenosis: age, pain pattern (location, onset, standing, sitting, bending stress), SLR test, plain x-ray?

A
  • > 60 years old
  • bilateral leg
  • insidious
  • increased stress standing
  • decreased stress sitting
  • decreased stress bending
  • positive SLR (stress) and xray
133
Q

Differential Dx of Mechanical LBP

Spondylolisthesis: age, pain pattern (location, onset, standing, sitting, bending stress), SLR test, plain x-ray?

A
  • 20 years old
  • back
  • insidious
  • increased stress standing
  • decreased stress sitting
  • increased stress bending
  • negative SLR
  • positive xray
134
Q

Differential Dx of Mechanical LBP

Scoliosis: age, pain pattern (location, onset, standing, sitting, bending stress), SLR test, plain x-ray?

A
  • 30 years old
  • back
  • insidious
  • increased stress standing
  • decreased stress sitting
  • increased stress bending
  • negative SLR
  • positive xray
135
Q

Positive Kemp Test

A
  • radicular pain w/ the kemp/quadrant standing test
  • nerve root impingement
136
Q

where pain, type, potential cause

Positive Quadrant Test

A
  • local pain w/ the kemp/quadrant standing test
  • non-radicular pain
  • may be disc or facet
137
Q

Kemp/Quadrant Test Positioning

A
  • standing
  • hip block
  • extension, ipsi SB and ipsi rot
138
Q

Fryette’s Laws

Fryette’s Laws definition.

A

naturally occurring kinematic motion

139
Q

Freyette’s Law: type 2

A
  • ipsilateral coupling
  • SB and rot occur in same direction
  • occurs while in flexion
  • ex. R SB associated w/ R rot
140
Q

Coupling Reliability is Poor

Anatomical factors?

A
  • curvature of the spine
  • influence of the disc
  • orientation of the ZAJs
141
Q

Fryette’s Law: type 1

A
  • contralateral coupling
  • SB and rot occur in opposite directions
  • ex. R SB associated w/ L rot
  • likely occurs in extension and neutral lordosis
142
Q

Coupling Reliability is Poor

Impact of age and degeneration?

A
  • increased age = greater change in coupling patterns
  • DDD = stiffness
  • instability = altered coupling patterns
144
Q

Takeaway on Coupling

There is minimal … plane motion so our main emphasis is movement in the … and … planes.

A
  • horizontal
  • sagittal
  • frontal
145
Q

Takeaway on Coupling

Unfortunately, due to individual … and … processes, no one model is completely …

A
  • variations
  • degenerative
  • reliable
146
Q

what does it stand for, what is it assessing

PPIVMs

A
  • Passive Physiological Intervertebral Movement
  • mobility testing: good at localizing hyper/hypo segments
  • can be performed with flexion, extension, SB, rotation
147
Q

stands for, primary goal, better reliability in identifying, ex.?

PAIVMs

A
  • Passive Accessory Intervertebral Movement
  • mobility testing
  • primary goal is to gain appreciation of the relationship between mobility and the onset of symptoms within each spinal segment
  • better reliability for identifying pain generator than degree of mobility
  • ex. spring test, P/As on spinous processes and the unilateral P/A of transverse process
148
Q

PPIVM Takeaway

PPIVM is used for assessing the … and example?

A
  • degree of motion
  • ex. chronic LBP w/ hypermobile L4-5 segment and hypomobile surrounding segments will demo more movement in flexion than other surrounding segments
149
Q

PAIVM Takeaway

PAIVMs used for assessing … and example?

A
  • degree of motion and ID pain generator
  • ex. chronic LBP w/ hypermobility/pain at L4-5 segment and hypomobile surrounding segments with spring testing
150
Q

PAIVM Takeaway

PAIVMs assess … (quality/quantity) and …

A
  • mobility
  • provocation
151
Q

PAIVM Takeaway

Most PAIVMs can be used as…

A

mobilizations

152
Q

Lumbopelvic rhythm is analogous to … rhythm.

A

scapulohumeral

153
Q

Define lumbopelvic rhythm/what is it?

A

close relationship between lumbar spine, pelvis, and hips to allow sagittal plane motion

154
Q

When considering the lumbopelvic rhythm into flexion, how many degrees of lumbar vs. hip flexion?

A
  • 45 degrees of lumbar flexion
  • 60 degrees of hip flexion
155
Q

muscle group and whether it’s concentric or eccentric, main movement

When considering the lumbopelvic rhythm into flexion, what is the 1st 25% of motion coming from?

