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Biomechanics - Spine > Lumbopelvic_Sacrum > Flashcards

Lumbopelvic_Sacrum Flashcards

1
Q

Describe the primary function of the pelvis:

A
  • bear weight
  • transfer loads from axial skeleton to appendicular skeleton
  • stable, limited mobility -> more efficient transfer of loads
  • serves as strong attachment point for muscles
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2
Q

Describe the gender differences in Pelvic Structures:

A

Male Pelvis:

  • Prominent bony features
  • Narrow, heart shaped pelvic inlet
  • Narrow distance between ASIS and Ischial tuberosities
  • Laterally facing acetabulum
  • Narrow pubic arch (70 degrees

Female Pelvis:

  • less prominent bony features
  • wide, oval pelvic inlet
  • wide distance between ASIS and Ischial Tuberosities
  • Anteriorly facing acetabulum
  • Wide pubic arch (100 degrees)
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3
Q

Describe the implications of Gender differences of the pelvis:

A
  • different mechanics in gait (acetabulum orientation)
  • smaller base of support for males in sitting
  • Different moment arm, length-tension relationships for musculature
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4
Q

The pelvis is an attachment location for external and internal rotators of the thigh, name:

A
  • Glut max
  • Glut medius
  • Glut minimus
  • Piriformis
  • Obturator internus & externus
  • quadratus femori
  • Inferior gemellus
  • superior gemellus
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5
Q

What do the muscle attachments of the pelvis have a large influence on?

A
  • the trunk, hip, and knee
  • transmission of loads
  • position influences length/tension relationships of muscles
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6
Q

What are the primary muscles for right unilateral stance?

A
  • right hip abductors (gluteus medium) = acting on the pelvis to pull into right lateral tilt
  • left lumbar erector spine = acting on pelvis to pull into right lateral tilt
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7
Q

Describe the Lumbopelvic rhythm:

A
  • coupled motion between pelvis and lumbar spine
  • can increase overall trunk motion for function
  • “ipsi-directional”
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8
Q

Describe the reason for the McClure study looking at the kinematic analysis of lumbar and hip motion while rising form a forward flexed position in patients with and without a history of LBP:

A
  • to determine amount and pattern of lumbar and hip motion when returning to stand form lumbar flexion
  • to determine if different between LBP/healthy
  • to investigate relationship with hamstring length
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9
Q

Describe the methods of the McClure study:

A
  • calculated lumbar angle to hip angle ratios during each 25% of extension phase
  • clinical assessment of hamstring length (passive straight leg raise and active knee extension)
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10
Q

Describe the Conclusions drawn from the McClure study:

A
  • the hip dominates during early phase
  • lumbar spine increases during middle phase
  • Lumbar spine is primary during final phase
  • LBP patients moved earlier from the lumbar spine early on (1st 25% of movement)
  • LBP patients had tighter hamstrings - no correlation with LP Rhythm
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11
Q

Describe the contributions during forward flexion:

A
  • lumbar angle/hip angle ratios during forward bending: 0-30 degrees = 1.9, 30-60 degrees = .9, 60-90 degrees = .4
  • lumbar spine dominates early flexion
  • hip dominates late flexion
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12
Q

Describe muscle recruitment strategies during lumbopelvic rhythm:

A
  • typical extensor recruitment strategy is caudal to cephalic in healthy people
  • purpose: investigate differences in extensor muscle recruitment during return to stand from lumbar flexion in people who develop LBP during standing (PD) compared to people who do not (NPD).
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13
Q

What did the results of the Nelson-Wong study show about muscle recruitment strategies during return from flexion:

A
  • NPD/PD demonstrated opposite recruitment strategies (bottom-up vs. Top-down
  • evidence for altered movement prior to pain development
  • potential for altered loading at the vertebral joint level with early activation of LES
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14
Q

How do you assess Dynamic Postures and Movements of the Lumbopelvic-sacral rhythm?

A
  • Quantity = ROM in all planes
  • Quality and Willingness to move = Aberrant Movement Patterns (sagittal plane): - lumboplevis rhythm, Gower’s sign, Instability Catch
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15
Q

Describe how to assess Reversal of Lumbopelvic Rhythm:

A
  • patient is asked to bend forward as far as they can (standing flexion) and return to upright posture
  • therapist observes relative timing and sequencing of trunk/pelvis motion
  • Typical = Trunk moves first in flexion, last in Extension (pelvis moves last in flexion, first in extension)
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16
Q

Describe the Gower Sign:

A
  • “thigh climbing”
  • Patient asked to bend forward as far as they can (standing flexion) and then return to upright
  • Sign is POSITIVE if they must use their hands on their thighs to assist with return to standing position
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17
Q

describe how to assess the Instability Catch Sign:

A
  • patient asked to bend forward as far as they can (standing flexion) and then return to standing
  • sign is positive if they cannot return to erect posture due to sudden painful “catch” in their low back
  • thought to indicate “spinal instability”
18
Q

Describe the interrupter reliability of the Reversal of Lumbopelvic rhythm, Gower sign, Instability Catch, and Aberrant Movement Patterns in General:

A
  • Reversal of Lumbopelvic Rhthym = k = .16 (-.15 - .46)
  • Gower Sign = 98% agreement b/w clinicians
  • Instability Catch = k = .25(-.10 - .60)
  • Aberrant Mvmnt Patterns = K = .60 (.47 - .73)
19
Q

Describe the Osteology of the Sacrum:

A
  • triangular shaped wedged b/w two halves of the pelvis
  • sacral base (sacral promontory) formed by the 1st sacral vertebra: 2 articular facets that face POSTERIORLY, and facets articulate with the inferior facets of the 5th lumbar vertebra (toward cephalic is base)
  • Sacral apex formed by the 5th sacral vertebra: articulates with the coccyx (toward caudal is apex)
  • Lateral region the sacrum (also called “ala”): Ear-shaped articular surface, Articulates with the ilium
20
Q

Describe the Sacroiliac Joint:

A

Rigid articulation - boomerang shape:

  • Auricular surface of the sacrum (lateral region)
  • Auricular surface of the ilium
21
Q

Why is the Sacroiliac Joint a Controversial Joint?

