Lumbar Spine, Sacrum, and Abdomen Flashcards
Describe the anatomy of the lumbar spine.
- 5 lumbar vertebrae
- Discs are like jelly donuts
- Spinal nerves come off each side
How are discs like donuts?
- Annulus fibrosus on outside
- Jelly = nucleus pulposus
Nerves = _____ pain
referred
What are we looking for when asking history for lumbar spine?
- Where they have pain
- When they have pain
- nerve pain will have referred pain
- Need to differentiate between leg injury and back injury etc.
What can we observe in lower back injuries?
- Muscle spasm
- Hard to see any bruising/inflammation
- Bruising will generally only be from a contact injury
What type of movements occur in the lumbar spine?
- flexion
- extension
- side/lateral flexion (tilting to left and right)
- rotation
What is the biggest movement in the lower back?
flexion
What percent of flexion movement occurs in the lumbar spine?
75%
The majority of flexion takes place in which specific places?
Majority of this movement is in very bottom of spine (L5, S1, L4-5)
What part of the spine has the most movement during extension?
Equal amount of movement all the way up lumbar and thoracic vertebrae
What part of the spine has the most movement during side/lateral flexion?
Equal amount of movement all the way up lumbar and thoracic vertebrae
What part of the back has the most movement during rotation?
- Most movement comes from torso
- Very little in low back
What is sciatica?
Inflammation or aggravation of the sciatic nerve
What are the 3 causes of sciatica?
- Can happen because you have a disc injury
- Can happen because you have a muscle (ext. Rotators or glutes) is squeezing sciatic nerve
- Can be a structural abnormality where the nerve runs through their piriformis muscle
What is the most important thing that we do when assessing sciatica?
figure out why they have it
What are the signs and symptoms of sciatica?
- burning pain down the back of leg
- Tingling or numbness
- Muscles by the sciatic nerve can stop working (long term)
Generally, what is the order that symptoms go in from mild to bad?
- pain
- tingling
- numb
Describe the burning pain that people experience when they have sciatica.
- Middle of sacrum to back of leg to knee, splits into 2 different sections
- Can have pain anywhere along sciatic nerve
- The farther it goes, the worse it is
- Can be all the time, or sharp and sudden, depending on their movements
Describe the tingling or numbness that people with sciatica experience.
- Nerves control sensation
- Pins and needles
- Completely numb
How do we manage sciatica?
- Due to disc injury = treat disc
- Due to tight muscle = find it, release muscle
- Due to structural abnormality = relax piriformis
- Rest (Need to make sure rest is helping)
- Usually in pain all the time, typically will rest
What is the special test for sciatica? What does it aim to do?
- slump test
- Increase neural tension in the back of the body
- Stretch out nerves as long as they can
What are the 4 stages of the slump test?
- Stage 1: slump, making spine as long as possible
- Stage 2: extend one leg out forward, stretch out nerves in leg
- Stage 3: flex neck: stretch out nerves in neck
- Stage 4: dorsi flex foot
What is the positive test for the slump test?
- Positive test is NOT tension
- Positive test: burning sensation, tingling, down sciatic nerve
- Wherever there is a burning pain, they should be able to go back a stage and it should go away
Where are the most commonly injured discs? Why?
- bottom of spine
- Between L5-S1
- Between L4-5
- Due to the amount of movement there
What is the MOI of disc injuries?
Most are damaged by flexion, or flexion with a rotation
Most discs are damaged on the ______ surface of the disc. Why is this?
- posterior
- during flexion, we compress front side, stretch back side, centre part of disc can bulge out the back
What is a herniated disc?
- nucleus pulposus leaks, not contained in annulus fibrosus
- leaking pushing back on spine will cause referred pain
What is prolapse?
- pushing out back on the nerve
- will have symptoms that come and go
What is a extruded disc?
- 2 segments, small channel between them
- will have constant symptoms
What is a sequestrated disc?
- no longer contained, leaking down
- will have constant symptoms
What kind of trauma causes disc injuries?
can be caused by micro traumas or 1 big trauma
What is the difference between the symptoms of sciatica and the symptoms of disc injuries?
Same but in disc injuries they can go past their knee into toes
What does coughing and sneezing affect discs?
- increases pressure in discs
- Can be painful
- Can lose feeling in legs
- Often comes with flexion action
How do we manage disc injuries?
- Centralization: try to pull all of symptoms in legs or hip so that they only have pain in back
- Back extension exercises (posture)
- Strong core exercises
Describe back extension exercises for disc injuries.
- Mechanism is flexing forward
- Extension would squish back, pushing all material forward
- Flexion would just push fluid to back, making all symptoms worse
Describe core exercises for disc injuries.
- Lots of spasm in low back, don’t want to move
- Shuts down abdominal muscles
- Core stabilizes everything as you move
- Less spasms
What are the special tests for disc injuries?
Valsalva maneuver
Describe the Valsalva maneuver.
- sneezing/coughing
- Hold breath, push yourself down into seat
- Will not have positive test with anything but disc injury
Describe the straight leg test.
- Patient flat on back
- Passive test
- Raise their leg
- See if they get symptoms and where they get symptoms
What is the positive test for the straight leg test?
