Lumbar Theory (Manual)

Question 1

Describe the etiology of lumbar radiculopathy. List some common causes. List the most commonly affected nerve roots.

Answer 1

Mechanical compression of the nerve root from musculoskeletal factors or inflammatory process in nerve or adjacent structures.

Common causes:
1. Lumbar disc herniation
Others… Paget’s, osteophyte formation or lateral stenotic narrowing, neurological factors (diabetes tumours cysts), meningeal/epidural disorders (infection, lipoma), or buckling of ligamentum flavum

Most common nerve roots L4, L5 and S1

Question 2

List the key testing features in suspected lumbar radiculopathy

Answer 2

1. Myotomal muscle testing
2. Dermatomal sensation testing
3. Deep Tendon Reflexes
4. SLR (neurodynamic)

Question 3

Describe the etiology and nature of spondylosis.

Answer 3

Spondylosis is compromise/fracture of the pars interarticularis in between vertebrae. It is thought to be caused by activities resulting in repeated flex/ext (ie . gymnastics/lacrosse) causing repeated impaction. If bilateral, it can cause forward slip of vertebrae known as spondylolisthesis.

Question 4

What are the types of spondylolysis/spondylolisthesis?

Answer 4

I Dyplastics: congenital malformation/lesion of sacral base of L5 arch causing elongation or separation of pars over time.

II Isthmic: i) lytic, due to pars fatigue fracture ii) elongation is a healed pars fracture that heals in an elongated form iii) acute traumatic pars fracture

III Degenerative: occurs in response to long standing intersegmental instability, flattening of articular processes into horizontal alignment and fracture of pars

IV Traumatic: caused by traumatic vertebral fracture other than pars

V Pathological: Loss of bony integrity as the result of other systemic disease (ex. Paget’s)

Question 5

What objective findings would you expect in the case of suspected spondylolysis/spondylolisthesis?

Answer 5

i) May have flattening of lumbar lordosis
ii) Flexed posture and hip flexor contracture if stenotic
iii) May have claudication, sciatica, neural signs
iv) Palpable step deformity
v) isthmic will likely have pain on ext ROM and may have other limited ROM

Question 6

Outline typical treatment components for spondylolisthesis.

Answer 6

i) repeat flexion exercises may reduce pain
ii) Abdominal strengthening
iii) TA and multifidus segmental training in functional positions
iv) lower extremity mobility and strength

If neural signs persist > 12 weeks, some evidence to show improved outcomes with surgery.

Question 7

Describe the etiology/common causes of lumbar spinal stenosis.

Answer 7

Narrowing of spinal canal, common causes include:

i) lumbar herniation
ii) ligamentum flavum hypertrophy
iii) spondylosis/OA of the spine
iv) thickened lamina/facet joint hypertrophy
v) degenerative spondylolisthesis/scoliosis

Question 8

Outline recommended treatment components for spinal stenosis.

Answer 8

i) stretching into flexion
ii) flexion based cardio (ie cycling)
iii) mobility for hips and spine with exercise
iv) manual therapy to improve mobility in L/sp as well as above and below
v) core strength/segmental stability

Question 9

What the functions of the pelvic floor?

Answer 9

i) support organs
ii) stabilize lumbopelvic
iii) sexual function
iv) sphincter control
v) sump pump for venous return

Question 10

What are the four groupings of pelvic floor muscle dysfunction?

Answer 10

i) loss of strength/endurance
ii) shortenned or lengthened state
iii) poor coordination/timing
iv) overactivity