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Musculoskeletal PT 2 > Lumbar Spine instability > Flashcards

Lumbar Spine instability Flashcards

1
Q

what causes excessive motion of a segment or segments

A
  • lacks normal restrain from
  • facets and capsules
  • ligaments
  • disc
  • muscles
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2
Q

What are the segmental Zones

A
  1. Neutral zone
  2. Elastic zone
    = the total ROM at a segment
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3
Q

Neutral zone

A
  • segment postition or movement in the normal laxity zone

*minimal loading of *

  • passive structures
  • IV disc
  • facet joint capsules
  • ligaments
  • Active structures: musucles and tendons
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4
Q

The elastic zone

A

position and movement of a segment where:

  • there is a substantial loading of passive structures
  • found at end ranges
  • creep: ligaments some resistance, repetitive loading or sustain posures can change the viscoelastic nature of the tissues
  • Inert tissues; capusle ligaments
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5
Q

Segmental Control: 3 system

A
  • Passive control
  • Active Control system
  • neural control system
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6
Q

Passive control

What are they and what occurs when there is damage?

A
  • inert tissue resistance during static and dynmaic activities
  • IV disc
  • facet joint capsules
  • ligaments

Damage to these structures result in:

  • decreased proprioceptive feedback
  • increase size of the neutral zone
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7
Q

Active control system

A
  • muscles and their tendons
  • dynamic function maintains spine stabilty
  • when passive control structures are inadequate
  • two components: local and global muscular system
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8
Q

Neural control system

A
  • maintenance of segmental stability

Via input from

  • passive control system: capsule and ligaments –joint/mechanoreceptors
  • active control systems: muscles –spindles
  • neural control system dysfunction - spine strutcture at risk
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9
Q

Look at segmental control summary slide

A

look

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10
Q

Active system control

types

A
  1. local system
  2. global system
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11
Q

Active system control

local system

A
  • role is segmental stabilization
  • key stabilizers in the spine are multifidi (TP-SP runs 2-4 segments)
  • transverse abdominus, internal oblqiues corset/cylinders increase intra-abdominal pressure
  • attachments into thoraco-lumbar fasccia
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12
Q

Active muscular control

Global system

A
  • general trunk/spine stabilization
  • larger torque producing muscles
  • linking pelvis, spine and extremities

Include:

  • rectus abdominus
  • external obliques
  • erector spinae
  • latissimus dorsi
  • gluteus maximus

*strengthen locally first then globably

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13
Q

LS stability: local system muscular role

What are they and when are they active

A
  • multifidus, TrA, IO are tonically active in upright postures and motions of the trunk
  • TrA recruited prior to movement
  • TrA, IO make rigid corset
  • local muscle system for segmental stability
  • multifidus, TrA, IO - are most important muscules
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14
Q

LS stability: local system malfunction

A
  • in presence of L/S injury and LBP
  • inhibition of TrA, multifidus
  • result = poor stabilization by this local system
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15
Q

What is spondylolysis

A
  • breakdown of vertebrae without vertebral slippage
  • fx of pars interarticularis (lamina)
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16
Q

What is spondylolisthesis

A
  • slip of one vertebrae or vertebral column above on the vertebrae directly below
17
Q

Factors with spondylolisthesis

A
  • trauma
  • spondylolysis (fx that turns into slippage)
  • degeneration -wearing of facets
  • facet joint too sagitially orientated
  • increased lumbosacral angle (greater than N 11.4º
  • ligament laxity
  • previous pregnancy
  • hormonal factors
18
Q

Spondylolisthesis incidence

A
  • most common L5 on S1
  • Women>men
  • spondylolisthesis - related to disc degeneration at the slip level
19
Q

Spondylolisthesis grades

A

graded according to % of slip
- grade I: 1-25%
- grade II: 26-50%
- grade III: 51-75%
- Grade IV: 76-100%

Slip % = distance from posterior aspect of S1 to posterior aspect of L5 body, dividied by the A/P distance of S1 body
higher grades common for neurological S&S

20
Q

Spondylolisthesis

radiography

A
  • degree of slip better apreciated in standing
  • should be done in flexed and extended positions
  • limitation: static = does not tell what is occuring during movement
21
Q

General instability causes

A
  • ligamentous/capsular weakness
  • disc degeneration, facet degeneration
  • muscle weakness, inhibition
  • spondylolisthesis
  • latrogenic surgery
  • Hx of self manipulation
22
Q

Physical signs of instability

A
  • step deformity standing, disappears lying (due to lumbosacral angle)
  • rotational deformity if unilateral
  • increased muscle tone standing disappears lying
  • hypertrophy - muscle band to protect instabiltiy
  • shaking on forward bending
  • history of catches
  • difficulty maintaining a static position
  • hypermobility PIVM higher gradse 5,6 Paris scale
  • instability tests
23
Q

What are some instability test

A
  • prone spondylolisthesis instability test
  • sidelying anterior instability test
  • standing axial load instability test
24
Q

LBP classification appoach: stabilization subgroup

what does that patient typically look like

A
  • younger age <40
  • greater flexibility average SLR >91º
  • instabilty catch during L/S flexion or extension ROM
  • (+) prone instability test
25
Q

LBP classification subgroup: instabilty in postpartum patients

what is usually seen clinically

A
  • (+) Post Sheer test: posterior provocation test/thigh thrust with axial load through femur
  • (+) active SLR test
  • (+) trendelenburg - opposite pelvis drops
  • (+) pain with palpation of SIJ long dorsal ligaments
26
Q

Clinical predication rule LS instability criteria

A
  • positive prone instability test
  • aberrant movements present
  • average SLR >91º
  • age <40 years
  • 3/4 = 67% likelihood of success with stabilization program
27
Q

Instability treatment

A
  • stabilization exercises: local system training => global system training
  • patient education: function of spine neutral, avoid end ranges
  • spinal surgery fusion: if conservative Tx fails, advancing neurological signs, unrelenting pain

Musculoskeletal PT 2 (25 decks)

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