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
