Lumbar Pelvic_Sacrum Flashcards
1
Q
What are the 4 primary functions of the pelvis?
A
- bear weight
- transfer loads from axial skeleton to appendicular skeleton
- stable, limited mobility –> more efficient transfer of loads
- serves as strong attachment point for muscles
2
Q
Prominent bony features is a feature of which gendered pelvis?
A
male
3
Q
Narrow, heart shaped pelvic inlet is a feature of which gendered pelvis?
A
male
4
Q
Narrow distance b/n ASIS and Ischial tuberosity is a feature of which gendered pelvis?
A
male
5
Q
Laterally facing acetabulum is a feature of which gendered pelvis?
A
male
6
Q
Narrow pubic arch (70˚) is a feature of which gendered pelvis?
A
male
7
Q
Less prominent bony features (rounded) is a feature of which gendered pelvis?
A
female
8
Q
Wide, oval pelvic inlet is a feature of which gendered pelvis?
A
female
9
Q
Wide distance between ASIS and Ischial tuberosities is a feature of which gendered pelvis?
A
female
10
Q
Anteriorly facing acetabulum is a feature of which gendered pelvis?
A
female
11
Q
Wide pubic arch (90˚-100˚) is a feature of which gendered pelvis?
A
female
12
Q
What are 3 implications of gender differences in pelvic structure:
A
- different mechanics in gait (acetabulum orientation)
- smaller base of support for males in sitting (@ ischial tub)
- Different moment are, length-tension relationships for musculature
13
Q
Males sit back on the _________ because they have closer _________________.
A
sacrum
ischial tubs
14
Q
Females purch-up on the ______________
A
ischial tuberosity
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
16
Q
Pelvis has large influence on the _________, _________ and ___________.
A
trunk, hip and knee
17
Q
The muscle attachments help:
A
- transmission of loads
2. position influences length/tension relationships of muscles
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
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
20
Q
Describe the characteristics of force couples:
A
- parallel forces
- equal magnitude
- opposite directions
- separated by some distance
21
Q
Lumbo pelvic rhythm =
A
coupled motion b/n pelvis and lumbar spine
22
Q
What can the lumbopelvic rhythm increase?
A
overal trunk motion for function
23
Q
In research, the lumbar angle to hip angle was calculated using ratios during 25% of ___________________ phase
A
extension
24
Q
@ 0-25% extension phase the L/Hip ratio =
A
0.26
25
@ 25-50% extension phase the L/Hip ratio =
0.61
26
@ 50-75% extension phase the L/Hip ratio =
0.81
27
@ 75-100% extension phase the L/Hip ratio =
2.3
28
ratio
hip dominate
29
>1 (L/H ratio) =
lumbar dominating
30
During extension what region dominates in early phase?
hip
31
During extension what region dominates in middle phase?
lumbar
32
During extension what region dominates in late/final phase?
lumbar
33
LBP patients moved earlier from the _________________________ (1st 25% of movement)
lumbar spine early on
34
LBP pts had tighter ___________ - no correlation with LP rhythm
hamstrings
35
L/H ratio during forward bending (flexion):
| 0-30˚ =
1.9
36
L/H ratio during forward bending (flexion):
| 30-60˚ =
0.9
37
L/H ratio during forward bending (flexion):
| 60-90˚ =
0.4
38
Lumbar spine dominates _____________ flexion
early
39
Hip dominates ______________ flexion
late
40
Typical extensor recruitment strategy is _______________________ in healthy people.
caudal to cephalic
41
NPD / PD demonstrated _______________________ recruitment strategies (bottom-up vs top-down)
opposite
42
Evidence for altered movement prior to _________ development.
pain
43
Which is typical: bottom-up vs top-down
bottom-up
44
Potential for altered loading at the vertebral joint level w/ ____________ activation of LES
early
45
quantity =
range of motion in all planes
46
quality and willingness to move =
aberrant movement patterns (sagittal plane)
47
Name 3 assessments for aberrant movement patterns:
1. lumbopelvic rhythm analysis
2. gower's sign
3. instability catch
48
Typically: trunk moves __________ in flexion, ___________ in extension (pelvis moves __________ in flexion and __________ in extension )
first in flexion, last in extension
last in flexion, first in extension
49
Gower sign =
"thigh climbing"
50
Gower sign is positive if they:
must use their hands on their thighs to assist with return to standing position ( due to pain, not weakness)
51
What is the procedure for the Gower sign test?
pt asked to bend forward as far as they can (standing flexion) and then return to upright
52
What is the procedure for reversal of lumbopelvic rhythm?
pt is asked to bend forward as far as they can )standing flexion) and return to upright posture.
