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Interventions II > Lecture 8: spinal strength & stabilization > Flashcards

Lecture 8: spinal strength & stabilization Flashcards

1
Q

Spinal muscle categories

A
  • superficial global

- deep segmental

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2
Q

Superficial global spinal m.

A
  • little/no direct attachment to vertebrae
  • further away from axis of motion
  • reaction to external load is direction specific
  • unable to stabilize individaul spinal segments
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3
Q

Erector spinae muscles

A
  • iliocostalis
  • longissimus
  • spinalis
  • long, multi-segmental
  • unitlateral: ipsilateral flexion or rotation
  • bilateral: extension
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4
Q

Quadratus lumborum

  • origin
  • insertion
  • action
A

origin: Posterior iliac crest & iliolumbar ligament
insertion: 12thrib & L1-L4 TP’s
Action:
-unilateral: ipsilateral lateral flexion
bilateral: flexion of ribs during inspiration, trunk extension

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5
Q

Rectus Abdominus

  • origin
  • insertion
  • action
A

origin: public symphysis/pubis
insertion: xiphoid process of sternum & costal cartilage of ribs 5-7
action:
-unitlateral: ipsilateral lateral flexion
-typically fire bialterally to flex the trunk & compress the abdomen

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6
Q

Internal oblique

  • origin
  • insertion
  • action
A

origin: Deep layer of TL fascia, anterior 2/3 of iliac crest, lateral 2/3 of inguinal ligament, iliopsoas fascia
Insertion: lower ribs 10-12
anterior & posterior layers of linea albaa
pubic crest

Unilateral; ipsilateral flexion and rotation of trunk
Bilateral: trunk flexion

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7
Q

external oblique

  • origin
  • insertion
  • action
A

origin: outer surface of ribs 5-12
insertion: linea alba, pubic crest, tubercle, ASIS/iliac spine
action:
-unilateral: ipsilateral lateral flexion & contralateral rotation
bilateral: trunk flexion and compresison of the abdomen

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8
Q

abdominal curls strengthening

A

rectus abdominus

external oblique

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9
Q

oblique curl strengthening

A

contralateral EO

Ipsilateral IO

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10
Q

side plank strengthening

A
  • ipsilateral EO

- ipsilateral IO

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11
Q

iliopsoas

  • origin
  • insertion
  • action
A

origin: L1-L5 TP
T12-L5 vertebra bodies and discs
insertion: lesser trochanter of femur
action: hip flexion

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12
Q

Deep segmental muscles

A
  • direct attachments across the vertebral segments
  • closer to the axis of motion
  • provide dynamic support across individual motion segments
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13
Q

Intratransversi

A

orgin: Superior aspect of TP
insertion: Inferior aspect of TP one
segment above
action:
-unilateral: ipsilateral trunk SB
-bilateral: stabilization

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14
Q

Rotatores

A

 Short:
 Origin: TP of thoracic vertebrae
 Insertion: Laminae/SP of vertebra 1
segment above

 Long:
 Origin: TP of thoracic vertebrae
 Insertion: Laminae/SP of vertebra 2
segments above

Action:

  • unilateral: rotate contralaterally
  • bilateraal: extension
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15
Q

Multifidus

A 
 Origin: 
 PSIS, dorsal surface of sacrum
 Mammillary processes (lumbar) 
 Transverse Processes (thoracic) 
 Articular Processes (C4-C7)

 Insertion: base of SP 2-4 segments above

Tonic stabilizer: high distribution of type I fibers and large capillary network, encased by middle and posterior lumbodorsal fascia

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16
Q

Low back-pain

A

 Multifidus atrophies quickly
 ↑’d fatty infiltration in muscle compared to healthy controls
 Delayed recruitment of the TA
 Specific training can improve activation and functional outcome
 Greatest association with LBP

17
Q

Transverse abdominus

A

 Origins:
 Inner surface of 7-12th costal cartilage
 Post/middle layers of thoracolumbar fascia
 Anterior 2/3 of iliac crest  Lateral 1/3 of inguinal ligament

 Insertions:
 Linea alba
 Pubic crest

 Action: develops tension around the lumbar spine

18
Q

obliques pulling in all different directions casuing thoracolumbar fascia to:

A

push out and laterally - creating tension and maintaining stabilization

19
Q

Head on neck
-axis of motion
COM on head
external & internal moment

A 
axis of motion: OA joint 
COM on head: anterior to joint 
External moment: flexion 
Internal moment: extension 
-suboccipital extensors, SCM, upper trap
20
Q

suboccipital muscles

A

 Obliquus Capitis Superior  O: TP of C1
 I: Occiput, below superior nuchal line
 A: Contalateral rotation of C1 on C2

 Obliquus Capitis Inferior  O: SP of C2
 I: TP of C1
 A: Ipsilateral rotation of head on C1

