Lumbar Spine/Core Flashcards
Which muscles are tight in the lower cross syndrome?
Erector spinae and iliopsoas
Which muscles are weak in the lower cross syndrome?
Abdominal muscles, gluteus maximus
What is the neutral zone in reference to the spine?
Region of laxity around the neutral resting position of a spinal segment (between flexion and extension, for example)
According to Panjabi, how can neutral zone impairment lead to pain and disability?
Decrease in the capacity of the stabilizing system of the spine to maintain the intervertebral neutral zones within physiological limits
How does high-speed trauma affect a spinal segment’s neutral zone?
Increases it
Biomechanically speaking, what is the most stable position for stress on the spine to be placed?
Within neutral zone
What things make up the passive system that influences the neutral zone?
Vertebrae, IVD, zygaphophyseal joints, ligaments
What things make up the active system that influences the neutral zone?
Muscles and tendons
What things make up the neural system that influences the neutral zone?
Central and peripheral nervous systems
What 3 large body concepts make up the overall stability of the spine?
Nervous system, spinal column, muscles
What muscles make up the core stabilizers?
Transversus abdominis, pelvic floor, diaphragm, multifidis
Which involves larger, torque-producing muscles that are anatomically more superficial: global system or local system of muscles?
Global: control spinal orientation and balance of external loads
Which involves anatomically deeper muscles that provide stability through increasing spinal segmental stiffness: global system or local system of muscles?
Local: play a role in anticipation of motion
When are the core stabilizers at work?
All times
When do the core stabilizers increase their action?
BEFORE any further loading or motion
Which pelvic tilt is utilized to find the neutral zone by drawing the belly up toward the rings and toward the floor while flattening the low back against the floor?
Posterior pelvic tilt
Which pelvic tilt is utilized to find the neutral zone by pushing the tail bone down and arching the low back up from the floor?
Anterior pelvic tilt
About how many muscle attachments make up the core area?
29
Which core muscles form the “core container”?
Pelvic floor, diaphragm, transversus abdomens
What additional muscles to the core function to stiffen the spine and stabilize the core?
Iliocostalis, longissimus, multifidi, rotators, intertransversarii (also ligaments and fascia, technically)
What are the extensors of the thoracolumbar spine?
Longissimus, iliocostalis, and multifidis
What is the thoracic portion of the erector spinae muscles that are extensors of the thoracolumbar spine?
Longissimus thoracis pars thoracics
Longissimus lumborum pars thoracis
What is the lumbar portion of the erector spinae muscles that are extensors of the thoracolumbar spine?
Longissimus thoracis pars lumborum
Longissimus lumborum pars lumborum
What is the origin of the pars thoracis?
Posterior sacrum and medial iliac crest
To where do the pars thoracis attach?
Ribs and vertebral components (run parallel to spine)
Is the pars thoracics mostly slow or fast twitch fibers?
Slow (type 1) (75%)
Is the pars thoracis a global/superficial muscle or local/deep?
Global/superficial
What is the function of the pars thoracics?
Produce greatest amount of lumbar extension with minimal compression of the spine
What is the origin of the pars lumborum?
Posterior sacrum and medial aspect of iliac crest
To where do the pars lumborum attach?
Mammillary and transverse processes of lumbar vertebrae
What is the action of the pars lumborum?
Generates posterior sheer with extension on the superior vertebrae
Is the pars lumborum made of mostly type 1 or type 2 fibers?
Even mix of both
To what does the multifidus attach to?
Spinous processes
Do the multifidi provide global or local muscle action?
Local
Multifidi have a high concentration of which muscle fiber type?
Type I (endurance) with extensive capillary system
How can a low back injury affect the multifidi?
Asymmetric atrophy
Which motions are the rotators and intertransversarii usually described as causing?
Twisting and lateral flexion (minimal contribution, however)
Which have more muscle spindles: rotators/intertransverarii or multifidi and why?
Rotators/intertransversarii: function as length transducers and position sensors at every lumbar and thoracic joint
An EMG study by McGill found that rotator muscles were silent upon which movement and active upon which?
Silent on side of trunk rotation, active on side of stretch
What is the action of the internal and external oblique abs?
Twisting and lateral flexion (also accessory muscles for respiration)
What fascia is seen anterior to the internal and external oblique abs? Posterior to?
Anterior = abdominal fascia Posterior = thoracodorsal fascia
The rectus abdominis is contained within what structure?
Abdominal fascia
The rectus abdominis also connects to what muscle superiorly?
Pec major
What is the action of rectus abdominis?
Trunk flexion
Why is the rectus abdomininis sectioned off?
Prevents bulking upon shortening and allows greater trunk flexibility when contracted
Why would it make sense for the rectus abdominis to not be sectioned off?
All section have the same nerve supply; one long muscle would create more force
The psoas muscle attaches to what part of the spine?
T12-L5
What is the action of the psoas?
Hip flexion (causes some substantial spinal compression)
How does the lower cross system affect the psoas muscle?
Facilitated (tight) and therefore puts chronic compression on the spine
What is the quadratus lumborum attached to?
Each lumbar vertebrae, pelvis, and rib cage
What is the strongest muscular stabilizer of the spine?
Quadratus lumborum
What type of contraction is seen with the QL?
