Low Back Assessment Flashcards
stability needs _____ and _____ to be equal
compression
tension forces
what do muscles provide for stability?
force transference
what does optimization of stabilization require?
adequate compression of joints
tensegrity
a force pulling in one direction is equally opposed by a force pulling in the opposite direction
compression is applied by?
gravity
tension is absorbed and provided by?
muscle
tendon
ligament
bone
what does spine stability depend on?
symmetry of muscle stiffness and forces all around the spine
no singl emuscle must exert too much force or too little, its activation level is in balance with all others
a neutral spine is required together with a broad base
what muscles are shortened for lumbar hyperlordosis?
erector spinae
anterior pelvic tilt has what weak muscles? tight?
weak gluteals, iliopsoas
tight quads, erector spinae
protruding abdomen is caused by weak what?
abdominals
foot flare is caused by?
tightness in external hip rotators
pain over lateral knee is caused by?
shortened TFL
hypolordosis is caused by weak what? tight?
weak: rectus abdominus, external oblique
tight: gluteals, hamstrings
anterior pelvic tilt is caused by what?
tight: erector spinae, rectus femoris
weak: iliopsoas
posterior pelvic tilt is caused by what?
tight: gluteus, hamstring, iliofemoral ligament
weak: rectus abdominis, external oblique
what are some screening methods for lower cross syndrome?
prone instability test
hip extension pattern
hip abduction pattern
glute bridges
what mobility tests are used for lumbar spine evaluation?
toe touch
prone instability test
what motor control tests are used for lumbar spine?
hip extension pattern
hip abduction pattern
glute bridge
what functional patterning tests are used for lumbar spine?
deadlift
lunge
deep squat
P-A instability test (feet down)
patient is prone, with legs off the end of the table
impulse at each lumbar spinous process. pain occurs at unstable segments
P-A instability test (feet up)
patient is prone on the table with the legs off the table
impulse at each lumbar spinous process. Pain lessens when legs raised as lumbar extensors are activated, stabilizing lumbar spinal segments
hip extension proper motion pattern
ipsilateral hamstring
ipsilateral gluteals
contralateral spinal extensors
ipsilateral spinal extensors
where are doctor’s hands on hip extension?
one hand on glutes
one hand on thoracolumbar paraspinals
hip extension motion pattern, what happens if they can’t hold knee extension?
facilitated hamstrings
inhibited glutes
hip extension motion pattern, what happens if there is forced lumbar extension?
facilitated thoraclolumbar extensors
inhibited glutes
hypermobile lumbar segments
hip extension motion pattern, what happens if the thoracic spine activation first with trapezius activation?
evaluate contralateral latissimus dorsi
what is the treatment for altered hip extension?
stretch tight muscles first
strengthen weak muscles
what muscles do you stretch when your patient has altered hip extension pattern
psoas
quads
hamstrings
what muscles do you strengthen in an altered hip extension pattern?
gluteals abdominals (curl up)
what else can you do for altered hip extension pattern?
adjust thoracics
lumbars
SI
what exercises can you use to help with hip extension?
quadruped leg reach
table top
quadruped leg reach
get on all fours
lift one leg up without extending lumbars
table top
lay top of back and head on exercise ball
lift hips up in air without extending lumbars
proper hip abduction motor pattern
side lying with lower leg flexed
slowly raise leg toward ceiling
observe for normal motion
hold position and observe for drift
altered hip abduction pattern
decrease ROM hip flexion (forward drift) hip external rotation (foot flare) hip hiking (bending at waist)
decreased ROM for hip abduction pattern
adductor tightness
hip flexion altered hip abduction
TFL substitution
hip external rotational altered hip abduction pattern
piriformis substitution
hip hiking altered hip abduction pattern
QL substitution
how do you treat altered hip abduction
stretch TFL, QL, piriformis
strengthen gluteus medius
adjust
how can you strengthen gluteus medius?
side-lying hip abduction
side plank wall press
monster walk
segmental stabilization of glutes
force closure of SI
control and centralize femur in acetabulum
co-contraction with psoas major provides pelvic stability
segmental stabilizer through tensing TL fascia and triggering deep lumbar multifidus
global stabilization of glutes
eccentric lengthening or isometric holding to control ROM
how do the glutes provide eccentric lengthening or isometric holding to control ROM
sagittal plane stabilization of trunk during gait and standing
controls trunk rotation during gait through conecction with lat
frontal plane stabilizer during single leg (trendelenburg)
global mobilizer of the glutes
produce high force or power
how do the glutes produce high force or power?
hip extension external rotation superior fibers (abduction) lower fibers (adduction
what are some lifting strategies to spare the spine?
avoid end range lumbar motion avoid lifting immediately after sitting flexed pre-stress the system for stability reduce the load moment direct force vector through the navel reduce the amount of weight lifted
how do you avoid end range lumbar motion
neber flex the lumbar spine to full flexion under load
how do you avoid pre-stressing the lumbar system for stability?
abdominal brace (increase intra-abdominal pressure)
how do you reduce the load moment?
keep the weight in close
golfer’s lift
lifting mechanics
practice lifting
avoid twisting
rolling in bed