- Positive test: pain, burning pain along nerve
- Pain at 30 degrees (pain in hip or back) = inflammation in nerve (sciatic nerve), or disc pushing on a nerve at back
- Pain gets worse, travels down leg at 60 degrees = sciatic nerve
- Anything from 60-90 degrees: very specific pain at SI joint (test for SI joint sprain)
The sacroiliac joint is between the ______ (____) and ______.
- pelvis (ilium)
- sacrum
Describe the sacroiliac joint.
- Not a fused joint
- Has a little bit of movement
- Very important for walking
Describe the ligaments of the sacroiliac joint.
- Ligaments on front and back side (inside abdomen)
- Can sprain one set or both
- 2 SI joints, rare to do both at same time
What is the MOI of a SI joint sprain?
- Feet planted, twisting
- Lying down, leg forcibly twisted across body
What are the signs and symptoms of a SI joint sprain?
- No referred pain
- Local pain to SI joint
- Pain with walking anytime that leg is in contact with ground (planting, walking through)
- Likely try to lean on things to take pressure off if they’re standing
- No visible inflammation
- Muscle spasm in muscles of low back and hip
Spraining posterior ligaments means…
it is easier to point out where
Spraining anterior ligaments means…
deep pain in hip, hard to point out where
How do we manage SI joint sprains?
- Always painful
- Modalities to calm down swelling and muscle spasms
- Generally like to be braced
- SI belt: belt that comes around and push SI joints together
- Will rest
- Longer heal, hard to make joint inactive
What are the special tests for SI joint sprains?
- SI shear test
- SI approximation test
Describe the SI shear test.
- Pushing front of ASIS apart, stresses ligaments on anterior SI joint
- Positive test is pain, will not see laxity
Describe the SI approximation test.
- Pushing ASIS together, stresses ligaments on posterior SI joint
- Positive test is pain at SI joint
What is the organ of concern in the right upper quadrant?
liver
What is the organ of concern in the left upper quadrant?
spleen
What is the organ of concern in the right lower quadrant?
appendix
What is the organ of concern in the left lower quadrant?
nothing
What is the fancy word for getting winded?
blow to the solar plexus
What is the MOI of a blow to the solar plexus?
- Can be blow from any side, but generally happens at front
- Blow is hard enough that it sends diaphragm into spasm
- Not contract/relax = not breathing
What happens during a blow to the solar plexus?
- Contusion to diaphragm
- Diaphragm sits on inside of rib cage, attaches on all sides
What is a complication that can come with a blow to the solar plexus?
rib fractures
How do we find rib fractures?
- Need to make sure whole rib cage has no point tenderness (more than just from the contusion)
- Pain every time you breathe
How do we manage a blow to the solar plexus?
- Can’t do anything to help them
- Can’t breathe for a bit, go unconscious, then diaphragm will relax, then they will breathe
- Comfort them, calm them down, help them relax
What is a hernia?
- Tear in fascia that covers intestines
- Intestine by it will stick through hole
- Creates pressure = pain
What happens with your intestine during activity if you have a hernia?
Intestine gets sucked back in during activity because abdominal muscles are tight
Where do hernias usually happen?
usually closer to pelvis
What happens if the intestine is sticking out for too long?
If intestine is there for too long without normal blood flow, that part of the intestine can die
What are the signs and symptoms of a hernia?
- The longer they have it, the longer they start to feel they have the flu
- Painful in a very specific location
- Local pain
- Can sometimes feel bubble where intestine is sticking out, tender
How do you manage a hernia?
- Day surgery: Push it back in, stitch it back
- Can wait with most
What is the test for the hernia?
- Cough
- Sit up
- Pain in one location
What abdominal muscles can you strain?
- tend to have it more in rectus abdominis
- can also happen in obliques
Describe the 3 grades of abdominal strains.
- Grade 1: stretch, no tearing
- Grade 2: some tearing, very common
- Grade 3: rupture, very rare
What is the MOI of abdominal strains?
- less likely to stretch too far
- Likely in extension position, then forcibly contracting forward
- Ex. volleyball strike, hockey slap shot
What are the signs and symptoms of abdominal strains?
- Bigger area of pain
- Can palpate it feeling very hard where it is painful
How do we manage abdominal strains?
- Abdominal muscles don’t get rest
- Can have constant pain at the site of injury
- Decrease muscle spasm
- Decrease pain
- Longer healing time because of how active the muscle is
- Cross fibre friction
- Limit their ability to do sit ups, crunches etc. for approx. 1 month (can do plank instead)
Describe cross fibre friction.
- Designed to help make the tissue stronger and break up scar tissue
- Break up all tissue that isn’t in line with where we need strength
- Work across fibres - Painful
- 30 seconds, any more would cause body to treat it as another injury
- Very deep pressure going back and forth
How do you test for internal abdomen injuries?
- palpation
- looking for rigidity
Why do we look for rigidity in internal injuries?
- Any injury means all muscles in area will contract to protect
- Muscles will also contract with blood or fluid rushing into area
- Can be specific or in entire area
What do we look for in assessing a strain?
palpation of muscle to feel for pain, or find tender hard area
What do we look for in assessing a hernia?
no spasm, will have bubble feeling when you palpate it, less painful when you push it back in
What do you do if they have a internal organ injury?
- ambulance
- emergency
What do you do if they have a hernia?
- not emergency
- go see family doctor
