Lumbar Spine Part 1

Question 1

The ______ spine refers to the “low back” and is made up of ___ vertebrae and their intervertebral discs.

Answer 1

Lumbar Spine
5 Vertebrae

Question 2

Beginning about ___ inches from the ________ angle of the scapula, the vertebrae of the lumbar spine create a ________ curve before finally attaching to the sacral spine.

Answer 2

6 Inches
Inferior Angle
Lordotic Curve

Question 3

Based on the following image, label numbers 1-9 of the lumbar spine.

Answer 3

1) Intervertebral Foramen
2) Nucleus Pulposus
3) Annulus Fibrosis
4) Vertebral Body
5) Intervertebral Disc
6) Superior Articular Facet
7) Posterior Longitudinal Ligament
8) Ligamentum Flavum
9) Supraspinous Ligaments

Question 4

In the lumbar spine, the _________ are commonly compared to hockey pucks interspaced with ______________ _____ known as jelly donuts.

Answer 4

Vertebrae
Intervertebral Discs

Question 5

The _________ allow for attachments of muscles and ligaments that provide _________ and mobility of the lumbar spine.

Answer 5

Vertebrae
Stability

Question 6

The ______________ _____ act to absorb and ________ axial loads and tensile stressed from one vertebra to another.

Answer 6

Intervertebral Discs
Transmit

Question 7

The ____ lumbar vertebra is the largest and transmits forces from the _____ extremities to the sacrum and pelvis.

Answer 7

5th Lumbar Vertebra
Upper Extremities

Question 8

T/F - The 5th lumbar vertebra is wedge shaped and forward orientated, therefore the above vertebra sits slightly anteriorly allowing for normal lordotic curve.

Answer 8

False - The 5th lumbar vertebra is wedge shaped and forward orientated, therefore the above vertebra sits slightly POSTERIORLY allowing for normal lordotic curve.

Question 9

Which segment of the vertebral column is the most common segment for problems?

Answer 9

L5-S1 Segment

Question 10

The lumbar facet joints sit in the ________ plane, therefore the available movements are _______ and _________.

Answer 10

Sagittal Plane
Flexion and Extension

Question 11

T/F - Rotation and side bending are very limited at the lumbar spine

Answer 11

True

Question 12

The role of the ______ are to stabilize the spine, allow limited movement and protect the IVDs from shear forces.

Answer 12

Facets

Question 13

There are ___ pairs of facets in the lumbar spine, consisting of ________ (facing medial and backward) and ________ (facing lateral and forward).

Answer 13

5 Pairs
Superior
Inferior

Question 14

Name the 3 spine conditions due to injury, degeneration and/or trauma.

Answer 14

1) Spondylosis
2) Spondylolysis
3) Spondylolythesis

Question 15

A spine condition involving degeneration of the intervertebral disc.

Answer 15

Spondylosis

Question 16

A spine condition where there is a defect in the pars interarticularis, involving a fracture between the lamina and pedicle.

Answer 16

Spondylolysis

Question 17

What is displayed in the following image?

Answer 17

Scottie Dog X-Ray

Question 18

A Scottie dog x-ray is used as a diagnostic sign for _____________ and occurs with over _________ pressing the SPs together.

Answer 18

Spondylolysis
Over Extension

Question 19

A spine condition involving forward displacement of one vertebrae over another.

Answer 19

Spondylolythesis

Question 20

T/F - Discs make up approximately 35% of the total length of the vertebral column and this will decrease with age due to overall degeneration.

Answer 20

False - Discs make up approximately 25% of the total length of the vertebral column and this will decrease with age due to overall degeneration.

Question 21

What are the 2 parts of an intervertebral disc?

Answer 21

1) Annulus Fibrosis
2) Nucleus Pulposus

Question 22

Part of the intervertebral disc consisting of approximately 20 rings of criss-crossing collagenous fibers.

Answer 22

Annulus Fibrosis

Question 23

Part of the intervertebral disc that is incompressible fluid.

Answer 23

Nucleus Pulposus

Question 24

A general term used to describe any change in the annulus shape of an intervertebral disc that will cause it to protrude beyond its normal perimeter.

Answer 24

Herniation

Question 25

What are the 4 categories of disc herniation?

Answer 25

1) Protrusion 2) Prolapse 3) Extrusion 4) Sequestration

Question 26

Based on the following image, label letters A-D with their associated type of disc herniation.

