Lumbar spine Flashcards
Movements of lumbar spine- flexion and limiting factor
greater than range of extension. more movements in lower segments (L4/5, L5/S1)- because in upper lumbar spine, the orientation of facets is more towards the vertical (thoracolumbar junction), ROM- 50°, (large variations), limited by PLL and supra-spinous and interspinous
Movements of lumbar spine- extension and limiting factor
approx 30° (large variations), limited by ALL, lig flavum
Movements of lumbar spine- rotation
1 at each segmental level with less rotation available at L5-S1, mean rotation of 8-12° in each direction, rotation is limited by orientation of facet joints- more limited in lumbar, limited by orientation of facet joint and ligaments flavour
Movements of lumbar spine- lateral flexion
approx 25°, difficult to measure, coupled with rotation, limited by inter transverse lig
Movements of lumbar spine- what should be done to measure ROM
the pelvis and hips should be fixed to isolate movement
anterolateral abdominal wall- muscles and fascia
rectus abdominals, external oblique, internal oblique, transversus abdominis
fascia- thoracolumbar fascia
thoracolumbar fascia- posterior layer
superficial to erector spinae and attached to spinous process
thoracolumbar fascia- middle layer
between erector spinae and quadratus lumborum, attach to transverse tips
thoracolumbar fascia-anterior layer
deep quadratus lumborum, attached to anterior of transverse process
anterolateral wall- llayers
externl oblique, internal oblique, transversus abdominus
anterolateral walls- vertical muscles
rectus abdominius, associated with rectus sheath
external oblique- origin and insertion
origin- outer surface of 5-12th ribs and costal cartilage
insertions- linea alba via rectus sheath, inguinal ligament, anterior 2/3 iliac crest
external oblique- actions (against resistance) and nerve
action- flexion of trunk, posterior pelvic tilt- ipsilaterally, contralateral (opposite) rotation (trunk on pelvis), lateral flexion- ipsilateral,
NS- anterior rami T7-12
internal oblique- origin and insertions
Origin - lateral 2/3 inguinal lig, anterior 2/3 iliac crest, thoracolumbar fascia
Insertion lower border of 10-12th ribs, linea alba via rectus sheath, pectin pubis (conjoint tendon- rectus abdominius)
internal oblique- actions and NS
action- posterior pelvic tilt- bilateral- if thorax is fixed
flexion- bilateral, ipsilateral rotation (trunk on pelvis), lateral flexion of trunk- ipsilateral
NS- L1 nerve, anterior rami T7-T12
transverses abdominus- origin and insertion
origin- interal surface of ribs 7-12 + CC, thoracolumabr fascia, iliac crest and lat 1/3 inguinal lig
insertion- linea alba via rectus sheath, pectin pubis (conjoined tendon)
transverses abdominus- action and NS
not associated with pure physiological movement due to horizontal presentation- stablises lumbar spine, prevents lumbar spine instability, and manage existing instability
NS- L1 nerve, anterior rami T7-T12
rectus abdominus- origin and insertion
origin- xiphoid process, 5-7TH CC
insertion- pubic symphysis, pubic crest
rectus abdominus- action and nerve
action- flexion of trunk against resistance, if trunk is stabilised then it will posteriorly rotate pelvis, unilateral rotation and ipsilateral flexion of trunk
NS- anterior ami of T6-12
functions of abdominius
trunk movement, sitting up lying/ getting out of bed, protection of the abdominal viscera, spinal stabilisation
abdominal pressure for?
forced expiration, micturition (1), defectation (2), parturition, vomiting
rectus sheath- different levels
anterior layer- origin EO and IO, posterior layer- origin- IO and TA, in lower region you have rectus sheath and rectus abdominis, degree of origin for EO, IO, TA, no posterior band,
why is there issues with linea alba
there are issues with linea alba the centre section more posteriorly than superiorly as it doesn’t have a dual band
where do layers of linea alba interlace
they interlace in midline
when is the linea alba vulnerable
during pregnancy, rectus diastasis- separtation of abdominal muscles- common in pregnancy
posterior abdominal wall
diaphragm superiorly, thoracolumbar fascia, muscles- psoas, iiiacus, quadratus lumborum, TrA, obliques, lumbar vertebra and discs
quadratus lamborum- origin and insertion
origin- iliac crest, ililumbar ligament
insertion- inferior border of rib, transverse processes- L1-4
quadratus lamborum- action and NS
action- muscle of inspiration, ipsilateral side flexion, lumbar extension
NS- ventral roots T12-L4
extensor group- 3 sections of erector spinae
iliocostalis, longissimus- associated with TP, spinalis- close to spinous process
erector spinae- lumbar spine
iliocostalis lumborum, from thoracolumbar fascia and iliac region, attaches rib angle, extensor of lumbar and thoracic spine, works unilaterally as side flexor
erector spinae- thoracic
iliocostalis- lumborum and thoracis, longissimus thoracis, spinalis thoracis
erector spinae action
bilateral: extension and control of flexion, maintenance of lumbar lordosis, unilateral- ipsilateral flexion/ rotation
NS- dorsal rami of adjacent thoracolumbar nerve
what is the transversospinalis
they are a group of stability muscles, prevent unwanted slip and glide of one spinal unit on another (L5/S1-CX1/2) These muscles lie between the transverse and spinous processes
groups of transversospinalis
semisoinalis (thorax)- in thoracic and cervical region
multifundas- 3 regions
rotatores- contralateral rotator, interspinalis, intertransversus- in between transverse process
