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Biomechanics - Spine > Lumbar Spine > Flashcards

Lumbar Spine Flashcards

1
Q

Describe the Osteology of the Lumbar Spine:

Relate the structure to function:

A
  • 66% lordosis L4-S1 (radiographic – 47-64 deg)
  • Facets are 90 deg from transverse, 45 deg from frontal
  • FSU – 2 vertebrae, IVD, and soft tissue structures
  • Anterior – bodies, discs, ALL (compression)
  • Posterior – SP, TP, facets, LF, PLL (guide motion)
  • IVD – endplates, AF (fibrocartilage), NP (gelatin – GAG, H2O) – distributes load, etc
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2
Q

Interpret the influence of the spine structure on osteo- and arthrokinematics:

A
  • Facet orientation (90 from trans; 45 from frontal)
  • Flex/Ext – 12-20 per segment
  • Rotation – 2 per segment (except L5-S1 has 6)
  • Lat Flex – 6 per segment
  • Limits on Flexion – posterior elements; on extension (anterior elements)
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3
Q

Compare and contrast lumbar spine with other spine regions:

A
  • C1-C2 – lots of rotation – 40-45 deg (20 from trans), limited LF
  • C3-C7 – 45 from frontal/45 from trans – F/E, LF, Rot – increases as you go down for flexion
  • T1-T12 – 60 from trans, 20 from frontal – limited F/E, LF, some rotation
  • L1-L5 – 90 from trans, 45 from frontal – increased F/E, some LF, limited Rotation
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4
Q

There is ______ extensor effort when Lordosis is maintained.

A

decreased

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5
Q

What is the gold standard for measuring Lumbar lordosis?

A

Radiographic Measurement

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6
Q

What is the gold standard for measuring Lumbar lordosis?

A

Radiographic Measurement

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7
Q

What are the typical ranges from measuring lumbar lordosis when Radiographically?

A

47 - 64 degrees

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8
Q

What are external ways to measure lumbar lordosis?

A
  • bendable rules
  • strain gauges embedded with tape
  • inclinometers
  • accelerometers
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9
Q

Describe external mesures validity when measuring lumbar lordosis?

A

all have poor concurrent validity when compared to radiograph

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10
Q

Describe external mesures validity when measuring lumbar lordosis?

A

all have poor concurrent validity when compared to radiograph

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11
Q

Describe how radiographic measurement is taken:

A
  • line drawn parallel to superior Endplate of L1
  • line drawn parallel to the endplate of L5
  • Lines drawn Perpendicular to both L1 and L5 lines
  • the angle between the intersection of the two perpendicular lines is the total lumbar lordosis angle
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12
Q

When speaking of spinal mechanics what is usually being spoken of?

A

The structures that make up the functional spinal unit

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13
Q

What does the Functional Spinal Unit consist of?

A
  • 2 Adjacent Vertebral bodies
  • Intervertebral Disc (IVD)
  • Associated Soft Tissue
  • is also called a “Motion Segment”
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14
Q

What elements does the Lumbar Vertebral Structure consist of

A 
Anterior Elements:
- 2 Vertebral bodies
- IVD
- Longitudinal Ligaments
Posterior Elements:
- Vertebral Arches
- Spinous and Transverse Processes
- Facet Joints
- Posterior Ligaments
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15
Q

Posterior Elements of Lumbar vertebral Structure:

A
  • Vertebral Arches
  • Spinous and Transverse Processes
  • Facet Joints
  • Posterior Ligaments
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16
Q

Anterior Elements of the Lumbar vertebral structure:

A
  • 2 Vertebral bodies
  • IVD
  • Longitudinal Ligaments
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17
Q

Anterior Elements of the Lumbar vertebral structure:

A
  • 2 Vertebral bodies
  • IVD
  • Longitudinal Ligaments
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18
Q

Purpose of Anterior Elements of the Lumbar vertebral structure:

A
  • bear compressive loads

- larger caudally (loading increases)

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19
Q

Purpose of Posterior Elements of the Lumbar vertebral structure:

A
  • Guide Movement

- Motion determined by facet joint orientation

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20
Q

Where does loading increase in the lumbar spine and why?

