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Active Care Exam Two > Lumbar Spine/Core > Flashcards

Lumbar Spine/Core Flashcards

1
Q

Which muscles are tight in the lower cross syndrome?

A

Erector spinae and iliopsoas

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2
Q

Which muscles are weak in the lower cross syndrome?

A

Abdominal muscles, gluteus maximus

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3
Q

What is the neutral zone in reference to the spine?

A

Region of laxity around the neutral resting position of a spinal segment (between flexion and extension, for example)

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4
Q

According to Panjabi, how can neutral zone impairment lead to pain and disability?

A

Decrease in the capacity of the stabilizing system of the spine to maintain the intervertebral neutral zones within physiological limits

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5
Q

How does high-speed trauma affect a spinal segment’s neutral zone?

A

Increases it

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6
Q

Biomechanically speaking, what is the most stable position for stress on the spine to be placed?

A

Within neutral zone

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7
Q

What things make up the passive system that influences the neutral zone?

A

Vertebrae, IVD, zygaphophyseal joints, ligaments

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8
Q

What things make up the active system that influences the neutral zone?

A

Muscles and tendons

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9
Q

What things make up the neural system that influences the neutral zone?

A

Central and peripheral nervous systems

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10
Q

What 3 large body concepts make up the overall stability of the spine?

A

Nervous system, spinal column, muscles

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11
Q

What muscles make up the core stabilizers?

A

Transversus abdominis, pelvic floor, diaphragm, multifidis

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12
Q

Which involves larger, torque-producing muscles that are anatomically more superficial: global system or local system of muscles?

A

Global: control spinal orientation and balance of external loads

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13
Q

Which involves anatomically deeper muscles that provide stability through increasing spinal segmental stiffness: global system or local system of muscles?

A

Local: play a role in anticipation of motion

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14
Q

When are the core stabilizers at work?

A

All times

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15
Q

When do the core stabilizers increase their action?

A

BEFORE any further loading or motion

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16
Q

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?

A

Posterior pelvic tilt

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17
Q

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?

A

Anterior pelvic tilt

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18
Q

About how many muscle attachments make up the core area?

A

29

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19
Q

Which core muscles form the “core container”?

A

Pelvic floor, diaphragm, transversus abdomens

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20
Q

What additional muscles to the core function to stiffen the spine and stabilize the core?

A

Iliocostalis, longissimus, multifidi, rotators, intertransversarii (also ligaments and fascia, technically)

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21
Q

What are the extensors of the thoracolumbar spine?

A

Longissimus, iliocostalis, and multifidis

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22
Q

What is the thoracic portion of the erector spinae muscles that are extensors of the thoracolumbar spine?

A

Longissimus thoracis pars thoracics

Longissimus lumborum pars thoracis

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23
Q

What is the lumbar portion of the erector spinae muscles that are extensors of the thoracolumbar spine?

A

Longissimus thoracis pars lumborum

Longissimus lumborum pars lumborum

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24
Q

What is the origin of the pars thoracis?

A

Posterior sacrum and medial iliac crest

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25
Q

To where do the pars thoracis attach?

A

Ribs and vertebral components (run parallel to spine)

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26
Q

Is the pars thoracics mostly slow or fast twitch fibers?

A

Slow (type 1) (75%)

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27
Q

Is the pars thoracis a global/superficial muscle or local/deep?

A

Global/superficial

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28
Q

What is the function of the pars thoracics?

A

Produce greatest amount of lumbar extension with minimal compression of the spine

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29
Q

What is the origin of the pars lumborum?

A

Posterior sacrum and medial aspect of iliac crest

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30
Q

To where do the pars lumborum attach?

A

Mammillary and transverse processes of lumbar vertebrae

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31
Q

What is the action of the pars lumborum?

A

Generates posterior sheer with extension on the superior vertebrae

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32
Q

Is the pars lumborum made of mostly type 1 or type 2 fibers?

A

Even mix of both

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33
Q

To what does the multifidus attach to?

A

Spinous processes

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34
Q

Do the multifidi provide global or local muscle action?

A

Local

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35
Q

Multifidi have a high concentration of which muscle fiber type?

