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705 > Lumbar Pelvic_Sacrum > Flashcards

Lumbar Pelvic_Sacrum Flashcards

1
Q

What are the 4 primary functions of the pelvis?

A
  1. bear weight
  2. transfer loads from axial skeleton to appendicular skeleton
  3. stable, limited mobility –> more efficient transfer of loads
  4. serves as strong attachment point for muscles
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2
Q

Prominent bony features is a feature of which gendered pelvis?

A

male

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3
Q

Narrow, heart shaped pelvic inlet is a feature of which gendered pelvis?

A

male

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4
Q

Narrow distance b/n ASIS and Ischial tuberosity is a feature of which gendered pelvis?

A

male

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5
Q

Laterally facing acetabulum is a feature of which gendered pelvis?

A

male

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6
Q

Narrow pubic arch (70˚) is a feature of which gendered pelvis?

A

male

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7
Q

Less prominent bony features (rounded) is a feature of which gendered pelvis?

A

female

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8
Q

Wide, oval pelvic inlet is a feature of which gendered pelvis?

A

female

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9
Q

Wide distance between ASIS and Ischial tuberosities is a feature of which gendered pelvis?

A

female

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10
Q

Anteriorly facing acetabulum is a feature of which gendered pelvis?

A

female

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11
Q

Wide pubic arch (90˚-100˚) is a feature of which gendered pelvis?

A

female

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12
Q

What are 3 implications of gender differences in pelvic structure:

A
  1. different mechanics in gait (acetabulum orientation)
  2. smaller base of support for males in sitting (@ ischial tub)
  3. Different moment are, length-tension relationships for musculature
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13
Q

Males sit back on the _________ because they have closer _________________.

A

sacrum

ischial tubs

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14
Q

Females purch-up on the ______________

A

ischial tuberosity

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15
Q

List the muscles involved in pelvic/lumbar/sacral support and function:

A

Obturator externus, piriformis, gluteus minimus, superior gemellus, inferior gemellus, obturator internus, quadratus femoris, gluteus medius, gluteus maximus, and iliotibial tract

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16
Q

Pelvis has large influence on the _________, _________ and ___________.

A

trunk, hip and knee

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17
Q

The muscle attachments help:

A
  1. transmission of loads

2. position influences length/tension relationships of muscles

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18
Q

What are the primary muscles involved in maintaining a unilateral stance of the frontal plane?

A
  • Right hip abductor (glut medius)

* Left lumbar erector spianae

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19
Q

In a right hip tilt the glut medius is responsible for ________________________________. The left lumbar erector spinae are responsible for ________________________.

A

acting on the pelvis to pull into right lateral tilt

acting on pelvis to pull into right lateral tilt

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20
Q

Describe the characteristics of force couples:

A
  • parallel forces
  • equal magnitude
  • opposite directions
  • separated by some distance
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21
Q

Lumbo pelvic rhythm =

A

coupled motion b/n pelvis and lumbar spine

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22
Q

What can the lumbopelvic rhythm increase?

A

overal trunk motion for function

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23
Q

In research, the lumbar angle to hip angle was calculated using ratios during 25% of ___________________ phase

A

extension

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24
Q

@ 0-25% extension phase the L/Hip ratio =

A

0.26

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25
Q

@ 25-50% extension phase the L/Hip ratio =

A

0.61

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26
Q

@ 50-75% extension phase the L/Hip ratio =

A

0.81

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27
Q

@ 75-100% extension phase the L/Hip ratio =

A

2.3

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28
Q

ratio

A

hip dominate

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29
Q

> 1 (L/H ratio) =

A

lumbar dominating

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30
Q

During extension what region dominates in early phase?

A

hip

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31
Q

During extension what region dominates in middle phase?

A

lumbar

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32
Q

During extension what region dominates in late/final phase?

A

lumbar

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33
Q

LBP patients moved earlier from the _________________________ (1st 25% of movement)

A

lumbar spine early on

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34
Q

LBP pts had tighter ___________ - no correlation with LP rhythm

A

hamstrings

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35
Q

L/H ratio during forward bending (flexion):

0-30˚ =

A

1.9

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36
Q

L/H ratio during forward bending (flexion):

30-60˚ =

A

0.9

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37
Q

L/H ratio during forward bending (flexion):

60-90˚ =

A

0.4

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38
Q

Lumbar spine dominates _____________ flexion

A

early

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39
Q

Hip dominates ______________ flexion

A

late

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40
Q

Typical extensor recruitment strategy is _______________________ in healthy people.

A

caudal to cephalic

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41
Q

NPD / PD demonstrated _______________________ recruitment strategies (bottom-up vs top-down)

A

opposite

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42
Q

Evidence for altered movement prior to _________ development.

