Lumbosacral Spine Flashcards
(Static/Dynamic) posture is how you hold yourself when you are not moving, like when you are sitting, standing, or sleeping.
Static
(Static/Dynamic) posture is how you hold yourself when you are moving, like when you are walking, running, or bending over to pick up something.
Dynamic
Good posture is defined as an optimal alignment and what that means is that one person’s optimal might not be someone else’s optimal. Overall, good posture (is/ is not) expending a lot of energy to be in said position.
is not
Static and Dynamic Posture are dependent upon the CNS, visual system, vestibular system, & NMS system
Got it
You want to keep your center of mass (COM) (within/outside) your base of support (BOS).
within
A lot of the GAIT devices or assisted devices such as walkers, canes, etc.. The idea behind those devices is to (increase/decrease) the BOS. If you have a walker out in front of you with 4 legs and you have your own 2 legs, now your BOS has just multiplied by that whole area. So your COM has more of an ability to be within that area. So if you took the walker away from the person who is leaning forward on their walker, they would tip over and fall. So we ideally like when our COM is within our BOS.
increase
The COM in the human body is just anterior to S_.
2
If you stand up and put your two feet together you will feel your ankles doing small little minor adjustments and you’ll kind of feel a little bit of a wobble back and forth which are corrections that your CNS is helping with in order to keep you on balance. This is called _____ . They are generally smaller oscillations, around 7 mm in direction.
postural sway
To (narrow/widen) someone’s BOS you can put someone in a tandem stance which puts your COM right over both feet because they are in a line and now that persons’s postural sway is going to be a little bit bigger.
narrow
The center of pressure is what you feel on the bottoms of your feet. So if you are standing up and you slowly start to move your COM forward, I now have my center of pressure going through the front of my foot, my toes and you will feel your calves turn on. One of the reasons your calf muscle turns on is because of this idea of GRF and the line of gravity (LOG). When the LOG goes through the axis of rotation (AOR) there (is/ is no) motion happening at that joint. When the LOG does not go through the AOR there will be (motion/ no motion) unless something within your body (internal force) counteracts that movement. So when you were up on your toe and leaning forward, the LOG was moving anterior to the ankle joint and your ankle was experiencing a dorsiflexion moment and because it was experiencing a dorsiflexion moment your calf muscles (plantar flexors) turned on to prevent you from falling down.
is no; motion
The LOG always gets drawn through the (AOR/COM).
COM
If you are looking at a joint and the LOG moves in a particular direction, the (proximal/distal) segment is going to move towards the LOG causing the more (proximal/distal) segment to move in the opposite direction.
proximal; distal
If I took the COM from just anterior to S2 and moved it anteriorly, now the LOG is shifting anterior to the knee joint. The proximal segment of the knee (the femur) is going to move (towards/away from) the LOG. So if the femur falls forward/anterior towards the LOG the knee joint will move (anteriorly/posteriorly) into extension.
towards; posteriorly
If we move the LOG further and further anterior then what happens is, the femur is going to roll anteriorly and now the posterior structures will be put on (slack/tension).
tension
The closer you are to the AOR there is (less/more) torque because the moment arm is small. As you shift the weight really far forward or away from the AOR the LOG goes further and further from the AOR so the moment arm is (smaller/bigger).
less; bigger
When the LOG moves anterior to the knee joint a torque is generated because the external force is creating a torque and the internal torque will resist it (the hamstring muscle). The hamstring muscle is going to try to flex the knee and contract to try and override the external torque.
Got it
The thing that keeps you from moving really far forward or backwards during postural sway is that your muscles are operating with your (CNS/PNS) in order to make those small adjustments. So they are constantly turning on and off and working as a team. If your muscle is not working for whatever reason then the (active/passive) subsystem is having to work a lot harder. The (active/passive) subsystem experiences things like CREEP, plastic deformation, the critical zone, etc. So those tissues could theoretically (with long term abnormal postures) become less and less competent.