53
What is the procedure for instability catch sign?
pt asked to bend forward as far as they can (standing flexion) and then return to standing
54
Catch sign is positive if they cannot:
return to erect posture due to sudden painful 'catch' in their low back
* due to pain
55
A positive Catch sign is though to indicate:
'spinal instability'
56
The interrator reliability for these tests is:
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)]
57
The sacrum is triangular shaped, wedged b/n:
2 halves of the pelvis
58
The sacral base (sacral promontory) is formed by the 1st sacral vertebra. It has 2 articular facets that face __________________.
Facets articulate with the __________________________________
posteriorly
inferior facets of the 5th lumbar vertebra
59
Sacral apex formed by the 5th sacral vertebra; articulates w/ the:
coccyx
60
The lateral sacrum region of the sacrum (ala) =
- ear shaped articular surface
| - articulates with the illium
61
Osteology of the sacroiliac joint:
rigid articulation = _____________________
auricular surface of the _____________ (lateral region) and auricular surface of the ______________
boomerang shape
sacrum
ilium
62
The sacroiliac joint is controversial because:
- amount of motion
| - making an accurate diagnosis is difficult
63
What are 4 functions of the sacroiliac joint?
1. weight bearing joint
2. relieve stress (pelvis region)
3. load transfer
4. stability
64
Name the 4 primary ligaments that stabilize the SI joint:
1. anterior sacroiliac ligament
2. Iliolumbar ligament
3. interosseous ligament
4. posterior sacroiliac ligament
65
The anterior sacroilac ligament attaches to the ___________________ to the ___________________.
anterior surface of sacrum --> anterior portion of ilium
66
The interosseous ligament attaches to the ___________________ to the ___________________.
lateral aspect of the sacrum (ALA) --> anterior portion of the sacroiliac joint
67
The iliolumbar ligament attaches to the ___________________ to the ___________________.
lumbar spine --> post. aspect of iliium
68
The short posterior sacroiliac and long posterior sacroiliac ligaments attach to the ___________________ to the ___________________.
posterior sacrum --> posterior ilium
69
Name 2 secondary ligaments?
1. sacrotuberous ligament
| 2. sacrospinous ligament
70
Motion @ the SI joint is poorly defined and difficult to measure: ______________ degrees of rotation and ____________ of translation
~1-4˚ of rotation
| and ~1-2mm of translation
71
Two terms used to describe rotational and translational movements at the SI joint =
1. nutation
| 2. counternutation
72
Nutation =
"forward nod" of sacrum
73
In nutation, the sacrum moves relative to ___________________. The base moves _______________________. The apex moves ________________________________. The innominate moves in _________________ motion: relative posterior pelvic tilt
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
Counternutation =
backward nod of sacrum
75
In counternutation, movement of the sacrum relative to the ___________________. Base moves ___________________. Apex moves ______________________. Innominate moves in ______________ motion: relative anterior pelvic tilt.
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
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.
counternutated
anterior pelvic tilt
77
@ lumbosacral joint, have relative extension or
increase in lordosis
78
Nutation and counternutation illustrate small movements that occur @:
the SI joint
79
Movements provide ________________________ within the pelvis during the functional activities of walking, running, and childbirth.
"stress relief"
80
Nutation at the SI joints increases congruence b/n the joint surfaces thus:
- increased articular stability (joint surfaces)
- optimizes transference of load
- ligaments (sacrotuberous and interosseous) get support from the nucleus
81
full nutation =
closed pack position
82
What is the most stable position for the sacroiliac joint?
nutation torque
83
The erector spinae act as active muscle force that pulss the sacrum into:
more nutated or anterior tilt
84
The biceps femoris and rectus abdominis act as active muscle forces to pull into:
posterior tilt position
85
What are 4 results of prolonged flexion (seated or standing)?
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
What are 4 results of prolonged hyperextension (standing)?
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
40-64% of asymptomatic individuals will develop clinically significant LBP during:
prolonged standing exposures
88
Prolonged standing is one the most consistent and important predicators of:
LBP
89
Upright sitting has higher compressive loads when compared to standing at:
L3/4 and L4/5
90
When do compressive loads increase while sitting?
when cross-legged or slumped sitting
91
In adults, longer periods of occupational standing times do not prevent:
the onset of overweight/ obesity or impaired glucose tolerance/ type 2 diabetes
92
What is the best approach in standing?
frequent postural cycling
93
'dynamic sitting' (such as therapy ball) has ________ effect.
no
94
Decreased pain with standing exposures following a 4-weak:
trunk/hip exercise program
95
Decisions must be made on a case-by-case basis and personalized for the individual. What should recommendations be based on?
posture, work demands, response, fitness level
| ** no one size fits all solution!!
96
Most important recommendation to change postures & take _______________________________.
frequent breaks (every 30-40 minutes)
97
What is spinal stability (instability)?
core stabilization, spine stabilization, lumbopelvic stabilization, dynamic stabilization, neuromuscular stabilization
98
Who is most clinical interventions/ literature based on the work of?
