Lecture 27 - Lumbar II Flashcards
-Planes of motion of the spine (review) -The functional vertebral unit used to describe vertebral movement and somatic dysfunctions (SD)s -Lumbar vertebral movements and the main muscles that cause them to move -The three principles of physiologic motion of the spine and which muscles are the ones theorized to maintain SDs (Review) -To diagnose Type I and Type II SDs (positional diagnosis) -The proper diagnostic notation that describes the position of the dysfunctional vertebra(e) -How
Vertebral Unit
Two adjacent vertebrae with their associated intervertebral disk, arthrodial, ligamentous, muscular, vascular, lymphatic and neural elements.
motion of one vertebra is described as…
as it moves in relation to the vertebra below.
NEVER MOVING BY ITSELF
lumbar spine movement
- flexion=the anterior aspects of the spine are
- extension= the poster aspects of the spine are
approximate… aka get closer together
Neutral mechanics occur when the patient is
in the erect position with normal anteroposterior curves (i.e., “easy normal”, not flexed or extended).
-involves the movement of 3 or more vertebrae
neutral vs not neutral
erect (easy normal) vs flexed/extended
Type I motion:
- motion from the neutral spinal position
- involved LONG muscles
- A Type I SD occurs when the spine gets stuck in that position, and it is maintained by long restrictor muscles3; (QL, Psoas, Erector Spinae)
non-neutral mechanics occurs when…
- there is alteration the anteroposterior curve into flexion or extension
- during flexion/extension your spine has a greater curve somewhere… when you flex/extend AND sidebent = issues = non-neutral
Type II SD occurs
when the spine gets stuck in that position. It is maintained by short restrictor muscles3.
If you move in one motion what happens to the other motinos?
the movement is diminished!
causes of Type II SD
TRAUMA
EXEEDING normal ROM
causes of Type I SD
postural; unleveled sacral base; a type II at the bottom or top curve
Type II SD involves how many vertebrae?
only ONE (one vertebral unit
Type I SD involves how many vertebrae
3 or more
Diagnostic procedure
1) Step One: Patient Seated. Screen the spine with the sweep
a) Sweep spinous processes from the side using the finger pads of one hand.
b) Palpate for changes in the A-P curves, especially any gap in the spinous processes that is not uniform.
2) Step Two: Requires the assessment of the paired transverse processes in three positions:
a) Neutral; b) Forward bent (flexed); c) Backward bent (extended) —> USE STATIC, MIOTION, and DYNAMIC PALPATION
3) Step Three: Diagnostic Interpretation –> POSITIONAL DIAGNOSIS WILL DESCRIBE THE SD IN MULTIPLE PLANES
Static Palpation looking for/doing?
We will find a transverse process that is POSTERIOR on one side.
Motion Palpation looking for/doing?
- how the vertebra moves (either becoming more symmetric or asymmetric) as the patient goes in and out of the position of neutral into flexion and extension.
- The physician will corroborate the restricted motion by pushing on the transverse process with the thumb. If it does not move anteriorly as much as the other side, then it is considered posterior.
- PUSH ON THE VERTEBRAE TO SEE WHICH SIDE IS HARDER TO PUSH FORWARD… THATS THE SIDE THATS ROTATED
Dynamic Palpation… looking for/doing?
LISTEN LECTURE HERE>… APROX 35-40 min in. WHat did he say after motion palpatio?
- Apply symmetric pressure to the paraspinals (about 5-7 lbs. of pressure). No asymmetric pressing of either side as done with motion testing.
- With pressure maintained and starting in neutral, have the patient flex forward, come back to neutral, then extend, while monitoring the motion of the lumbar vertebrae the entire time.
If the rotation of three or more vertebrae are to one side, then the sidebending is to the
opposite side (principle 1)
If the rotation of one or two vertebrae are to one side, then the sidebending is to the
same side (principle 2)
Flexed Somatic Dysfunctions
If one transverse process is posterior on one side while the patient is on the extended position and it then becomes symmetric with the other transverse process in the flexed position, then it is a flexed SD, rotated and side bent towards the side of the posterior transverse process.
Extended Somatic Dysfunctions
If one transverse process is posterior on one side while the patient is on the flexed position and it then becomes symmetric with the other transverse process in the extended position, then it is an extended SD, rotated and side bent towards the side of the posterior transverse process.
Neutral Somatic Dysfunctions
If three or more transverse processes are posterior on one side while the patient is on all three positions, then it is a neutral SD, rotated towards the side of the posterior transverse processes and side bent towards the opposite side (Principle 1).
Direct Treatment of specific segmental SDs of the lumbar spine…
For a Direct Treatment the physician reverses the diagnostic formula
-works on type II and I
Lateral Sims Technique used for
type II lumbar SD
-LV/MA technique
-not in direct category
-The patient is positioned on the side of vertebral rotation, i.e., if the SD is one of sidebending and rotation to the left, the patient would be positioned on his/her left side.
Then the patient’s leg is used as a lever to increase the vertebra’s general range of motion.
Lateral Sims Technique treats
extended or flexed Type 2 Lumbar SD