Answer 26

A) Protrusion B) Prolapse C) Extrusion D) Sequestration

Question 27

A type of disc herniation when the nucleus pulposus is only contained by the outer fibres of the annulus and supporting ligamentous structures.

Answer 27

Protrusion

Question 28

A type of disc herniation involving rupture of the nuclear material into the vertebral canal.

Answer 28

Prolapse

Question 29

A type of disc herniation involving extension of nuclear material beyond the confines of the posterior longitudinal ligament or above and below the disc space, but still in contact with the disc.

Answer 29

Extrusion

Question 30

A type of disc herniation in which the extruded nucleus has separated from the disc and moved away from the prolapsed area.

Answer 30

Sequestration

Question 31

The following actions increase pressure in the ___ intervertebral disc: - Walking (15%) - Small jumps (40%) - Laughing (40-50%) - Bending forward (150%) - Lifting 2kg with back straight (73%) - Lifting 2kg with back bent (169%)

Answer 31

L3 Intervertebral Disc

Question 32

T/F - It is highly recommended to avoid laughing while taking a small jump with your back bent.

Answer 32

True

Question 33

The resting position of the lumbar spine is midway between _______ and _________.

Answer 33

Flexion and Extension

Question 34

The close packed position of the lumbar spine is _________.

Answer 34

Extension

Question 35

Some common questions to ask when getting a patient's history include their primary _________, general health and mechanism of ______.

Answer 35

Primary Complaint Mechanism of Injury

Question 36

If a patient is experiencing a past injury or complaint, you want to ask about prior ___________ and how they were treated.

Answer 36

Prior Occurrences

Question 37

The following lumbar spine injuries are examples of _____ pain: - Facet joint irritation - Paravertebral muscle spasm - Ligament Sprain

Answer 37

Local Pain

Question 38

A type of pain that travels down the involved limb due to spinal nerve and/or root irritation, such as with sciatica.

Answer 38

Radiating Pain

Question 39

The following impairments are examples of ________ pain: - Trigger points - Visceral organs (e.g. prostrate cancer) - Systemic conditions (e.g. ankylosing spondylitis)

Answer 39

Referred Pain

Question 40

Match the following behaviour/symptoms with the associated impairment area. 1) Popping/Tearing 2) Numbness 3) Catching 4) Tingling/Warmth/Coldness A) Nerve Root/Circulation B) Muscle C) Peripheral Nerve/Nerve Root Irritation D) Muscle Spasm/Facet Joint

Answer 40

1) Popping/Tearing - B) Muscle 2) Numbness - C) Peripheral Nerve/Nerve Root Irritation 3) Catching - D) Muscle Spasm/Facet Joint 4) Tingling/Warmth/Coldness A) Nerve Root/Circulation

Question 41

When doing our ____________ of the patient's lumbar spine, we want to look at: - Regular landmarks (e.g. alignments of SPs) - Spinal posture - Upper and lower extremity landmarks (e.g. acromion process, patellae, malleoli) - Lordotic curve

Answer 41

Observations

Question 42

When creating our testing __________, we must consider if the MOI was traumatic or non-traumatic.

Answer 42

Testing Hypothesis

Question 43

Which 3 areas need to be ruled out prior to functional testing for the lumbar spine?

Answer 43

1) Hip 2) Pelvis 3) Cervical Spine

Question 44

T/F - When ruling out the hip, we want to do active free flexion and external rotation with overpressure.

Answer 44

False - When ruling out the hip, we want to do active free flexion and MEDIAL rotation with overpressure.

Question 45

Which 3 tests are used to rule out the pelvis?

Answer 45

1) Rocking 2) Gapping 3) Approximation

Question 46

When ruling out the cervical spine, we want to do active free flexion, extension, side bend and rotation with overpressure, expect _________.

Answer 46

Extension

Question 47

Active flexion range is usually ___ to ___ degrees in the lumbar spine.

Answer 47

40 to 60 degrees

Question 48

With active _______ of the lumbar spine, the patient is standing and tucks their chin to their chest and forward bends as far as possible.

Answer 48

Flexion

Question 49

T/F - Active flexion of the lumbar spine is initiated by a concentric contraction of the sacrospinal and multifidi muscles, and controlled eccentrically by the psoas and abdominal muscles.

