Lumbar Instabilities and Stabilization Flashcards by Kelsy Schoen

Term: controls normal loads and stressed placed on the spine

Stabilizing structures

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System: Passive system/stabiliy of bones, joints, capsules, and ligaments

Osteoligamentous subsystem

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System: Active system/dynamic stability

Muscle system

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System: Guides the muscle system via timing, force control, etc.

Neural control subsystem

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3 Components of a Stabilized Spine

Osteoligamentous subsystem
Muscle system
Neural control subsystem

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Describe the effect of dysfunction in one of the three subsystems

Added stress/demand to the other systems

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Term: first few degress of motion

Neutral zone

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Term: zone in which movement occurs in a free range against little resistance

Neutral zone

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Zone: Grades 1 and 2

Neutral zone

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Term: From the end of the neutral zone to the end of ROM

Elastic zone

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Term: zone in which movemtn occurs with considerable internal resistance

Elastic zone

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Zone: Grades 3 and 4

Elastic zone

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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.

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Zone: Passive structures

Elastic zone

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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

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Term: increase in neutral zone

Segmental instability

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Term: Decrease in elastic zone

Segmental instability

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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

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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

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Term: Abnormal movement of one vertebra on another

Segmental instability

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System: Osseous and ligamentous system that limited the neutral zone and stabilizes the elastic zone

Passive system

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System: Muscle and facia system that control motion dynamically under load and controls both zones

Active system

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System: Determines amount of stability needed, acts on muscles to produce force

Neural system

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System: Adds stiffness by activating specific pattern of muscle activity

Neural system

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3 ways to assess dysfunction in the PASSIVE subsystem

1. PPVIMs (hypo/hyper) 2. PAVIMs (central/unilateral PA) 3. Instability test

5 ways to assess dyfunction in the ACTIVE subsystem

1. US reveals decreased in CSA 2. Decreased contraction with palpation 3. Decreased feedback with pressure device 4. Mm fatigue seen with EMG 5. Unable to resist/accept load

3 ways to assess dysfunction in the NEURAL subsystem

1. Delayed mm onset (EMG) 2. Altered MUR (EMG) 3. 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 1. Normal 2. Stage 1 3. Stage 2 4. Stage 3 5. Stage 4

1. Vertebral bodies (L5-S1) aligned 2. 0-25% anterior translation (conscerv. tx) 3. 25-50% anterior translation (conscerv. tx) 4. 50-75% anterior translation (fusion) 5. 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

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

1. Proprioceptive and kinesthetic awareness 2. Dynamic stability 3. Preparatory and reactive muscle characteristics 4. Conscious and unconscious functional motor patterns

3 Phases of Motor Training

1. Phase 1 = static stabilization 2. Phase 2 = transitional stabilization 3. Phase 3 = dynamic stabilization