A

increases caudally because the V. bodies get larger

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21
Q

What elements guide the movement of the lumbar vertebrae?

A

posterior elements

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22
Q

What determines the motion of the lumbar vertebrae?

A

the facet joint orientation

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23
Q

Lumbar facet joints:

A
  • restrict motion (but also allow motion depending on orientation)
  • serve as a site for muscle attachments
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24
Q

Lumbar Transvers Processes:

A
  • muscle & ligament attachments

- increase moment arm by extending out laterally (better mechanical advantage)

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25
Q

Lumbar Spinous Processes:

A

similar to Transverse Processes:

  • muscle & ligament attachments
  • increase moment arm by offsetting attachment point from the axis of rotation
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26
Q

Another name for Facet Joint is a __________.

A

Z joint

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27
Q

Describe the articulation of a typical facet joint:

A

superior facet articulates with the inferior facet of the adjacent vertebrae

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28
Q

Describe the innervation of the facet joints:

A
  • Highly Innervated!
  • Full of Mechanoreceptor (for proprioception)
  • also full of nociceptors (for pain)
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29
Q

Where does most of our sense of where our bodies are in space come from?

A

Facet Joint Mechanoreceptors

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30
Q

Describe the Joint Surface Orientation of the Lumbar facet joints:

A
  • 90 degrees to Transverse plane

- 45 degrees to frontal plane

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31
Q

What do the lumbar facet orientations also?

A
  • Flexion/Extension
  • Lateral flexion
  • Minimal Rotation
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32
Q

describe the lumbosacral facet joint:

A
  • oblique orientation

- allows more rotation

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33
Q

What are the facet joints of lumbar spine important for?

What does it depend on

A
  • load sharing with the IVD

- posture (contact between facets changes depending on posture position)

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34
Q

How much of total load is on facet joints during hyperextension?

A

30% of total load

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35
Q

What positions increase loading on facets?

A
  • hyperextension

- flexion combined with rotation (don’t twist and bend!!)

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36
Q

Describe the purpose of the passive structures involved with lumbar spine:

A

Anterior longitudinal ligament:
- v. body attachment
- less attachment to the disc
-

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37
Q

Describe the purpose of the passive structures involved with lumbar spine:

A 
Anterior longitudinal ligament:
- v. body attachment
- less attachment to the disc
- tight in extension (limits extension)
Posterior Longitudinal Ligament:
- mainly Disc attachment
- less attachment to body
- tight in flexion (limits flexion)
Ligamentum Flavum:
- connects adjacent vertebral arches
- High elastin content (means it is an active ligament)
- because active, Contracts during extension, elongates during flexion
- under constant tension
-- pre-stresses the disc to create intradiscal pressure (important for: providing stability to the spine)
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38
Q

Name the components of the IVD:

A
  • inferior/superior endplates
  • annulus fibrosis (fibers that surround gel substance in center)
  • nucleus pulposus
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39
Q

Name the 3 functions of the IVD:

A
  • weight bearing
  • load distribution
  • restrains excessive motion between segments
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40
Q

Describe the Nucleus pulposus of the IVD:

A
  • gelatinous mass
  • Hydrophilic (water loving) glycosaminoglycan (GAG) content
  • GAG and water content decrease with age (disc dries out, becomes smaller)
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41
Q

Describe the Annulus Fibrosis of IVD:

A
  • Fibrocartilage

- annular layers with different collagen fiber orientations (adds greatly to strength of disc)

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42
Q

Describe Intradiscal Pressure (IDP)

A
  • Hydrostatic pressure within the disc ensures uniform load distribution
  • Nucleus Pulposus is incompressible - resists compressive loads (you push it, it pushes back)
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43
Q

When is IDP the smallest?

A

when we are sleeping (laying supine)

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44
Q

Rank postures from most stress to least stress on IDP:

A
  • sitting in poor posture (200%)
  • bending over (160%)
  • seated with decent posture (150%)
  • standing erect (normal 100%)
  • lying supine (25%)
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45
Q

Wilke study showed a little different results about posture on IDP:

A
  • IDP is lower in unsupported, relaxed sitting than in standing
  • Found IDP increased over 7 hours of rest
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46
Q

What plane does the primary motion of the lumbar spine take place in? What degrees at each segment and all together?

