Ortho Final Review Lumbopelvic Flashcards
What is the basic pelvic anatomy?
SI Joints
Pubic Symphysis
What is the basic SI Joint Anatomy?
Articulation between Sacrum and Coxal Bones that are supported by thick ligaments anteriorly and posteriorly
What plane of motion are pelvic facet joints?
Primarily in the sagittal plane, facilitating flexion and extension
How many planes of motion does pelvis move in?
All 3 planes of motion
Lumbar contribution Flexion/Extension
Flexion= 50
Extension= 20
Lumbar contribution in sidebending
Sidebending= 30
Lumbar Contribution in rotation
Rotation= 32 each side
Rotation and Sidebending occur _________
TOGETHER
In lumbar flexion, the sacrum _________________
counter nutates, PPT
In lumbar extension, the sacrum _______________
nutates, APT
The pelvis can:
- Anteriorly or Posteriorly Tilt
- Hike or Drop
- Rotate on top of the Femur
What happens in a PPT?
Abs are pulled up and hip extensors pulled down
Hip flexors and back extensors are stretched
What happens in a APT?
Back extensors pull up, and hip flexors pull down
Hip extensors and abs stretch
What are the special tests used for the lumbar spine?
SLR
Slump Test
Prone Knee Flexion
Gower’s Sign
What happens when the psoas is shortened?
The lumbar spine is pulled into further extension
What is the SLR test?
Pt in supine, leg passively flexed by PT
Test is positive if there is pain in back/leg between 30-70 degrees
*Neural tension on the sciatic nerve
What is the slump test?
Patient in sitting, flexes in trunk first, then cervical, then extension, then knee one at a time
* abnormal dural tension
What is prone knee flexion test?
Patient prone, with knee passively bent by PT, pain in front of thigh = tightness in quads or femoral nerve
Pain in back can mean L2/L3 disc injury
*test abnormal tension of femoral nerve
What is Gower’s sign test?
Patient in standing, flexes trunk and does 1/2 squat, if they need to use UE to stand back up, test is positive
*used often for Duchennes
*tests inhibited LE/Spinal extensor muscles
What tests are performed to test SI mobility?
Standing/Seated Flexion
Gillet (Stork) test
Squish Test
What test is performed for sacral torsion?
Sphinx Test
What is the Long Sit test used for?
inominate rotation
What exercises should a patient do for spinal stabilization or movement awareness/control?
Pelvic Clocks
TA contractions
Neutral Spine Education
What exercises should a patient do for gentle ROM?
SKTC
DKTC
LTR
What are the 3 fundamental goals for lumbopelvic stabilization?
1.Education on neutral spine
2. Facilitate activation of core stabilizers (Multifidi/TA/pelvic floor)
3. Progress to dynamic activities, maintaining a neutral spine and contraction of spinal stabilizers
What is the primary goal for Lumbar disc herniation when there are neurological signs?
reduce/eliminate compression of neural tissue
If patient is acute: reduce inflammation and spasm with goals to initiate interventions to improve neuro symptoms
What is the focus for treating lumbar spondylosis?
decreasing stress on discs or joints to prevent further damage to the spine and LE
What is lumbar stenosis?
narrowing of spinal canal or IV Foramen
*Can affect any area of the spine
What are the symptoms for lumbar stenosis?
Pain
Radiculopathy
Myelopathy in standing or extension of the spine (bc it closes the facets)
Should you use williams or mckenzie exercises for lumbar stenosis?
Williams FLEXION
What is lumbar spondylolysis?
small fracture in the pars articularis (scotty dog) due to trauma or over stress
Can be unilateral or bilateral
*Bilateral can create instability causing vertebra to slip forward
What sort of treatment should be performed for a patient with lumbar spondylolysis?
Treat pain or spasm
Stabilization of the spine
Patient Education
*Avoid high-impact or excessive extension
How long does it primarily take spondylolysis to heal?
3-6 Months
What is lumbar spondylolisthesis?
forward slippage of vertebral body after bilateral pars fracture
What is the most common lumbar spondylolisthesis?
L5-S1
What is retrolisthesis- Complete?
vertebra slips back between the spinal segment
What is retrolisthesis- Partial?
Vertebra slips backward to either spinal segment above or below
What is retrolisthesis- Stair Step?
Vertebra slips backward TO THE spinal segment above it an ahead of one below it.
What are possible causes for sciatica?
HNP
Stenosis
Spondylolisthesis
Spinal Tumor
Muscle tightness
What are common symptoms for Sciatica?
LBP
Pain in the buttocks
Pain/Tingling in posterior thigh to leg or foot
What is the early tx for SI joint sprains or strains?
Reduce Pain
Inflammation
Education
How do you restore balance to muscles that affect the joint?
Stretch
Strengthen
Stabilization
Proprioception
What muscles need to be re-educated in SI Joint instability?
Glute Max
Erector Spinae
Biceps Femoris
Lats
Piriformis
Multifidi
What muscles need to be re-educated in lumbar instability?
Multifidi
Erector Spinae
TA
(Pelvic Floor)