A

Type I (endurance) with extensive capillary system

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36
Q

How can a low back injury affect the multifidi?

A

Asymmetric atrophy

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37
Q

Which motions are the rotators and intertransversarii usually described as causing?

A

Twisting and lateral flexion (minimal contribution, however)

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38
Q

Which have more muscle spindles: rotators/intertransverarii or multifidi and why?

A

Rotators/intertransversarii: function as length transducers and position sensors at every lumbar and thoracic joint

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39
Q

An EMG study by McGill found that rotator muscles were silent upon which movement and active upon which?

A

Silent on side of trunk rotation, active on side of stretch

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40
Q

What is the action of the internal and external oblique abs?

A

Twisting and lateral flexion (also accessory muscles for respiration)

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41
Q

What fascia is seen anterior to the internal and external oblique abs? Posterior to?

A 
Anterior = abdominal fascia
Posterior = thoracodorsal fascia
42
Q

The rectus abdominis is contained within what structure?

A

Abdominal fascia

43
Q

The rectus abdominis also connects to what muscle superiorly?

A

Pec major

44
Q

What is the action of rectus abdominis?

A

Trunk flexion

45
Q

Why is the rectus abdomininis sectioned off?

A

Prevents bulking upon shortening and allows greater trunk flexibility when contracted

46
Q

Why would it make sense for the rectus abdominis to not be sectioned off?

A

All section have the same nerve supply; one long muscle would create more force

47
Q

The psoas muscle attaches to what part of the spine?

A

T12-L5

48
Q

What is the action of the psoas?

A

Hip flexion (causes some substantial spinal compression)

49
Q

How does the lower cross system affect the psoas muscle?

A

Facilitated (tight) and therefore puts chronic compression on the spine

50
Q

What is the quadratus lumborum attached to?

A

Each lumbar vertebrae, pelvis, and rib cage

51
Q

What is the strongest muscular stabilizer of the spine?

A

Quadratus lumborum

52
Q

What type of contraction is seen with the QL?

A

Isometric (hardly changes length during any spine motion)

53
Q

What is the deepest muscle of the abdominals?

A

Transversus abdominis

54
Q

From where does the transversus abdominis arise?

A

From thoracolumbar fascia between the iliac crest and 12th rib

55
Q

To what does the transversus abdominis attach?

A

Inguinal ligament, iliac crest, and lower 6 ribs (anteriorly to abdominal aponeurosis)

56
Q

Contraction of the transversus abdominis has what effects on the body?

A

1 increased intra-abdominal pressure
2 core and lumbar spine stiffening
3 provides compression to SI joints

57
Q

During movement of the upper and lower extremities, which muscle is recruited first before any limb movement occurs?

A

Transversus abdominis

58
Q

Does the compression of the SI joints by the transversus abdominis cause force closure or form closure of the SI joint?

A

Force closure

59
Q

What is “form closure”?

A

Shape of the joint compresses or closes the joint (think form = shape)

60
Q

What is “force closure”?

A

Force from contraction of transversus abdominis compresses/closes SI joint space

61
Q

What are the exercises used to strengthen the pelvic floor?

A

Kegel exercises

62
Q

What muscles make up the pelvic floor?

A

Coccygeus, levator ani, iliococcygeus, pubococcygeus

63
Q

What else are the muscles involved with kegel exercises used for?

A

Stop flow of urine

64
Q

How many times per day should kegel exercises be done by a patient?

A

200X

65
Q

What does the diaphragm attach to?

A

Lower 6 ribs, xiphoid, L1-L4, central tendon

66
Q

What structure forms the top of the abdominal core?

A

Diaphragm

67
Q

What role does compression play when it comes to core stability?

A

Equal dispersion of compression and tension forces are necessary for optimal stabilization

68
Q

What is tensegrity?

A

A force pulling in one direction is equally opposed by a force pulling in the opposite direction (leading to stability overall)

69
Q

What is the cause of compression with the concept of tensegrity?

A

Gravity

70
Q

What structures of the human body allow for tension to be absorbed and provided via tensegrity?