Panjabi
99
List the 3 categories of Panjabi's stability model:
1. passive stablizers
2. active stabilizers
3. motor control
100
Passive subsystems include:
vertebrae, IVDs, joint capsules, passive components of muscle
101
Active subsystems include:
muscles & tendons
102
Neural control subsystems include:
feedback systems from mechanoreceptors and neural control centers
103
In the example of an "abnormally large intervertebral motion" causes: _________________________ to the passive subsystem, _________________________ of the active subsystem and ____________________ in the neutral subsystem.
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
A region around the neutral position where motion is produced with minimal internal resistance =
neutral zone
105
Define clinical spinal instability:
' 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
Hypothesis: neutral zone, passive and active spinal function are:
inter-related
107
Size of neutral zone ______________ with inadequate muscle force or damage to passive structures
increases
108
Neutral zone can only be measure ________________.
in vitro
109
What are 2 interventions based on spinal stability?
1. spinal stability
| 2. bracing
110
What are the implications of instability as a clinical term/ diagnosis?
* a vague descriptor
* cannot measure/quantify in vivo
* might make patients fearful (words matter)
* does not serve to guide interventions
111
Extrinsic stabilizers (GLOBAL stability) =
long muscles attach to structures outside the vertebral column
112
Extrinsic stabilizers include:
all of abdominals / erector spinae / hip muscles / quadratus lumborum / psoas major / Latissimus dorsi / scapular muscles
113
Intrinsic stabilizers (SEGMENTAL stability) =
short, deep muscles attach to structures within spinal column
114
Intrinsic stabilizers include:
```
transversospinal group (semispinalis, multifidi, rotatores)
short segmental group (interspinalis, intertransversarii)
```
115
What are the extrinsic stabilizers activated in supine slide heel slide w/ straight leg?
psoas major, TrA, EO, IO, rectus femoris, iliacus
116
What are the intrinsic stabilizers activated in supine slide heel slide w/ straight leg?
multifidus, rotators
117
What are the extrinsic stabilizers activated in bird dog?
glut max, lower trap, lats, QL, serratus anterior, TrA, EO, IO, rectus A., errector spinae
118
What are the intrinsic stabilizers activated in supine slide heel slide w/ straight leg?
rotators, multifidi, semispinalis
119
Base on finds that TrA function impaired in people with LBP --> Theory:
a primary specific stabilizer for lumbar spine
120
TrA selectively activate through 'drawing a maneuver' ; increases intrabdominal pressure and tension fascia _________________________.
WITHOUT moving lumbar spine
121
TrA is difficult for most pts to learn; need to use _____________________________.
biofeedback - EMG or pressure
122
Biofeedback pressure example:
air bladder - maintain at 40 mmHg and ultrasound imaging of TrA concurrently while performing abdominal 'drawing in'
123
Was there correlation b/n biofeedback and TrA activation?
No correlation b/n pressure biofeedback and TrA activation on ultrasound (r = 0.7)
124
Was there a difference in TrA activation b/n those who were / were not able to perform EX successfully?
NO (no change in pressure)
125
Success w/ pressure biofeedback has been associated with improved outcomes, BUT....
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
Take home messages:
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
What are the anatomy and clinical implications of the sacral iliac joint?
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
Historical: SIJs mobile only during _____________.
pregnancy
129
Historical: SIJ shown to be mobile in _________________
both men and women
130
Historical: Nutation and
counternutation (flexion/ extension)
131
Historical: x-ray analysis during supine to stand showed _____________________.
0.5-0.7 cm motion (nutation - relative between endpoints)
132
Historical: classified as an intermediate joint -
freely mobile ventral aspect and ossified dorsal aspect
133
Historical: concluded movement not possible except for
during pregnancy
134
Current view of SIJ: primary function of SIJ = ______________________
stable support to upper body
135
Current view of SIJ: has limited mobility, but sacral movement involves SIJ, directly influences discs and _______________________.
higher lumbar joints
136
Current view of SIJ: Nutation/ counternutation of sacrum affects _____________.
L5/ S1
137
Current view of SIJ: Finite element models estimate a 1 cm leg length discrepancy results in ______________________________.
5-fold increase in SIJ loads
138
__________ translation during nutation (3 mm error in measurement system - roentgenogram)
6 mm
139
__________ translation (rods in iliac bones)
5 mm
140
2º movement between:
double and single leg stance (surgical rods in ilia and sacrum)
141
Conclusion (about SIJ):
current studies support limited motion of ~ 2º in all 3 planes
142
clinical assessment of mobility =
gillet test
143
Gillet test Utility: balance challenge -
SIJ 'locks' for stability; movement of the external pelvis relative to the hips gives the illusion that the SIJ are repositioned
144
Standing flexion test utility:
represents a non-specfic change in lumbo-pelvic-hip mechanics, not specific to SIJ