A
  • sagittal plane (flexion/extension)

- 12 to 20 degrees at each segment (60 to 100 degrees total)

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47
Q

What plane does the secondary motion of the lumbar spine take place in? What degrees at each segment and all together?

A
  • Frontal Plane
    (lateral flexion)
  • 6 degrees at each segment (36 degrees total)
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48
Q

What plane does the tertiary motion take place around in the lumbar spine? What degrees at each segment and all together?

A
  • Transverse plane

- 2 degrees at each segment (10 degrees total)

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49
Q

What dictates available motion?

A

ORIENTATION OF THE FACET JOINTS

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50
Q

What plane movement do the lumbar facets allow and restrict?

A
  • allow sagittal and frontal plane motion

- restrict transverse plane motion

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51
Q

Explain the differences in the lumbosacral (L5S1) joint:

A
  • oblique orientation that allows MORE ROTATION and FLEXION and LIMITS LATERAL FLEXION
  • from side view: can see articular surfaces of L5S1; looking right at us.
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52
Q

Explain the differences in the lumbosacral (L5S1) joint:

A
  • oblique orientation that allows MORE ROTATION and FLEXION and LIMITS LATERAL FLEXION
  • from side view: can see articular surfaces of L5S1; looking right at us.
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53
Q

Describe the arthrokinematics of the lumbar spine:

A

Flexion:
- Inferior facets of superior vertebra slide upward on the superior facets of inferior vertebra
Extension:
- inferior facets of superior vertebra slide downward on superior facets of inferior vertebra
Right Lateral flexion:
- right inferior facet of superior vertebra slides down, and left inferior facet of superior vertebra slides up on corresponding superior facets of inferior vertebra
Left lateral flexion:
- opposite of right lateral flexion
Rotation:
- ipsilateral gapping, contralateral approximation

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54
Q

T or F: there is no coupled motion in the lumbar spine.

A

False; there is coupled motion during flexion/rotation in the lumbar spine

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55
Q

What should a PT do when applying coupled motion concepts to the lumbar spine?

A

use caution

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56
Q

Why do we look at coupled motions in the lumbar spine?

A

To assess active motion:
- observe compensatory motions that could be attributed to deficient coupled motion (may treat coupled motion to restore primary motion)
To assess passive motion/mobility:
- look at coupling patterns that take place
For clinical intervention:
- guide direction of mobilization, treat restrictions in both motions to restore the primary movement

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57
Q

Compare and contrast the regions of the spine:

A
  • Bodies – small in cervical (limited weight); wedge shaped and bigger in T-spine (gives kyphosis); largest in L-spine (compression)
  • SP’s – AP orientation, shorter; T-spine – longer and angle inf; L-spine – AP and larger/thicker – increase moment arm
  • TP’s – C-spine (vert foramen); T-spine – costal facets; L-spine – bigger
  • IVD’s – bigger as you go caudal
58
Q

Name the risk factors for Injury of the Lumbar Spine:

A
  • compression and shear Exposure
  • Repetitive lifting
  • prolonged sitting, standing
  • psychosocial factors
  • posture (reduced lordosis)
59
Q

During acute overload exposure on spinal segments, what was the result?

A

Primarily endplate fractures, no IVD injuries

60
Q

If you have a single event injury during compression, what will most likely be damaged in the lumbar spine?

A

the endplates will be fractured

61
Q

What is the OSHA threshold limit of force for compression and shear?

A
  • 10,000 N compression

- 3,000 N shear

62
Q

When looking at the Cumulative Exposure chart of compression over 5 seconds, what is being analyzed?

A
  • amount of compression experienced at the lumbar spine throughout all 5 seconds
  • Looking at the area under the curve and adding all of it together
63
Q

T or F: Cumulative loading is important.

