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
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)
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
4
Q
There is ______ extensor effort when Lordosis is maintained.
A
decreased
5
Q
What is the gold standard for measuring Lumbar lordosis?
A
Radiographic Measurement
6
Q
What is the gold standard for measuring Lumbar lordosis?
A
Radiographic Measurement
7
Q
What are the typical ranges from measuring lumbar lordosis when Radiographically?
A
47 - 64 degrees
8
Q
What are external ways to measure lumbar lordosis?
A
- bendable rules
- strain gauges embedded with tape
- inclinometers
- accelerometers
9
Q
Describe external mesures validity when measuring lumbar lordosis?
A
all have poor concurrent validity when compared to radiograph
10
Q
Describe external mesures validity when measuring lumbar lordosis?
A
all have poor concurrent validity when compared to radiograph
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
12
Q
When speaking of spinal mechanics what is usually being spoken of?
A
The structures that make up the functional spinal unit
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”
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
15
Q
Posterior Elements of Lumbar vertebral Structure:
A
- Vertebral Arches
- Spinous and Transverse Processes
- Facet Joints
- Posterior Ligaments
16
Q
Anterior Elements of the Lumbar vertebral structure:
A
- 2 Vertebral bodies
- IVD
- Longitudinal Ligaments
17
Q
Anterior Elements of the Lumbar vertebral structure:
A
- 2 Vertebral bodies
- IVD
- Longitudinal Ligaments
18
Q
Purpose of Anterior Elements of the Lumbar vertebral structure:
A
- bear compressive loads
- larger caudally (loading increases)
19
Q
Purpose of Posterior Elements of the Lumbar vertebral structure:
A
- Guide Movement
- Motion determined by facet joint orientation
20
Q
Where does loading increase in the lumbar spine and why?
A
increases caudally because the V. bodies get larger
21
Q
What elements guide the movement of the lumbar vertebrae?
A
posterior elements
22
Q
What determines the motion of the lumbar vertebrae?
A
the facet joint orientation
23
Q
Lumbar facet joints:
A
- restrict motion (but also allow motion depending on orientation)
- serve as a site for muscle attachments
24
Q
Lumbar Transvers Processes:
A
- muscle & ligament attachments
- increase moment arm by extending out laterally (better mechanical advantage)
25
Lumbar Spinous Processes:
similar to Transverse Processes:
- muscle & ligament attachments
- increase moment arm by offsetting attachment point from the axis of rotation
26
Another name for Facet Joint is a __________.
Z joint
27
Describe the articulation of a typical facet joint:
superior facet articulates with the inferior facet of the adjacent vertebrae
28
Describe the innervation of the facet joints:
- Highly Innervated!
- Full of Mechanoreceptor (for proprioception)
- also full of nociceptors (for pain)
29
Where does most of our sense of where our bodies are in space come from?
Facet Joint Mechanoreceptors
30
Describe the Joint Surface Orientation of the Lumbar facet joints:
- 90 degrees to Transverse plane
| - 45 degrees to frontal plane
31
What do the lumbar facet orientations also?
- Flexion/Extension
- Lateral flexion
- Minimal Rotation
32
describe the lumbosacral facet joint:
- oblique orientation
| - allows more rotation
33
What are the facet joints of lumbar spine important for?
| What does it depend on
- load sharing with the IVD
| - posture (contact between facets changes depending on posture position)
34
How much of total load is on facet joints during hyperextension?
30% of total load
35
What positions increase loading on facets?
- hyperextension
| - flexion combined with rotation (don't twist and bend!!)
