Lecture 26 - Lumbar Spine Flashcards
-Students will be taken through an overview of the lumbar spine anatomy -Student will know why we evaluate and treat the lumbar spine -Student can identify red flags in low back pain patient -Student can explain effects of the trunk base on the rest of the body -Student can define fascial patterns of the body -Student will know CCP, variations, and specifically how CCP relates to the lumbar spine -Student can perform Supine Osteopathic Structural Evaluation of lumbar spine fascial patterns
The superior articular facets of lumbar vertebrae face
Backward, Upward, Medially (B.U.M.)
Superior articular surfaces of cervical vertebrae face
Backward, Upward, Medially (B.U.M.)
Superior articular surfaces of thoracic face
BUL - LATERAL
Erector Spinae
- Origin: musculotendinous mass over posterior surface of sacrum, iliac crest, spinous processes of lumbar and last 2 thoracic vertebrae
- Insertion: Different for each muscle but inc:Lower borders of all 12 ribs, TPs of C4-6, TPs of T2-12, Mastoid process, SPs of T spine
- Innervation: dorsal rami of spinal nerves
- Actions: Strong extensor; also a sidebender and rotator to the same side: LUMBAR EXTENSION
Rectus Abdomini
- lumbar flexion
- Origin: pubis (between pubic tubercle and symphysis)
- Insertion: cartilages of 5th to 7th ribs, xiphoid process of sternum
- Innervation: intercostal nerves T5-T12
- Action: flexes trunk, compresses abdomen, stabilizes pelvis, prevents lumbar lordosis: Initiates sit-up from supine & Iliopsoas helps
Iliopsoas (Iliacus and Psoas)
-lateral side bending
-Origin: Psoas Major: T12-L4 vertebral bodies and intervertebral discs (superficial layer), L1-L5 transverse processes (deep layer); Iliacus: Iliacus fossa
-Insertion: lesser trochanter of femur
-Innervation: L2,3
-Action: Hip: flexes and externally rotates
Lumbar spine: with hip flexed, it unilaterally side-bends trunk; bilaterally flexes trunk from supine
Inc. Lumbar lordotic curve when tight?
iliopsoas
Common cause of muscle imbalance that causes low back pain?
iliopsoas
How do you treat a disc?
- First step is to balance the lumbars and the pelvis
- Next is to look at the psoas and iliacus
Quadratus lumborum
- side bender
- attaches to the transverse processes of L1-L4/L5 (also iliac crest and rib 12)
Abdominal muscles
- transversus abdominis and internal obliques)
- Origin: along the thoracolumbar fascia
- Insertion: aponeurosis into linea alba and lower ribs
- Weak abdominals = anterior rotation of innominates = increased lordosis
lumbar side bending muscles
iliopsoas quadratus lumborum transversus abd internal oblique intertransversari
lmbar rotation muscles
-Abdominal Obliques
-Transversospinalis system: Lies deep to the erector spinae;
Rotation to the OPPOSITE side
-Multifidus: Origin: base of sacrum, erector spinae, PSIS, iliac crests; Insertion: superior spinous process; Spans 2-4 vertebral segments.
-Rotatores: Origin: transverse process; Insertion: superior spinous process; Spans 1-2 vertebral segments.
Why do we evaluate and treat the Lumbar Spine?
Somatic dysfunctions in lumbar spine can:
- Cause low back pain
- Result in biomechanical disruptions to LE, -sacrum, and the rest of the spine
- Affect the function of the diaphragms
- Respiratory/circulatory effect
What are the attachments of the diaphragm?
- rib 7-12
- L1-L3 vertebral bodies, intervertebral disks, and ALL
- Posterior surface of xiphoid process.