A
  • more lumbar flexion
  • eccentric load of lumbar extensors
156
Q

muscle group and whether it’s concentric or eccentric, main movement

When considering the lumbopelvic rhythm into flexion, what is the last 25% of motion coming from?

A
  • more hip flexion
  • eccentric load of hip extensors
157
Q

main movement

When considering the lumbopelvic rhythm into flexion, what is the middle 50% of motion coming from?

A

combo of lumbar and hip flexion

158
Q

When considering lumbopelvic rhythm RETURN from flexion, it’s ROM is…

A
  • the same as lumbopelvic rhythm into flexion
  • 45 lumbar flexion
  • 60 hip flexion
159
Q

When considering lumbopelvic rhythm RETURN from flexion, the early phase of motion is more … and may be a … for lumbar spine.

A
  • hip extension
  • strong hip extensor activation
  • may be protective mechanism for lumbar spine
160
Q

When considering lumbopelvic rhythm RETURN from flexion, the middle phase of motion is more … and … equal work from the …

A
  • combo hip/lumbar extension
  • eual work from the hip/lumbar extension
161
Q

When considering lumbopelvic rhythm RETURN from flexion, at completion, there is relative … of muscles.

A

inactivity

162
Q

Study slides 55-58 images.

163
Q

Variations in Lumbopelvic Rhythms

Describe what movement is limited and what movement is excessive with lumbar dominant lumbopelvic rhythm.

A
  • limited hip flexion
  • excessive lumbar flexion
164
Q

Variations in Lumbopelvic Rhythms

Describe what movement is limited and what movement is excessive with hip dominant lumbopelvic rhythm.

A
  • limited lumbar flexion
  • excessive hip flexion
165
Q

The pelvis consists of…

A

2 innominates, sacrum, coccyx

see image on slide 61

166
Q

Define lumbarization.

A

movement between S1-S2

167
Q

Define sacralization.

A

fusion of L5-S1

168
Q

The sacroiliac (SI) joint has very little movement due to…

A

inherent stability (coarse texture, ridges, and depressions of joint surfaces)

169
Q

In the SI joint, anatomical variation is the…

170
Q

How is SI joint movement described?

A
  • “innominate rotation”
  • “sacral torsion”
171
Q

How is SI joint movement measured?

A

in millimeters

172
Q

… is responsible for up to … percent of chronic low back pain.

A
  • SI Joint
  • 25%
173
Q

The pubic symphysis is connected by a ….

A

fibrocartilaginous disc

174
Q

Which ligament helps maintain the stability of the pubic symphysis?

A

arcuate ligament

175
Q

The pubic symphysis is an insertion site for which muscles?

A
  • rectus abdominus
  • adductor longus
176
Q

With pubic symphysis mobility, it will follow the …

A

innominate

177
Q

For example, when you have a L posteriorly rotated innominate, the L pubic ramus is …

A

elevated and posteriorly rotated

178
Q

How much movement does the pubic symphysis have?

A

less than 0.5 cm

179
Q

The pubic symphysis will have more mobility in pregnancy due to …

A

the hormone relaxin

180
Q

SI Joint

With a form closure in vertical, the wedge shape creates a ….

A

bony closure

181
Q

SI Joint

With force closure in horizontal, …. and … create closure. name some?

A
  • ligaments and muscles
  • interosseus, long dorsal, sacrotuberous, sacrospinous ligaments
182
Q

What does the long dorsal ligament resist?

A

counternutation

183
Q

What does the sacrotuberous ligament resist?

184
Q

What do the sacrospinous ligaments resist?

185
Q

SI Joint

What occurs at age 50 for men more than women?

186
Q

Even with fusion of SI joint, … can be maintained long after that

187
Q

…% of people over the age of 60 have degenerative changes on imaging but no …

A
  • 85%
  • no pain
188
Q

See image on slide 63

189
Q

Define iliosacral motion.

A

movement of ilum on fixed sacrum

190
Q

Define sacroiliac motion.

A

movement of sacrum on fixed ilium

191
Q

Iliosacral and sacroiliac motion both mainly occur in the … plane

192
Q

The SI joint transitions from a … joint in childhood to a modified … joint and articular surfaces move from … to …

A
  • synovial
  • synarthroidal
  • smooth
  • rough
193
Q

Due to inherent stability, the SI joint is often injured as a result of… and give examples.

A
  • trauma
  • falls, MVA, childbirth
194
Q

In addition to trauma, SI joint injury can also be related to …… and examples.

A
  • repeated stress
  • running, martial arts
195
Q

A …cm leg length asymmetry can result in … times the … load, generally felt on longer limb side.