A

True

64
Q

In the cumulative exposure study, at what amount of cycles and force did initiation of herniation occur during compression?

A

between 3850 - 5870 cycles at 1000 N

65
Q

In the cumulative exposure study, at what amount of cycles and force did complete herniation occur during compression?

A

at 26,400 cycles at 1000 N.

66
Q

When do you begin to see more disc damage?

A

during combined flexion/extension/twisting loading

67
Q

Describe what happens during Disc Herniation:

A

The nucleus pulposus material tracks through clefts in the annular fibers - it is not a straight shot, it can take multiple pathways as it has to go in between the layers before it finds another weakness to track through. Not a jelly donut.

68
Q

What % of people are going to have an imaging finding that correlates with their symptoms?
What does this lead to many times?

A

< 15%

leads to unnecessary surgeries in lumbar spine

69
Q

T or F: people with symptoms of lower back pain most definitely have some structural defect.

A

False; patients can have symptoms and have nothing wrong structurally

70
Q

What are two important elements to look at when assessing multifactorial problem of lower back pain?

A
  • control of whole body movement

- muscle activation patterns

71
Q

What makes a big impact on loading patterns? So what?

A
  • individual movement strategies

- so need personalized intervention and training

72
Q

during static standing posture, what are the primary loads?

A
  • body weight
  • muscle activity
  • pre-stress from ligaments
  • external loads
73
Q

during static standing posture, thoracic kyphosis curvature puts us in a __________________ ?
What does this create?
What resists this motion?

A
  • constant flexion moment
  • anterior shear
  • extensor muscles
74
Q

posture influences:

how?

A

joint loading and specific tissues that are stressed

  • moment arms
  • ligamentous constraints
  • bony constraints
  • active constraints (muscles)
75
Q

What do the Erector Spinae muscles provide for the lumbar spine?

A
  • Buttress (support) anterior shear

- add to shear force

76
Q

T or F: when we estimate loading, we don’t include the muscle activity

A

False; we must include muscle activity or we underestimate loading!

77
Q

Excessive muscle contraction/loading may have __________ effects through increased compression.

A

detrimental effects

78
Q

What passive stabilizers does dynamic posture when lifting put stress on?

A

ligaments and IVD

79
Q

Describe the concept of regional interdependent between the lumbar spine and pelvic girdle:

A

-

80
Q

What structure is linked to the lumbar spine?

A

pelvic girdle

81
Q

Who could we not have without the pelvic girdle?

A

Elvis

82
Q

Pelvis is linked to what structures?

A

the lumbar spine and the femur

83
Q

Describe the Pelvis movement relative to femur (closed-chain):

A
  • in weight-bearing, femur is fixed
  • there is reversal of motion (pelvis moves on femur instead of femur on pelvis)
  • there is a change in primary action for muscles
    • reversal of origin and insertion (i.e. glut. med.: lateral tilt of pelvis vs hip abduction & rectus fem: anterior tilt of pelvis vs hip flexion
84
Q

Describe the Trendelenburg sign in right unilateral stance & what causes it:

A
  • weak glut. med. that causes a lateral tilting of the pelvis in the frontal plane
  • pelvis = left lateral tilt
  • right femur = adducts
  • lumbar spine = right lateral flexion
85
Q

Describe the regional interdependence during pelvis rotation:

A
  • In the horizontal plane, rotation of the pelvis produces medial/lateral rotation at the hip joints
  • rotating to the right:
    • pelvis = rotates right
    • right hip = internal rotation
    • left hip = external rotation
86
Q

What motion takes place at the pelvis in the sagittal plane?