CNS; passive; passive
If the external auditory meatus is anterior to the flexion/extension axis the torque is being created by a (flexion/extension) torque and it is going to be controlled by the upper cervical spine (flexors/extensors).
flexion; extensors
Kendall (1952) thought that the LOG moves right through the vertebral bodies in the cervical and lumbar spine and it is anterior to the thoracic bodies. The torque created in the cervical and lumbar spine would be (flexion/none) and in the thoracic spine it would be (flexion/none).
If there is thoracic flexion and that is the only torque generated, the thoracic (flexors/extensors) would be controlling against that torque.
none; flexion; extensors
The line of gravity is slightly (anterior/posterior) to the medial-lateral axis at the SI joint. As it is (anterior/posterior) to the SI joint the torque created is something called ____ . This is the idea that once gravity is loaded on your spine it causes your sacrum to tilt forward because of the weight that is being placed on it. The torque is controlled by the ____ and the ____ ligaments.
anterior; anterior; nutation; sacrotuberous and the sacrospinous
As we continue to move inferior in the body, the LOG will be (anterior/posterior) to the greater trochanter of the femur. The greater trochanter is just (anterior/posterior) to the medial-lateral axis of the hip. Since the proximal segment moves towards the LOG, the torque that is created at the hip joint will fall towards (flexion/extension). The torque will be controlled by the ____ ligament. It is a very thick ligament that sits in front of the hip that when you lean backwards gets taught and prevents too much extension at the hip joint.
posterior; posterior; extension; iliofemoral
At the knee, the LOG is (anterior/posterior) to the patella. This will create an (flexion/extension) torque and this (flexion/extension) is controlled by the ____ ligaments and the ____ posteriorly.
posterior; extension; extension; cruciate; joint capsule
The LOG is (anterior/posterior) to the lateral malleolus which is (anterior/posterior) to the M/L axis of the ankle. The torque that is created will be (dorsiflexion/plantarflexion) and this will be controlled by the (dorsiflexor / plantar flexor) muscles.
anterior; anterior; dorsiflexion; plantar flexors
Forward head/Forward shoulders – excessive (protraction/retraction)
protraction
(Anterior/Posterior) pelvic tilt – If you have your hand on your iliac crest and you go forward (imagine pouring water out of the front of the bowl). If you go far enough you will feel a really tight sensation in your lower back.
Anterior
(Anterior/Posterior) pelvic tilt – A movement in which the front of the pelvis rises and the back of the pelvis drops.
Posterior
Forward/Backward translation of the pelvis – You have your pelvis translating too far forward or backward so that COM is moving too far forward or backwards.
Got it
Genu recurvatum – Excessive (flexion/extension) of the knee in a resting state that puts a lot of strain on the (anterior/posterior) capsule.
extension; posterior
We know that the body is a kinetic chain. If you change one thing at one location and it effects a lot of different areas. If there is an excessive lumbar lordosis, as a result there will be an (anterior/posterior) pelvic tilt and because you have that pelvic tilt and the LOG is now shifting forward, now your knee gets driven into genu recurvatum. And because of that now your head also gets moved forward into a forward head posture. So one small change with that pelvic tilt can change a lot about your posture at a lot of different points.
anterior
If you have an overly flexed hip or a hip flexion contracture it changes the LOG significantly and that makes all of these external torques bigger and it makes the individual have to work really hard through the (anterior/posterior) chain. All of the (anterior/posterior) muscles on the back of the leg and all the way up to the glutes have to work to overcome the external torque. If you are standing upright, all of those muscles don’t have to work as hard.
posterior; posterior
Look for symmetry on a lot of the easy landmarks to spot. Do their shoulders line up evenly, do their iliac crests line up evenly, are their greater trochanters even, what about their popliteal lines? Are they even?
Got it
The LOG should fall through the (middle/side) of your vertebral body in quiet standing.
middle
Scoliosis is characterized by abnormal curvatures in all three planes, but most notably in the ___ and ____ plane.
frontal and horizontal
In scoliosis in the frontal and horizontal plane, there is going to be some disruption in the alignment. Think of lateral flexion and rotation.
Got it
Scoliosis mostly affects the ____ spine the most, but sometimes it does go to other regions including the lumbar spine.
thoracic
Non-structural/non-fixed/functional OR structural/fixed scoliosis – it is accommodating for something. Someone might have a functional scoliosis that could be due to posture reasons. So if I have my computer monitor set to the right and I am rotated to the right for 8 hours a day, that could be an example. If I shifted my posture I could potentially get rid of that scoliosis.
