Lumbar & sacral regions w/ function Flashcards
Describe lumbar facet arthrokinematics for flexion
- inferior facet of superior vertebra slides superior
Describe lumbar facet arthrokinematics for extension
- inferior facet of superior vertebra slides inferior
Describe lumbar facet arthrokinematics for rotation
- VERY limited
- IF moving right; left inferior facet will contact L superior facet and R inferior facet will gap from R superior facet
Describe lumbar facet arthrokinematics for lateral flexion
- ipsilateral facet slides down
- contralateral facet slides up
What happens to the contact area and contact pressure of the lumbar facets at extremes of flexion & extension?
Extreme flexion:
- contact area decreases which increases contact pressure
Extreme extension:
- contact area increases which decreases contact pressure
How does lumbar flexion affect intervertebral foramen & nerve roots and discs?
IV foramen & nerve roots:
- increases (opens) IV foramen
- decompresses nerve roots exiting nerves
Discs:
- anterior compresses
- nucleus migrates posterior
How does lumbar extension affect intervertebral foramen & nerve roots and discs?
IV foramen & nerve roots:
- decreases (closes) IV foramen
- compresses nerve roots exiting nerves
Discs:
- posteriorly compresses
- nucleus migrates anterior
What position reduces pressure on the lumbar discs?
- full, sustained lumbar extension
What is centralization?
- 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
Describe lumbo-pelvic rhythm during forward bending
Lumbar flexion:
- 1st 25% of movement
- 45 degrees flexion
Hip flexion:
- last 25% of movement
- 60 degrees flexion
What are the consequences of limited hip flexion?
- increased excessive lumbar flexion
- more pressure on discs increases degeneration
- over stretches T-L fascia
- reduces ability of tissues to limit flexion
What are the consequences of limited lumbar flexion?
- excessive hip flexion
- more demand of hip extensors
- leads to greater compressive loads at hip joints
- painful w/ arthritis
Describe lumbo-pelvic rhythm during return from forward bending
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
How does the T-L fascia help stabilize the lumbar spine?
- many muscle attachments
- QL, erector spinae, multifidi, glute max, lats, transversus abdominis, internal oblique
How do the transverse abdominis and internal obliques help to stabilize the lumbar spine?
- they fuse together to form a central tendon that connects directly w/ middle layer of T-L fascia
- called lateral raphe
What happens to the multifidi in patients with low back pain?
- becomes atrophied
- increased fat content
- muscular inhibition
What muscles would you want to strengthen to increase lumbar stability?
- IO & Trans Abd
- multifidi
- active b/f perturbations occur w/ electro studies
How does anterior pelvic tilting affect the lumbar spine?
- increases lumbar lordosis
What happens at the L5/S1 junction with increased lumbar lordosis?
- increase sacrohorizontal angle which increases anterior shear force on L5/S1
Which structures resist anterior shear in the L5/S1 region?
- intervertebral discs
- facet joints & capsule
- ALL
- iliolumbar ligaments
What is spondylolisthesis?
- vertebral slipping
Pars articularis:
- fractures causing slipping of vertebra
What lumbar motion would you want to avoid with a spondylolisthesis?
- avoid extension exercises/activities if progressive or unstable
How does posterior pelvic tilting affect the lumbar spine?
- decreases lumbar lordosis
Which muscles form force couples for pelvic tilting when the lumbar spine is stabilized?
Ant Tilt:
- erector spinae
- sartorius
- iliopsoas
Post Tilt:
- glute max
- hamstrings
- rectus abdominus
What happens to the lumbar spine if the hip flexors are too tight?
- causes excessive lumbar lordosis
What is the difference between disc protrusion, extrusion, and sequestration?
Protrusion:
- nucleus still w/in annulus
Extrusion:
- nucleus herniates through annulus
Sequestration:
- nuclear material stick in epidural space
What are some causes of disc bulging?
- repetitive/sustained lumbar flexion
- series of low-magnitude forces over the years
- sudden strenuous event
How can a disc bulge resolve without specific intervention?
- macrophages could absorb the nuclear material which clear it out of the epidural space
Where does disc related pain come from?
- degenerated disc = damaged periphery of annulus, PLL, or end plates
- herniated disc is compressing spinal cord/neural tissue
What is peripheral sensitization?
- increased growth/sensitivity of nociceptors in the area of disc degeneration
- also inflammation
- starts to radiate down the dermatomes
What are some causes of SIJ pain?
- injury to joint
- trauma
- difficult childbirth
- unilateral torsions
- excessive stress from postural positioning
What is one of the best diagnostic tools to determine if the SIJ is the source of pain?
- assess pain after injecting an anesthetic into the joint
List the ligaments associated with the SIJ and their respective jobs
Reinforce anterior joint:
- Anterior sacroiliac ligament
- iliolumbar ligament
Binds sacrum to ilium:
- interosseous ligament (strongest)
- short/long posterior iliac ligaments
Stability:
- sacrotuberous
- sacrospinous
What is nutation of sacral motion on a fixed ilium?
- sacral base tilts anterior
What is nutation of ilium motion on a fixed sacrum?
- ilium posteriorly rotates
What is counternutation of sacral motion on a fixed ilium?
- sacral base tilts posterior
What is counternutation of ilium motion on a fixed sacrum?
- ilium anteriorly rotates
What are some passive stabilizers of the SIJ?
- interosseous
- sacrospinous
- sacrotuberous
- gravity w/ body weight forces
What are some active stabilizers of the SIJ?
- multifidi
- erector spinae
- biceps femoris
- external oblique
- rectus femoris
- lats
- glute max
- transverse abdominis
- piriformis
Name the plane of motion that the cervical region moves the best
- most in axial rotation
- horizontal plane
Name the plane of motion that the thoracic region moves the best
- frontal plane
- lateral flexion
Name the plane of motion that the lumbar region moves the best
- sagittal plane
- flexion/extension
Explain proper sitting posture as if you were explaining it to a patient
- anterior pelvic tilt
- natural lumbar lordosis
- natural cervical lordosis
What happens to the rest of the spine with a posterior pelvic tilt in sitting?
- decreased lumbar lordosis
- posterior migration of nucleus pulposus
- forward head posture
What are the consequences on cervical muscle structures of a chronic forward head posture?
- adaptive shortening of suboccipitals
- stresses neck extensors
- can lead to local muscle spasms/trigger points (levator scap/suboccipitals)
- headaches
What differences exist between the sit-up and curl-up?
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
What are 4 ways to improve lumbopelvic stability?
- activate deeper stabilizers
- simultaneously challenge wide range of muscles
- endurance
- postural control, equilibrium, positional awareness
Which functional activities place the greatest pressure on the lumbar discs?
- forward flexion (picking up laundry basket)
- holding load in front of body + forward bending
- lifting w/ knees straight
- sitting in forward-slouched position
What is the difference between a squat lift and stoop lift?
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
Which lift is better squat or stoop lift?
- squat lift
- less pressure on back muscles
- decreased pressure on discs & shear forces
What is the valsalva maneuver?
- increased intraabdominal pressure by contraction of abdominals against a closed glottis in throat
How does the valsalva maneuver affect lumbar discs?
- increases pressure on discs
How can you teach your patient to safely lift an object from the ground?
- lift slowly
- reduce weight
- keep close to body
- keep neutral spine
- core tight
- avoid twisting
- wide BoS
What are the ROM norms for thoracolumbar flexion and extension?
Flex:
- 80
Ext:
- 25
What are the ROM norms for thoracolumbar lateral flexion and rotation?
Lateral flex:
- 35
Rotation:
- 45
