Lumbar Spine and Pelvis Pathology and Assessment Flashcards
What is the most common region in the vertebrae for low back pain?
L4/L5
Sacroiliac
State the normal arches of the spine (kyphosis, lordosis)
Cervical - lordosis
Thoracic - kyphosis
Lumbar - lordosis
Sacrococcygeal - kyphosis
What is normal thoracolumbar flexion and extension?
Flexion: 85 degrees
Extension: 35 degrees
What is normal lateral flexion and rotation of the thoracolumbar?
Lateral flexion = 45 degrees
Rotation = 120 degrees (40 degrees thoracolumbar, 80 degrees craniocervical)
What do anterior ligaments of the spine prevent?
Excessive extension
What do posterior ligaments of the spine prevent?
Excessive flexion
What does the nucleus pulposus do?
Resists compression forces to the vertebral end plates and translates vertical compression forces into circumferential tensile forces in annulus fibrosis
What does the annulus fibrosis do?
Resists tensile (nearly all directions), torsional and shear forces
What muscles are used for spine flexion?
Rectus abdominis
External and internal oblique
Psaos major and iliacus when foot is at 90 degrees fixed
What muscles are used for spine extension?
Longissimus Iliocostalis Multifidi Rotatores Semispinalis capitis Quadratus lumborum Interspinalis Intertransversarii Latissimus dorsi when arm is flexed
What muscles are used for spine rotation?
External oblique Internal oblique Multifidi Rotatores Transverse abdominis
What muscles are used for lateral flexion
Iliocostalis External and internal oblique Longissimus Quadratus lumborum Psaos major Intertransversarii Spinalis Latissimus dorsi
Explain the muscles involved, and the purpose of the anterior SLING
Adductors and obliques work together to allow rotation when launching something like a javelin
Explain the muscles involved, and the purpose of the posterior SLING
Gluteus maximus and latissimus dorsi working together to allow rotation when doing a golf swing
State an initial hypothesis for the following
- Restricted motion of lumbar spine
- Lower buttock pain exacerbated by a pattern of movement such as sidebending or rotation
- Decreased extension
Zygapophyseal joint pain syndrome
State an initial hypothesis for the following
-centralisation or peripheralisation of symptoms during repetitive movements or prolonged periods in certain positions
Discogenic pain
State an initial hypothesis for the following
- Lower extremity parathesia
- Lower extremity weakness
Sciatica or lumbar radiculopathy
State an initial hypothesis for the following
-Pain in lower extremity exacerbated by extension and quickly relieved by flexion
Spinal stenosis
State an initial hypothesis for the following
-Recurrent locking, clicking or catching of the low back
Lumbar instability
State an initial hypothesis for the following
- Low back pain exacerbated by stretch of ligament or muscle
- Pain with contraction of muscle
Muscle/ ligament sprain or strain
What percent of low back injuries are non specific?
90%
What is the difference between spondylolysis and spondylolisthesis
Spondylolysis is a fracture through the lamina of the vertebrae with no displacement. Spondylolisthesis is a fracture of the lamina of the vertebrae with anterior displacement
What are some subjective signs of spondylolysis?
- Pain with lumbar extension, rotation and side flexion
- Pain worsening with activity
- Pain localised and deep
- Stiff and sore in the morning
What are some objective signs of spondylolysis?
- Pain with lumbar extension, rotation and side flexion
- Pain with quadrant testing
- Pain on palpation
What is the biggest risk factor for spondylolysis or spondylolisthesis
-Young athlete younger than 18 who performs a lot of extension activities
Explain osteoarthritis in the lumbar spine and possible complications.
Growth of bony spurs, or wearing down of the joint cartilage
Complications occur when their is spinal nerve compression and hyperextension deformities
What percentage of people with low back pain have sacroiliac joint dysfunction?
15-25%
True or false, sacroiliac joint dysfunction results in neural symptoms such as pins and needles down the back of the leg.
False. It does not have any neural symptoms
Explain form and force closure in relation to sacroiliac joint dysfunction
Force closure - lack of motor control or strength in muscles leading to poor stability forces across the pelvis
Form closure - reduced stability in the SIJ due to structural injury (ligaments etc)
What are some subjective signs of sacroiliac joint dysfunction?
Deep and persistent pain
Sitting down too long is painful
Pain with walking, running or kicking
What are some objective signs of sacroiliac joint dysfunction?
- Positive Laslett cluster testing, (2/4 at least)
- Positive stork test
- Unilateral functional testing differences
- Poor recruitment of hip
What is discogenic pain?
A tear in the disc structure that causes compression on spinal nerves
What are some subjective signs of disc injuries?
- Constant back pain which worsens with flexion
- Pain and stiffness in the morning
- Pain down the leg
- Pins and needles
- Pain with coughing and sneezing
What are some objective signs of disc injuries?
- Flexion and extension ROM reduction
- Repeated flexion causing pain
- Positive SLR
- Positive slump test
True or false, patients with chronic low back pain have more positive special tests compared to acute and subacute
True, on average chronic low back pain reported 3 positive tests compared to 2 and 2
