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Unit 3 Biomechanics Winter 2024 > Lumbar & sacral regions w/ function > Flashcards

Lumbar & sacral regions w/ function Flashcards

1
Q

Describe lumbar facet arthrokinematics for flexion

A
  • inferior facet of superior vertebra slides superior
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2
Q

Describe lumbar facet arthrokinematics for extension

A
  • inferior facet of superior vertebra slides inferior
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3
Q

Describe lumbar facet arthrokinematics for rotation

A
  • VERY limited
  • IF moving right; left inferior facet will contact L superior facet and R inferior facet will gap from R superior facet
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4
Q

Describe lumbar facet arthrokinematics for lateral flexion

A
  • ipsilateral facet slides down
  • contralateral facet slides up
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5
Q

What happens to the contact area and contact pressure of the lumbar facets at extremes of flexion & extension?

A

Extreme flexion:
- contact area decreases which increases contact pressure

Extreme extension:
- contact area increases which decreases contact pressure

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6
Q

How does lumbar flexion affect intervertebral foramen & nerve roots and discs?

A

IV foramen & nerve roots:
- increases (opens) IV foramen
- decompresses nerve roots exiting nerves

Discs:
- anterior compresses
- nucleus migrates posterior

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7
Q

How does lumbar extension affect intervertebral foramen & nerve roots and discs?

A

IV foramen & nerve roots:
- decreases (closes) IV foramen
- compresses nerve roots exiting nerves

Discs:
- posteriorly compresses
- nucleus migrates anterior

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8
Q

What position reduces pressure on the lumbar discs?

A
  • full, sustained lumbar extension
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9
Q

What is centralization?

A
  • pain that was radiating down the LE’s begins to migrate back to the low back
  • suggests reduced contact pressure b/w disc material & nerve root
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10
Q

Describe lumbo-pelvic rhythm during forward bending

A

Lumbar flexion:
- 1st 25% of movement
- 45 degrees flexion

Hip flexion:
- last 25% of movement
- 60 degrees flexion

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11
Q

What are the consequences of limited hip flexion?

A
  • increased excessive lumbar flexion
  • more pressure on discs increases degeneration
  • over stretches T-L fascia
  • reduces ability of tissues to limit flexion
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12
Q

What are the consequences of limited lumbar flexion?

A
  • excessive hip flexion
  • more demand of hip extensors
  • leads to greater compressive loads at hip joints
  • painful w/ arthritis
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13
Q

Describe lumbo-pelvic rhythm during return from forward bending

A

Hip Ext:
- early phase hip extensors active when external force greatest on lumbar spine

Lumbar Ext:
- middle phase lumbar extensors active when EMA reduced

Muscles relax in erect standing if LoG through/posterior to hip

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14
Q

How does the T-L fascia help stabilize the lumbar spine?

A
  • many muscle attachments
  • QL, erector spinae, multifidi, glute max, lats, transversus abdominis, internal oblique
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15
Q

How do the transverse abdominis and internal obliques help to stabilize the lumbar spine?

A
  • they fuse together to form a central tendon that connects directly w/ middle layer of T-L fascia
  • called lateral raphe
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16
Q

What happens to the multifidi in patients with low back pain?

A
  • becomes atrophied
  • increased fat content
  • muscular inhibition
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17
Q

What muscles would you want to strengthen to increase lumbar stability?

A
  • IO & Trans Abd
  • multifidi
  • active b/f perturbations occur w/ electro studies
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18
Q

How does anterior pelvic tilting affect the lumbar spine?

A
  • increases lumbar lordosis
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19
Q

What happens at the L5/S1 junction with increased lumbar lordosis?

A
  • increase sacrohorizontal angle which increases anterior shear force on L5/S1
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20
Q

Which structures resist anterior shear in the L5/S1 region?

A
  • intervertebral discs
  • facet joints & capsule
  • ALL
  • iliolumbar ligaments
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21
Q

What is spondylolisthesis?

A
  • vertebral slipping

Pars articularis:
- fractures causing slipping of vertebra

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22
Q

What lumbar motion would you want to avoid with a spondylolisthesis?

A
  • avoid extension exercises/activities if progressive or unstable
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23
Q

How does posterior pelvic tilting affect the lumbar spine?

A
  • decreases lumbar lordosis
24
Q

Which muscles form force couples for pelvic tilting when the lumbar spine is stabilized?

A

Ant Tilt:
- erector spinae
- sartorius
- iliopsoas

Post Tilt:
- glute max
- hamstrings
- rectus abdominus

25
Q

What happens to the lumbar spine if the hip flexors are too tight?

A
  • causes excessive lumbar lordosis
26
Q

What is the difference between disc protrusion, extrusion, and sequestration?

A

Protrusion:
- nucleus still w/in annulus

Extrusion:
- nucleus herniates through annulus

Sequestration:
- nuclear material stick in epidural space

27
Q

What are some causes of disc bulging?

A
  • repetitive/sustained lumbar flexion
  • series of low-magnitude forces over the years
  • sudden strenuous event
28
Q

How can a disc bulge resolve without specific intervention?

