Lecture 27 - Lumbar II

Question 1

Vertebral Unit

Answer 1

Two adjacent vertebrae with their associated intervertebral disk, arthrodial, ligamentous, muscular, vascular, lymphatic and neural elements.

Question 2

motion of one vertebra is described as…

Answer 2

as it moves in relation to the vertebra below.

NEVER MOVING BY ITSELF

Question 3

lumbar spine movement

• flexion=the anterior aspects of the spine are
• extension= the poster aspects of the spine are

Answer 3

approximate… aka get closer together

Question 4

Neutral mechanics occur when the patient is

Answer 4

in the erect position with normal anteroposterior curves (i.e., “easy normal”, not flexed or extended).
-involves the movement of 3 or more vertebrae

Question 5

neutral vs not neutral

Answer 5

erect (easy normal) vs flexed/extended

Question 6

Type I motion:

Answer 6

• 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)

Question 7

non-neutral mechanics occurs when…

Answer 7

• 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

Question 8

Type II SD occurs

Answer 8

when the spine gets stuck in that position. It is maintained by short restrictor muscles3.

Question 9

If you move in one motion what happens to the other motinos?

Answer 9

the movement is diminished!

Question 10

causes of Type II SD

Answer 10

TRAUMA

EXEEDING normal ROM

Question 11

causes of Type I SD

Answer 11

postural; unleveled sacral base; a type II at the bottom or top curve

Question 12

Type II SD involves how many vertebrae?

Answer 12

only ONE (one vertebral unit

Question 13

Type I SD involves how many vertebrae

Answer 13

3 or more

Question 14

Diagnostic procedure

Answer 14

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

Question 15

Static Palpation looking for/doing?

Answer 15

We will find a transverse process that is POSTERIOR on one side.

Question 16

Motion Palpation looking for/doing?

Answer 16

• 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

Question 17

Dynamic Palpation… looking for/doing?

LISTEN LECTURE HERE>… APROX 35-40 min in. WHat did he say after motion palpatio?

Answer 17

• 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.

Question 18

If the rotation of three or more vertebrae are to one side, then the sidebending is to the

Answer 18

opposite side (principle 1)

Question 19

If the rotation of one or two vertebrae are to one side, then the sidebending is to the

Answer 19

same side (principle 2)

Question 20

Flexed Somatic Dysfunctions

Answer 20

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.

Question 21

Extended Somatic Dysfunctions

Answer 21

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.

Question 22

Neutral Somatic Dysfunctions

Answer 22

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).

Question 23

Direct Treatment of specific segmental SDs of the lumbar spine…

Answer 23

For a Direct Treatment the physician reverses the diagnostic formula
-works on type II and I

Question 24

Lateral Sims Technique used for

Answer 24

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.

Question 25

Lateral Sims Technique treats

Answer 25

extended or flexed Type 2 Lumbar SD