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705 > Lumbar > Flashcards

Lumbar Flashcards

1
Q

66% of the lumbar lordosis from ____________.

A

L4-S1

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2
Q

Decreased lumbar lordosis associated with ________ disc degeneration.

A

L5S1

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3
Q

Decreased ___________ effort when lordosis is maintained.

A

extensor

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4
Q

Gold standard = radiographic measurement; range from ______________.

A

47* - 64*

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5
Q

External measures =

A
  • bendable rulers
  • strain gauges embedded in tape
  • inclinometers
  • accelerometers
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6
Q

Do external measures have a better or poorer validity?

A

All external measures have poor concurrent validity against radiograph.

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7
Q

For lumbar lordosis: line parallel to superior endplate of ____.

A

L1

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8
Q

For lumbar lordosis: line parallel to inferior endplate of ____.

A

L5

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9
Q

For lumbar lordosis: _________________ drawn to these lines.

A

Perpendiculars

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10
Q

For lumbar lordosis: angle between the _____________ of these perpendiculars

A

intersection

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11
Q

The functional spinal unit is made up of what 4 components?

A
  1. two adjacent vertebral bodies
  2. intervertebral disc (IVD)
  3. associated soft tissue
  4. motion segment
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12
Q

Lumbar vertebral structure, anterior elements:

A
  1. two vertebral bodies
  2. intervertebral disc (IVD)
  3. Longitudinal ligaments
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13
Q

Lumbar vertebral structure, posterior elements:

A
  1. vertebral arches
  2. spinous and transverse processes
  3. facet joints
  4. posterior ligaments
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14
Q

The anterior elements of the lumbar spine function to:

A
  1. bear compressive loads

2. larger caudally (loading increases)

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15
Q

The posterior elements of the lumbar spine function to:

A
  1. guide movement

2. motion determined by facet joint orientation

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16
Q

The facet joints function to:

A

restrict motion

and as muscle attachments

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17
Q

The TP function to:

A

as muscle and ligament attachments

Increase moment arm

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18
Q

The SP function as:

A

muscle and ligament attachments

increase moment arms

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19
Q

The superior facet joint articulates with the

A

inferior facet of the adjacent vertebrae

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20
Q

The highly innervated joint capsule functions as:

A

mechanoreceptors for proprioception

nociceptors –> pain

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21
Q

The surface orientation of the lumbar facet is:

A

90* transverse plane

45* FRONTAL plane

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22
Q

The lumbar facets allow for:

A
  1. flex/ ext
  2. lateral flex
  3. minimal rotation
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23
Q

The lumbosacral joint is in __________ orientation for __________.

A

oblique orientation for rotation

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24
Q

Lumbar facet joints load share with IVD, which is _______ dependent.

A

posture

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25
Q

Hyperextension causes ________ total load on facets

A

30%

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26
Q

Flexion coupled with rotation ____________________________.

A

increases loading of facets

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27
Q

what is tight in extension?

A

anterior longitudinal ligament

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28
Q

What serves as a vertebral body attachment (less to disc)

A

anterior longitudinal ligament

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29
Q

What serves as a IVD attachment (less to body)

A

the posterior longitudinal ligament

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30
Q

What is tight in flexion?

A

posterior longitudinal ligament

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31
Q

What connects adjacent vertebral arches?

A

ligamentum flavum

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32
Q

What are are 3 properties of the ligamentum flavum?

A
  1. high elastin content
  2. contracts during extension
  3. elongates during flexion
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33
Q

Under constant tension the ligamentum flavum:

A
  • pre-stresses the disc to create intradiscal pressure

- provides stability to the spine

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34
Q

What are 3 components of the IVD?

A
  1. inferior/superior endplates
  2. annulus fibrosis
  3. nucleus pulposus
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35
Q

What are 3 functions of the IVD?

A
  1. weightbearing
  2. load distribution
  3. restrains excessive motion
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36
Q

What are 3 components of the nucleus pulposus?