Answer 49

False - Active flexion of the lumbar spine is initiated by a concentric contraction of the PSOAS and ABDOMINAL muscles, and controlled eccentrically by the SACROSPINAL and MULTIFIDI muscles.

Question 50

T/F - If active flexion of the lumbar spine is full and pain free, over pressure may be applied.

Answer 50

True

Question 51

With active flexion, the lumbar lordosis should flatten but not produce a ________. If it does not fully flatten, consider whether the lumbar spine is _____________ in postural assessment.

Answer 51

Kyphosis Hyperlordotic

Question 52

With active flexion, the therapist may wish to measure from ____ to ___ as the patient bends forward. The tape should ________ in length by about 7-8 cm.

Answer 52

T12 to S1 Increase

Question 53

Pain with movement during active_______ of the lumbar spine may be caused by: - Spasm or tightness of the back muscles - Local facet capsular restriction - Advanced ankylosing spondylitis - Sacrospinalis muscle spasm (common in degenerative diseases)

Answer 53

Flexion

Question 54

Pain at end range during active _______ of the lumbar spine may be caused by: - Dura mater stretch - Lumbar nerve root irritation or nerve compression - Thoracolumbar fascial injury - Centralized pain may indicate a sprain of the posterior capsular ligament of the facet joint, the supraspinous ligament or ligamentum flavum

Answer 54

Flexion

Question 55

Radiating pain in the lower limb felt distal to the knee may indicate ____ __________ with nerve root irritation.

Answer 55

Disc Herniation

Question 56

Pain that does not travel past the knee is likely to be ________ pain from trigger points in local guarding muscles, or compression on the peripheral _______ nerve.

Answer 56

Referred Pain Sciatic Nerve

Question 57

Active extension range is usually ___ to ___ degrees in the lumbar spine.

Answer 57

20 to 35 degrees

Question 58

Active _________ will often be the last range tested for the lumbar spine, as the muscles involved are often injured or guarding.

Answer 58

Extension

Question 59

The safest position for active lumbar extension is the ______ position. The lumbar area is observed during movement for an increase in ________, which should be evenly distributed.

Answer 59

Sphinx Position Lordosis

Question 60

Only if the patient is able (physically and emotionally), can the patient be ________ to do active lumbar extension, while the therapist stabilizes the ______ and possibly the small of the back.

Answer 60

Standing Pelvis

Question 61

T/F - Active extension of the lumbar spine is initiated by a concentric contraction of the long back extensors and controlled eccentrically by the abdominal muscles.

Answer 61

True

Question 62

With active _________ of the lumbar spine, note any segmental vertebral hypo or hypermobility by looking for any ____________ movements for the above or below segments.

Answer 62

Extension Compensatory

Question 63

Pain with movement during active _________ of the lumbar spine may be caused by: - SI dysfunction - Gluteal or hamstring strain or sprain - Ankylosing spondylitis - Articular derangement in a joint - Abdominal muscle spasm

Answer 63

Extension

Question 64

Pain at the end or limited range during active _________ may be caused by: - Posterior facet joint problem - Osteophyte formation - SI joint dysfunction - Spondylolithesis

Answer 64

Extension

Question 65

Active side bending range is usually ___ to ___ degrees in the lumbar spine.

Answer 65

15 to 20 degrees

Question 66

The safest position for active lumbar side bending is ____ ______. If the patient is capable of ________ for this motion, they may side bend by reaching down the side of their leg attempting to touch their knee.

Answer 66

High Seated Standing

Question 67

T/F - Active side bending of the lumbar spine should be done with some flexion or extension.

Answer 67

False - Active side bending of the lumbar spine should be done WITHOUT ANY flexion or extension.

Question 68

The lumbar spine should have a smooth even curve with active side bending. A sharp bend or angulations may indicate _____________ at that particular segment.

Answer 68

Hypermobility

Question 69

Pain on the side being ____ with active lumbar side bending may be caused by: - Ipsilateral muscles that initiate the movement (e.g. external/internal obliques, quadratus lumborum, transverse abdominus)

Answer 69

Bent

Question 70

Pain on the side bending _________ with active lumbar side bending may be cause by: - Eccentric contraction of muscles used to initiate the movement (e.g. external/internal obliques, quadratus lumborum, transverse abdominus), but on the contralateral side

Answer 70

Stretched