36
Describe the purpose of the passive structures involved with lumbar spine:
Anterior longitudinal ligament:
- v. body attachment
- less attachment to the disc
-
37
Describe the purpose of the passive structures involved with lumbar spine:
```
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)
```
38
Name the components of the IVD:
- inferior/superior endplates
- annulus fibrosis (fibers that surround gel substance in center)
- nucleus pulposus
39
Name the 3 functions of the IVD:
- weight bearing
- load distribution
- restrains excessive motion between segments
40
Describe the Nucleus pulposus of the IVD:
- gelatinous mass
- Hydrophilic (water loving) glycosaminoglycan (GAG) content
- GAG and water content decrease with age (disc dries out, becomes smaller)
41
Describe the Annulus Fibrosis of IVD:
- Fibrocartilage
| - annular layers with different collagen fiber orientations (adds greatly to strength of disc)
42
Describe Intradiscal Pressure (IDP)
- Hydrostatic pressure within the disc ensures uniform load distribution
- Nucleus Pulposus is incompressible - resists compressive loads (you push it, it pushes back)
43
When is IDP the smallest?
when we are sleeping (laying supine)
44
Rank postures from most stress to least stress on IDP:
- sitting in poor posture (200%)
- bending over (160%)
- seated with decent posture (150%)
- standing erect (normal 100%)
- lying supine (25%)
45
Wilke study showed a little different results about posture on IDP:
- IDP is lower in unsupported, relaxed sitting than in standing
- Found IDP increased over 7 hours of rest
46
What plane does the primary motion of the lumbar spine take place in? What degrees at each segment and all together?
- sagittal plane (flexion/extension)
| - 12 to 20 degrees at each segment (60 to 100 degrees total)
47
What plane does the secondary motion of the lumbar spine take place in? What degrees at each segment and all together?
- Frontal Plane
(lateral flexion)
- 6 degrees at each segment (36 degrees total)
48
What plane does the tertiary motion take place around in the lumbar spine? What degrees at each segment and all together?
- Transverse plane
| - 2 degrees at each segment (10 degrees total)
49
What dictates available motion?
ORIENTATION OF THE FACET JOINTS
50
What plane movement do the lumbar facets allow and restrict?
- allow sagittal and frontal plane motion
| - restrict transverse plane motion
51
Explain the differences in the lumbosacral (L5S1) joint:
- 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.
52
Explain the differences in the lumbosacral (L5S1) joint:
- 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.
53
Describe the arthrokinematics of the lumbar spine:
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
54
T or F: there is no coupled motion in the lumbar spine.
False; there is coupled motion during flexion/rotation in the lumbar spine
55
What should a PT do when applying coupled motion concepts to the lumbar spine?
use caution
56
Why do we look at coupled motions in the lumbar spine?
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
57
Compare and contrast the regions of the spine:
- 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
Name the risk factors for Injury of the Lumbar Spine:
- compression and shear Exposure
- Repetitive lifting
- prolonged sitting, standing
- psychosocial factors
- posture (reduced lordosis)
59
During acute overload exposure on spinal segments, what was the result?
Primarily endplate fractures, no IVD injuries
60
If you have a single event injury during compression, what will most likely be damaged in the lumbar spine?
the endplates will be fractured
61
What is the OSHA threshold limit of force for compression and shear?
- 10,000 N compression
| - 3,000 N shear
62
When looking at the Cumulative Exposure chart of compression over 5 seconds, what is being analyzed?
- 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
T or F: Cumulative loading is important.
True
64
In the cumulative exposure study, at what amount of cycles and force did initiation of herniation occur during compression?
between 3850 - 5870 cycles at 1000 N
65
In the cumulative exposure study, at what amount of cycles and force did complete herniation occur during compression?
at 26,400 cycles at 1000 N.
66
When do you begin to see more disc damage?
during combined flexion/extension/twisting loading
67
Describe what happens during Disc Herniation:
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
What % of people are going to have an imaging finding that correlates with their symptoms?
What does this lead to many times?
< 15%
leads to unnecessary surgeries in lumbar spine
69
T or F: people with symptoms of lower back pain most definitely have some structural defect.
False; patients can have symptoms and have nothing wrong structurally
70
What are two important elements to look at when assessing multifactorial problem of lower back pain?
- control of whole body movement
| - muscle activation patterns
71
What makes a big impact on loading patterns? So what?
- individual movement strategies
| - so need personalized intervention and training
72
during static standing posture, what are the primary loads?