A
  • macrophages could absorb the nuclear material which clear it out of the epidural space
29
Q

Where does disc related pain come from?

A
  • degenerated disc = damaged periphery of annulus, PLL, or end plates
  • herniated disc is compressing spinal cord/neural tissue
30
Q

What is peripheral sensitization?

A
  • increased growth/sensitivity of nociceptors in the area of disc degeneration
  • also inflammation
  • starts to radiate down the dermatomes
31
Q

What are some causes of SIJ pain?

A
  • injury to joint
  • trauma
  • difficult childbirth
  • unilateral torsions
  • excessive stress from postural positioning
32
Q

What is one of the best diagnostic tools to determine if the SIJ is the source of pain?

A
  • assess pain after injecting an anesthetic into the joint
33
Q

List the ligaments associated with the SIJ and their respective jobs

A

Reinforce anterior joint:
- Anterior sacroiliac ligament
- iliolumbar ligament

Binds sacrum to ilium:
- interosseous ligament (strongest)
- short/long posterior iliac ligaments

Stability:
- sacrotuberous
- sacrospinous

34
Q

What is nutation of sacral motion on a fixed ilium?

A
  • sacral base tilts anterior
35
Q

What is nutation of ilium motion on a fixed sacrum?

A
  • ilium posteriorly rotates
36
Q

What is counternutation of sacral motion on a fixed ilium?

A
  • sacral base tilts posterior
37
Q

What is counternutation of ilium motion on a fixed sacrum?

A
  • ilium anteriorly rotates
38
Q

What are some passive stabilizers of the SIJ?

A
  • interosseous
  • sacrospinous
  • sacrotuberous
  • gravity w/ body weight forces
39
Q

What are some active stabilizers of the SIJ?

A
  • multifidi
  • erector spinae
  • biceps femoris
  • external oblique
  • rectus femoris
  • lats
  • glute max
  • transverse abdominis
  • piriformis
40
Q

Name the plane of motion that the cervical region moves the best

A
  • most in axial rotation
  • horizontal plane
41
Q

Name the plane of motion that the thoracic region moves the best

A
  • frontal plane
  • lateral flexion
42
Q

Name the plane of motion that the lumbar region moves the best

A
  • sagittal plane
  • flexion/extension
43
Q

Explain proper sitting posture as if you were explaining it to a patient

A
  • anterior pelvic tilt
  • natural lumbar lordosis
  • natural cervical lordosis
44
Q

What happens to the rest of the spine with a posterior pelvic tilt in sitting?

A
  • decreased lumbar lordosis
  • posterior migration of nucleus pulposus
  • forward head posture
45
Q

What are the consequences on cervical muscle structures of a chronic forward head posture?

A
  • adaptive shortening of suboccipitals
  • stresses neck extensors
  • can lead to local muscle spasms/trigger points (levator scap/suboccipitals)
  • headaches
46
Q

What differences exist between the sit-up and curl-up?

A

Sit-up:
1) trunk flexion phase
- lumbar spine flat/posterior pelvic tilt
- small hip flexor activity

2) hip flexion phase
- hip flexors contract
- trunk moves toward femurs
- hamstrings/gastroc stabilize LE’s

Curl-up:
- less disc pressure
- only trunk flexion phase
- focuses more on abdominals

47
Q

What are 4 ways to improve lumbopelvic stability?

A
  • activate deeper stabilizers
  • simultaneously challenge wide range of muscles
  • endurance
  • postural control, equilibrium, positional awareness
48
Q

Which functional activities place the greatest pressure on the lumbar discs?

A
  • forward flexion (picking up laundry basket)
  • holding load in front of body + forward bending
  • lifting w/ knees straight
  • sitting in forward-slouched position
49
Q

What is the difference between a squat lift and stoop lift?

A

Squat:
- hips/knees extend powered by LE
- lumbar can remain neutral
- load b/w knees
- decreased EMA
- decreased internal extensor demands
- increased total work needed
- increased stress on knees

Stoop:
- lumbar flexion
- long EMA
- increases required back extensor torque
- large compression & shear forces

50
Q

Which lift is better squat or stoop lift?

A
  • squat lift
  • less pressure on back muscles
  • decreased pressure on discs & shear forces
51
Q

What is the valsalva maneuver?

A
  • increased intraabdominal pressure by contraction of abdominals against a closed glottis in throat
52
Q

How does the valsalva maneuver affect lumbar discs?

A
  • increases pressure on discs
53
Q

How can you teach your patient to safely lift an object from the ground?

A
  • lift slowly
  • reduce weight
  • keep close to body
  • keep neutral spine
  • core tight
  • avoid twisting
  • wide BoS
54
Q

What are the ROM norms for thoracolumbar flexion and extension?

A

Flex:
- 80

Ext:
- 25

55
Q

What are the ROM norms for thoracolumbar lateral flexion and rotation?

A

Lateral flex:
- 35

Rotation:
- 45

Unit 3 Biomechanics Winter 2024 (8 decks)

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