A
  1. gelatinous mass
  2. hydrophilic glycosaminoglycan (GAG) content
  3. GAG and water content decrease w/ age
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37
Q

What are 2 components of the annulus fibrosis?

A
  1. fibrocartilage

2. layers w/ different collagen fiber orientations

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38
Q

What kind of pressure within the disc ensures uniform load distribution?

A

hydrostatic pressure

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39
Q

The nucleus pulposus is incompressible, meaning it

A

resists compressive loads

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40
Q

A new study found that the intradiscal pressure (IDP) is lower in _____________________________________. This study also found that IDP increased over 7 hours of ____________

A

unsupported, relaxed sitting than in standing

rest (sleeping)

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41
Q

The lumbar spine has how many degrees of freedom:

A

6

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42
Q

What are the 6 degrees of freedom in the lumbar spine:

A
  1. flexion/ extension
  2. lateral flexion
  3. rotation
  4. anterior/posterior translation
  5. medial/lateral translation
  6. superior/ inferior translation
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43
Q

What is the primary motion of the lumbar spine?

A

In the sagittal plane

-12-20* @ each segment

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44
Q

What is the secondary motion of the lumbar spine?

A

Frontal plane, 6* @ each segment

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45
Q

What is the tertiary motion of the lumbar spine?

A

Transverse plane, 2* @ each segment

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46
Q

What dictates available motion?

A

orientation of the facets!

-allows sagittal and frontal plane motion, limits transverse plane

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47
Q

L5S1 facet is different . It is in the oblique orientation.

A

Allow for rotation and flexion

Limits lateral flexion

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48
Q

Approximation (closing) =

A

facet surfaces move closer together

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49
Q

Separation (gapping) =

A

facet surfaces move further apart

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50
Q

Sliding (gliding) =

A

linear translation of facet surfaces in the plane of the facet joint.

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51
Q

Flexion of lumbar spine =

A

inferior facets of superior vertebra slide upward on superior facets of inferior vertebra

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52
Q

Extension of lumbar spine =

A

inferior facets of superior vertebra slide downward on superior facets of inferior vertebra

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53
Q

Describe the arthrokinematics of right lateral flexion:

A

RIGHT inferior facet of superior vertebra slides DOWN and left inferior facet of superior vertebra slides UP on corresponding superior facets of inferior vertebra

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54
Q

Describe the arthrokinematics of left lateral flexion:

A

LEFT inferior facet of superior vertebra slides DOWN and RIGHT inferior facet of superior vertebra slides UP on corresponding superior facets of inferior vertebra

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55
Q

Describe the arthrokinematics of right rotation:

A

SEPARATION (opening, gapping) of RIGHT facet joint and APPROXIMATION (closing, compression) of left facet joint

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56
Q

Describe the arthrokinematics of left rotation:

A

SEPARATION or LEFT facet joint and APPROXIMATION of RIGHT facet joint

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57
Q

Coupled motion conclusion =

A

PTs should use caution when applying coupled motion concepts to lumbar spine

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58
Q

In assessment of active motion:

A

observe compensatory motions

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59
Q

Assessment of passive motion / mobility :

A

assess coupling patters

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60
Q

Clinical intervention?

A

guide direction of mobilization, treat restriction in both motions to restore the primary movement.

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61
Q

Segmental motion ________ in the lower segments

A

increases

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62
Q

Lateral flexion occurs in __-lumbar segements

A

mid-lumbar

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63
Q

Rotation is minimal in lumbar region with slight ________ @ L5S1

A

increase

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64
Q

Men and women are affected __________ for LBP (ages 30-50)

A

equally

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65
Q

Within a lifetime _____ of adults will have one episode of LBP

A

2/3rds

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66
Q

_____ out of every 4 will experience chronic LBP

A

1 out of 4

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67
Q

LBP is the _______ highest means for pts / Md visit

A

2nd

68
Q

______ of pts seeking PT in outpatient clinics have LBP

A

50%

69
Q

What are 5 risk factors for LBP injury?