Non-structural/non-fixed/functional
Leg length discrepancy would change the level of the pelvis and the body would accommodate with a curve in order to shift the posture and would be an example of (non-structural/structural) scoliosis because it is at the spine level. So the leg could physically be longer and that drives you to now have a scoliosis, but as soon as I put a heel lift on the other side then the scoliosis is gone.
non-structural
(Non-structural/Structural) scoliosis is idiopathic, meaning they can’t figure out a reason for it, it just kind of happens. As you are growing your spine grows into this curve and it is fixed. This is a bony deformity.
Structural
(20%/80%) of all structural scoliosis is termed idiopathic, there is no real reason or biological or apparent cause for it.
80%
(80%/20%) of all structural scoliosis is caused by neuromuscular pathology, trauma, or congenital abnormalities (muscular dystrophy, cerebral palsy, etc). Think of the really bad neuromuscular diseases where you are creating spasticity throughout your muscles and joints and you aren’t moving around as normally as your peers. That can lead to the formation of a scoliosis.
20%
We describe scoliosis by the location, direction, and number of (sagittal/frontal) plane curves.
frontal
The direction of the primary lateral curve is defined by the side of convexity of the lateral deformity and the location is based on where the apex of the curve is located. A right thoracic curve would have the apex of the spine located in the (lumbar/thoracic) spine and the convexity would be towards the (right/left) side of the individual’s body.
thoracic; right
(Single/double) curves in scoliosis are more common and what you will usually see compared to (single/double) curves.
single; double
A single curve in scoliosis is sometimes termed a (C/S) curve and a double curve would be termed an (C/S) curve.
C; S
In imaging, the superimposition of bones is really hard to tell what direction you are going in. In imaging, there is usually an indicator that the Xray Tech puts on the films to orient yourself on the direction.
Got it
If there is a rotation through your thoracic spine there is going to be what is called a rib hump that is present. If a vertebrae was rotated, one side would have more of a prominent rib protrusion. The presence of a rib hump is typically on the (concave/convex) side of the spine. You can identify scoliosis with a straight edge ruler by using the bend over rib hump check which is a little easier than seeing if the spine is a little curved.
convex
Scoliosis during the growing years when you hit a growth spurt can get a lot worse pretty quickly so the goal would be to identify it early.
Got it
Look at the WHOLE body to identify any discrepancies in posture. If you only look at one location you might miss the bigger picture when looking at asymmetries because there can be a lot of root causes for it.
Got it
A (valgus/varus) force is when the distal segment is directed laterally away from the bodies midline.
valgus
A (valgus/varus) force is when the distal segment is directed medially towards the bodies midline.
varus
Genu (valgum/varum)- the lower extremities turn inward, causing the appearance of the knees to be touching while the ankles remain apart (knock knees).
valgum
Genu (valgum/varum) - a condition in which the knees stay apart even when standing with feet and ankles together, also known as bowlegs.
varum
Pes (cavus/planus) - A condition in which the entire sole of the foot touches the floor when standing (flat feet).
planus
Pes (planus/cavus) – A descriptive term for a foot morphology characterized by high arch of the foot that does not flatten with weightbearing. The arch does not pronate or fall to the ground, the arch is very rigid, very stiff, and not a lot of pliability.
cavus
In an anterior pelvic tilt the lordosis (increases/decreases).
increases
In a posterior pelvic tilt the lordosis (increases/decreases).
decreases
Between the passive, active, and neural control subsystem, when one system fails, because of the interdependence between all three systems you (can/can’t) get a decent amount of compensation up to a certain point from the other subsystems.
can
The curves in our spine are there to help with shock absorption. Due to the curves and the vertebrae being slightly off center it allows there to be a dampening effect. Imagine jumping off of a height and landing with your knees completely straight. Think of the feeling you would get from that versus jumping off of a height and landing and your knees are able to bend and flex. There would be a lot (more/less) shock felt through the joint, bones, and passive structures in the latter.
