Lumbar muscle Energy - Exam 1 - Spring 2013

Question 1

What is the definition of Muscle Energy Technique?

Answer 1

• A system of diagnosis and treatment in which the patient voluntarily moves the body as specifically directed by the physican; this directed patient action is from a precisely controlled position, against a defined resistance by the physician.

Question 2

When do you use muscle energy technique?

Answer 2

1) mobilize joints in which movement is restricted.
2) Stretch tight muscles and fascia
3) Improve local circulation
4) Alter related respiratory and circulatory function
5) Balance neuromuscular relationships to alter muscle tone.

Question 3

What is the oculocervical reflex?

Answer 3

• patient makes eye movements, certain cervical and muscles reflexively contract and anatagonist muscles relax.

Question 4

What is the respiratory assistance.

Answer 4

Physician directs the forces of respiration while simultaneously uses a fulcrum (hand) to direct the Somatic dysfuction through the barrier.

Question 5

What is post-isometric relaxation?

Answer 5

Following increased tension on the Golgi tendon receptors (contraction), there is a refractory period in which there is a muscle relaxation (lengthening).

Question 6

What is joint mobilization in muscle energy?

Answer 6

• Similar to HVLA but the patient actively contracts muscles to cause movement, use patient positioning and muscle contractions to restore motion.

Question 7

What is reciprocal inhibition?

Answer 7

Contracting an agonist to relax the anatgonistic muscles.

Question 8

What are absolute Contraindications of muscle energy?

Answer 8

• Fracture, dislocation or severe joint instability at treatment site.
• Uncooperative patient

Question 9

What are relative contraindications?

Answer 9

• Moderate to severe muscle strains, advanced osteoporosis, severe illness (post-surg., patient on monitor in)

Question 10

State the process of the muscle energy technique?

Answer 10

1) Engage the barrier
2) Patient contracts into the freedom of motion with a small amount of force for 3-5 sec. against physician resistance.
3) Wait 1-2 sec. (allowing tissue relax)
4) Physician re-engages the barrier
5) Repeat 3-5 times
6) Recheck

Question 11

In the lumbar vertebral body what is the large size, what is the the higher portion?

Answer 11

• Large size designed to support weight, higher in the front, L4 at level of iliac crest.

Question 12

What motion causes the facets to align backward and medial. And couples with ventral-dorsal translatory slide?

Answer 12

• Flexion/Extension motion

Question 13

What motion couples with contralateral lateral translatory slide. The side bent- translates left.

Answer 13

• Sidebending

Question 14

What intervertebral motion is couples with disk compression?

Answer 14

Rotation

Question 15

Latissimus Dorsi:
    Origin-
  Insertion-
     Action- 
Innervation-

Answer 15

Origin: T7-T12, Iliac crest, Thoracolumbar fascia
Insertion: humerus
Action: Adducts, extends, internally rotates arm, Extension and sidebending of lumbar spine
Innervation- Theracodorsal nerve (C6-C8)

Question 16

Where can the pain be located in hypertonicity of the latissimus dorsi?

Answer 16

• Yields shoulder pain.

Question 17

What is the gluteus maximus:
    Origin?
    Insertion?
    Action?
    Innervation?

Answer 17

Origin: Thoracolumbar fascia, Dorsal sacrum, Sacrotuberous ligament, ilium,
Insertion: Iliotibial band, Greater tuberosity of femur
Action: Extend hip and stabilizes torso
Innervation: Inferior gluteal nerve (L5, S1-S2)

Question 18

What is the Erector Spinae:
Origin?
Insertion?
Action?

Answer 18

Origin: Sacrum
Insertion: cervical
Muscles included are iliocostalis, longissimus, spinalis
- Action: Bilateral contraction- extension;
Unilateral contraction- extension and ipsilateral sidebending

Question 19

What is the Quadratus Lumborum:

- Origin?
- Insertion?
- Action?
- Innervation?

Answer 19

Origin: 12th rib, lumbar transverse processes
Insertion: iliolumbar ligament, iliac crest
Action: bilateral contraction creates extension, unilateral contraction causes extension with ipsilateral sidebending
Innervation: T12 and L1-L4 ventral rami

Question 20

What is the action of the multifidus and rotators?

Answer 20

Postural muscles.

Action: control and stabilizes individual vertebral motions

Question 21

Psoas Major- 
Origin
Insertion
Action
Insertion

Answer 21

Psoas Major

• Origin: Transverse process of T12-L5
• Insertion: Lesser trochanter of femur
• Action: Flexes and internally rotates hip
• Innervation: L1-L3 (2-4) ventral rami

Question 22

Illiacus-
Origin:
Action:

Answer 22

Iliacus
Origin: superior 2/3 of iliac fossa inner lip of illiac crest, ventral sacroilliac and iliolumbar ligaments, upper lateral sacrum.
Insertion: Lateral Tendron of psoas
Actions: Hip flexion, lumbar sidebending (unilateral contraction), constant activity in erect posture, important in function and stability.

Question 23

What is the course of the anterio longitudinal ligament?
What is the course of the posterior longitudinal ligament?
-What two pathologies can be caused by narrowing of posterior longitudinal ligament?

Answer 23

• From base of occiput to the anterior sacrum
• From the posterior body of the axis to the sacrum
• decreases support and increases risk of disc herniation

Question 24

What is the attachment of the iliolumbar ligament? What is its action?

Answer 24

Attachment: transverse processes of L4 and L5 and iliac crest.
- Increases stability at the lumbosacral junction (commonly strained in traumatic injuries)

Question 25

What is the first ligament to become tender with lumbar posture change?

Answer 25

Iliolumbar ligament - tender area 1” superior and lateral to PSIS on the crest.

Question 26

What would severe low back pain of sudden onset and without history of trauma.

Answer 26

• Dissecting aortic aneurysm.

Question 27

Pain that wakes the patient that sleep?

Answer 27

Malignancy until proven otherwise.

Question 28

Rapidly progressing neuroloical deficits?

Answer 28

Epidural abscess/infection

Question 29

Claudication symptoms with back pain?

Answer 29

Spinal stenosis.

Question 30

What planes of motion occur in:
Coronal:
Horizontal:
Sagittal:

Answer 30

Coronal (sidebending)
Horizontal (Rotation)
Sagittal (FB or BB)

Question 31

What are the main attributes of a type I somatic dysfunction?
What are the main attributes of a type iI somatic dysfunction?

Answer 31

Type I SD: Neutral, sidebending and rotation in opposite directions, group
Type II SD: Flexed or extended, sidebend and rotate in same direction, single

Question 32

What does FDR stand for?

Answer 32

Flexion dysfunction
Down (rotation side of S.D. down)
Recumbent (that’s lateral rec.)

-

Question 33

What does SUE stand for?

Answer 33

Sims (lateral Sims)
Up (S.D. side up)
Extension dysfunction

( Patient in the Sims flexes: psoas and abdominal muscles, rotates the lumbar spine into the barrier)

Question 34

For a type I somatic dysfunction name the muscle energy technique.

Answer 34

• Pt. conVEX up, lateral recumbent
• Doc faces patient and monitors apex
• Flex knees and hip until motion felt
• Doc lifts both ankles toward the ceiling until motion at apex
• Pt. pushes legs toward floor against doc’s isometric resistance.

Question 35

What are the classic somatic dysfunction of Lumbar Spine?

Answer 35

Low back/buttock pain, aching, increased pain with activity/ prolonged positions