L1-2 Lumbar Spine: Biomechanics

Question 1

ROM: lumbar flexion

Answer 1

70-90

Question 2

ROM: lumbar extension

Answer 2

30-50

Question 3

ROM: lumbar SB

Answer 3

25-35

Question 4

ROM: lumbar rotation

Answer 4

20-40

Question 5

lumbar facet open pack position

Answer 5

flexion
contralateral SB
ipsilateral rotation

Question 6

lumbar facet closed pack position

Answer 6

extension
ipsilateral SB
contralateral rotation

Question 7

capsular pattern of lumbar spine facet

Answer 7

normal flexion
decreased extension with rotation
side bending limited equally BL

Question 8

flexion: arthrokinematics of facet

Answer 8

inferior facet of the upper vertebrae will glide up/forward

Question 9

flexion: arthrokinematics of disc

Answer 9

nucleus pulposus moves posterior, annulus fibrosis moves anterior

Question 10

flexion: arthrokinematics of spinal canal

Answer 10

lengthen and open foramen

Question 11

extension: arthrokinematics of facet

Answer 11

inferior facet of superior vertebrae moves down and back

Question 12

extension: arthrokinematics of disc

Answer 12

nucleus pulposus moves anterior
annulus fibrosis moves posterior

Question 13

extension: arthrokinematics of spinal canal

Answer 13

shortens and closes foramen

Question 14

side bend: arthrokinematics of facets

Answer 14

right SB
right facet glides down, L glides up

Question 15

side bend: arthrokinematics of intervertebral foramen

Answer 15

R SB
R side closes, L side opens

Question 16

coupled motion: how/why does it occur

Answer 16

orientation of bones in joints create one motion along with another when one is generated

Question 17

lumbar coupled motion

Answer 17

SB coupled to contralateral rotation
ex) SB right coupled with left rotation

Question 18

annulus fibrosis fibers

Answer 18

oriented at 65 degrees, alternating directions with 10-12 layers
resist rotation and torsion

Question 19

vascular supply of lumbar disc

Answer 19

none!

Question 20

how does disc get nutrients

Answer 20

osmosis, compression/decompression cycle pumps nutrients in

Question 21

cause of bulging disc

Answer 21

uneven loading pushing nucleus posteriorly

Question 22

makeup of intervertebral disc

Answer 22

80% water to 65% water as we age
type 2 collagen
nucleus pulposus and annulus fibrosis allow flexibility at low loads and stability at high loads

Question 23

which area of lumbar segments get the most sagittal plane motion?

Answer 23

lower

Question 24

which area of lumbar segments get the most frontal plane motion?

Answer 24

mid lumbar

Question 25

fryette's law 1:

Answer 25

neutral spine: rotation in opposite direction of side bend in coupled motion

Question 26

fryette's law 2:

Answer 26

full flex/ext, locking facets: rotation and side bending occur in the same direction

Question 27

fryette's law 3:

Answer 27

if motion is introduced in one plane, motion in other planes is reduced eg a spinal segment sidebending will have less rotation than neutral spine

Question 28

which area of lumbar segments get the most transverse plane motion/rotation?

Answer 28

lumbosacral junction

Question 29

arthrokinematics of vertebrae in flexion

Answer 29

anterior roll/glide posterior pelvic tilt

Question 30

arthrokinematics of vertebrae in extension

Answer 30

posterior roll/glide comes with anterior pelvic tilt

Question 31

flexion pattern

Answer 31

common pattern with central back pain pain worsens with flexion and rotation reduced lordosis

Question 32

extension pattern

Answer 32

central back pain worse with extension and rotation pain with standing/swimming often hinge at unstable segment shows increased lordosis

Question 33

lateral shift pattern

Answer 33

patient shows recurrent shift with unilateral back pain shows lateral movement with sagittal plane flex/ext can have excess QL/erector spinae/multifidi activation

Question 34

multidirectional pattern

Answer 34

high pain and disability all movement in WB painful often unable to achieve neutral spine

Question 35

flexion syndrome: sahrmann

Answer 35

has more flexion in spine than hip shortened posterior chain

Question 36

extension syndrome: sahrmann

Answer 36

more extension in spine than hip often older pts pain with lordosis shortened hip flexors, obliques

Question 37

rotation syndrome: sahrmann

Answer 37

unilateral pain increasing with rotation only one segment rotates more easily than ones above or below it spinal instability caused by repetitive movement/leg length

Question 38

flexion with rotation syndrome: sahrmann

Answer 38

unilateral pain increased by flexion with rotation

Question 39

extension with rotation syndrome: sahrmann

Answer 39

unilateral pain increased by extension with rotation

Question 40

How to assess disc with McKenzie

Answer 40

repeated motion or sustained positions

Question 41

closing restriction

Answer 41

facet limitation in ext, ipsl SB, CL rotation

Question 42

opening restriction

Answer 42

facet limited in flexion, CL SB, ipsl rotation

Question 43

compression forces do what to lumbar spine

Answer 43

compress disc cause disc to bulge/widen

Question 44

tension force does what to lumbar spine

Answer 44

pulls apart loading structures can cause injury in trauma like hyperextension

Question 45

shear force does what to lumbar spine

Answer 45

load parallel to vertabrae caused by trauma or repetitive force spondylolisthesis causing anterior shift with flexion

Question 46

torsional force effect on lumbar spine

Answer 46

twisting stresses and injures soft tissue caused by generation of large muscle forces loads IV disc

Question 47

slump test

Answer 47

tesnions nerves pt in seated, slump forward straighten leg then DF worse in slump - internal problem worse sititng up - external problem of nerve, adhesion

Question 48

disc pressure by position - least to most disc pressure

Answer 48

supine sidelying standing seated lean forward seated lean forward lean forward standing with weight seated lean forward with weight

Question 49

symptoms based classification

Answer 49

symptom modulation - active rest, control pain movement control - address impairments, irritated structures w/ ther ex functional optimization - symptoms resolved, return to high level activity

Question 50

painful arc in flexion

Answer 50

pt often has pain in midrange but not early or end range

Question 51

painful arc

Answer 51

pain only on return from lumbar flexion also often in midrange

Question 52

gower's sign

Answer 52

thigh climbing where pt needs to push on thighs for assistance when returning to uprught from flexion

Question 53

instability catch

Answer 53

any trunk movement outside of the specified motion with sudden accleration/deceleration eg going into flexion and sudden SB

Question 54

reversal of lumbopelvic rhythm

Answer 54

when returning from flexion to neutral, trunk extending first, then hips and pelvis extend to bring body upright