Examination and Treatment of the Lumbar Spine

Question 1

The intervertebral disc consists of these 3 structures

Answer 1

annulus
nucleus pulposus
vertebral end plate

Question 2

This part of the intervertebral dis has substantial resistance to tensile loads, is type 1 collagen, has lamellar/parallel configuration and outer neurovascular structures

Answer 2

annulus

Question 3

This portion of the intervertebral disc is surrounded by 3 layers of annulus and a gel-like region like water

Answer 3

nucleus pulposus

Question 4

This part of the intervertebral disc is large with flat cartilage, and semipermiable barrier between vertebral body and IVD for nutritional transport

Answer 4

vertebral end plate

Question 5

The function of the intervertebral disc

Answer 5

stabilizes spine

absorbs and distributes load

Question 6

If pain is reduced following manual therapy or exercise what is likely happening

Answer 6

the fluid is just getting moving again

Question 7

Intervertebral disc failure risk increase with what two motions

Answer 7

bending and rotation

Question 8

The zygopophyseal joints orientation is parallel in what plane

Answer 8

sagittal plane

Question 9

The z-joint restricts this motion, which protects from what?

Answer 9

rotation

shearing stresses

Question 10

Connection site for the multifidus and interspinous ligament

Answer 10

zygopophyseal joint

Question 11

This ligament is a strong resister of extension

Answer 11

anterior longitudinal ligament

Question 12

This ligament has a weak restraint against flexion

Answer 12

posterior longitudinal ligament

Question 13

This ligament can be elastic and associate with stenosis

Answer 13

ligamentum flavum

Question 14

These ligaments have multidirectional restraints

Answer 14

iliolumbar ligaments

Question 15

This ligament of the spine can be palpated

Answer 15

supraspinous ligament

Question 16

Posterior superficial musculature of the lumbar region

Answer 16

latissimus dorsi
thoracolumbar fascia
gluteus maximus

Question 17

Function of the erector spinae

Answer 17

bilateral: extension
unilateral: sidebending

Question 18

Posterior intermediate musculature of the lumbar spine

Answer 18

erector spinae:
iliocostalis
longissimus
spinalis group

Question 19

Posterior deep musculature of the lumbar spine

Answer 19

multifidus

quadratus lumborum

Question 20

Function of the posterior deep musculature

Answer 20

counteract anterior shear of lumbar spine during forward bending activities

Question 21

Function of the multifidi

Answer 21

bilateral back extension

unilateral - contralateral rotation

Question 22

Anterior musculature of the lumbar spine

Answer 22

rectus abdominis
transversus abdominis
psoas
ilacus
external oblique
internal oblique

Question 23

The pelvic floor musculature provides inferior support to:

Answer 23

the abdominal-pelvic region

Question 24

3 key functions of intra-abdominal pressure

Answer 24

• stability of spine
• relief of pressure on spine during heavy lifting
• diaphragm is key in pressure determination and/or distribution

Question 25

3 key features of the pelvic floor

Answer 25

• functions as lower core stabilizer/increases IAP
• maintains continence
• key in retraining core stability

Question 26

What occurs during diaphragm inspiration

Answer 26

• diaphragm flattens
• rise of upper abdomen
• lateral costal expansion

Question 27

What occurs during expiration of the diaphragm

Answer 27

• diaphragm rises
• caudal shift in rib cage
• passive process

Question 28

Lower body cross syndrome has tight _______ and weak _______

Answer 28

tight: erector spinae and iliopsoas
weak: gluteus maximus and abdominal

Question 29

The 4 global lumbar stabilizing muscles

Answer 29

rectus abdominus
iliacus/psoas major
latissimus dorsi
gluteus maximus

Question 30

The 4 local lumbar stabilizing muscles

Answer 30

transverse abdominus
multifidus
pelvic floor mm
diaphragm

Question 31

Spinal cord terminates at which level of the lumbar

Answer 31

L1-2, conus medullaris

Question 32

Lower quarter screen consists of these 6 test/measures

Answer 32

• dermatomes
• DTR
• myotomes
• neural tension (SLR/slump)
• consider UMN tests
• vascular screening

Question 33

Osteokinematics of the lumbar spine

Answer 33

flexion
extension
rotation
side bend/side glide

Question 34

1st law/Type 1 of the arthrokinematics: Fryette’s Law of Spinal Motion

Answer 34

• spine in neutral position

- rotation and SB occur OPPOSITE directions of each other

Question 35

2nd law/Type 2 of the arthrokinematics: fryette’s law of spinal motion

Answer 35

• spine flexed or extended

- rotation and SB occur in SAME direction

Question 36

3rd law/Type 3 of the arthrokinematics: fryette’s law of spinal motion

Answer 36

• motion introduced in one direction will significantly reduce motion in all other directions

Question 37

Pain, muscle tension, or stiffness localized below the costal margins and above the inferior gluteal fold, with or without leg pain

Answer 37

low back pain

Question 38

The 4 implications of the medical model of disease

Answer 38

signs/symptoms analyzed
pathology is determined
treatment corrects pathology
signs/symptoms disappear

Question 39

What other 4 clinical expressions of pain are there besides physical dysfunction?

Answer 39

psychological distress
attitudes and beliefs
the social environment
illness behavior

Question 40

The 3 domain factors, that help with identifying therapeutic focus

Answer 40

personal factors
environmental factors
body functions and structures (deficits)

Question 41

From the personal factors domain, what are the two drivers of pain AND disability?

Answer 41

comorbidity drivers

cognitive-emotional drivers

Question 42

From the environmental factors domain, what are the drivers of DISABILITY?

Answer 42

contextual drivers

Question 43

From the body functions and structures domain, what are the two drivers of PAIN?

Answer 43

nociceptive pain drivers

nervous system dysfunctions drivers