Lumbar Flashcards
1
Q
66% of the lumbar lordosis from ____________.
A
L4-S1
2
Q
Decreased lumbar lordosis associated with ________ disc degeneration.
A
L5S1
3
Q
Decreased ___________ effort when lordosis is maintained.
A
extensor
4
Q
Gold standard = radiographic measurement; range from ______________.
A
47* - 64*
5
Q
External measures =
A
- bendable rulers
- strain gauges embedded in tape
- inclinometers
- accelerometers
6
Q
Do external measures have a better or poorer validity?
A
All external measures have poor concurrent validity against radiograph.
7
Q
For lumbar lordosis: line parallel to superior endplate of ____.
A
L1
8
Q
For lumbar lordosis: line parallel to inferior endplate of ____.
A
L5
9
Q
For lumbar lordosis: _________________ drawn to these lines.
A
Perpendiculars
10
Q
For lumbar lordosis: angle between the _____________ of these perpendiculars
A
intersection
11
Q
The functional spinal unit is made up of what 4 components?
A
- two adjacent vertebral bodies
- intervertebral disc (IVD)
- associated soft tissue
- motion segment
12
Q
Lumbar vertebral structure, anterior elements:
A
- two vertebral bodies
- intervertebral disc (IVD)
- Longitudinal ligaments
13
Q
Lumbar vertebral structure, posterior elements:
A
- vertebral arches
- spinous and transverse processes
- facet joints
- posterior ligaments
14
Q
The anterior elements of the lumbar spine function to:
A
- bear compressive loads
2. larger caudally (loading increases)
15
Q
The posterior elements of the lumbar spine function to:
A
- guide movement
2. motion determined by facet joint orientation
16
Q
The facet joints function to:
A
restrict motion
and as muscle attachments
17
Q
The TP function to:
A
as muscle and ligament attachments
Increase moment arm
18
Q
The SP function as:
A
muscle and ligament attachments
increase moment arms
19
Q
The superior facet joint articulates with the
A
inferior facet of the adjacent vertebrae
20
Q
The highly innervated joint capsule functions as:
A
mechanoreceptors for proprioception
nociceptors –> pain
21
Q
The surface orientation of the lumbar facet is:
A
90* transverse plane
45* FRONTAL plane
22
Q
The lumbar facets allow for:
A
- flex/ ext
- lateral flex
- minimal rotation
23
Q
The lumbosacral joint is in __________ orientation for __________.
A
oblique orientation for rotation
24
Q
Lumbar facet joints load share with IVD, which is _______ dependent.
A
posture
25
Hyperextension causes ________ total load on facets
30%
26
Flexion coupled with rotation ____________________________.
increases loading of facets
27
what is tight in extension?
anterior longitudinal ligament
28
What serves as a vertebral body attachment (less to disc)
anterior longitudinal ligament
29
What serves as a IVD attachment (less to body)
the posterior longitudinal ligament
30
What is tight in flexion?
posterior longitudinal ligament
31
What connects adjacent vertebral arches?
ligamentum flavum
32
What are are 3 properties of the ligamentum flavum?
1. high elastin content
2. contracts during extension
3. elongates during flexion
33
Under constant tension the ligamentum flavum:
- pre-stresses the disc to create intradiscal pressure
| - provides stability to the spine
34
What are 3 components of the IVD?
1. inferior/superior endplates
2. annulus fibrosis
3. nucleus pulposus
35
What are 3 functions of the IVD?
1. weightbearing
2. load distribution
3. restrains excessive motion
36
What are 3 components of the nucleus pulposus?
1. gelatinous mass
2. hydrophilic glycosaminoglycan (GAG) content
3. GAG and water content decrease w/ age
37
What are 2 components of the annulus fibrosis?
1. fibrocartilage
| 2. layers w/ different collagen fiber orientations
38
What kind of pressure within the disc ensures uniform load distribution?
hydrostatic pressure
39
The nucleus pulposus is incompressible, meaning it
resists compressive loads
40
A new study found that the intradiscal pressure (IDP) is lower in _____________________________________. This study also found that IDP increased over 7 hours of ____________
unsupported, relaxed sitting than in standing
rest (sleeping)
41
The lumbar spine has how many degrees of freedom:
6
42
What are the 6 degrees of freedom in the lumbar spine:
1. flexion/ extension
2. lateral flexion
3. rotation
4. anterior/posterior translation
5. medial/lateral translation
6. superior/ inferior translation
43
What is the primary motion of the lumbar spine?