A
  • 1 cm
  • 5X
  • compressive
196
Q

Pain and dysfunction in the SI joint can also be related to ….

A

malalignment/asymmetry

197
Q

The … is challenging to differentially diagnosis.

198
Q

Often, an … is used to confirm SI joint pathology.

A

intra-articular injection of anesthetic

199
Q

What does the pelvic ring do?

A

transfers body weight bi-directionally between the trunk and femurs

see image on slide 65

200
Q

Iliosacral Mobility

Describe what the ASIS and PSIS do during anterior rotation of the innominate.

A
  • ASIS moves anterior and inferior
  • PSIS moves anterior and cranially (superior)
201
Q

Iliosacral Mobility

Describe what the ASIS and PSIS do during posterior rotation of the innominate.

A
  • ASIS moves posterior and cranial (superiorly)
  • PSIS moves posterior and caudal (inferiorly)
202
Q

Iliosacral Mobility

Describe what the ASIS do during innominate inflare and outflare.

A

ASIS moves medial or lateral

203
Q

Sacroiliac Mobility

Describe what the ASIS and PSIS do during innominate upslip and downslip.

A
  • Both ASIS and PSIS move superior or inferior together
  • this is considered normal during gait
204
Q

Study images on slides 68, 70-71

205
Q

Iliosacral Special Test

Brief, general description.

A

supine to sit (functional) leg length

have pt bridge to “reset” pelvis, traction both legs to ensure neutral position

206
Q

Iliosacral Special Test

What is the acronym for the supine position?

207
Q

Iliosacral Special Test

If the pt was supine short and sitting long, how would you describe the position of the innominate?

A

posterior rotation

208
Q

Iliosacral Special Test

If the pt was supine long and sitting short, how would you describe the position of the innominate?

A

anterior rotation

209
Q

Iliosacral Special Test

If the pt was supine short and sitting short, how would you describe the position of the innominate?

210
Q

Iliosacral Special Test

If the pt was supine long and sitting long, how would you describe the position of the innominate?

211
Q

With the iliosacral special test, the diagnosis is often based on …

A

previous provocative tests - what side is symptomatic?

212
Q

Study slides 73-76.

check out video on slide 73

213
Q

Sacroilial Mobility

… motion around 2 axes.

214
Q

Sacroilial Mobility

What are the 2 axes that triplanar motion occurs around?

A
  • L oblique axis
  • R oblique axis
215
Q

Sacroilial Mobility

Position is defined as to what …. the … side of the sacrum is facing.

A
  • direction
  • anterior
216
Q

Sacroilial Mobility

Forward Torsion Options?

A
  • R on R forward sacral torsion
  • L on L forward sacral torsion
217
Q

Sacroilial Mobility

What do we mean when we say R on R forward sacral torsion?

A

the anterior sacrum is facing right and moving on R oblique axis (ROA)

218
Q

Sacroilial Mobility

Backward torsion options?

A
  • R on L backward sacral torsion
  • L on R backward sacral torsion
219
Q

Sacroilial Mobility: deep vs. prominent

What is happening with a sacroilial R on R oblique axis (ROA) forward torsion?

A
  • L sacral base is deep
  • R ILA is prominent
220
Q

Sacroilial Mobility: deep vs. prominent

What is happening with a sacroilial L on L oblique axis (LOA) forward torsion?

A
  • R sacral base is deep
  • L ILA is prominent
221
Q

Sacroilial Mobility: deep vs. prominent

What is happening with a sacroilial L on R oblique axis (ROA) backward torsion?

A
  • L sacral base is prominent
  • R ILA is deep
222
Q

Sacroilial Mobility: deep vs. prominent

What is happening with a sacroilial R on L oblique axis (LOA) backward torsion?

A
  • R sacral base is prominent
  • L ILA is deep
223
Q

Define nutation.

not completely clear on this topic, see slide 77

A

In kinesiology, “nutation” refers to the anterior-inferior movement of the sacrum (while the coccyx moves posteriorly) relative to the ilium, often occurring during weight absorption at the sacroiliac joint.

224
Q

Define counternutation.

not completely clear on this topic, see slide 77

A

The opposite movement, where the sacrum moves posteriorly and superiorly while the coccyx moves anteriorly, is called counternutation.

224
Q

Nutation can be considered… while counternutation can be considered…

not completely clear on this topic, see slide 77

225
Q

Sacral Mobility

… is considered closed packed position

not completely clear on this topic, see slide 77

A

full nutation

226
Q

What muscles are: part of the transversospinal group, thickest in the lumbosacral region, designed for the stability of the base of the spine, extend spine bilaterally, ipsilaterally SB, contralaterally rotate?

