Lx Spine Flashcards
What are the 4 major nerves that exist the lumbosacral plexus and enter lower limb?
Obturator
Femoral
Common Tibial and Fibular
What forms the Sciatic nerve?
The common fibular and tibial nerve which originate in L4-S3 branch off forming the Sciatic nerve
Where do the nerves innervate?
Obturator-Medial thigh
Femoral-Anterior thigh
Tibial-Posterior thigh and leg
Comon Fib-Post thigh,ant leg and foot
What are symptoms of caudia eqina?
Bowel and bladder incontinence and paralysis of lower limbs
What could cause caudia equina?
Trauma
Disc herniation
Tumor
What is not innervated in the lumbar innervation?
Nuclear pulposus
Ligament flavum
Articular cartilage
What are the local stabilizers?
Transverse abdominus
Deep lumbar multifidus
What can dysfunction leading to poor stability cause?
Poor control
Recruitment deficiency
Recruitment dysfunction due to pain and pathology
What are the global stabilizers?
Internal and External obliques
What are the global movers?
Rectus abdominus
Erector spinae
Psoas major and minor
What does dysfunction of global movers cause?
Myofascial shortening
Spasms with pain and pathology
Limits accessory motion
What happens when a person flexes?
There’s an anterior translation of the anterior vertebra on the inferior vertebra
The Annulus pulpisus compresses anteriorly and stretches Posteriorly and NP moves to the back
Facet joint opens towards the back
Spinal cord lengthens
PLL and Ligamentum flavum stretches
What happens during extension?
The intervertebral foramen narrows
Spinous processes move together
Anterior annulus stretch and post part of disk bulges Posteriorly
What are rare cases that aren’t physiotherapy indicated?
Virus and autoimmune
Severe central stenosis
What are other red flags when a patient has severe Lx?
Previous HIV
Unexpected weight loss
Trauma
Cancer
Structural spinal deformity
Systematically unwell
What is the difference between central and lateral stenosis?
Central stenosis is when bone growth pushes down the spinal cord and lateral is when bone growth pushes down the nerve and often is the same or worse with sitting
Which is the common site for spondylosis and spondylolisthesis?
L5
Where does the defect occur when someone has Spondylosis?
In the Pars interarticularis
What is spondylolisthesis?
It’s when the vertebra either slips backwards or forwards compared to the vertebra below or above occurs at L5 on S1
What effect does degeration have on the spine?
Decreased spinal ROM
Increased deformation under constant load
Stiffness upon walking but improves with movement
What is the Mckenzie method known as?
The mechanical diagnosis and therapy
What combination is the Mckenzie method composed of?
Active therapy and education for patients with acute,sub acute and chronic lower back pain
What are the 3 syndrome classifications ?
Postural
Dysfunction
Derangement
What is derangement syndrome?
Specific repeated movement or sustained position causes a relevant improvement in symptoms
What are aims of the derangement syndrome?
Reduce pain
Centeralization of symptoms
Complete recovery of pain
What are the types of exercises chosen for the derangement syndrome?
Flexion
Extention
Lateral shift
What is the Dysfunction syndrome?
Pain consistently at end of range with reduced or eliminated symptom on returning from the end of range position to neural
What treatment is used for the dysfunction syndrome?
Repeated movements in the direction of the dysfunction
What is the aim of the dysfunction syndrome?
Remodel tissue which limits movement through exercises
What is postural syndrome?
Pain due to mechanical deformation of soft tissue
What treatment is used for postural syndrome?
Education on ergonomics and postures
Correct posture
Avoid postures which cause pain