21
Q

subocitpial muscles continued

A 
 Rectus Capitis Posterior Major
 O: SP of C2
 Lateral part of occiput, below
inferior nuchal line
 A: extension of head; ipsi rotation

 Rectus Capitis Posterior Minor

 O: Posterior tubercle of C1
 Medial part of occiput, below inferior nuchal line
 A: extension of head

22
Q

Deep cervical flexors

A

 Rectus Capitis Anterior
 O: TP/lateral mass of atlas (C1)
 I: inferior surface of occipital bone
 A: flex head on the neck at AO joint

 Rectus Capitis Lateralis
 O: upper TP atlas (C1) 
 I: jugular process of occipital
bone
 A: flex head on neck at AO joint
23
Q

Deep cervical flexors continued

A

 Longus Capitis
 O: anterior tubercle of TP’s (C3-C5)
 I: tubercle of anterior arch of atlas (C1)
 A: cervical spine flexion (B)) and ipsilateral rotation (unilateral)

 Longus Colli
 O: anterior surfaces of vertebral bodies
I:

24
Q

scalenes

A

 Anterior
 O: Ant tubercles of TP’s of C3-C6
 I: Scalene tubercle on 1st rib
 A: elevate first rib, ipsilateral lateral flexion

 Middle
 O: Post tubercles of TP’s of C2-C7
 I: Undersurface of 1st rib
 A: elevate first rib, ipsilateral lateral flexion

 Posterior
 O: Post tubercles of TP’s of C4-C6
 I: lateteral surface of 2nd rip
A: elevate second rib, ipsilateral lateral felxion

25
Q

Upper trap

A 
O: external occipital protuberance and
superior nuchal line; nuchal ligament 
 I: Posterior lateral 1/3 of clavicle,
acromion, and spine of scapula
 Action:
-unilateral: ipsilateral side flexion of neck
26
Q

SCM

A

 Origin:
 Anterior surface of manubrium
 Medial 1/3 of clavicle

 Insertion:
 Mastoid process
 Lateral part of superior nuchal line

 Action:
 Unilateral: contralateral rotation
 Bilateral: neck flexion

27
Q

Forward head posture - upper cervical extensors

A
  • sub-occipital extensors: tight
  • capital flexors: weak/lengthened
  • hyoid mm: may be lengthned
28
Q

forward head posture upper thoracic/lower cervical flexion

A

flexors: tight
extensors: weak/lengthend

protracted scap: weak/lengthened retractors

29
Q

damanging forward head posture

A

for every inch of forward head posture, it can increase the weight of the head on the spine by an additional 4.5 kgs

30
Q

spinal muscle performance

A

 Activation
 Neuromuscular Control

 Stabilization
 Building on TA Activation
 Isometric/Co-contraction of trunk
 Superimposed extremity motion

 Strengthening

31
Q

capital flexion -activaiton

A

nod head
axis of motion: external auditory meatus
PT may need to passively create this motion to start

32
Q

Cerivcal-thoracic activiation

A

Capital flexion – slight nod
 Axis of motion: external auditory meatus
 Upper cervical (C0-C2)

 Mid-cervical flexion (Not retraction)
 Slight decrease in cervical lordosis

 Lower cervical/upper thoracic extension
 Decreasing kyphosis
 Also, a little bit of scapular retraction

33
Q

TA activaiton (drawing in)

A 
Transverse Abdominis
 Drawing-in maneuver
 Co-contraction of Multifidus and pelvic 
floor
 Tightening of Thoracolumbar fascia

 Supine
 All fours
 Sitting
 Standing

34
Q

Transverse Abdominus Activation

A

 Responds with anticipatory activity (feed-
forward) with rapid arm/leg movement
 Coordinated activity
 Pelvic floor mm./perineum mm.
 Respiration
 Multifidus
 Active with both isometric flexion or
extension
 Drawing in maneuver – most independent
activity of TA (relative to other abdominal
mm.)

35
Q

Lumbar stabilization

A

Perform Drawing-In Maneuver
ADD extremity motions
 Maintain neutral spine by co-contraction/isometric contraction of deep
mm.
 Increase endurance and strength
 Stop the exercise or decrease intensity if
unable to maintain neutral spine

36
Q

lumbar stabilization

A 
Diagonal exercises 
 more consistently activate the multifidus 
and abdominal oblique mm.
 Functional Activities
 Driving, reaching, push/pull, walking, lifting
 Sport simulation activities
 Transitional positions/exercises

37
Q

Stabilization

A

 Spinal muscles: higher percentage of Type I muscle fibers than extremity
muscles
 Deep spinal muscles: greatest percentage of Type I fibers
 Use longer hold times and more repetitions
 Stop if the patient cannot control the position

38
Q

Strenthening

A 
Overloading the muscle 
throughout the range of motion
 Concentric
 Eccentric
 Isometric
 Endurance at lower loads

Interventions II (11 decks)

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