Lumbar region

Question 1

Describe the lumbar plexus

Answer 1

• from ventral rami L1-L4
• extend into the psoas and post. abdominal wall.
• small branches abs wall and psoas
• main branches = ant. thigh

Question 2

Name the cutaneous branches of LP.

Answer 2

T12 - L1: iliohypogastric nerve: buttocks and pubis, transverse abdominus and lower portion.
L1: ilioinguinal: skin of genitalia, proximal and medial sensory skin thigh.

L1-L2: genitofemoral: scrotum, labia majora, ant thigh and inguinal region

L2-L3: Lateral femoral cutaneous: skin of lateral thigh and peritoneum.

L4-L5: more motor branches.

Question 3

Name the motor branches of LP

Answer 3

Femoral: L2-4:
Iliac, satorius, quads, pectinous.
Located in the inguinal ligament / anterior compartment.

Obturator nerve: L2-4: adductor longus, brevis, magnus, gracilis, obturator internus.
Located in the medial compartment.

Question 4

Name the muscles involved with the lumbar spines, origin, insertion, function, nerve.

Answer 4

Psoas: TP 12- L5 to lesser trochanter.
L1-L2 anterior rami.
flexion of the thigh / balances the trunk

Iliac: Iliac fossa to lesser trochanter.
L2-L4 femoral nerve
flexion / stabilisation
blend with psoas

QL: 12th ribs to L1-5 TP to iliolumbar ligament, iliac crest
T12-L1-4 nerves
extension and lateral flexion

Question 5

What are the transversopinal group muscles of the back?

Answer 5

• semispinalis
• multifidi
• rotatores

Question 6

What are the short segmental group mm of the back?

Answer 6

• interspinalis

- intertransversarius

Question 7

What is the erector spinae? name origin, insertion, action, innervation?

Answer 7

Group of muscles: iliocostalis, longissimus, spinals mm

1. iliocostalis: lateral band - extends to C4
2. longissimus: intermediate band - thoracic spine
3. spinalis - medial band.

Question 8

What is the difference causes between an athlete and a non athlete experiencing lower back pain?

Answer 8

Non athlete: body tilts forward, poorly trained back, legs, abs mm.
Athlete: excessive or uneven stress, sudden mets.

Question 9

Functional anatomy of lumbar: give keys words or brief explanation of the region.
Movement, structures, function, ect..

Answer 9

• 5 lumbar for weight bearing upper body.
• ID: annulus fibrosis/nucleus pulposus.
• shock absorber.
• spine flexibility
• distort as uneven loads.
• excessive loads create bulge or prolapse discs.

Vertebral arches = protection of spinal cord in the posterior aspect.

Flexion / extension sidebending and rotation

Ligaments: inter transverse, ligamentum flavum, anterior longitudinal, interspinous.

Question 10

Explain the relationship between the abdominal muscles and the intervertebral discs:

Answer 10

the centre of gravity goes 5 cm front to the back and 5 cm behind L3 on a standing position. When sitting, the CoG goes 15 cm in the center of L3.

Heavy weight, long duration stress (sitting) or asymmetrical stress (bad postures) create pressures on the discs. all those elements create more load on the lumbar.

This pressure is unloaded when abdomen and diaphragm are tighten together. Therefore core stability of the transverse abdominal, rectus abdomens, internal and external oblique are activated.

Question 11

Explain the briefly facets structure, function and orientation of the lumbar:

Answer 11

• prevents excessive mvts.
• Sup. facet concave medial/ post
• Infer. facet convex laterally/ ant.

L1-L4 favour flexion-extension mvt but generate a limit to extension on a sagittal plane. The orientation of the facets from L1 to L5 changes in the coronal planes to L5-S1 creating counter act shear forces.

Question 12

Explain L3 and T12 function:

Answer 12

L3 serves as a relay station where it attaches the iliolumbar fibres of latissimus dorsi to TP L3 and the ascending fibres of spinalis of SP L3.