A

Muscle, tendon, bone, ligament

71
Q

Should a patient be instructed to suck in or “hollow” the abdominal wall?

A

NO - always try to keep the spine in NEUTRAL during exercises

72
Q

What muscles cause lumbar hyperlordosis?

A

Shortened erector spinae

73
Q

What muscles cause anterior pelvic tilt?

A

Weakness in gluteals, tight quads

74
Q

What muscles cause a protruding abdomen?

A

Weak abdominals (duh)

75
Q

What muscles are responsible for foot flare?

A

Tightness in external hip rotators

76
Q

What muscle could be responsible for pain over the lateral knee or lateral SI area?

A

Shortened TFL

77
Q

What is the area of concern with an active straight leg raiser test?

A

Ability to perform test on a graded scale (not focused on pain like in NMS testing)

78
Q

What muscle is being tested during an active straight leg test when compressing the ASIS? Trochanters? PSISs up and medial?

A 
ASIS = transverse abdominis
Trochanters = pelvic floor
PSIS = multifidis
79
Q

What is a positive sign for the prone instability test?

A

Reduce pain when lifting legs of floor

80
Q

What does it mean if a patient has a positive sign for the prone instability test?

A

Means they’re likely to benefit from stabilization exercises

81
Q

What is the hip extension motion pattern order?

A

1 ipsilateral hamstring
2 ipsilateral gluteals
3 contralateral spinal extensors
4 ipsilateral spinal extensors

82
Q

When a patient has weak glutes, which muscles must be recruited further for hip extension?

A

Paraspinals

83
Q

What muscles are weak and tight if the patient expresses an inability to hold knee extension?

A

Facilitated hamstrings; inhibited glutes

84
Q

What muscles are weak and tight if the patient exhibits forced lumbar extension?

A

Facilitated thoracolumbar extensors; inhibited glutes

85
Q

What muscle should be evaluated when upper back/thoracic spine activation is seen to occur first with trap activation?

A

Contralateral lattisimus dorsi

86
Q

According to the George Constanza Method of rehab, how would you treat altered hip extension?

A

Stretch the tight muscles (psoas, quads, and hamstrings), strengthen the weak ones (gluten, abdominals) and also adjust thoracics, lumbars, SI

87
Q

What could be a muscular cause of decreased ROM with an altered hip abduction pattern?

A

Adductor tightness

88
Q

What could be a muscular cause of forward drift and hip flexion during an altered hip abduction pattern?

A

TFL substitution

89
Q

What could be a muscular cause of foot flare and hip external rotation during an altered hip abduction pattern?

A

Piriformis substitution

90
Q

What could be a muscular cause of hip hiking (aka bending at the waist) during altered hip abduction pattern?

A

QL substitution

91
Q

What would be the retraining treatment for an altered hip abduction motor pattern?

A

Stretch adductors (TFL, QL, piriformis), strengthen glutes, adjust

92
Q

What is a failed test for the glute activation screen?

A

Cramping of down leg hamstring or if hip drops/elevates as a compensation for glute weakness

93
Q

What muscles are overactive or inhibited with a failed flute activation screen?

A

Overactive hamstring inhibited glutes

94
Q

Monster walks help strengthen what muscle?

A

Glutes (med/min)

95
Q

What is another name for the stratification syndrome?

A

Layer syndrome

96
Q

What syndrome is a combination of both upper and lower cross?

A

Stratification syndrome (aka layer syndrome)

97
Q

Which erector spinae are tight and which are weak with the stratification syndrome?

A 
Tight = thoracolumbar
Weak = lumbosacral (think just like glutes)
98
Q

The lumbar spine should never be fully placed into what motion?

A

Flexion

99
Q

What is a good way to pre-stress the lumbar system for stability during lifting?

A

Abdominal brace

100
Q

The saddle toss maneuver for lifting involves what body part?

A

Knee

101
Q

The direct force during a big lift should be directed through what part of the body?

A

Naval (keeps forces through low back)

102
Q

What organization is responsible for the development of proper lifting recommendations?

A

National Institute for Occupational Safety and Health (NIOSH)

Active Care Exam Two (4 decks)

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