- body weight
- muscle activity
- pre-stress from ligaments
- external loads
73
during static standing posture, thoracic kyphosis curvature puts us in a __________________ ?
What does this create?
What resists this motion?
- constant flexion moment
- anterior shear
- extensor muscles
74
posture influences:
| how?
joint loading and specific tissues that are stressed
- moment arms
- ligamentous constraints
- bony constraints
- active constraints (muscles)
75
What do the Erector Spinae muscles provide for the lumbar spine?
- Buttress (support) anterior shear
| - add to shear force
76
T or F: when we estimate loading, we don't include the muscle activity
False; we must include muscle activity or we underestimate loading!
77
Excessive muscle contraction/loading may have __________ effects through increased compression.
detrimental effects
78
What passive stabilizers does dynamic posture when lifting put stress on?
ligaments and IVD
79
Describe the concept of regional interdependent between the lumbar spine and pelvic girdle:
-
80
What structure is linked to the lumbar spine?
pelvic girdle
81
Who could we not have without the pelvic girdle?
Elvis
82
Pelvis is linked to what structures?
the lumbar spine and the femur
83
Describe the Pelvis movement relative to femur (closed-chain):
- 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
Describe the Trendelenburg sign in right unilateral stance & what causes it:
- 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
Describe the regional interdependence during pelvis rotation:
- 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
What motion takes place at the pelvis in the sagittal plane?
Anterior and posterior tilting
87
Describe Anterior and Posterior Pelvis Tilting:
- Anterior: hip flexion & Lumbosacral Extension (increased lumbar lordosis)
- Posterior: Hip extension & Lumbosacral Flexion (decreased lumbar lordosis)
88
Describe Lumbopelvic Rhythm:
- 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
Describe the Flexion Relaxation Phenomenon (FRP):
- at full forward flexion, the lumbar extensors "shut off"
| - this transfers loads to the passive structures in the spine
90
Describe how FRP is different in people with Low Back Pain:
- 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
Describe ideal standing posture; plumb line passes through =
- Ear
- Cervical V bodies
- Shoulder
- lumbar V bodies
- posterior to hip axis
- anterior to knee axis
- anterior to lateral malleolus
92
Describe how posture varies between and within days in healthy people:
- 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
There is also Lumbosacral Lordosis, describe it:
- 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
T or F: Lumbosacral lordosis and lumbosacral angle are the same thing
False; lumbosacral angle is the angle between a horizontal line through L5 and a line along the superior endplate of S1
95
What is the average lumbosacral average?
40 degrees while standing
96
Describe measurement of Pelvic Tilt:
- 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
Describe Gender Differences in seated postures:
```
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
Describe Lumbar spine and pelvic postures in automobile seats:
- 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
What must we be aware of when considered pain in the lumbar spine?
- 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
Describe the position of the L spine, pelvis, hips, and knee during Decreased Lumbar Lordosis:
- lumbar spine = flexion (arthrokin = bilateral upslide)
- pelvis = posterior tilt
- hip = extension
- knee = extended/hyperextended
101
Describe the loading during decreased Lumbar lordosis:
- 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
Describe the position of the L spine, pelvis, hips, and knee during Increased Lumbar Lordosis:
- Lumbar spine = extended (arthrokinematics = downward sliding)
- pelvis = anterior tilt
- hip = flexion
- knee = hyperextension
103
Describe the loading during increased Lumbar lordosis:
- 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
What dysfunction takes place during prolonged flexion (seated or standing)?
- 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
What dysfunction takes place during prolonged hyperextension (seated or standing)?
- compression of facets
- increased anterior shear at lumbosacral junction
- may lead to development of spondylolisthesis
- effects kinetic/kinematic chain
106
Name the superficial layer of active stabilizers of the lumbar spine and what they do:
- Traps, Lats, rhomboids, levator scapula, serratus anterior
| - Bilateral activation = extension; unilateral activation = lateral flexion & axial rotation
107
What determines the amount of lateral flexion and rotation you get?
amount of angulation of the muscle fibers
108
Name the intermediate layer of active stabilizers of the lumbar spine and what they do:
- ONLY ONE = serratus posterior
- does not contribute very much to movement or stability
- Primarily contributes to ventilation
109
What does Serratus anterior primarily contribute to?
