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S2 Biomechanics > Lumbar Spine AEP > Flashcards

Lumbar Spine AEP Flashcards

1
Q

lumbar lordosis

  • where is it
  • decreased lumbar lordosis associated with…
  • lumbar lordosis inversely proportion to…
  • decreased _____ effort when lordosis maintained
A

66% of lumbar lordosis from L4-S1
decreased lumbar lordosis associated with L5S1 disc degeneration
intradiscal pressure inversely proportional to lumbar lordosis
decreased extensor effort when lordosis maintained

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2
Q

measurement of lumbar lodrosis

  • gold standard
  • external measurement methods
  • all external measures vs. radiograph
A 
gold standard
-radiographic measurement
-range from 47-64 degrees
external measures
-bendable rulers
-strain gauges embedded in tape
-inclinometers
-accelerometers
all have poor concurrent validity
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3
Q

radiographic measurement - total lumbar lordosis

-how is it measured

A

line parallel to superior endplate of L1
line parallel to inferior endplate of L5
perpendiculars drawn to these lines
angle bewteen the intersection is measured

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4
Q

functional spinal unit

-composition

A

two adjacent vertebral bodies
intervertebral disc (IVD)
associated soft tissue
“motion segment”

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5
Q

lumbar vertebral structure

  • anterior elements
  • posterior elements
A 
anterior
-two vertebral bodies
-IVD
-longitudinal ligaments
posterior
-vertebral arches
-spinous and transverse processes
-facet joints
-posterior ligaments
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6
Q

anterior elements function and characteristic

A 
bear compressive loads
larger caudally (loading increases)
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7
Q

posterior elements

  • function
  • motion determined by…
A

guide movement

motion determined by facet joint orientation

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8
Q

facet joint function

A

restrict motion

muscle attachments

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9
Q

transverse processes

-functions

A

muscle and ligament attachments

increase moment arm

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10
Q

spinous processes functions

A

muscle and ligament attachments

increase moment arm

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11
Q

facet joints

  • level of innervation
  • what type of innervation
A 
highly innervated
types
-mechanoreceptors --> proprioception
-nociceptors --> pain
disruption of the mechanoreceptors may lead to LBP
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12
Q

lumbar facet joints

  • joint surface orientation
  • orientation allows…
A 
orientation
-90 to transverse plane
-45 to frontal plane
allows
-flexion/extension
-lateral flexion
-minimal rotation
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13
Q

lumbosacral joint

  • orientation
  • allows…
A

oblique orientation

-allows rotation

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14
Q

lumbar facet joints - load sharing

  • with what?
  • dependent on…
A

shares load with IVD

posture dependent

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15
Q

lumbar facet joints and hyperextension

A

30% of total load on facets

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16
Q

lumbar facet joints and flexion coupled with rotation

A

increases loading of facets

17
Q

anterior longitudinal ligament

  • attachment
  • tight in_____
A

vertebral body attachment (less to disc)

tight in extension

18
Q

PLL

  • attachment
  • tight in_____
A 
IVD attachment (less to body)
tight in flexion
19
Q

ligamentum flavum

  • function
  • difference compared to other ligaments
  • -why is this important
  • function
A 
connects adjacent vertebral arches
high elastin content
-makes it more of an active ligament
-contracts during extension
-elongates during flexion
under constant tension
-pre-stresses the disc to create intradiscal pressure
-provides stability to the spine
20
Q

IVD

  • components
  • functions
A 
components
-inferior/superior endplates (bony)
-annulus fibrosis
-nucleus pulposus
functions
-weight bearing
-load distribution
-restrains excessive motion
21
Q

IVD - nucleus pulposus

  • what is it
  • components
  • what happens with age
A

gelatinous mass
hydrophilic glycosaminoglycan (GAG) content
GAG and water content decrease with age

22
Q

IVD - annulus fibrosis

  • what is it
  • layers with…
A

fibrocartilage

layers with different collagen fiber orientations

23
Q

intradiscal pressure (IDP)

  • what is it
  • nucleus pulposus is…
  • role of posture (classic study)
A 
hydrostatic pressure within the disc ensures uniform load distributino
nucleus pulposus in incompressible - resists compressive loads
posture (low to high pressure)
-lying
-standing
-sitting
-forward bending (leaning over)
-forward bending with sitting
24
Q

IDP

-newer study findings

A

IDP lower in unsupported, relaxed sitting than in standing

found IDP increased over 7 hours of rest (sleeping)

25
Q

kinematics of the lumbar spine

-DF

A 
flexion/extension
lateral flexion
rotation
A/P translation
M/L translation
superior/inferior translation
26
Q

osteokinematics

  • primary motion and amount
  • secondary motion and amount
  • tertiary motion and amount
A 
primary
-sagittal plane
-12-20 at each segment
secondary
-frontal plane
-6 at each segment
tertiary motion
-transverse plane
-2 at each segment
27
Q

lumbosacral joint

  • where is this?
  • orientation
  • allows…
  • limits…
A

L5S1
oblique orientation
-allows rotation and flexion
-limits lateral flexion

28
Q

arthrokinematics - facet joints

  • approximation (closing)
  • separation (gapping)
  • sliding (gliding)
A 
approximation
-facet surfaces move closer together
separation
-facet surfaces move further apart
sliding
-linear translation of facet surfaces in the plane of the facet joint
29
Q

arthrokinematics

-flexion

A

inferior facets of superior vertebra slide upward on superior facets of inferior vertebra

30
Q

arthrokinematics

-extension

A

inferior facets of superior vertebra slide downward on superior facets of inferior vertebra

31
Q

arthrokinematics

-lateral flexion

A

ipsipateral downslide

contralateral upslide

32
Q

arthrokinematics

-R rotation

A

separation of right facet joint

approximation of left facet joint

33
Q

arthrokinematics

-L rotation

A

separation on left facet joint

approximation of right facet joint

34
Q

coupled motion - lumbar spine

-what PTs should know

A

should use caution when applying coupled motion concepts to lumbar spine
-studies do not agree on what direction it occurred

35
Q

why do we care about coupled motion (in general)?

A 
assessment of active motion
-observe compensatory motions
assessment of passive motion/mobility
-assess coupling patterns
clinical intervention
-guide direction of mobilization, treat restrictions in both motions to restore the primary movement

S2 Biomechanics (13 decks)

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