Lumbar Flashcards
What is the importance of finding, maintaining, and using neutral spine position in the lumbar spine?
- awareness and control of safe spinal motion -awareness of neutral spinal position in supine, prone, sitting and standing -awareness of effect of ADL’s and extremity motions of spine
What happens to your lumbar spine when you move your extremities away from your body?
spinal motion is extension
What happens to your lumbar spine when you move your extremities toward your body?
spinal motion is flexion
What is the significance of a patients breathing if they are injured?
they will not inhale fully
Inhalation facilitates what things in the spine?
-stability of the spine when hips in flexion -spinal extension -scapular elevation and humeral IR
Exhalation facilitates what things in the spine?
-stability of the spine when hips in extension -spinal flexion -scapular depression and humeral ER
What can inhaling into each (one) lung facilitate?
Side bending
In a patient with LBP what muscle is ineffective?
the transverse abdominis
What is the primary function of the transverse abdominis?
stabilization
What lower ( in lumbar region) muscle precedes trunk movement?
transverse abdominis
What other muscles activate with the transverse abdominis?
pelvic floor muscles (synergists)
What is the primary role of the multifidus?
stabilization
What does the multifidus co-contract with?
with the transverse abdominis
What muscles are activated when you do the drawing in maneuver?
the multifidi and the transverse abdominis
What position is the drawing in maneuver done in?
quadruped or prone
How do you isolate activating the multifidi?
-done in quadruped or prone -draw your navel into your spine and at the same time swell your back into my thumbs
What are the global muscles of the lumbar spine?
-rectus abdominis -external and internal obliques -quadratus lumborum (lateral portion) -erector spinae -iliospoas
How do you perform the abdominal stabilization with a blood pressure cuff?
-stabilizer in small of back -40mmHg of pressure in the cuff -slowly slide one leg away from the body -gauge should stay at 40mmHg
How do you increase and decrease pressure in the abdominal stabilization with a blood pressure cuff?
-increase pressure-posterior pelvic tilt (PPT) -decreased pressure- anterior pelvic tilt (APT)
How do you find the neutral spine?
-begin in supine or hooklying -have them move through APT and PPT -find most comfortable position -if not possible=teach imprinting
What is imprinting with finding neutral spine?
-in a posterior pelvic tilt, with back imprinted flat on the mat -may need to do passively if active movement and control are not possible for the patient
What muscle should also be accompanied by finding pelvic neutral ?
transverse abdominis
What is the progression of stability exercises?
-emphasis on endurance -use props (yard stick, pressure cuff biofeedback) -extremity loading (moving all 4 extremities at once, change planes- transverse/diagonal) -external resistance -position changes (sitting, kneeling, standing) -unstable surfaces
Examples of dynamic strengthening for the abdominals?
-curl-ups -curl-downs -diagonal curl-up
Describe how to progress curl-ups for abdominals?
-arms by side -across chest -behind head -holding weight/med ball (shoulder flex to 90)
describe how to do diagonal curl-ups
curl up and reach one hand toward opposite knee, or bring knee toward opposite shoulder
How do you progress for dynamic strengthening for trunk flexion?
-resisted in sitting or standing -using resistance secured behind -flex/rotate trunk
What muscles does this activate and how do you progress it?
- Activates erector spinae and multifidi
- progress by adding weights in hands
What is the name of this exercise, what muscles does it work and how do you progress it?
- superman
- works the erector spinae and multifidi
- increase resistance with shoulder adbuction to 90 or elevating to 180
When should you start adding functional activities in the exercise program?
initiate once patient has learned to manage signs and symptoms of inflammation diminish
If pateint is unable to do a normal pushup what can they do instead?
Have patient do a wall pushup
how do you progress ADLs?
- Lifting with stable spine
- Carrying with stable spine
- Reaching with stable spine
What is the extension bias approach? What does the patient look like? What might be wrong with them (reason for bais)?
- Extension tests decrease or centrilize symptoms
- Patient presents with flexed posture (lateral shift present)
- IVD lesions, imparied flexed posture, osteoperosis
What can you do to help with someone the has extension or flexion bias?
core stabilization exercises and stretching
How do you specifically treat extension bias besides doing core stabililzation?
- Treat lateral shift (manual or self correct)
- Treat with extension techniques
- Isometric activities
What exercises do you avoid in the acute phase for extension bias and why?
Lumbar flexion or extension exercises increase intra-disc pressure
What happenes after the acute symptoms stabilized?
- decreased pain & neurological signs
- imporved posture, increased mobility
After acute symptoms stabilize, how do you progress for extension bias?
- have them do flexion exercises or prolonged flexion and then end with extension exercises
- NOTE: if symptoms reoccur perform just extension exercises
What is osteoporosis?
Loss of bone mineral density
What is the standard deviations is osteoperosis and osteropenia?
- osteoporsis: 2.5 SD
- Osteopenia: 1 SD
What is osteopenia?
mildly reduced bone mineral density
What motion MUST you avoid with people with osteoperosis/penia?
Avoid flexion exercises and ADL’s
What is flexion bias?
- patient is more comfortable in flexed posture
- extension tests increase or peripherilize symptoms
What could be wrong with the patient if they have a flexion bias approach?
- spondolosis
- stenosis
- extension load injuries
- facet joint irritation
What is spondylosis?
Degenerative osteoarthritis of the joints in the spine
- descripitve term, not really a diagnosis
- You can have pain and degeneration regardless of location
What is stenosis?
Narrowing of the neural foramin or narrowing of the spinal canal itself
What can cause stenosis?
- Osteoarthritis
- Loss of disk height
- ligamentous changes
What can cause hypermobility and functional instability in the lumbar spine?
- trauma
- ligamentous laxity
- spondololysis
- spondololisthesis
how can you fix hypermobility and functional instability ?
core stabilization
What is a spondylolysis?
- Defect in the pars interarticularis (pedicle)
- pedicle breaks off and tries to heal, but fails (held in place by soft tissue)
Where is the most common location for a spondoloysis and who is it most common in?
- usually at L5-S1
- boys who play football (linemen)
- girls who are gymnasts
- can occur due to changes with ageing
If there is pars defect does the scotty dog have a collar?
YES
What is a spondylolisthesis?
- Forward displacement of a vertebrae
where is the most common location for a spondylolisthesis and what are the grades of severity?
- L5-S1
- grades 1-5 (step off can usually be palpated)
What does the patient look like if they have a spondylolisthesis?
Patient presents with decreased lumbar curve and flattening of buttocks
If patient presents with gaurded posture or increased muscle tension what could their problem be?
- strains, tear, contusions, and overuse
With impairment based diagnostic approach what is the first stage of exercises and how do you progress?
exercise in position of confort and progress to core stabilization
What is postural pain syndrome?
- Patient presents with faulty posture
- Symptoms increase with sustained position
What could be wrong with the patient if they have postural pain syndrome?
- Postural strain
- cervicogenic headache
- thoracic ourlet syndrome
- poor physcial condition
How do you treat postural pain syndrome?
movement, posture correction and exercise decrease symptoms
For every one Standard deviation away from the mean how much affect does it have for the risk of fracturing (for osteoperosis)?
It doubles
