Lumbar Flashcards
Lumbar movements in general
a lot of flex/ext
some LF
minimal rotation
Ferguson’s angle is what
line parallel to superior aspect of sacrum and horizontal line
Greater in F than M - angle inc in pregnant women
Larger angle = more likely to have back pain
IVD function
separate the vertebrae
absorb stress and shock
enable movement in 3 planes
IVD made of what
fibrocartilage
NP and AF
IVD with anterior bending (flex)
Tension, NP shifts towards region of compression
IVD with posterior bending (ext)
Compression, AF bulges towards region of tension
IVD - torsion
shear stress increased from center to periphery
denser on outside than in center
Facet joint - orientation at cervical, thoracic, lumbar
cervical = 45
thoracic = 60
lumbar = 90
Hardly any rotation in lumbar
External oblique action
if contract B will flex
unilateral contraction will do contralateral rot, ipsilateral SB
Internal oblique action
Ipsilateral SB and Rot (unilaterally contracting)
Flex/Relaxation phenomenon
Flex forward - gravity will take over, use the extensors to control flex ecc, ligaments will stretch out to suport weight
Greater inclination of pelvis leads to what
increase shear, compression, and lordosis
makes abs looser
get ant pelvic tilt
Smaller inclination of pelvis leads to what
increase compression, decrease shear and lordosis
Shear forces are common where
L4-L5 because of superincumbent weight (HAT)
Shear is largest with what pelvic position
anterior pelvic tilt
Compression is largest with what pelvic position
posterior pelvic tilt
Load based on posture
supine standing straight sitting bending slouching
Cauda equina syndrome
B/B changes, saddle anesthesia, global or progressive weakness in LE, sensory deficits/weakness in L4-S1 dermatomes/myotomes
Red flags
Constant/severe night pain paralysis unexplained weight loss loss of appetite unusual fatigue persistent root pain pain worse after 1 month radicular pain with cough paresthesias visual disturbance B nerve root s/s SOB
Spondylolysis is what
separation of vertebrae - sliding between structures
Defect in pars interarticularis “scotty dog fracture”
Most common at L5-S1, common in young women
Spondylolysis s/s - pain with what movement
pain with ext
Spondylolisthesis is what
forward movement of vertebral body, fracture on vertebrae
common at lumbosacral angle
Spondylolisthesis s/s - pain with what movement
pain with ext/rot
Disc herniation
Protrusion of NP from the AF
Disc herniation - pain with what movemment
usually posterolateral herniation
Pain with flexion
repeated flex will peripheralize, ext will centralize
Degenerative spinal stenosis - pain with what
extension
Capsular pattern
lat flexion and rotation, then ext
Facet joint dysfunction - aggravated with what movement
end range movements
Lower crossed syndrome
Short ES, iliopsoas, gastroc, soleus, hip add
Long abductors, glut max
SLR
pt supine, passively flex hip with knee ext until pt complains, slowly lower limb and then DF
+ if reproduction of sx with DF foot
Quadrant test
Pt standing
Intervertebral foramen - pt SB L, rot L, ext to max close L foramen
Facet - pt SB L, rot R, ext to max compress L facet joint?
+ with pain or pares
Stork standing test
identifies spondylolisthesis
pt stand on one leg - cue pt into trunk ext
+ if pain in low back with ipsi leg on ground
McKenzie slide glide test
differentiate btw scoliotic curvature vs/ neurologic dysfunction causing lateral shift
Pt stand - stand on side that upper trunk is shifted towards, place shoulders into pt upper trunk, wrap arms around their pelvis, and pull pelvis to normal alignment while stabilizing trunk
+ if reproduction of neuro symptoms as alignment of trunk is corrected
Femoral nerve traction test
pt lay on nonpainful side with trunk in neutral, head flexed slightly, lower limb and hip/knees flexed
passively extend hip while knee of painful limb is in ext (flex knee if no s/s)
Vasalva identifies what
space occupying lesion
+ if inc LBP or neuro sx in LE
Repeated lumbar flexion should dec pain of what
facet or stenosis
Repeated lumbar extension should dec pain of what
disc problem
Babinski - what is pos
extension of big toe and splaying (abd) of other toes
Freyettes laws of biomechanics - in the neutral spine
LF and rot occur in opp directions at lumbar level
Freyettes laws of biomechanics - in hyperextended/hyperflexed lumbar spine
LF and rot occur in same direction
Coupled movement - type I
LF and rot in opp directions
Neutral
tends to occur in groups of segments (3+)
Coupled movement - type II
LF and rot in same directions
Non-neutral
seen in one segment only
Group dysfunction
3+ segments
type 1
neutral
Restrict in LF in one direction and Rot in other
Single segment dysfunction
1 vertebral motion unit involved
type II
restriction of Flex/Ext, LF and Rot limited on same side
Direction of motion is named by what
ant and sup vertebrae
If S is first (before R) means what (or if N is first letter)
coupled opp
If R is first (before S) means what (or if E/F is first letter)
coupled same
Ex: NSR(L)
Motion available
Position
Motion restriction
flex/ext
R SB
L rot
Neutral, R SB, L rot
L SB, R rot
Ex: ERS(L)
Motion available
Position
Motion restriction
ext
L rot
L SB
extended, L rot, L SB
flexion
R rot, R SB
Ex: FRS(R)
Motion available
Position
Motion restriction
flexion
R rot
R SB
flex, R rot, R SB
extension
L rot, L SB
Example of ERS(R), what motion are restricted?
what happens with flex and ext
ERS(R) - they are extended, R rot, and R SB R facet does not open Flexion - R TP prominent Extension - TPS more equal Restriction - flex, L rot, L SB
Example of FRS(R), what motion are restricted?
what happens with flex and ext
FRS(R) - they are flex, R rot, R SB L facet will not close Ext - R TP more prominent Flex - TPs equal Restriction - ext, L rot, L SB