In the sagittal plane
| -12-20* @ each segment
44
What is the secondary motion of the lumbar spine?
Frontal plane, 6* @ each segment
45
What is the tertiary motion of the lumbar spine?
Transverse plane, 2* @ each segment
46
What dictates available motion?
orientation of the facets!
| -allows sagittal and frontal plane motion, limits transverse plane
47
L5S1 facet is different . It is in the oblique orientation.
Allow for rotation and flexion
| Limits lateral flexion
48
Approximation (closing) =
facet surfaces move closer together
49
Separation (gapping) =
facet surfaces move further apart
50
Sliding (gliding) =
linear translation of facet surfaces in the plane of the facet joint.
51
Flexion of lumbar spine =
inferior facets of superior vertebra slide upward on superior facets of inferior vertebra
52
Extension of lumbar spine =
inferior facets of superior vertebra slide downward on superior facets of inferior vertebra
53
Describe the arthrokinematics of right lateral flexion:
RIGHT inferior facet of superior vertebra slides DOWN and left inferior facet of superior vertebra slides UP on corresponding superior facets of inferior vertebra
54
Describe the arthrokinematics of left lateral flexion:
LEFT inferior facet of superior vertebra slides DOWN and RIGHT inferior facet of superior vertebra slides UP on corresponding superior facets of inferior vertebra
55
Describe the arthrokinematics of right rotation:
SEPARATION (opening, gapping) of RIGHT facet joint and APPROXIMATION (closing, compression) of left facet joint
56
Describe the arthrokinematics of left rotation:
SEPARATION or LEFT facet joint and APPROXIMATION of RIGHT facet joint
57
Coupled motion conclusion =
PTs should use caution when applying coupled motion concepts to lumbar spine
58
In assessment of active motion:
observe compensatory motions
59
Assessment of passive motion / mobility :
assess coupling patters
60
Clinical intervention?
guide direction of mobilization, treat restriction in both motions to restore the primary movement.
61
Segmental motion ________ in the lower segments
increases
62
Lateral flexion occurs in __-lumbar segements
mid-lumbar
63
Rotation is minimal in lumbar region with slight ________ @ L5S1
increase
64
Men and women are affected __________ for LBP (ages 30-50)
equally
65
Within a lifetime _____ of adults will have one episode of LBP
2/3rds
66
_____ out of every 4 will experience chronic LBP
1 out of 4
67
LBP is the _______ highest means for pts / Md visit
2nd
68
______ of pts seeking PT in outpatient clinics have LBP
50%
69
What are 5 risk factors for LBP injury?
1. compression & shear exposure
2. repetitive lifting
3. prolonged sitting, standing
4. psychosocial factors
5. posture (reduced lordosis)
70
Why are poor lifting biomechanics a problem?
1. increased demand on extensor muscles
| 2. structures stronger in compression than shear
71
With poor body mechanics, stresses are put on which (3) passive stabilizing structures?
1. ligaments
2. intervertebral disc
3. joint capsule
72
Define compression:
squeezing force acting along the longitudinal axis of an object
73
Define shear:
sliding force of one subject with respect to another object
74
How much compression force is too much?
```
males = 5.7 kN
females = 2.69 kN
```
75
How much shear force is too much?
```
males = 0.5 kN
females = 34kN
```
76
What are other factors contributing to biomechanical stress?
age, gender, occupation, genetics, socioeconomic status, psychosocial, previous LBP, health, diet & fitness level
77
Describe how LBP is a multifactorial problem?