A

Anterior and posterior tilting

87
Q

Describe Anterior and Posterior Pelvis Tilting:

A
  • Anterior: hip flexion & Lumbosacral Extension (increased lumbar lordosis)
  • Posterior: Hip extension & Lumbosacral Flexion (decreased lumbar lordosis)
88
Q

Describe Lumbopelvic Rhythm:

A
  • coupled motion b/w pelvis and lumbar spine; pelvis and lumbar are moving ipsi-directionally (lumbar flexes, pelvis flexes)
  • can increase overall trunk motion for function
  • only 12-20 degrees of flexion at each segment in lumbar spine (60-100 degrees total), but with LP rhythm it increases ROM for functional activities
  • “contralateral” LP rhythm direction allows trunk to remain stable as pelvis rotates over femur; trunk and pelvis move in opposite directions (pelvic tilts)
89
Q

Describe the Flexion Relaxation Phenomenon (FRP):

A
  • at full forward flexion, the lumbar extensors “shut off”

- this transfers loads to the passive structures in the spine

90
Q

Describe how FRP is different in people with Low Back Pain:

A
  • FRP does not happen in people with LBP (they typically show increased extensor activation during flexion)
  • Glut Max activation decreases in people with LBP
91
Q

Describe ideal standing posture; plumb line passes through =

A
  • Ear
  • Cervical V bodies
  • Shoulder
  • lumbar V bodies
  • posterior to hip axis
  • anterior to knee axis
  • anterior to lateral malleolus
92
Q

Describe how posture varies between and within days in healthy people:

A
  • flexion/extensions in sagittal plane showed to be very repeatable
  • frontal plane motion WAS NOT as repeatable and showed much more variability from day to day
93
Q

There is also Lumbosacral Lordosis, describe it:

A
  • angle between:
  • -the line from center of L3 body to L5 body
  • -line from L5 body to S1 body
  • average = 150 degrees in standing
94
Q

T or F: Lumbosacral lordosis and lumbosacral angle are the same thing

A

False; lumbosacral angle is the angle between a horizontal line through L5 and a line along the superior endplate of S1

95
Q

What is the average lumbosacral average?

A

40 degrees while standing

96
Q

Describe measurement of Pelvic Tilt:

A
  • measured from the horizontal to a line drawn through the ASIS
  • Larger Angle indicates Anterior Pelvic Tilt (ASIS moved inferiorly)
  • Smaller Angle indicates Posterior Pelvic Tilt (ASIS moved superiorly)
97
Q

Describe Gender Differences in seated postures:

A 
females:
- maintain lordosis
- sit upright on pelvis
- 'perch' on the front edge of the seat
Males:
- posteriorly rotate pelvis
- 'slouch' and sit towards back of the seat
98
Q

Describe Lumbar spine and pelvic postures in automobile seats:

A
  • lumbar lordosis decreases while sitting in automobile seat
  • lumbosacral angle decreased from 40 degrees (standing) to 13 degrees (sitting)
  • sacral inclination decreased from 43 degrees (standing) to -2 degrees (sitting)
99
Q

What must we be aware of when considered pain in the lumbar spine?

A
  • regional interdependence of upper quarter, trunk, pelvis, and lower quarter
  • relationship understanding; be observant of ALL regions and how things move within entire kinetic chain
  • POSTURE and its impact on the spine
100
Q

Describe the position of the L spine, pelvis, hips, and knee during Decreased Lumbar Lordosis:

A
  • lumbar spine = flexion (arthrokin = bilateral upslide)
  • pelvis = posterior tilt
  • hip = extension
  • knee = extended/hyperextended
101
Q

Describe the loading during decreased Lumbar lordosis:

A
  • increased compression through front part of vertebrae and IVD
  • back portion of vertebrae has tension or stretching
  • smaller contact area on facets, less compression coming through facets, but INCREASED PRESSURE (more force per area)
102
Q

Describe the position of the L spine, pelvis, hips, and knee during Increased Lumbar Lordosis:

A
  • Lumbar spine = extended (arthrokinematics = downward sliding)
  • pelvis = anterior tilt
  • hip = flexion
  • knee = hyperextension
103
Q

Describe the loading during increased Lumbar lordosis:

A
  • Increased anterior Shear at L5S1
  • more compression toward bac aspect of vertebrae
  • more tension at front aspect of vertebrae
  • Increased contact area at facets; MORE COMPRESSION = more force through facets
  • compression of interspinous ligaments
  • reduced diameter of intervertebral foramina
104
Q

What dysfunction takes place during prolonged flexion (seated or standing)?