A

pain

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43
Q

Which is typical: bottom-up vs top-down

A

bottom-up

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44
Q

Potential for altered loading at the vertebral joint level w/ ____________ activation of LES

A

early

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45
Q

quantity =

A

range of motion in all planes

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46
Q

quality and willingness to move =

A

aberrant movement patterns (sagittal plane)

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47
Q

Name 3 assessments for aberrant movement patterns:

A
  1. lumbopelvic rhythm analysis
  2. gower’s sign
  3. instability catch
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48
Q

Typically: trunk moves __________ in flexion, ___________ in extension (pelvis moves __________ in flexion and __________ in extension )

A

first in flexion, last in extension

last in flexion, first in extension

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49
Q

Gower sign =

A

“thigh climbing”

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50
Q

Gower sign is positive if they:

A

must use their hands on their thighs to assist with return to standing position ( due to pain, not weakness)

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51
Q

What is the procedure for the Gower sign test?

A

pt asked to bend forward as far as they can (standing flexion) and then return to upright

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52
Q

What is the procedure for reversal of lumbopelvic rhythm?

A

pt is asked to bend forward as far as they can )standing flexion) and return to upright posture.

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53
Q

What is the procedure for instability catch sign?

A

pt asked to bend forward as far as they can (standing flexion) and then return to standing

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54
Q

Catch sign is positive if they cannot:

A

return to erect posture due to sudden painful ‘catch’ in their low back
* due to pain

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55
Q

A positive Catch sign is though to indicate:

A

‘spinal instability’

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56
Q

The interrator reliability for these tests is:

A

POOR!!!

reversal of lumbopelvic rhythm: [K=0.16 (-.15-.46)]

gower sign: 98% agreement between clinicans

Instability catch: [K = .25 (-.10-.60)]

Aberrant movement patterns in general: [k= .60 (.47-.73)]

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57
Q

The sacrum is triangular shaped, wedged b/n:

A

2 halves of the pelvis

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58
Q

The sacral base (sacral promontory) is formed by the 1st sacral vertebra. It has 2 articular facets that face __________________.
Facets articulate with the __________________________________

A

posteriorly

inferior facets of the 5th lumbar vertebra

59
Q

Sacral apex formed by the 5th sacral vertebra; articulates w/ the:

A

coccyx

60
Q

The lateral sacrum region of the sacrum (ala) =

A
  • ear shaped articular surface

- articulates with the illium

61
Q

Osteology of the sacroiliac joint:
rigid articulation = _____________________
auricular surface of the _____________ (lateral region) and auricular surface of the ______________

A

boomerang shape

sacrum

ilium

62
Q

The sacroiliac joint is controversial because:

A
  • amount of motion

- making an accurate diagnosis is difficult

63
Q

What are 4 functions of the sacroiliac joint?

A
  1. weight bearing joint
  2. relieve stress (pelvis region)
  3. load transfer
  4. stability
64
Q

Name the 4 primary ligaments that stabilize the SI joint:

A
  1. anterior sacroiliac ligament
  2. Iliolumbar ligament
  3. interosseous ligament
  4. posterior sacroiliac ligament
65
Q

The anterior sacroilac ligament attaches to the ___________________ to the ___________________.

A

anterior surface of sacrum –> anterior portion of ilium

66
Q

The interosseous ligament attaches to the ___________________ to the ___________________.

A

lateral aspect of the sacrum (ALA) –> anterior portion of the sacroiliac joint

67
Q

The iliolumbar ligament attaches to the ___________________ to the ___________________.

A

lumbar spine –> post. aspect of iliium

68
Q

The short posterior sacroiliac and long posterior sacroiliac ligaments attach to the ___________________ to the ___________________.

A

posterior sacrum –> posterior ilium

69
Q

Name 2 secondary ligaments?

A
  1. sacrotuberous ligament

2. sacrospinous ligament

70
Q

Motion @ the SI joint is poorly defined and difficult to measure: ______________ degrees of rotation and ____________ of translation

A

~1-4˚ of rotation

and ~1-2mm of translation

71
Q

Two terms used to describe rotational and translational movements at the SI joint =

A
  1. nutation

2. counternutation

72
Q

Nutation =

A

“forward nod” of sacrum

73
Q

In nutation, the sacrum moves relative to ___________________. The base moves _______________________. The apex moves ________________________________. The innominate moves in _________________ motion: relative posterior pelvic tilt

A

In nutation, the sacrum moves relative to INNOMINATE. The base moves ANTERIORLY/INFERIORLY. The apex moves POSTERIORLY/SUPERIORLY. The innominate moves in OPPOSITE motion: relative posterior pelvic tilt

74
Q

Counternutation =

A

backward nod of sacrum

75
Q

In counternutation, movement of the sacrum relative to the ___________________. Base moves ___________________. Apex moves ______________________. Innominate moves in ______________ motion: relative anterior pelvic tilt.