Isometric (hardly changes length during any spine motion)
What is the deepest muscle of the abdominals?
Transversus abdominis
From where does the transversus abdominis arise?
From thoracolumbar fascia between the iliac crest and 12th rib
To what does the transversus abdominis attach?
Inguinal ligament, iliac crest, and lower 6 ribs (anteriorly to abdominal aponeurosis)
Contraction of the transversus abdominis has what effects on the body?
1 increased intra-abdominal pressure
2 core and lumbar spine stiffening
3 provides compression to SI joints
During movement of the upper and lower extremities, which muscle is recruited first before any limb movement occurs?
Transversus abdominis
Does the compression of the SI joints by the transversus abdominis cause force closure or form closure of the SI joint?
Force closure
What is “form closure”?
Shape of the joint compresses or closes the joint (think form = shape)
What is “force closure”?
Force from contraction of transversus abdominis compresses/closes SI joint space
What are the exercises used to strengthen the pelvic floor?
Kegel exercises
What muscles make up the pelvic floor?
Coccygeus, levator ani, iliococcygeus, pubococcygeus
What else are the muscles involved with kegel exercises used for?
Stop flow of urine
How many times per day should kegel exercises be done by a patient?
200X
What does the diaphragm attach to?
Lower 6 ribs, xiphoid, L1-L4, central tendon
What structure forms the top of the abdominal core?
Diaphragm
What role does compression play when it comes to core stability?
Equal dispersion of compression and tension forces are necessary for optimal stabilization
What is tensegrity?
A force pulling in one direction is equally opposed by a force pulling in the opposite direction (leading to stability overall)
What is the cause of compression with the concept of tensegrity?
Gravity
What structures of the human body allow for tension to be absorbed and provided via tensegrity?
Muscle, tendon, bone, ligament
Should a patient be instructed to suck in or “hollow” the abdominal wall?
NO - always try to keep the spine in NEUTRAL during exercises
What muscles cause lumbar hyperlordosis?
Shortened erector spinae
What muscles cause anterior pelvic tilt?
Weakness in gluteals, tight quads
What muscles cause a protruding abdomen?
Weak abdominals (duh)
What muscles are responsible for foot flare?
Tightness in external hip rotators
What muscle could be responsible for pain over the lateral knee or lateral SI area?
Shortened TFL
What is the area of concern with an active straight leg raiser test?
Ability to perform test on a graded scale (not focused on pain like in NMS testing)
What muscle is being tested during an active straight leg test when compressing the ASIS? Trochanters? PSISs up and medial?
ASIS = transverse abdominis Trochanters = pelvic floor PSIS = multifidis
What is a positive sign for the prone instability test?
Reduce pain when lifting legs of floor
What does it mean if a patient has a positive sign for the prone instability test?
Means they’re likely to benefit from stabilization exercises
What is the hip extension motion pattern order?
1 ipsilateral hamstring
2 ipsilateral gluteals
3 contralateral spinal extensors
4 ipsilateral spinal extensors
When a patient has weak glutes, which muscles must be recruited further for hip extension?
Paraspinals
What muscles are weak and tight if the patient expresses an inability to hold knee extension?
Facilitated hamstrings; inhibited glutes
What muscles are weak and tight if the patient exhibits forced lumbar extension?
Facilitated thoracolumbar extensors; inhibited glutes
What muscle should be evaluated when upper back/thoracic spine activation is seen to occur first with trap activation?
Contralateral lattisimus dorsi
According to the George Constanza Method of rehab, how would you treat altered hip extension?
Stretch the tight muscles (psoas, quads, and hamstrings), strengthen the weak ones (gluten, abdominals) and also adjust thoracics, lumbars, SI
What could be a muscular cause of decreased ROM with an altered hip abduction pattern?
Adductor tightness
What could be a muscular cause of forward drift and hip flexion during an altered hip abduction pattern?
TFL substitution
What could be a muscular cause of foot flare and hip external rotation during an altered hip abduction pattern?
Piriformis substitution
What could be a muscular cause of hip hiking (aka bending at the waist) during altered hip abduction pattern?
QL substitution
What would be the retraining treatment for an altered hip abduction motor pattern?
Stretch adductors (TFL, QL, piriformis), strengthen glutes, adjust
What is a failed test for the glute activation screen?
Cramping of down leg hamstring or if hip drops/elevates as a compensation for glute weakness
What muscles are overactive or inhibited with a failed flute activation screen?
Overactive hamstring inhibited glutes
Monster walks help strengthen what muscle?
Glutes (med/min)
What is another name for the stratification syndrome?
Layer syndrome
What syndrome is a combination of both upper and lower cross?
Stratification syndrome (aka layer syndrome)
Which erector spinae are tight and which are weak with the stratification syndrome?
Tight = thoracolumbar Weak = lumbosacral (think just like glutes)
The lumbar spine should never be fully placed into what motion?
Flexion
What is a good way to pre-stress the lumbar system for stability during lifting?
Abdominal brace
The saddle toss maneuver for lifting involves what body part?
Knee
The direct force during a big lift should be directed through what part of the body?
Naval (keeps forces through low back)
What organization is responsible for the development of proper lifting recommendations?
National Institute for Occupational Safety and Health (NIOSH)