78
In firefighter study: low back loads are ________ in firefighting activities.
high
79
In firefighter study: loading patterns highly sensitive to personal movement strategies -
personalized intervention & training
80
Personal factors (_________________________________) cam influence movement behavior and injury potential
gender, fitness, movement, competency)
81
Primary loads are:
- body weight
- muscle activity
- pre-stress from ligaments
- external loads
82
Constant flexion moment:
- anterior shear
| - must be relaxed by extensor muscles
83
Posture influences:
joint loading and the specific tissues that are stressed
84
How does posture influence joint loading and associated tissues?
moment arms
ligamentous contraints
bony constraints
active constraints
85
Erector spinae buttress anterior shear
??? (Fshear + Fcompression = Deep erector spinae)
86
Which lift technique is better, the "stoop" lift or "squat" lift?
depends on pt
87
Pelvis movement relative to femur: in weight-bearing, femur is:
fixed (closed chain)
88
Pelvis movement relative to femur: reversal of motion =
pelvis on femur versus femur on pelvis
89
Pelvis movement relative to femur: change primary action for muscles =
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
Trendelenburg sign in right unilateral stance: pelvis =
right femur =
lumbar spine =
pelvis = left lateral tilt
right femur = adducts
lumbar spine = right lateral flexion
91
In the horizontal plane rotation of pelvis produces:
medial/lateral rotation at the hip joints
92
Stand and rotate to the right:
pelvis =
right hip =
left hip =
pelvis = right rotation
right hip = internal rotation
left hip = external rotation
93
Sagital plane tilts:
anterior pelvic tilts =
posterior pelvic tilts =
anterior pelvic tilts = hip flexion & lumbosacral extension
posterior pelvic tilts = hip extension & lumbosacral flexion
94
Lumbopelvic rhythm =
coupled motion between pelvis and; lumbar spine
95
Lumbopelvic rhythm can _____________ overall trunk motion for function.
increase
96
Lumopelvic rhythm in 'contra-lateral' direction allows trunk to remain:
stable as pelvis rotates over femur.
97
Flexion relaxation phenomenon (FRP): At full forward flexion, lumbar extensors =
```
shut off
(loads transfered to passive structures in the spine)
```
98
FRP _________ in people with LBP
does not happen
99
Gluteal activation __________ in people with LBP
decreases
100
Describe the ideal standing posture in sagittal view:
plumb line - ear, cervical vertebral bodies, shoulder, lumbar vertebral bodies, posterior to hip axis, anterior to knee axis, anterior to lateral malleolus
101
Which produces a more stable/ repeatable measure; posterior or sagittal view?
sagittal
102
When the lumbosacral lordosis involves an angle between ___________________________________________, there is an average _____ in standing.
line from center of L3 body to L5 body & line from L5 body to S1 body
150*
103
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:
40*
104
Pelvic tilt is measured from the horizontal to a line drawn through the:
ASIS
105
Larger angle indicates:
anterior pelvic tilt
106
Smaller angle indicates:
posterior pelvic tilt
107
what is the ideal seated posture?
neutral (balance) pelvis
108
Females in a seated posture:
- maintain lordosis
- sit upright on pelvis
- 'perch' on the front edge of the seat
109
Males in a seated posture:
- posteriorly rotate pelvis
| - 'slouch' and sit towards the back of the seat
110
Lumbosacral angle decreased from __* in standing to __* sitting
decreased from 40* in standing to 13* sitting
111
Sacral inclination decreased from __* in standing to __* sitting
decreased from 43* in standing to -2* sitting
112
With decrease lordosis we see (think Michael Young)
- 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
With increased lumbar lordosis (think Bri)
- pelvis anterior tilt
- hips flexed
- knees extended
- hip contracture
- more shear
114
What are the superficial layers of the trunk?
lats, traps, rhomboids, levator scapulae
115
Posterior muscles of the trunk, bilateral activation:
extension
116
Posterior muscles of the trunk, unilateral activation:
lateral flex (not really rotation)
117
Intermediate layer of Posterior muscles of the trunk:
serratus posterior
118
Primarily contribution to:
depressed ribs, help w/ respiration
119
________ contribution to movement or stability.
little
120
What are the deep posterior muscles of the trunk ?
