Lumbar Instabilities and Stabilization Flashcards
Term: controls normal loads and stressed placed on the spine
Stabilizing structures
System: Passive system/stabiliy of bones, joints, capsules, and ligaments
Osteoligamentous subsystem
System: Active system/dynamic stability
Muscle system
System: Guides the muscle system via timing, force control, etc.
Neural control subsystem
3 Components of a Stabilized Spine
- Osteoligamentous subsystem
- Muscle system
- Neural control subsystem
Describe the effect of dysfunction in one of the three subsystems
Added stress/demand to the other systems
Term: first few degress of motion
Neutral zone
Term: zone in which movement occurs in a free range against little resistance
Neutral zone
Zone: Grades 1 and 2
Neutral zone
Term: From the end of the neutral zone to the end of ROM
Elastic zone
Term: zone in which movemtn occurs with considerable internal resistance
Elastic zone
Zone: Grades 3 and 4
Elastic zone
Describe the relationship between load and displacement
Non-linear relationship
The stiffness of the spine varies with the load. At low load the spine is flexible (larger displacement) while at high load the spine is stiff (small displacement). At some point/high force there is a plateau in displacement.
Zone: Passive structures
Elastic zone
Describe the effect of laod on displacement when passive structures are injuried
When the elastic zone/passive structures are injuried there is more displacement at higher loads because stiffness from the elastic zone is compromised
Term: increase in neutral zone
Segmental instability
Term: Decrease in elastic zone
Segmental instability
Define segmental instability
Panjabi says: When the stability system is compromised and neutral zone is increased
Bogduc says: Decreased stiffness/elastic zone resulting in hypermobility
Term: dysfunction in one or more stabilizing components leading to an increase in the size of the neutral zone, loss of stiffness, and abnormal movement
Segmental instability
Term: Abnormal movement of one vertebra on another
Segmental instability
System: Osseous and ligamentous system that limited the neutral zone and stabilizes the elastic zone
Passive system
System: Muscle and facia system that control motion dynamically under load and controls both zones
Active system
System: Determines amount of stability needed, acts on muscles to produce force
Neural system
System: Adds stiffness by activating specific pattern of muscle activity
Neural system
3 ways to assess dysfunction in the PASSIVE subsystem
- PPVIMs (hypo/hyper)
- PAVIMs (central/unilateral PA)
- Instability test
5 ways to assess dyfunction in the ACTIVE subsystem
- US reveals decreased in CSA
- Decreased contraction with palpation
- Decreased feedback with pressure device
- Mm fatigue seen with EMG
- Unable to resist/accept load
3 ways to assess dysfunction in the NEURAL subsystem
- Delayed mm onset (EMG)
- Altered MUR (EMG)
- Change in proprioception
Describe the effect of dysfunction in any one of the systems over time
Can lead to habitual changes in spinal movement and movement impairment
Condition: defect in pars interarticularis
Sponylolysis/Spondylolisthesis
Condition: Results in increased intervertebral segment motion
Spondylolysis/Spondylolisthesis
Condition: Typically in teens due to trauma
Spondylolysis/Spondylolisthesis
Condition: can be seen in adults due to repeated (occupational) stress
Spondylolysis/Spondylolisthesis
Term: degenerative changes in pars interarticularis
Spondylosis
Term: Defect of partial fx in pars interarticularis
Spondylolysis
Term: “Collar on Scottie dog”
Spondylolysis
Term: Complete fx of pars interarticularis with slippage
Sponydlolisthesis
Term: Decapitated Scottie dog
Sponydlolisthesis
Describe the types of anterior slippage
- Normal
- Stage 1
- Stage 2
- Stage 3
- Stage 4
- Vertebral bodies (L5-S1) aligned
- 0-25% anterior translation (conscerv. tx)
- 25-50% anterior translation (conscerv. tx)
- 50-75% anterior translation (fusion)
- 75+% anterior translation (fusion)
Term: Segmental instability due to degeneration of discs, ligament/muscle injury, or poor motor control
Functional instability
Term: Inability to maintain neutral zone, segmental hypermobility
Functional instability
Term: Instability related to either muscle or neural system changes
Functional instability
Condition: Subjective
- Young > Old
- Commonly L5-S1
- Fluctuating symptoms, rarely radiating
- Localized pain
Functional Instability
Condition: Subjective
- Constantly moving positions
- Pain decreased when new positions reached
- Hx of catching/locking
Functional Instability
Condition: Aggravating Factors
- s/p vigorous activity
- Static posture
Functional Instability
Condition: Easing factors
- Rest
- Changing to a new position
Functional Instability
Condition: Ojective
- Increased lumbar lordosis
- End ROM may provoke symptoms
- Hesitation in flexion at 30-40 degrees
- Hinging with extension
- Gowers +
Functional Instability
Decreased the amount of lumbar vs. hip extension in those with functional instability.
Will see more lumbar extension compared to hip extension
Condition: Objective
- Poor pelvic and abdominal control
- Central PA painful with altered end feel
- Leg load test +
Functional Instability
End feel and Motion: Hypermoble Central PA
Increased neutral zone motion with a soft end feel
End feel and Motion: Hypomobile Central PA
Decreased neutral zone motion with a stiff end feel
Describe how hypomobility and instability/hypermobility can co-exist
They can co-exist but not at the same segment, must be at different segments
Describe who would benefit most from a stabilization/TA exercise regiment.
Those who lack control in local muscles
Describe how global exercises impact the spine and stability
Global muscle exercises apply a compressive force
They provide nonspecific stability and can’t control shear forces
Muscle type: Provide stiffness, control translation, adjust segments to reduce shear
Local muscles
Muscle Type: anticipate load/movement and respond to WB exercises
Local muscles
Muscle Type: Provide proprioception, support, and protection to the joint
Local muscles
Muscle: First to register activity on EMG irrespective of direction of movement of limb or direction of forces acting on spine
TA
Muscle: Active during ipsilateral and contralateral trunk rotation
Multifidus
Muscle: Controls the neutral zone and lordosis
Multifidus
Muscle: Controls pelvic rotation
Multifidus
Describe how which exercises bias the internal and external obliques
Internal: crunches, sit up
External: side plank, SL hip ABD
**Focus on external because most people are generally inernal dominant
Describe why it is difficult to activate hip musculature
- Has small cortical representation
- Is a redundant system making it easy to compensation with other muscles (thus they aren’t activated)
Describe they it is difficult to activate postural muscles
- We don’t typically think about activating activating them since they are “automatic” (it’ll take some time to due it on command)
- Small cortical representation (with chronic LBP this small representation may be “shut down” making it even more diffiicult to find the pathways needed to activate these muscles)
Term: Mind’s attempt to teach the body conscious control of a specific movement
Motor training
4 Element of Motor Training
- Proprioceptive and kinesthetic awareness
- Dynamic stability
- Preparatory and reactive muscle characteristics
- Conscious and unconscious functional motor patterns
3 Phases of Motor Training
- Phase 1 = static stabilization
- Phase 2 = transitional stabilization
- Phase 3 = dynamic stabilization