A
  • Multifidi
  • Rotatores
228
Q

What muscles are responsible for fine motor control and have a high density of muscle spindles provide sensory feedback?

A
  • interspinalis
  • intertransversarius
229
Q

See image of pelvic floor muscles slide 84.

230
Q

Which muscle’s fibers are oriented diagonally like sticking your hands in your pockets, its most superficial, and does contralateral rotation?

A

exernal oblique

231
Q

Which muscle’s fibers are oriented opposite like crossing arms, 2nd layer, and attaches to thoracolumbar fascia?

A

internal oblique

232
Q

Which muscle has the largest cross-sectional area of all the abs?

A

internal oblique

233
Q

What muscle has a very large force production, making it a stabilizer?

A

internal oblique

234
Q

Function of internal obliques?

A

ipsilateral rotation

235
Q

What is known as your corset muscle and attaches to thoracolumbar fascia?

A

transverse abdominis

236
Q

Look at box analogy slide 87.

237
Q

… are made up of muscles, fascia, and ligaments all working together to create …

A
  • myofascial slings
  • stability
238
Q

muscles/structures involved, how/where stability created, exercise ex.

Describe the anterior oblique sling.

A
  • exernal oblique and internal oblique, connecting with contralateral adductor muscles via the adductor abdominal fascia
  • crosses pubic symphysis and provides pelvic stability
  • exercise examples: walking, running
239
Q

muscles/structures involved, how/where stability created, exercise ex.

Describe the posterior oblique sling.

A
  • glute max, opposite latissimus dorsi and thoracolumbar fascia
  • through the thoracolumbar fascia, this sling stabilizes the SIJ and creates stability at the back of the pelvis, especially during single-leg propulsion
  • exercise examples: swimming, squats, lunges, etc.
240
Q

muscles/structures involved, how/where stability created, exercise ex.

Describe the deep longitudinal sling.

A
  • the great communicator as it assists the lower body to know where the upper body is in space
  • creates stability around the pelvis during forwards and backwards movements
  • erector spinae, multifidus, thoracolumbar fascia, sacrotuberous ligament, and biceps femoris on same side of body
  • create stability during any standing activity
  • exercise examples: single leg bridge and the roll down exercises
241
Q

muscles/structures involved, exercise ex.

Describe the lateral sling.

A
  • gluteus medius, gluteus minimus, tensor fascia latae, iliotibial band, and opposite adductors
  • pelvis rotatory control especially in single leg stance
  • exercise examples: sidelying glute exercises such as leg lifts and side planks
242
Q

Spinal Stabilization

What does VPAC stand for?

A

volitional pre-emptive abdominal contraction

aka enganging core/core stabilization

243
Q

Spinal Stabilization

During a lifting task, VPAC is associated with increased trunk and hip extensor … , increased internal oblique … , and increased intra–abdominal …

A
  • force
  • thickness
  • pressure

All factors are associated with increased power during hip and trunk extension movements.

244
Q

VPAC has been associated with reducing…

A

LBP recurrence

245
Q

Inability to perform a VPAC may place an individual at a higher risk for…

246
Q

VPAC has been shown to improve performance during several dynamic activities, such as…

A
  • active forward reach
  • unipodal lower extremity balance test
  • stair descent
  • drop landing
247
Q

What are the 2 most common VPAC strategies described in literature?

A
  • drawing-in maneuver
  • abdominal bracing maneuver (ABM)
249
Q

describe, cue

Describe the drawing-in maneuver VPAC strategy.

A
  • volitional transverse abdominis contraction intended to pull umbilicus toward spine
  • cue to draw belly button up and in toward spine
  • thanksgiving dinner trick and remember to breathe
250
Q

describe, cue

Describe the abdominal bracing maneuver VPAC strategy.

A
  • involves concurrent muscle contraction around entire trunk (including TA contraction)
  • cue to “gently inhale, then exhale, now stiffen your trunk as though you will be hit in the belly. hold this contraction.”
  • ABM is most commonly used method in the health and fitness industry and is very effective in providing spinal stability
251
Q

See image on slide 94 on TA recruitment and pelvic floor/breathing exercises.

252
Q

Pelvic tilts have … TA activation compared to draw-in.

253
Q

based on…

When may pelvic tilts be appropriate for TA activation?

A

based on directional preference

254
Q

pt dx

Which patient population are pelvic tilts commonly used with?

A

stenotic patients

255
Q

Key to pelvic tilt is to train in … posture and then adjust “tilt” as needed for the individual.

Kines II (2 decks)

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