A

In counternutation, movement of the sacrum relative to the INNOMINATE. Base moves POSTERIORLY/SUPERIORLY. Apex moves ANTERIORLY. Innominate moves in OPPOSITE motion: relative anterior pelvic tilt.

76
Q

In bilateral hip extension while in prone position, the sacrum moves in a _________________________ position relative to the innominate bones. The innominate bones move in a relative ________________________ which is “relative” to the sacrum.

A

counternutated

anterior pelvic tilt

77
Q

@ lumbosacral joint, have relative extension or

A

increase in lordosis

78
Q

Nutation and counternutation illustrate small movements that occur @:

A

the SI joint

79
Q

Movements provide ________________________ within the pelvis during the functional activities of walking, running, and childbirth.

A

“stress relief”

80
Q

Nutation at the SI joints increases congruence b/n the joint surfaces thus:

A
  • increased articular stability (joint surfaces)
  • optimizes transference of load
  • ligaments (sacrotuberous and interosseous) get support from the nucleus
81
Q

full nutation =

A

closed pack position

82
Q

What is the most stable position for the sacroiliac joint?

A

nutation torque

83
Q

The erector spinae act as active muscle force that pulss the sacrum into:

A

more nutated or anterior tilt

84
Q

The biceps femoris and rectus abdominis act as active muscle forces to pull into:

A

posterior tilt position

85
Q

What are 4 results of prolonged flexion (seated or standing)?

A
  1. adaptive shortening of muscles and connective tissue
  2. increased flexor moment on the spine
  3. increased pressure on anterior aspect of IVD
    (may weaken posterior annulus fibrosis over time)
  4. impact on the entire kinetic/kinematic chain
86
Q

What are 4 results of prolonged hyperextension (standing)?

A
  1. compression of facets
  2. increased anterior shear at lumbosacral junciton
  3. may lead to development of spondylolisthesis (in severe cases)
  4. effect on kinetic/kinematic chain
87
Q

40-64% of asymptomatic individuals will develop clinically significant LBP during:

A

prolonged standing exposures

88
Q

Prolonged standing is one the most consistent and important predicators of:

A

LBP

89
Q

Upright sitting has higher compressive loads when compared to standing at:

A

L3/4 and L4/5

90
Q

When do compressive loads increase while sitting?

A

when cross-legged or slumped sitting

91
Q

In adults, longer periods of occupational standing times do not prevent:

A

the onset of overweight/ obesity or impaired glucose tolerance/ type 2 diabetes

92
Q

What is the best approach in standing?

A

frequent postural cycling

93
Q

‘dynamic sitting’ (such as therapy ball) has ________ effect.

A

no

94
Q

Decreased pain with standing exposures following a 4-weak:

A

trunk/hip exercise program

95
Q

Decisions must be made on a case-by-case basis and personalized for the individual. What should recommendations be based on?

A

posture, work demands, response, fitness level

** no one size fits all solution!!

96
Q

Most important recommendation to change postures & take _______________________________.

A

frequent breaks (every 30-40 minutes)

97
Q

What is spinal stability (instability)?

A

core stabilization, spine stabilization, lumbopelvic stabilization, dynamic stabilization, neuromuscular stabilization

98
Q

Who is most clinical interventions/ literature based on the work of?

A

Panjabi

99
Q

List the 3 categories of Panjabi’s stability model:

A
  1. passive stablizers
  2. active stabilizers
  3. motor control
100
Q

Passive subsystems include:

A

vertebrae, IVDs, joint capsules, passive components of muscle

101
Q

Active subsystems include:

A

muscles & tendons

102
Q

Neural control subsystems include:

A

feedback systems from mechanoreceptors and neural control centers

103
Q

In the example of an “abnormally large intervertebral motion” causes: _________________________ to the passive subsystem, _________________________ of the active subsystem and ____________________ in the neutral subsystem.

A

DAMAGE to the passive subsystem, OVER-CONTROL/ RECRUITMENT of the active subsystem and ALTERED (WON’T BE ABLE TO BALANCE) in the neutral subsystem.

104
Q

A region around the neutral position where motion is produced with minimal internal resistance =

A

neutral zone

105
Q

Define clinical spinal instability:

A

’ A decrease in the capacity of the stablizing system of the spine to maintain the intervertebral neutral zones within the physiological limits so that there is no neurological dysfunction, no major deformity, and no incapacitating pain’

106
Q

Hypothesis: neutral zone, passive and active spinal function are:

A

inter-related

107
Q

Size of neutral zone ______________ with inadequate muscle force or damage to passive structures

A

increases

108
Q

Neutral zone can only be measure ________________.

A

in vitro

109
Q

What are 2 interventions based on spinal stability?

A
  1. spinal stability

2. bracing

110
Q

What are the implications of instability as a clinical term/ diagnosis?