less
The forces impacting the spine are the (strongest/weakest) at the junctions and it is usually due to the change in the facet orientation.
strongest
The junctions between the curves is the area where (most/least) of the forces occur. Examples of junctions are C7-T1, T12-L1, L5-S1, etc. At these transition zones there is an area of relatively high levels of stress. At T12-L1 there is a very abrupt transition from the frontal plane to almost nearly the sagittal plane. Because of that transition, the T12-L1 transition area is also susceptible to a higher incidence of traumatic paraplegia. If someone were to experience a heavy load from a traumatic injury the load is transferred to that area, so this is a very typical area where someone can have a spinal cord injury. The thoracic articulation with the ribs and their articulation with the thoracic spine help stiffen things up, so once you get down to the L1 level there’s a lot less stiffness. So all of those things are at play into the TL junction becoming an area of high stress at T12-L1.
most
In L5-S1 we transition back to the (sagittal/frontal) plane.
frontal
When there is a lumbarization that means S1 behaves more like a (sacral/lumbar) vertebrae and it is not fused. It is just a normal anatomic variant.
lumbar
When there is a sacralization at the L5-S1 junction, L5 (fuses to/separates from) S1
fuses to
The thoracolumbar fascia can’t make a contraction itself but it is taking fibers from all of these muscle groups and connects them along certain planes so they can work together. Because the thoracolumbar fascia is a generalized attachment point it has the ability to where we make certain muscles contract, that fascia acts like a coarsest around the spine. It tightens and it acts as a stabilizer. So in a way it’s almost like the active and passive subsystem are working together. The muscle system is able to act on part of the passive subsystem and work together to tighten up the area around the spine to create (mobility/stability).
stability
The sacrum has an anterior-inferior slope (lumbosacral angle/sacrohorizontal angle) of about 30-40 degrees and it is tilted (uphill/downhill). The downhill slope makes L5 kind of like the car that is parked downhill, so it has to have its’ brakes on all of the time in order to stop from sliding down. That is the reason why L5-S1 has those brakes, it is the reason why it has that facet orientation. It keeps it from sliding downhill.
downhill
An anterior pelvic tilt would make the lumbosacral angle more downhill and that would (increase/decrease) the load of the facet joints between L5-S1 because they would have to work harder to prevent it from sliding downhill.
increase
A posterior pelvic tilt would level out the downhill slope at L5-S1, it would allow the facet joints to work a little (more/less) hard, and there would be less pressure on them.
less
If I anteriorly pelvic tilt, the L5 vertebrae is now (increasing/decreasing) the forces across the facet joint interaction. The lumbar lordosis would increase which means it is increasing extension.
increasing
The forces at L5-S1 is most of the body weight above the junction. So all of this body weight transitions down to L5-S1, which is why it has the biggest vertebrae, which is why it has the biggest intervertebral disk, which is why it has those very big facet joints, it keeps everything center. The body weight is going to increase the force of L5-S1 kind of sliding down the hill and this force is a (shear/tension) force.
shear
The larger the angle, the larger the anterior pelvic tilt, the (smaller/larger) the shear force.
larger
As you continue to (flex/extend) your spine you are going to get a reversal of the natural lordosis.
flex
The (higher/lower) end of the lumbar spine is typically fixed by the SI joint.
lower
Resistance to motion during lumbar flexion will be due to the lumbar (flexors/extensors) and the posterior ligaments such as the PLL.
extensors
At the facet joints, what resists flexion would be the ____. When you flex forward the facet joints move to an open position. So the capsules as the facet joints open up are going to provide a little bit of resistance. The capsule surrounds the facet joint so as those two bones get pulled apart in lumbar flexion the capsule has to accommodate to that.
capsules
As you go into lumbar flexion, the disk is going to provide some level of resistance
Got it
Bone (does/does not) stop you going forward into lumbar flexion, it is all soft tissue that will prevent you from flexing.
does not
As you flex forward the spinal canal (closes/opens) up a little bit more.
opens
In (flexion/extension) of the lumbar spine, the annulus bulges anteriorly and the nucleus pulposus bulges posteriorly. In a healthy spine the posterior migration of the nucleus pulposus is minimal. If the disk starts to become compromised then the disk material can shift further and further out until sometimes it can bulge into the canal.