A
  • amount of motion

- making an accurate diagnosis is difficult

22
Q

What is the function of the Sacroiliac Joint?

A
  • weight bearing joint
  • relieve stress (pelvis region)
  • load transfer
  • stability
23
Q

Name the primary ligaments that stabilize the SI Joint:

A
  • Anterior Sacroiliac Lig
  • Iliolumbar ligament
  • Interosseous Lig
  • Posterior Sacroiliac Ligament
24
Q

Name and Describe the Secondary ligaments of the sacroiliac joint:

**add more!!

A
  • Sacrotuberous ligament = goes from the PSIS down to the sacrum and ischial tuberosity
  • sacrospinous ligament = goes from the sacrum to the ischial spine
25
Q

Describe Kinematics of the SI Joint:

A
  • Motion at the SI joint is poorly defined: research findings reveal difficulty in measuring; ~1-4 degrees of rotation & ~ 1-2 mm of translation
  • Two terms used to describe rotational and translational movements at the SI joint: 1) Nutation, 2) Counternutation
26
Q

Describe Nutation:

A
  • “forward Nod” of the sacrum
  • Sacrum moves relative to innominate
  • Base moves anteriorly/inferiorly
  • Apex moves posteriorly/superiorly
  • innominate moves in opposite motion: relative posterior pelvic tilt

this is close pack position

27
Q

Describe counternutation:

A
  • “Backward Nod of Sacrum”
  • movement of the sacrum relative to the innominate
  • base moves posteriorly/superiorly
  • apex moves anteriorly
  • Innominate moves in opposite motion: relative anterior pelvic tilt

open pack position

28
Q

In bilateral hip extension, describe the direction the sacrum will move relative to the innominate bones:

A

The sacrum will be Nodding backward (“Counternutation”): - base moves posteriorly/superioly & apex moves Anteriorly, - while the pelvis tilts anteriorly

29
Q

Why are kinematics of the SI joint important?

A
  • Nutation and counternutation illustrate small movements that occur at the SI joint.
  • Movements provide “stress relief” within the pelvis = Important for functional activities such as walking, running, childbirth
  • Nutation at the SI joints increase congruence b/w the joint surfaces: 1) increased articular stability (joint surfaces), 2) optimizes transference of load, 3) ligaments (sacrotuberous and interosseous) get support from the muscles
30
Q

Describe Nutation Torque:

Add more!!!

A
  • Have stabilizing effects due to gravity, stretched ligaments, and active muscle force

-

31
Q

Describe the relative motion between:

  • Lumbar spine and pelvis
  • Sacrum and pelvis:
  • Sacrum and Lumbar Spine
A
  • Lumbar spine and pelvis:
  • Sacrum and pelvis:
  • Sacrum and Lumbar Spine:
32
Q

What are the 3 subsystems of Biomechanics Stability ?

A
  • passive subsystem
  • active subsystem
  • neural control subsystem
33
Q

Describe the Biomechanics Spinal Instability:

A
  • “abnormally large intervertebral motions”
  • Causes: 1)______ to the passive subsystem, 2 _______ of the active subsystem, 3) ________ in the neural subsystem
  • Quantified by “neutral zone”: a region around the natural position where motion is produced with minimal internal resistance
34
Q

Define Clinical Spinal Instability:

A
  • “a decrease in the capacity of the stabilizing system of the spine to maintain the intervertebral neutral zones within the physiological limits so that there is no neurological dysfunction, no major deformity, and no incapacitating pain”
  • Hypothesis: Netural Zone size, passive and active spinal function are inter-related: size of neutral zone increases with inadequate muscle force or damage to passive structures
35
Q

What are some problems with the definition of Clincal Spinal Instability?

**ADD MORE

A
  • neutral zone can only be measured in vitro

- interventions based on spinal “instability”

36
Q

Describe Passive Subsystem Instability;

A
  • Vertebrae, IVDs, joint capsule, passive component of muscle
  • Patient would present deficit with ________
  • Tests & measures to isolate =
37
Q

Describe Active Subsystem Instability

A
  • muscles and tendons
  • Patient would present deficit with ________
  • Tests & measures to isolate =
38
Q

Describe the Neural Control Subsystem Instability:

A
  • feedback systems from mechanoreceptors and neural control centers
  • Patient would present deficit with ________
  • Tests & measures to isolate =
39
Q

Describe Instability as a Clinical Term/Diagnosis:

A
  • a vague descriptor
  • cannot measure/quantify in vivo
  • might make patients fearful (words matter)
  • DOES NOT serve to guide interventions
40
Q

Name the muscular extrinsic (global) stabilizers of the trunk:

A
  • long muscles attach to structures outside the vertebral column
  • all of the abdominals
  • erector spinae
  • Hip muscles
  • QL
  • Psoas
  • Lat. Dorsi
  • Scapular muscles
41
Q

Name the muscular intrinsic (segmental) stabilizers of the trunk:

A
  • short, deep muscles that attach to structures within spinal column:
    1) Transversospinal group: Semispinalis, multifidi, rotatores
    2) Short segmental group: Interspinalis, Intertransversarii

Biomechanics - Spine (2 decks)

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