A
  • adaptive shortening of muscles and connective tissues
  • increased flexor moment on the spine
  • increased pressure on anterior aspect of IVD (may weaken posterior annulus fibrosis over time)
  • impact on the entire kinetic/kinematic chain
105
Q

What dysfunction takes place during prolonged hyperextension (seated or standing)?

A
  • compression of facets
  • increased anterior shear at lumbosacral junction
  • may lead to development of spondylolisthesis
  • effects kinetic/kinematic chain
106
Q

Name the superficial layer of active stabilizers of the lumbar spine and what they do:

A
  • Traps, Lats, rhomboids, levator scapula, serratus anterior

- Bilateral activation = extension; unilateral activation = lateral flexion & axial rotation

107
Q

What determines the amount of lateral flexion and rotation you get?

A

amount of angulation of the muscle fibers

108
Q

Name the intermediate layer of active stabilizers of the lumbar spine and what they do:

A
  • ONLY ONE = serratus posterior
  • does not contribute very much to movement or stability
  • Primarily contributes to ventilation
109
Q

What does Serratus anterior primarily contribute to?

A

Ventilation

110
Q

Name the deep layer of active stabilizers of the lumbar spine and what they do:

A
  • Erector spine group (spinalis, longissimus, iliocostalis),
  • transversospinal group (semispinalis, multifidi, rotators)
  • Short segmental group (interspinalis, intertransversarius)
  • goes deeper into spine, becoming shorter with each layer, becomes more angulated and cross fewer segments with increasing depth
111
Q

Describe Erector Spinae Group anatomy and purpose:

A
  • “powerhouse muscles” for motion
  • common tendon attachment in sacral region (thoracolumbar fascia)
  • cross multiple segments
  • control gross movement across a large part of axial skeleton (BIG FLEX/EXT)
  • generate large extensor moment for lifting and carrying (bilaterally)
  • can anteriorly tilt pelvis and increase lordosis
112
Q

Out of the erector spinaeactive stabilizers, what is the role of the iliocostalis?

A
  • large lateral flexion and ipsilateral rotation (unilaterally)
  • most lateral position
113
Q

What are the attachments for the Transversospinal group?

How many vertebrae does each muscle group cross?

A

TP of inferior vertebra to spinous process of more superior vertebra

  • Semispinalis = cross 6-8 vertebrae (more motion)
  • multifidi = corse 2-4 vertebrae
  • rotatores = cross 1-2 vertebrae (importance for fine movements of spine)
114
Q

What is the importance of the multifidi pertaining to Lumbar spine?

A
  • LBP relation
  • produces extension torque
  • Primarily a stabilizer with multiple attachment points and overlapping fibers
115
Q

What is the role of the Transversospinalis active stabilizer group?

A
  • fine control and stabilizing forces (cross fewer segments than erector spinae)
  • bilateral = extension
  • unilateral = contralateral rotation (poor leverage - short moment arm)
116
Q

Describe the Short segmental group of active stabilizers:

A
  • cross one segment (most prominent in craniocervical region for control of neck)
  • blend with interspinous ligaments (loaded with proprioception, provide intervertebral stabilization)
  • Have small extension moment (due to small muscle size and small moment arms)
  • Most important role = sensory feedback (have high density of muscle spindles)
117
Q

Name the 4 abdominal muscles of the trunk:

A
  • rectus abdominus
  • internal oblique
  • external oblique
  • transverse abdominus
118
Q

Describe the Rectus Sheaths and Linea Alba:

A
  • anterior rectus sheath = from internal and external obliques
  • posterior rectus sheaths = from internal oblique and transverse abdominus
  • sheaths thicken and cross at midline to form Linea Alba
119
Q

What is the importance of the Rectus Sheaths and Linea Alba?

A
  • add strength to abdominal wall

- mechanically link left an right to transfer forces across midline

120
Q

Describe the Muscle architecture of the Rectus Abdominus:

A
  • Tendinous intersections of RA (‘6-pack’) allows for muscles not to “bow out” and smooth transmission of force throughout motion
  • longitudinal orientation
  • action = trunk flexion and posterior tilting of pelvis
121
Q

people with flat back postures could have ________

A

tight abdominal muscles

122
Q

Describe the orientation of internal, external, and TRA:

What is another name for them? why are they important?