flexion
In lumbar extension you are going to (increase/decrease) the natural lordosis.
increase
In a healthy state as you are extending, the load bearing is mostly on the (disk/capsule) material in a neutral posture. In an unhealthy state, the disk won’t be able to take on as much load and the load would fall on the facet joints.
disk
The resistance to motion in lumbar extension will come from the disk and the (anterior/posterior) longitudinal ligament.
anterior
During lumbar (flexion/extension) the disk bulges posteriorly and the nucleus pulposus migrates anteriorly.
extension
Lumbar rotation in the lumbar spine is (minimal/maximal), approximately 5 degrees. The resistance to rotation is bone on bone contact.
minimal
The resistance to motion in lateral flexion is from the capsule, the disk, and the ligaments.
Got it
If I laterally flex to the left, the capsule on the (right/left) will be giving me resistance.
right
If I laterally flex to the left, the ligaments on the (right/left) will be giving me resistance.
right
The right side intertransversii ligaments will resist lateral flexion to the (right/left).
left
If I laterally flex to the left, the intervertebral foramen on the left is going to (close down/open up).
close down
If I laterally flex to the left, the annulus will bulge to the (right/left), and the nucleus pulposus will migrate to the (right/left).
left; right
Accessory motion – Passive motion that can glide A-P (anterior-posterior), superior-inferior, laterally, etc. The motions that the patient does not experience on their own, but it is coming from an outside force.
Got it
If the therapist had their hands on L5-S1 and was trying to work in this area there would not be a whole lot of motion in this area because the ____ would resist that motion.
facet joints
If you put a P-A (posterior-anterior) force on one side of the spine you would cause a (tension force/rotational force) at the spine.
rotational force
Max (closing/opening) – things like flexing, sidebending to the opposite side
opening
Max (opening/closing) – things like extension, sidebending to the same side
closing
If a therapist notices a patient does not have any limitations in max closing tests, but has limitations in max opening tests, the therapist will start to think that they have problems (opening up/closing up) that facet joint and will think that the joint on the side that the patient has limitations in is compressed limiting the motion.
opening up
For the patient that does not have any limitations in max closing tests, but has limitations in max opening tests, joint mobilizations and self stretching techniques in the direction limitation would be the prescription. If you put the patient in lumbar (flexion/extension) this should help maintain any gains you have made from mobilization or manual therapy.
flexion
Joint ___ - Getting the joint to arthrokinematically move a little better. Restricted segments centrally and unilaterally.
mobilizations
Lumbar (flexion/extension) is an anterior and superior slide.
flexion
Lumbar (flexion/extension) is a posterior and inferior glide.
extension
If the lumbar spine tries to rotate to the right, the (right/left) articular facet will come under compression and limit this motion.
left
In left lateral flexion, the right articular facet is going to slide in a (supero-lateral/infero-medial) direction and the left articular facet is going to slide in a (supero-lateral/infero-medial) direction.
supero-lateral; infero-medial
It’s the fibers from the external oblique that are coming with the internal oblique that create almost like a train of muscle fibers where they work together to pull. So it’s the right external oblique working with the (right/left) internal oblique to pull my right shoulder to towards my pelvis on that side.
left
Out of the external oblique, internal oblique, and the transverse abdominis, what muscle(s) does not have the ability to move the lumbar spine?
The transverse abdominis
When the (internal oblique/transverse abdominis) contracts it is pulling on the thoracolumbar fascia which is posterior. So it’s almost like creating a cylindrical effect where they just wrap around and stabilize everything. They don’t have the potential to flex or extend the spine, it’s just tightening around the spine.
transverse abdominis
So overall, the (internal oblique/transverse abdominis) has no flexion force, its’ primary role is to increase the intra abdominal pressure for functions such as coughing
transverse abdominis
The (internal oblique/transverse abdominis) plays a major role in the theory surrounding low back stability
transverse abdominis
The (erector spinae group/transversospinalis group) unilaterally, laterally flex the vertebral column and bilaterally they extend the head and vertebral column and as the back is flexed they help control movement by gradually lengthening the fibers.