A
  1. compression & shear exposure
  2. repetitive lifting
  3. prolonged sitting, standing
  4. psychosocial factors
  5. posture (reduced lordosis)
70
Q

Why are poor lifting biomechanics a problem?

A
  1. increased demand on extensor muscles

2. structures stronger in compression than shear

71
Q

With poor body mechanics, stresses are put on which (3) passive stabilizing structures?

A
  1. ligaments
  2. intervertebral disc
  3. joint capsule
72
Q

Define compression:

A

squeezing force acting along the longitudinal axis of an object

73
Q

Define shear:

A

sliding force of one subject with respect to another object

74
Q

How much compression force is too much?

A 
males = 5.7 kN
females = 2.69 kN
75
Q

How much shear force is too much?

A 
males = 0.5 kN
females = 34kN
76
Q

What are other factors contributing to biomechanical stress?

A

age, gender, occupation, genetics, socioeconomic status, psychosocial, previous LBP, health, diet & fitness level

77
Q

Describe how LBP is a multifactorial problem?

A
78
Q

In firefighter study: low back loads are ________ in firefighting activities.

A

high

79
Q

In firefighter study: loading patterns highly sensitive to personal movement strategies -

A

personalized intervention & training

80
Q

Personal factors (_________________________________) cam influence movement behavior and injury potential

A

gender, fitness, movement, competency)

81
Q

Primary loads are:

A
  • body weight
  • muscle activity
  • pre-stress from ligaments
  • external loads
82
Q

Constant flexion moment:

A
  • anterior shear

- must be relaxed by extensor muscles

83
Q

Posture influences:

A

joint loading and the specific tissues that are stressed

84
Q

How does posture influence joint loading and associated tissues?

A

moment arms
ligamentous contraints
bony constraints
active constraints

85
Q

Erector spinae buttress anterior shear

A

??? (Fshear + Fcompression = Deep erector spinae)

86
Q

Which lift technique is better, the “stoop” lift or “squat” lift?

A

depends on pt

87
Q

Pelvis movement relative to femur: in weight-bearing, femur is:

A

fixed (closed chain)

88
Q

Pelvis movement relative to femur: reversal of motion =

A

pelvis on femur versus femur on pelvis

89
Q

Pelvis movement relative to femur: change primary action for muscles =

A

reversal of origin and insertion (ex. glut med = lateral tilt of pelvis versus hip abduction & rectus femoris = anterior tilt of pelvis versus hip flexion)

90
Q

Trendelenburg sign in right unilateral stance: pelvis =
right femur =
lumbar spine =

A

pelvis = left lateral tilt
right femur = adducts
lumbar spine = right lateral flexion

91
Q

In the horizontal plane rotation of pelvis produces:

A

medial/lateral rotation at the hip joints

92
Q

Stand and rotate to the right:
pelvis =
right hip =
left hip =

A

pelvis = right rotation
right hip = internal rotation
left hip = external rotation

93
Q

Sagital plane tilts:
anterior pelvic tilts =
posterior pelvic tilts =

A

anterior pelvic tilts = hip flexion & lumbosacral extension
posterior pelvic tilts = hip extension & lumbosacral flexion

94
Q

Lumbopelvic rhythm =

A

coupled motion between pelvis and; lumbar spine

95
Q

Lumbopelvic rhythm can _____________ overall trunk motion for function.

A

increase

96
Q

Lumopelvic rhythm in ‘contra-lateral’ direction allows trunk to remain:

A

stable as pelvis rotates over femur.

97
Q

Flexion relaxation phenomenon (FRP): At full forward flexion, lumbar extensors =

A 
shut off 
(loads transfered to passive structures in the spine)
98
Q

FRP _________ in people with LBP

A

does not happen

99
Q

Gluteal activation __________ in people with LBP

A

decreases

100
Q

Describe the ideal standing posture in sagittal view:

A

plumb line - ear, cervical vertebral bodies, shoulder, lumbar vertebral bodies, posterior to hip axis, anterior to knee axis, anterior to lateral malleolus

101
Q

Which produces a more stable/ repeatable measure; posterior or sagittal view?