L3 is pulled posteriorly by muscle arising from sacrum to ilium. Also L3 serves as origin for thoracic mm. In conclusion, L3 is truly mobile compared to L4-5 which are static and bound to ilium and sacrum.

T12 is the inflexion between the lumbar and the thoracic curvatures and act as swivel of vertebral axis.

Question 13

Define the term sacralisation:

Answer 13

L5 fuses with the sacrum during the development resulting in 4 lumbar vertebrae and six sacral segment

Question 14

Define lumbarisation of S1:

Answer 14

The first sacral segment amy form as a separate segment complete with an intervertebral discs. (does create always problems)

Question 15

Give the different motion of the lumbar spine:

Answer 15

extension - flexion - rotation - side-bending

Question 16

Give an important element of spinal motion:

Answer 16

• sidebending and rotation are coupled together
• coupled motions
• cannot occur without another

Question 17

Explain the coupled motions of the lumbar spine by Fryette:

Answer 17

• Neutral sagittal plane, side-bending and rotation occur to opposite sides usually as a group of vertebrae. type I
• Hyper-extension or flexion, the sagittal plane isn’t neutral create de degree sufficient to engage the facets as prime movers of the spine. Side-bending and rotation would occur at the same side. Type II.

Question 18

Explain the relation of QL with the lumbar spine and its function, describe shortly its importance in osteopathy practise:

Answer 18

• QL is attached to the 12th ribs, L1-5 TP, iliolumbar ligament and iliac crest generating extension and lateral flexion.
• Imbalances of QL is either due to hypertonicity or lumbar scoliosis or short leg that can create dysfunction along functional linkages of the thoracic cage, lumbar spine, lumbopelvic region, hip, knee and ankle.
• contraction of a shorten QL can shortens the distance between the rib cage and the ilium, elevates the ilium, side shifts the pelvis, increases the angle of the femoral head within the acetabulum and creates strain on the medial collateral ligament and medial compartment of the knee.
• from functional perspective long term QL imbalances would adversely affect lumbopelvic rhythm and muscle balance within the lower limb.

Question 19

Explain briefly the spinal reflexes and the relationship with the lumbar plexus and sacral plexus:

Answer 19

• Reflex tests are used to determine the integrity of the spinal cord and the peripheral nervous system that we can detect the presence of a neuromuscular disease.
• Reflexes are protective mechanisms of the body to prevent injury.
• Reflex contraction of the associated muscle is a result of activation of golgi tendon receptors in the musculotendinuous junction, sudden stretch results in a reflex contraction.
• Knee patella jerk dysfunction will give indication of anomalies of the femoral nerve L3,L4 and ankle achilles jerk dysfunction, tibial nerves of S1 and S2.

Question 20

Describe the fascia of the lumbar region

Answer 20

• the thoracolumbar fascia ant/middle/post
• Aponeurotic origin of transverses abdomens
• Post part of left kidney and right middle part of kidney between L1-L4 are surrounded by perirenal fat capsule containing the vessels and reals sinuses and renal fascia. There is also paranephric fat and extraperitoneal fat in the lumbar region. The renal fascia is connected to the paranephric fat with collagen bundles.
• Lateral raphe
• QL fascia
• Supraspinous ligament
• SP process
• interspinous ligament
• Articular facet
• Intertransverse ligament btw TP
• Ligamentum flavus
  Vertebral canal
• Lumbar spine
• post longitudinale ligament
• Annulus fibrosus / nucleus pulposus
• vertebral body
• ID
• Anterior longitudinal ligaments.
• Psoas fascia.

Question 21

Why is the fascia of the lumbar region as a significant importance in osteopathy approach:

Answer 21

• The function of the fascia is in general to enable contracting muscles to move smoothly against all neighbouring structures.
• The thoracolumbar fascia is continuous with the abdominal wall and the gluteus medium and the lower limb.
• Vleeming and Al. discuss about the mechanical link between the gluteus max on one side and the latissimus dorsi in the other. As a result of inflammation, they found that the fascia do not glide against the neighbouring structures, notably against bone.