erector spinae group
Acting eccentrically, the erector spinae group controls (flexion/extension) of the spine.
flexion
When you stand up and you flex forward, even though you are going into lumbar flexion you’re not using your lumbar flexors, it is actually eccentric activation of the lumbar (flexors/extensors).
extensors
Because of their vertical orientation, the main function of the (erector spinae group/transversospinalis group) is to stabilize the spine, contract, and make sure that their segments do not translate on themselves.
transversospinalis
The quadratus lumborum extends and laterally flexes the vertebral column. If it is tight, it also has the ability to (elevate/depress) the pelvis which could make a patient appear that they have a hip hike.
elevate
If none of the muscles existed in the lumbar spine and you put a weight on top of a dissected spine, the whole spine would collapse over and have no stability.
The ligaments are constructed in a way, in order to allow for a lot of range of motion, but not restrict movement all that much. So now you require all of these complex and coordinated interactions in order to stabilize these segments. I can bend down and pick up a load of laundry no problem because the segments are able to move, flex, and extend over the segment underneath, it’s not a rigid cylinder. Likewise we need some help and stabilization and that comes through the (active/passive) subsystem. If there is a problem within the active subsystem, the spine and its’ stability will not be working as well on one side and now the compression is causing segmental instability. If it was working better and tugging on the spine in a coordinated effort along with the other muscle groups it would be much more stable.
active
If you are comparing the rectus abdominis and transversus abdominis on a scale, the rectus abdominis would lean more to the (strength side/the stabilization side), while the transversus abdominis is the opposite.
strength side
Generally speaking, if someone were to have back pain, the overall thought process is that we are going to target the core stabilization muscles in the (early/late) phase.
Studies show that people who have lumbar spine pain for a long period of time lose control of these kind of smaller stabilization muscles so they’re not available to turn on quickly and respond to things like a deadlift, or a back squat, or picking up an object off of the floor. So now the prime movers are working without the stabilization effect and now you get pain.
early
If someone’s having trouble turning on their stabilization muscles you’re not going to want to put them in a gravity (minimized/maximized) position, you’re going to want to put them in a gravity (minimized/maximized) position.
minimized; maximized
In a phased stabilization program, exercises have to be done correctly with the correct muscle activation to get the therapeutic benefits. The spine has to be controlled (lumbar spine isn’t going into flexion or extension, transverse abdominis is engaged, etc).
Got it
If you go too far into hip extension, all of a sudden it is not the hip anymore that is moving. It is the ___ that is moving into anterior pelvic tilt which extends the spine which increases lordosis. In a patient who is doing the bird dog, maybe they shouldn’t try to lift their hip up so high and they need to adjust the exercise.
pelvis
A side plank without the leg fully extended is a lot easier than a side plank with the legs fully extended because you are (increasing/decreasing) the external moment arm. In a side plank without the legs fully extended you are only dealing with the body weight from the knees up as the external moment is bringing the pelvis and body down to the ground, so the core muscles do not have to work as hard.
decreasing
Phase 3 examples are what we would call dynamic stability. It is when the patient is on an unstable surface. We want everyone to be able to get to that point because this is how life occurs. We want the core to be able to stabilize in uncertain environments (Ex- balance ball exercises)
Got it
If someone can’t stand up straight due to pain and they kind of have a hunched back, being in a position that (increases/decreases) their lordosis will be painful for them. Forcing the patient into extension right away to fix their problem is not going to go well. Finding ways to slowly increase the lordosis over time will be more effective. Think of the pillow underneath the patients spine being there for a little bit, transitioning to propping them up on their elbows, into a press up with their arms fully extended. Since the patient is prone, gravity is our friend and will help drive the nucleus pulposus down towards the middle so it is not bulging posteriorly.
increases
The sacrum and pelvis form a very (mobile/stable) pelvic ring.
stable
With a little bit of play between the joints we are able to absorb these significant forces coming from the top down on the sacrum and pelvis, but then also there is a little bit of wiggle room so if things happen, like falling, you don’t necessarily automatically fracture your pelvis.