A

sagittal

102
Q

When the lumbosacral lordosis involves an angle between ___________________________________________, there is an average _____ in standing.

A

line from center of L3 body to L5 body & line from L5 body to S1 body

150*

103
Q

When the lumboscacral angle is between a horizontal line through L5 and a line along the superior endplate of S1, the angle is an average of:

A

40*

104
Q

Pelvic tilt is measured from the horizontal to a line drawn through the:

A

ASIS

105
Q

Larger angle indicates:

A

anterior pelvic tilt

106
Q

Smaller angle indicates:

A

posterior pelvic tilt

107
Q

what is the ideal seated posture?

A

neutral (balance) pelvis

108
Q

Females in a seated posture:

A
  • maintain lordosis
  • sit upright on pelvis
  • ‘perch’ on the front edge of the seat
109
Q

Males in a seated posture:

A
  • posteriorly rotate pelvis

- ‘slouch’ and sit towards the back of the seat

110
Q

Lumbosacral angle decreased from __* in standing to __* sitting

A

decreased from 40* in standing to 13* sitting

111
Q

Sacral inclination decreased from __* in standing to __* sitting

A

decreased from 43* in standing to -2* sitting

112
Q

With decrease lordosis we see (think Michael Young)

A
  • relatively posterior pelvis
  • spine flexed
  • hip extened
  • knees extended
  • shortened hamstrings
  • lengthened erector spinae
  • more compression
  • cause could be various things
  • direct treatment to cause of pain
113
Q

With increased lumbar lordosis (think Bri)

A
  • pelvis anterior tilt
  • hips flexed
  • knees extended
  • hip contracture
  • more shear
114
Q

What are the superficial layers of the trunk?

A

lats, traps, rhomboids, levator scapulae

115
Q

Posterior muscles of the trunk, bilateral activation:

A

extension

116
Q

Posterior muscles of the trunk, unilateral activation:

A

lateral flex (not really rotation)

117
Q

Intermediate layer of Posterior muscles of the trunk:

A

serratus posterior

118
Q

Primarily contribution to:

A

depressed ribs, help w/ respiration

119
Q

________ contribution to movement or stability.

A

little

120
Q

What are the deep posterior muscles of the trunk ?

A
  • erector spinae group (spinalis, longissimus, iliocostalis)
  • transversospinal group (semispinalis, multifidi, rotators)
  • short segmental group (interspinalis, intertransversarius)
121
Q

Posterior muscles of the trunk become __________, more ____________ and cross ________ segments with __________ depth.

A

shorter,
more angulated
and cross fewer segments with increasing depth

122
Q

The common attachment in sacral region is the

A

erector spinae group

123
Q

The erector spinae group cross:

A

multiple segments

124
Q

The erector spinae group control gross movement across a large part:

A

of axial skeleton

125
Q

What is the primary movement of the erector spinae muscles?

A

extension

126
Q

The erector spinae group generate _________ extensor moment for lifting/carrying (bilaterally)

A

large

127
Q

the erector spinae group can ___________ tilt pelvis and __________ lordorsis

A

anterior

increase

128
Q

Iliocostalis: large _______ flexor and _____________ rotation (unilateral)

A

lateral flexor
ipsilateral rotation
(*most lateral)

129
Q

Attachments of transversospinal group =

A

TP of inferior vertebra to spinous process of more superior vertebra

130
Q

Semispinalis cross _______ vertebrae

A

6-8

131
Q

Multifidi cross __________ vertebrae

A

2-4

132
Q

Extension torque AND stability =

A

multiple attachments and overlapping fibers

133
Q

Rotatores cross ______ vertebrae

A

1-3

134
Q

_____________ and ____________ forces (cross fewer segments than erector spinae)

A

Controlled/ small

stabilizing

135
Q

Transversospinal group bilateral -

A

extension

136
Q

Transversospinal group unilateral -

A 
contralateral rotation
(small leverage - shorter moment arm)
137
Q

Short segmental group: cross 1 segment. Most prominent in craniocervical region for what?