- erector spinae group (spinalis, longissimus, iliocostalis)
- transversospinal group (semispinalis, multifidi, rotators)
- short segmental group (interspinalis, intertransversarius)
121
Posterior muscles of the trunk become __________, more ____________ and cross ________ segments with __________ depth.
shorter,
more angulated
and cross fewer segments with increasing depth
122
The common attachment in sacral region is the
erector spinae group
123
The erector spinae group cross:
multiple segments
124
The erector spinae group control gross movement across a large part:
of axial skeleton
125
What is the primary movement of the erector spinae muscles?
extension
126
The erector spinae group generate _________ extensor moment for lifting/carrying (bilaterally)
large
127
the erector spinae group can ___________ tilt pelvis and __________ lordorsis
anterior
| increase
128
Iliocostalis: large _______ flexor and _____________ rotation (unilateral)
lateral flexor
ipsilateral rotation
(*most lateral)
129
Attachments of transversospinal group =
TP of inferior vertebra to spinous process of more superior vertebra
130
Semispinalis cross _______ vertebrae
6-8
131
Multifidi cross __________ vertebrae
2-4
132
Extension torque AND stability =
multiple attachments and overlapping fibers
133
Rotatores cross ______ vertebrae
1-3
134
_____________ and ____________ forces (cross fewer segments than erector spinae)
Controlled/ small
| stabilizing
135
Transversospinal group bilateral -
extension
136
Transversospinal group unilateral -
```
contralateral rotation
(small leverage - shorter moment arm)
```
137
Short segmental group: cross 1 segment. Most prominent in craniocervical region for what?
control of nekc
138
Short segmental group blend w/ interspinous ligaments =
true intervertebral stabilizers (hard to see)
139
Short segmental group = small extension moment (______________________________)
small muscle size
| small moment arms
140
Most important role =
sensory feedback
| (high density of muscle spindles)
141
What are the 4 abdominal muscles of the trunk?
1. rectus abdominus
2. internal oblique
3. external oblique
4. transversus abdominus
142
anterior rectus sheath =
from internal and external obliques
143
Posterior rectus sheath =
from internal oblique and transversus abdominus
144
Sheaths thicken and cross at midline to form:
linea alba
145
Rectus abdominus =
tendinous intersections of rectus abdominus '6-pack'
146
What is the orientation of the rectus abdominus?
longitudinal
147
What is the action of the rectus abdominus?
trunk flexion & posterior rotation of the pelvis
148
the internal, external obliques and transversus abdominus originate laterally and run toward midline to blend with:
sheaths and linea alba
149
"hoop muscles" =
important stabilizers (wrap around & stabilize)
150
Which muscles is the largest, most superficial (hands in pocket)
external oblique
151
What is the action of the external oblique?
```
Bilaterally = trunk flexion, posterior pelvic tilt and compression of abdominal cavity
Unilaterally = lat. flexion to same side and conta-lateral rotation
```
152
What muscle is deep to the external oblique (ilac crest to midline)
internal oblique
153
What is the fiber orientation of the internal obliques?
perpendicular to external obliques
154
What are the action of the internal oblique?
- bilateral: trunk flexion, posterior pelvic tilt, tension thoracolumbar fascia
- unilateral: lateral flexion, to same side, ipsilateral rotation
155
Describe the transveruss abdominus (TrA):
- deepest , 'corset'
- stability of lumbar spine
- attachments to thoracolumbar fascia
156
What is the action of the transversus abdominus (TrA)
- stabilizes attachment sites for other muscles
- compresses abdominal cavity
- tensions thoracolumbar fascia
157
What are 2 additional muscles of the trunk?
1. psoas major
| 2. quadratus lumborum
158
What is the action of the QL?
bilateral action - extension
| unilateral - lateral flexion (open chain - elevates pelvis)
159
What is the action of the psoas?
vertically stabilizes the lumbar spine - line of action close to rotation axes
- strong hip flexor
160
Motion in the sagittal plane is:
vertical orientation
- primary flexion / extension (bilateral)
- lateral flexion (unilateral) depends on moment arm from midline
161
Motion in the frontal plane is:
oblique orientation
- vertical force component - lateral flexion
- horizontal force component - axial rotation
162
Motion in the transverse plane is:
axial rotation
163
Extrinsic stabilizers (global stability) : long muscles attache to structures __________ the vertebral column
outside
164
Intrinsic stabilizers (segmental stability) : short, deep muscles attach to structures _________ spinal column
inside
165
extrinsic stabilizers include:
all of abdominals, hip muscles, erector spinae, QL, psoas major, lats, scauplar muscles
166
Intrinsic stabilizers include:
```
transversopinal group (semispinalis, multifid, rotatores)
& short segmental group (interspinalis, intertransversal)
```