Got it
The forces coming from the bottom up in the sacrum and pelvis are ___ forces, so we are absorbing a lot of force coming through this pelvic ring.
ground reaction
The ligaments that go from the sacrum to the iliac crest on either side are called ____ ligaments.
sacroiliac
The sacroiliac ligaments are oriented in such a way that they are going to resist certain forces and the ones that they are going to resist are an (anterior-posterior/medial-lateral) glide and slide. So the fibers here are going to prevent this portion of the pelvis from sliding anterior and posterior. It is also going to resist distraction forces. It is also going to probably resist anything that is a (superior-inferior/medial-lateral) force that is being held into place by these fibers.
anterior-posterior; superior-inferior
The other thing that is going to be resisted by the sacroiliac ligament is called (mutation/nutation) and counter (mutation/nutation).
nutation; nutation
Nutation is just a little bit of tilting with the sacrum going (anterior/posterior) and the iliac bone going (anterior/posterior). This is not a large movement, it is really just a tilt. Do not think of this as an anterior-posterior pelvic tilt, it is just a small adjustment.
anterior; posterior
Counter nutation is the sacrum going (anterior/posterior) and the iliac bone going (anteriorly/posteriorly).
posterior; anteriorly
Nutation torque increases the (mobility/stability) at the sacroiliac joint.
stability
The body weight is coming down and forcing you into nutation. Then we have this hip joint compression force coming back, that is the force coming up with the GRF. So the pelvis is being acted on by this hip joint and it is driving this posterior tilt of the pelvis. Those two forces are what is causing nutation to occur. This is gravity (independent/dependent). So this idea of nutation is that it is occurring as soon as you stand up. So if you are sitting and then you stand up, now gravity is working from the top down and the hip joint compression allows that joint to nutate. And what is happening is, that nutation torque is going to wind up the sacroiliac ligaments. So now these ligaments are going to be wound up and adding stability to the system. So what we have is this idea of stretched ligaments which is now providing increased (active/passive) system stability. On top of stretching the interosseous ligaments we also stretched out the sacrotuberous ligaments
dependent; passive
The pubic symphysis helps (mobilize/stabilize) the ring but also gives you a small amount of translation and rocking. There has to be some requisite amount of motion and translation in order to provide stress relief throughout the ring. Otherwise, you’re going to have too rigid of a structure and then have potential for increased injury. So this stuff moves and translates slowly and in a minute amount. With everyday activities, you know.. In walking and running - all of those forces are getting transferred through your pelvis. And then also in females for childbirth. This area has to be allowed to expand in order to have an appropriate amount of room for childbirth.
stabilize
There is very (minute/large) movements that occur at the SI joint so it is very hard to assess if the SI joint has moved out of place or not.
The overall relative amount and some of these larger movements are in very specific populations - females, who are pregnant, who are now having hormonal changes, etc. That allows these ligaments to be expandable and allow for a little bit more movement, whereas generally speaking we’re in these really small ranges.
minute
We know that from the pubic symphysis to the ilium and the ribs, we have those large (primary/secondary) movers such as the rectus abdominis.
primary
You can’t talk about the pelvis without talking about some of the muscles that attach to it from below, things like the quadriceps femoris and the hip abductors and adductors. They are large muscles that go from the pelvis down to your greater trochanter. They provide a lot of (active/passive) system stability to the whole pelvis complex.
active
For stability and mobility just remember that (there are/there aren’t) muscles running directly from the sacrum to the ilium, so all of these muscles are multiple joint muscles.
there aren’t
In an anterior pelvic tilt, the lumbar spine goes into (flexion/extension).
extension
In a posterior pelvic tilt, the lumbar spine goes into (flexion/extension).
flexion
Lumbo-pelvis osteokinematic motion (anterior/posterior pelvic tilt) are overall small motions to describe a coordinated movement between the pelvis and the lumbar spine. These (are/are not) large motions.
are not
We have these force couples that allow A/P pelvic tilt to occur. So when we are talking about a posterior pelvic tilt we’re talking about the rectus abdominal muscle that’s pulling in this (superior/inferior) direction, and then we have the glute max which is a hip extensor going in an (superior/inferior) direction. The glute max and the rectus abdominis are working together to perform this posterior pelvic tilt. We also have some contribution from the external oblique and also the hamstring muscle is pulling down on the ischial tuberosity in order to help posterior tilting.