A
  • originate laterally and run toward midline to blend with sheaths and linea alba
  • “hoop” muscles
  • IMPORTANT STABILIZERS
123
Q

Describe the Muscle architecture of the External Obliques:

A
  • largest, most superficial (hands in pockets)
  • Action = bilaterally flexes trunk and posterior pelvic tilt; unilaterally laterally flexes and rotates contra-laterally
124
Q

Describe the Muscle architecture of the internal Obliques:

A
  • deep to external obliques
  • fiber orientation perpendicular to external obliques
  • action = bilaterally flexes trunk, posteriorly tilts pelvis, and tensions thoracolumbar fascia; unilaterally flexes laterally and rotates ipsilaterally
125
Q

Describe the Muscle architecture of the Transversus Abdominus (TRA):

A
  • deepest, “corset-like”
  • stability of lumbar spine
  • strong attachments to thoracolumbar fascia
  • Action = stabilizes attachment sites for other muscles, compresses abdominal cavity, and tensions thoracolumbar fascia
126
Q

T or F: TRA contraction results in no movement.

A

True; primarily stabilizes and compresses abdominal cavity

127
Q

Name additional muscles important for trunk stabilization:

A
  • posts major

- quadratus lumborum

128
Q

Name attachments of Psoas major and its purpose to lumbar spine:

A
  • anterior V. bodies of L1-L3 and lesser trochanter of femur

- purpose = vertically stabilizes lumbar spine; line of action close to rotation axes; STRONG HIP FLEXOR

129
Q

Describe the purpose of the Quadratus lumborum to the lumbar spine:

A
  • bilateral action = extension

- unilateral action = lateral flexion (open chain = elevates pelvis) “HIP HIKES”

130
Q

Two muscles that tend to get spasms and become guarded due to injury:

A
  • poas major

- QL

131
Q

muscles with vertical orientation producing sagittal plane motion (flexion/extension):

A
  • Longissimus thoracis and Rectus Abdominus

- these produce very limited lateral flexion (unilaterally)

132
Q

Muscles with oblique orientation will be more involved in what motions in what planes?
What are the vertical force components? Horizontal force components?

A
  • frontal plane (lateral flexion) and transverse plane motion (rotation)
  • vertical = iliocostalis (lateral flexion)
  • horizontal = external oblique (rotation)
133
Q

What are the two STRONG axial rotators?

A
  • multifidus

- external oblique

134
Q

Describe “global” stabilizers:

A
  • AKA: extrinsic or general stabilizers
  • long muscles attach to structures OUTSIDE the vertebral column
  • Lats, traps, abs, serratus posterior, erector spinae, QL, hip muscles, psoas major, scaps
135
Q

Describe “segmental” stabilizers:

A
  • AKA: intrinsic or “specific” stabilizers
  • short, deep muscles attach to structures WITHIN spinal
  • Transversospinal group: rotators, multifidus, semispinalis
  • short segmental group: interspinalis, intertransversarii
136
Q

Should we be doing General or specific stabilizers??

A

It depends on the individual. An individually designed, higher intensity program may be most beneficial

137
Q

T or F: TRA is the “fix all” for LBP.

A

not necessarily

138
Q

T or F: there is a difference in TRA activation between those who were and were not able to perform TRA exercises successfully.

A

false. there is no difference.

139
Q

Success with biofeedback is associated with improved outcomes. What does this mean?

A

biofeedback should still be utilized it just may not be attributed to activation of the TRA.

140
Q

Summarize the importance of muscle activity in LBP treatment:

A
  • Muscles do not work in isolation (There is more to it than TrA alone)
  • Focus on perfect performance of the desired movement/task (Atypical compensations should become apparent (notice maladaptive movements)
    Multiple ways to produce a specific goal)
  • Likely using a combination of global and segmental stabilizing muscles
  • Always return to foundation principles, functional anatomy, motor control

Biomechanics - Spine (2 decks)

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