A
  • a vague descriptor
  • cannot measure/quantify in vivo
  • might make patients fearful (words matter)
  • does not serve to guide interventions
111
Q

Extrinsic stabilizers (GLOBAL stability) =

A

long muscles attach to structures outside the vertebral column

112
Q

Extrinsic stabilizers include:

A

all of abdominals / erector spinae / hip muscles / quadratus lumborum / psoas major / Latissimus dorsi / scapular muscles

113
Q

Intrinsic stabilizers (SEGMENTAL stability) =

A

short, deep muscles attach to structures within spinal column

114
Q

Intrinsic stabilizers include:

A 
transversospinal group (semispinalis, multifidi, rotatores)
short segmental group (interspinalis, intertransversarii)
115
Q

What are the extrinsic stabilizers activated in supine slide heel slide w/ straight leg?

A

psoas major, TrA, EO, IO, rectus femoris, iliacus

116
Q

What are the intrinsic stabilizers activated in supine slide heel slide w/ straight leg?

A

multifidus, rotators

117
Q

What are the extrinsic stabilizers activated in bird dog?

A

glut max, lower trap, lats, QL, serratus anterior, TrA, EO, IO, rectus A., errector spinae

118
Q

What are the intrinsic stabilizers activated in supine slide heel slide w/ straight leg?

A

rotators, multifidi, semispinalis

119
Q

Base on finds that TrA function impaired in people with LBP –> Theory:

A

a primary specific stabilizer for lumbar spine

120
Q

TrA selectively activate through ‘drawing a maneuver’ ; increases intrabdominal pressure and tension fascia _________________________.

A

WITHOUT moving lumbar spine

121
Q

TrA is difficult for most pts to learn; need to use _____________________________.

A

biofeedback - EMG or pressure

122
Q

Biofeedback pressure example:

A

air bladder - maintain at 40 mmHg and ultrasound imaging of TrA concurrently while performing abdominal ‘drawing in’

123
Q

Was there correlation b/n biofeedback and TrA activation?

A

No correlation b/n pressure biofeedback and TrA activation on ultrasound (r = 0.7)

124
Q

Was there a difference in TrA activation b/n those who were / were not able to perform EX successfully?

A

NO (no change in pressure)

125
Q

Success w/ pressure biofeedback has been associated with improved outcomes, BUT….

A
  1. this may not be due to increased TrA activation (not correlated/predictive)
  2. training using ADIM maybe beneficial in individuals fitting into this classification system for LBP
126
Q

Take home messages:

A
  1. muscles do not work in isolation
  2. focus on perfect performance of the desired movement/task
  3. likely using a combination of global and segmental stabilizing muscles
  4. always return to foundation principles, functional anatomy, motor control
  5. always refer to the literature as a guide
127
Q

What are the anatomy and clinical implications of the sacral iliac joint?

A
  1. anatomical structures do not function in isolation!
  2. sacrum, pelvis, spine and connections to appendicular skeleton are functionally interrelated
  3. “the most contentious issue in SIJ research is mobility of the joint”
128
Q

Historical: SIJs mobile only during _____________.

A

pregnancy

129
Q

Historical: SIJ shown to be mobile in _________________

A

both men and women

130
Q

Historical: Nutation and

A

counternutation (flexion/ extension)

131
Q

Historical: x-ray analysis during supine to stand showed _____________________.

A

0.5-0.7 cm motion (nutation - relative between endpoints)

132
Q

Historical: classified as an intermediate joint -

A

freely mobile ventral aspect and ossified dorsal aspect

133
Q

Historical: concluded movement not possible except for

A

during pregnancy

134
Q

Current view of SIJ: primary function of SIJ = ______________________

A

stable support to upper body

135
Q

Current view of SIJ: has limited mobility, but sacral movement involves SIJ, directly influences discs and _______________________.

A

higher lumbar joints

136
Q

Current view of SIJ: Nutation/ counternutation of sacrum affects _____________.

A

L5/ S1

137
Q

Current view of SIJ: Finite element models estimate a 1 cm leg length discrepancy results in ______________________________.

A

5-fold increase in SIJ loads

138
Q

__________ translation during nutation (3 mm error in measurement system - roentgenogram)

A

6 mm

139
Q

__________ translation (rods in iliac bones)

A

5 mm

140
Q

2º movement between:

A

double and single leg stance (surgical rods in ilia and sacrum)

141
Q

Conclusion (about SIJ):

A

current studies support limited motion of ~ 2º in all 3 planes

142
Q

clinical assessment of mobility =

A

gillet test

143
Q

Gillet test Utility: balance challenge -

A

SIJ ‘locks’ for stability; movement of the external pelvis relative to the hips gives the illusion that the SIJ are repositioned

144
Q

Standing flexion test utility:

A

represents a non-specfic change in lumbo-pelvic-hip mechanics, not specific to SIJ

705 (7 decks)

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