If an individual did not have good motor control and a good amount of rectus abdominis and glute max contraction, they might have an (anterior/posterior) pelvic tilt in standing.
superior; inferior; anterior
In an anterior tilt, the erector spinae are now the dominant muscle and your rectus femoris along with your iliopsoas are working to anteriorly pelvic tilt. Your rectus femoris attaches to your ASIS so it is going to provide that (upward/downward) vector and the same thing with your iliopsoas. So if you think about these movements, along with these force couples, it will give you a really good idea of how some of these postures and movement patterns are present.
downward
Someone bending forward has motion that is happening at a lot of different joints. It’s happening at the hip, it’s happening at the lumbar spine, it’s actually happening at the thoracic spine in order to allow your hands to touch your toes. If we are talking about this lumbopelvic rhythm, during the flexion phases, the lumbar spine flexion is the (primary/secondary) movement pattern. It is ideally happening first. So as you’re standing up you go to reach your toes. your lumbar spine flexes first and then what happens is you get this secondary motion movement pattern, so now your lumbar spine is flexing as your hip joint is also flexing. And then, towards the end when you have exhausted all the lumbar spine motion the end phase of this flexion pattern is primarily the hip flexion movement pattern. This is variable from person to person.
primary
In the lumopelvic rhythm (flexion/extension) phases, your hip and your glute max are going to fire first, in order to bring your hips forward as the primary movement. And then you’re going to have combined lumbar and hip motion on the way up. And then towards the end phase of that lumbo sacral rhythm you’re going to have your lumbar spine primarily responsible for standing up straight.
extension
In the lumbopelvic rhythm, in the (flexion/extension) phase it is typically more of a phased action, meaning that you are going to see a lot of variation in your classmates.
extension
One of the interesting things that people with this lumbar spine instability do is they don’t want to move their lumbar spine because subconsciously their neural subsystem tells them hey there’s going to be a lot of shifting around those segments. So what that individual will do is primarily lockout their spine and keep their spine in a lordosis, and then use their (hip/lumbar spine) primarily in order to get them up. You can see this kind of pattern a lot in people who are dancers, they get most of their toe touch by their hip flexibility in their hip movement and they really lock out their spine. You can also see it in individuals who have a lot of spine pain going on their erector spinae are in spasm and locking up and like really trying to increase their stability as they try to move in order to perform functional tasks.
hip
Your pelvis can also move on your femur by performing a lateral tilt. This lateral tilt happens a lot during unilateral stance. When the non-stance side elevates, then we are calling it a (superior/inferior) lateral tilt. When the non-stance side tilts inferiorly, we’re calling that an (superior/inferior) lateral tilt. So this movement is always based on the non-stance side.
superior; inferior
In a superior lateral tilt then the lumbar spine side bend is going to be such that the convexity occurs to the side of the (stance/non-stance) leg. So the convexity is going to occur to the side of the stance leg when this pelvis elevates. When the pelvis drops on the non-stance side, the convexity of the lumbar spine is now going to occur towards the (stance/non-stance) leg.
Remember that the body is trying to keep its’ COM over the base of support which is now only one foot.
stance; non-stance
The pelvis and the lumbar spine are so intricately linked that it’s almost like what happens in one place causes movements to happen at the other place.
Got it
In anterior/posterior pelvic rotation (the pelvis is moving on the femur) we are looking at the plane of motion now being in the horizontal plane. A lot of times what you’ll see is the pelvis rotating anterior and posterior during gait and so during forward gait it’s always going to be a sequence of (anterior/posterior) pelvis rotations
anterior
If we are on one leg and let’s say the right foot is the stance foot in this situation and the left foot is off the ground and walking forward, we now have described this as left (forward/backward) rotation.
forward
Let’s say the stance leg is the right leg and you take a step backwards with your left leg, and now you are performing left (forward/backward) rotation.
backward
In a superior lateral tilt the hip is in (adduction/abduction).
abduction
In an inferior lateral tilt the hip is in (adduction/abduction).
adduction
