Lumbar Spine Flashcards
Movements of the lumbar spine
Flexion -
Greater than the range of extension
More movement in lower segments - L4/5, L5/S1
ROM - approx 50-60 degrees
Varies A LOT between people
Movements of lumbar spine
Extension -
Approx 30 degrees (large variation between studies)
Movements of lumbar spine
Side flexion -
Approx 25 degrees
Difficult to measure
Coupled with rotation
Movements of lumbar spine
Rotation -
1 degree at each segmental level with less rotation available at L5-S1
Mean rotation of 8-12 degrees in each direction
Rotation is limited by the orientation of the facet joints - most amount in thoracic spine
Muscles of the trunk
Thoracolumbar fascia:
Posterior -
Middle -
Anterior -
Posterior layer - superficial to erector spinae and attached to spinous processes
Middle layer - between erector spinae and quadratic lumborum, attached to transverse tips
Anterior layer - deep to quadratus lumborum, attached to anterior of transverse process
What are are the layers of the anterior wall?
Layers - external oblique, internal oblique and transversus abdominis
Vertical muscles - rectus abdominis
External oblique -
Origins - muscular slips from the outer surfaces of the lower either ribs (ribs 5-12)
Insertions - lateral lip of iliac crest
Aponeurosis ending in midline raphe (lines alba)
Actions - compress abdominal contents
Both muscles flex trunk
Each muscle bends trunk to same side, turning anterior part of abdomen to opposite side (ipsilateral side flexion and contralateral rotation)
Nerve supply - anterior rami of lower six thoracic spinal nerves (T7-T12)
Internal oblique -
Origins - thoracolumbar fascia
Iliac crest between origins of external oblique and transversus abdominis
Lateral two-thirds of inguinal ligament
Insertions - inferior border of the lower three or four ribs
Aponeurosis ending in linea alba
Pubic crest and pectineal line
Actions - compress abdominal contents
Both muscles flex trunk
Each muscle bends trunk and turns anterior part of abdomen to same side
(Ipsilateral side flexion and rotation)
Sits deeper than ext.
Nerve supply - anterior rami of lower six thoracic spinal nerves (T7-T12) and L1
Transverse abdominus -
Origins - thoracolumbar fascia
Medial lip of iliac crest
Lateral one-third of inguinal ligament: costal cartilages lower six ribs (ribs VII to XII)
Insertions - Aponeurosis ending in linea alba
Pubic crest and pectineal line
Action - compress abdominal contents
Core stability muscle
Nerve - anterior rami of lower six thoracic spinal nerves (T7 to T12) and L1
Rectus abdominis -
Origins - pubic crest, pubic tubercle and pubic symphysis
Insertions - costal cartilages of ribs 5 to 7
Xiphid process
Actions - compress abdominal contents
Flex vertebral column
Tense abdominal wall
Nerve supply - anterior rami mainly of the lower six thoracic spinal nerves (T7-T12)
Function of abdominals -
Trunk movement
Sitting up from lying, getting out of bed
Protection of abdominal viscera
Spinal stabilisation
Abdominal pressure for:
Forced expiration
Micturition
Defecation (opening bowels)
Parturition
Vomiting
Rectus sheath -
What is rectus diastasis?
Complex - formation differs at levels
- anterior layer - external/internal obliques)
- posterior layer - internal oblique, and transversus abdominus
Layers interlace in midline - LINEA ALBA
Rectus diastasis - females pregnancy
Separation of rectus abdominis muscle from the linea alba
Can come back together naturally, or sometimes it doesn’t
Clinically - may give exercises to strengthen RA
Contents of the posterior wall -
Diaphragm superiorly
Thoracolumbar fascia Iliac crest- muscles
Psoas, iliacus, quadratus lumborum, TrA, Obliques
Lumbar vertebrae and discs
Quadratus lumborum -
Attachments - posterior border of iliac crest iliolumbar ligament
Transverse processes L1-L5
Inferior border of 12th rib
Action - muscle of inspiration
Ipsilateral side flexion - side flex to the same side
Lumbar extension (both acting)
Nerve - ventral rami T12-L4
Erector spinae
The three sections -
Largest group of intrinsic back muscles
Iliocostalis - iliocostalis lumborum, iliocostalis thoracic
Longissimus - longissimus thoracis
Spinalis - spinalis thoracis
Erector spinae -
Origins - lower six ribs and rib angles
Insertions - T11-L5 spinous processes
Suprapsinous/sacro-iliac ligament
Sacral crests
Posterior part of iliac crest
Iliac tuberosity
Inner lip of iliac crest
Thoracolumbar fascia
Actions - bilateral - extension, control of flexion
Maintenance of lumbar lordosis
Unilateral - ipsilateral flexion/rotation
Nerve supply - dorsal rami of adjacent thoracolumbar nerves
What are the stability muscles? (Transversospinalis)
Semispinalis thoracics
Multifidus
Rotatores
Interspinalis
Inter transversus
Semispinalis (thoracics) -
Origins - transverse processes of TVI to TX
Insertions - spinous processes of upper four thoracic and lower two cervical vertebrae
Multifidus -
Origins - sacrum
Origin of erector spinae
Posterior superior iliac spine
Mammillary processes of lumbar vertebrae
Transverse processes of thoracic vertebrae
Articular processes of lower four cervical vertebrae
Insertions - base of spinous processes of all vertebrae from LV to CII (axis)
Intertransversarii and interspinales -
Interspinales pass between adjacent spinous processes
Intertransversarii pass between adjacent transverse processes
These postural muscles stabilise the joining vertebrae during movements of the vertebral column to allow more effective action of the large muscle group
What exists the intervertebral foramen?
Spinal neves
How do you measure AROM at lumbar region?
You can’t use a goniometer
Therefore use landmarks - ie trace hands down body as you move to get a point of how far you can go
Passive physiological intervertebral movements -
Flexion and extension - model off edge - cradle legs and one hand on lumbar area, move into each movement
Side flexion - bed height really low - arm under lower thigh and knee and lift up. Other hand on waist
Body in straight line with knees bent
Rotation - one hand along femur and on GT
Other arm under their top arm and place hand on lumbar area
Push hips back and resistance against lumbar to do rotation
Accessory movements
PA of spinous processes/ transverse processes
Can use grades 1-4
