Lumbar Spine Part 2

Question 1

decreased lordosis

• lumbar spine arthrokinematics
• why is this important

Answer 1

bilateral upslide

• decreased contact area
• -more force/area (while there is decreased pressure overall at the facet joint, there is decreased contact area so there is more force/area)

Question 2

decreased lordosis

• loading differences on spine
• what structures are affected

Answer 2

more compression

-pressure movign from facets to anterior IVD and vertebral bodies

Question 3

increased lordosis

-lumbar spine arthrokinematics

Answer 3

downslide

Question 4

increased lordosis: position of

• lumbar spine
• pelvis
• hip
• knee

Answer 4

spine
-extension
pelvis
-anterior tilt
hip
-flexion
knee
-flexion or extension

Question 5

increased lordosis

• loading
• affected structures

Answer 5

increased shear (particularly at L5S1)
increased pressure on posterior IVD
compression of interspinous ligaments
reduced diameter of intervertebral foramina
-nerve entrapment

Question 6

importance of lumbar facet downslide with increased lordosis

Answer 6

increase force

will be almost locked out in resting posture

Question 7

effect of prolonged flexion (seated or standing) on dysfunction

Answer 7

adaptive shortening of muscles and connective tissues
increased flexor moment on the spine
increased pressure on anterior aspect of IVD
-may weaken posterior annulus fibrosis over time
impact on the entire kinetic/kinematic chain

Question 8

effect of prolonged hyperextension on dysfunction

Answer 8

compression of facets
increased anterior shear at lumbosacral junction
may lead to development of spondylolisthesis
-anterior ligaments are compromised
effect on kinetic/kinematic chain

Question 9

posterior muscles of the trunk: intermediate later

• what
• function

Answer 9

serratus posterior
little contribution to movement or stability
primarily contribute to ventilation

Question 10

erector spinae

-function

Answer 10

control gross movement across a large part of axial skeleton

generate large extensor moment for lifting/carrying (bilateral)

Question 11

erector spinae group

-can _____ tilt pelvis and _____ lordosis

Answer 11

can anteriorly tilt pelvis and increase lordosis

Question 12

multifidi function

Answer 12

extension torque and stability

-multiple attachments and overlapping fibers

Question 13

transversospinalis functions

Answer 13

bilateral extension

unilateral contralateral rotation, ipsilateral lateral flexion

Question 14

short segmental group

• most prominent in…
• blend with…..
• most important role

Answer 14

most prominent in craniocervical region for control of neck
blend with interspinous ligaments
-intervertebral stabilizers
most important role
-sensory feedback (high density of muscle spindles)

Question 15

anterior rectus sheath

-comes from

Answer 15

internal and external obliques

Question 16

posterior rectus sheath

-comes from

Answer 16

interal oblique and transversus abdominus

Question 17

sheaths thicken and cross at midline to form…

Answer 17

linea alba

Question 18

rectus abdominus

-actions

Answer 18

trunk flexion

posteirior rotation of pelvis

Question 19

internal, external oblique, and transversus abdominus

-function

Answer 19

“hoop” muscles - important stabilizers

Question 20

external oblique actions

Answer 20

bilateral
-trunk flexion, posterior pelvic tilt
unilateral
-lateral flexion, contralateral rotation

Question 21

internal oblique actions

Answer 21

bilateral
-trunk flexion, posterior pelvic tilt
-tensions thoracolumbar fascia
unilateral
-lateral flexion
-ipsilateral rotation

Question 22

transversus abdominus

-function

Answer 22

stabilizes attachment sites for other muscles
compresses abdominal cavity
tension thoracolumbar fascia

Question 23

“additional” muscles of the trunk

Answer 23

psoas major

quadratus lumborum

Question 24

psoas major function

Answer 24

vertically stabilizes the lumbar spine
-line of action close to rotation axes
strong hip flexor

Question 25

QL functions

Answer 25

bilateral -extension unilateral -lateral flexion (open chain - elevates pelvis)

Question 26

sagittal plane muscles (erector, rectus) - orientation - motions

Answer 26

primarily flexion/extension (bilateral) | lateral flexion depends on moment arm from midline

Question 27

frontal plane movers - what muscles - vertical force component gives - horizontal force component gives

Answer 27

``` any muscle with oblique orientation vertical force -lateral flexion horizontal force -transverse rotation ```

Question 28

transverse plane | -what muscles

Answer 28

multifidus | external oblique

Question 29

extrinsic stabilizers of the trunk - what are they - what do they do

Answer 29

attach to structures outside the vertebral column | global stability

Question 30

what muscles are extrinsic?

Answer 30

``` abs erector spinae hip muscle QL psoas lat scapular muscles ```

Question 31

intrinsic stabilizers - what are they - what do they do

Answer 31

segmental stability | short, deep muscles that attach to structures within spinal column

Question 32

what muscles

Answer 32

``` transversospinalis -semispinalis -multifidi -rotatores short segmental group -interspinalis -intertransversarii ```

Question 33

"general" versus "specific" stabilization

Answer 33

better short-term outcomes with "specific (ultrasound feedback) motor control exercises but no differences long term specific stabilization exercises effective for chronic but not acute LBP individually designed, higher intensity programs may be most beneficial

Question 34

TrA - theory - selectively activate through...

Answer 34

theory -a primary specific stabilizer for lumbar spine --based on findings that TrA function impaired in people with LBP selectively activate through "drawing in maneuver"

Question 35

drawing in maneuver | -function

Answer 35

increases intra-abdominal puressure and tension thoracolumbar fascia without moving lumbar spine

Question 36

how to teach drawing in maneuver

Answer 36

use biofeedback - EMG or pressure

Question 37

TrA: pressure biofeedback | -diagnostic accuracy

Answer 37

no correlation bewteen pressure biofeedback and TrA activation on ultrasound no difference in TrA activation between those who were and were not able to perform exercise successfully (no change in pressure)

Question 38

implications for pressure biofeedback

Answer 38

success with pressure biofeedback has been associated with improved outcomes -pressure biofeedback is good, but it doesn't necessarily mean they have learned how to use their TrA

Question 39

TrA take-home messages

Answer 39

muscles do not work in isolation -there is more to it than TrA alone focus on perfect performance of the desired movement/task -atypical compensations should become apparent likely using a combination of global and segmental stabilizing muscles always return to foundation principles, function anatomy, motor control