A

control of nekc

138
Q

Short segmental group blend w/ interspinous ligaments =

A

true intervertebral stabilizers (hard to see)

139
Q

Short segmental group = small extension moment (______________________________)

A

small muscle size

small moment arms

140
Q

Most important role =

A

sensory feedback

(high density of muscle spindles)

141
Q

What are the 4 abdominal muscles of the trunk?

A
  1. rectus abdominus
  2. internal oblique
  3. external oblique
  4. transversus abdominus
142
Q

anterior rectus sheath =

A

from internal and external obliques

143
Q

Posterior rectus sheath =

A

from internal oblique and transversus abdominus

144
Q

Sheaths thicken and cross at midline to form:

A

linea alba

145
Q

Rectus abdominus =

A

tendinous intersections of rectus abdominus ‘6-pack’

146
Q

What is the orientation of the rectus abdominus?

A

longitudinal

147
Q

What is the action of the rectus abdominus?

A

trunk flexion & posterior rotation of the pelvis

148
Q

the internal, external obliques and transversus abdominus originate laterally and run toward midline to blend with:

A

sheaths and linea alba

149
Q

“hoop muscles” =

A

important stabilizers (wrap around & stabilize)

150
Q

Which muscles is the largest, most superficial (hands in pocket)

A

external oblique

151
Q

What is the action of the external oblique?

A 
Bilaterally = trunk flexion, posterior pelvic tilt and compression of abdominal cavity
Unilaterally = lat. flexion to same side and conta-lateral rotation
152
Q

What muscle is deep to the external oblique (ilac crest to midline)

A

internal oblique

153
Q

What is the fiber orientation of the internal obliques?

A

perpendicular to external obliques

154
Q

What are the action of the internal oblique?

A
  • bilateral: trunk flexion, posterior pelvic tilt, tension thoracolumbar fascia
  • unilateral: lateral flexion, to same side, ipsilateral rotation
155
Q

Describe the transveruss abdominus (TrA):

A
  • deepest , ‘corset’
  • stability of lumbar spine
  • attachments to thoracolumbar fascia
156
Q

What is the action of the transversus abdominus (TrA)

A
  • stabilizes attachment sites for other muscles
  • compresses abdominal cavity
  • tensions thoracolumbar fascia
157
Q

What are 2 additional muscles of the trunk?

A
  1. psoas major

2. quadratus lumborum

158
Q

What is the action of the QL?

A

bilateral action - extension

unilateral - lateral flexion (open chain - elevates pelvis)

159
Q

What is the action of the psoas?

A

vertically stabilizes the lumbar spine - line of action close to rotation axes
- strong hip flexor

160
Q

Motion in the sagittal plane is:

A

vertical orientation

  • primary flexion / extension (bilateral)
  • lateral flexion (unilateral) depends on moment arm from midline
161
Q

Motion in the frontal plane is:

A

oblique orientation

  • vertical force component - lateral flexion
  • horizontal force component - axial rotation
162
Q

Motion in the transverse plane is:

A

axial rotation

163
Q

Extrinsic stabilizers (global stability) : long muscles attache to structures __________ the vertebral column

A

outside

164
Q

Intrinsic stabilizers (segmental stability) : short, deep muscles attach to structures _________ spinal column

A

inside

165
Q

extrinsic stabilizers include:

A

all of abdominals, hip muscles, erector spinae, QL, psoas major, lats, scauplar muscles

166
Q

Intrinsic stabilizers include:

A 
transversopinal group (semispinalis, multifid, rotatores)
& short segmental group (interspinalis, intertransversal)

705 (7 decks)

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