Ventilation
110
Name the deep layer of active stabilizers of the lumbar spine and what they do:
- 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
Describe Erector Spinae Group anatomy and purpose:
- "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
Out of the erector spinaeactive stabilizers, what is the role of the iliocostalis?
- large lateral flexion and ipsilateral rotation (unilaterally)
- most lateral position
113
What are the attachments for the Transversospinal group?
| How many vertebrae does each muscle group cross?
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
What is the importance of the multifidi pertaining to Lumbar spine?
- LBP relation
- produces extension torque
- Primarily a stabilizer with multiple attachment points and overlapping fibers
115
What is the role of the Transversospinalis active stabilizer group?
- fine control and stabilizing forces (cross fewer segments than erector spinae)
- bilateral = extension
- unilateral = contralateral rotation (poor leverage - short moment arm)
116
Describe the Short segmental group of active stabilizers:
- 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
Name the 4 abdominal muscles of the trunk:
- rectus abdominus
- internal oblique
- external oblique
- transverse abdominus
118
Describe the Rectus Sheaths and Linea Alba:
- 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
What is the importance of the Rectus Sheaths and Linea Alba?
- add strength to abdominal wall
| - mechanically link left an right to transfer forces across midline
120
Describe the Muscle architecture of the Rectus Abdominus:
- 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
people with flat back postures could have ________
tight abdominal muscles
122
Describe the orientation of internal, external, and TRA:
| What is another name for them? why are they important?
- originate laterally and run toward midline to blend with sheaths and linea alba
- "hoop" muscles
- IMPORTANT STABILIZERS
123
Describe the Muscle architecture of the External Obliques:
- largest, most superficial (hands in pockets)
- Action = bilaterally flexes trunk and posterior pelvic tilt; unilaterally laterally flexes and rotates contra-laterally
124
Describe the Muscle architecture of the internal Obliques:
- 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
Describe the Muscle architecture of the Transversus Abdominus (TRA):
- 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
T or F: TRA contraction results in no movement.
True; primarily stabilizes and compresses abdominal cavity
127
Name additional muscles important for trunk stabilization:
- posts major
| - quadratus lumborum
128
Name attachments of Psoas major and its purpose to lumbar spine:
- 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
Describe the purpose of the Quadratus lumborum to the lumbar spine:
- bilateral action = extension
| - unilateral action = lateral flexion (open chain = elevates pelvis) "HIP HIKES"
130
Two muscles that tend to get spasms and become guarded due to injury:
- poas major
| - QL
131
muscles with vertical orientation producing sagittal plane motion (flexion/extension):
- Longissimus thoracis and Rectus Abdominus
| - these produce very limited lateral flexion (unilaterally)
132
Muscles with oblique orientation will be more involved in what motions in what planes?
What are the vertical force components? Horizontal force components?
- frontal plane (lateral flexion) and transverse plane motion (rotation)
- vertical = iliocostalis (lateral flexion)
- horizontal = external oblique (rotation)
133
What are the two STRONG axial rotators?
- multifidus
| - external oblique
134
Describe "global" stabilizers:
- 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
Describe "segmental" stabilizers:
- AKA: intrinsic or "specific" stabilizers
- short, deep muscles attach to structures WITHIN spinal
- Transversospinal group: rotators, multifidus, semispinalis
- short segmental group: interspinalis, intertransversarii
136
Should we be doing General or specific stabilizers??
It depends on the individual. An individually designed, higher intensity program may be most beneficial
137
T or F: TRA is the "fix all" for LBP.
not necessarily
138
T or F: there is a difference in TRA activation between those who were and were not able to perform TRA exercises successfully.
false. there is no difference.
139
Success with biofeedback is associated with improved outcomes. What does this mean?
biofeedback should still be utilized it just may not be attributed to activation of the TRA.
140
Summarize the importance of muscle activity in LBP treatment:
- 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
