Part 1 Final Review

Question 1

Based on moment arm length alone, which connective tissue most effectively limits flexion torque within the thoracolumbar region?

Answer 1

Supraspinous ligaments are located farthest posterior to the medial-lateral axis of rotation through the body of each vertebra. This position maximizes the tissue’s moment arm for resisting a flexion torque.

Question 2

Describe the arthrokinematics at the apophyseal joints between L2 and L3 during full axial rotation to the right.

Answer 2

The left inferior articular facet of L2 approximates (or compresses) against the left superior articular facet of L3, and the right inferior articular facet of L2 gaps (separates) from the right superior articular facet of L3.

Question 3

Persons with a history of a posterior herniated disc are usually advised against lifting a large load held in front the body, especially with a flexed lumbar spine. How would you justify this advice?

Answer 3

Lifting a large load held in front of the body can generate large muscular-based compression forces across the lumbar intervertebral discs. Lifting with a flexed lumbar spine converts the large compression force to a large disc pressure. Lumbar flexion tends to direct the flow of the nucleus pulposus in a posterior direction. If degenerative clefts exist in the annulus, the nucleus may flow posteriorly in the direction of the sensitive neural elements.

Question 4

Assume the subject depicted in Fig. 9-10C has increased lumbar lordosis caused primarily by tightened (shortened) hip flexor muscles. Describe the possible negative kinesiologic or biomechanical consequences that may result within the lumbar and lumbosacral regions.

Answer 4

Significantly increased lumbar lordosis may be associated with the following negative kinesiologic consequences:
1. Increased stress on fully extended lumbar apophyseal joints
2. Increased sacrohorizontal angle and resultant increased anterior shear forces at the L5–S1 junction
3. Reduced size of the intervertebral foramina and possible compression of the exiting lumbar spinal nerve roots

Question 5

With the visual aid of Fig III-1 (in Appendix III, Part A), explain why a severe posterior herniated disc between the bodies of L4 and L5 can compress the L4 spinal nerve root, but possibly L5 and all sacral nerve roots as well.

Answer 5

The spinal cord ends approximately at the L1 vertebral level. The spinal nerve roots that flow caudally from the end of the spinal cord form the cauda equina, which occupies the vertebral canal of most of the lumbar and sacral vertebrae. Disc material that protrudes posteriorly into the vertebral canal adjacent to L4 and L5, for example, could potentially impinge on all remaining fibers within the cauda equina, which includes all sacral nerve roots.

Question 6

Describe the mechanical role of the annulus fibrosis in distributing compression forces across the interbody joint.

Answer 6

Increasing the intervertebral joint compression increases hydrostatic pressure within the nucleus pulposus. The increased nuclear pressure pushes radially (outward), as it is resisted and partially absorbed by tension in the stretched annulus fibrosis. The combined nuclear pressure and taut annular rings help support and evenly distribute intervertebral compression. Tears or weakness within the annulus fibrosis reduce the effectiveness of this load absorption system.

Question 7

Facet orientation:
____-_______ apophyseal joints much closer to ______ plane

Provides ___/____ stability to lumbosacral junction

Answer 7

L5- S1
frontal
A/P

Question 8

Question 9

Describe how an overshortened (contracted) iliacus muscle can cause an increased lumbar lordosis while a person is standing. What effect could this posture have on the stress at the lumbosacral junction?

Answer 9

While in a standing position, a contracted iliacus muscle rotates the ilium (pelvis) anteriorly toward the femur. Assuming the trunk is maintained upright, this movement is typically described as an excessive anterior tilt of the pelvis. The lumbar spine is forced to rotate into extension, which increases its lordosis. Excessive lumbar lordosis is likely associated with an increased sacrohorizontal angle and an increased anterior shear force at the L5–S1 junction.

Question 10

_______ _______ : The amount of intervertebral movement that occurs with the least passive resistance from the surrounding tissues (minimal stiffness zone)

Answer 10

neutral zone

Question 11

Neutral zone: is increased with _______ or _______ or surrounding tissues

______ or ________ instability can acuse further injury (legs/facets/discs/neural)

Answer 11

weakness; injury
marked; chronic

Question 12

________ _________ anterior, primary weight-bearing component

Answer 12

vertebral body

Question 13

_______ _______ : transverse/spinous processes, laminae, articular processes

Answer 13

posterior elements

Question 14

_________ : bridge that connects body-posterior elements; thick and strong, transfers muscles forces applied to posterior elements for dispersion across body/disc

Answer 14

pedicles

Question 15

It is thought that the _______ ________ is a better measurement of instability than spine ROM

Answer 15

neutral zone

Question 15

If the neutral zone grows larger as disc _______ or _________ injury occurs, there is more laxity or instability in the spine to control and more demands are placed on the _______ ________

Answer 15

degeneration
ligamentous
stabilizing systems

Question 16

_______ stability can also be viewed from a segmental level as well as ______ spine level. When the neutral zone is larger than usual, there is more ______, ________, and ______ of the vertebrae and the spinal segments become ________

Answer 16

Core stability

whole

slide, glide, rotation

unstable

Question 17

The neutral zone has been found to increase with _______ and _________ and decrease with ______ ______

Answer 17

injury; degeneration
muscle force

Question 18

With injury (DDD) the _______ motion pattern changes and influences the motion of the whole spine, potentially causing ______ and _______

Answer 18

vertebral
pain
hypermobility

Question 19

Marked or chronic spinal instability

Believed to cause further injury to _____ _______

Injury to ______ (apophyseal joints), ______ and possibly _____ structures

Can result in loss of pain-free ______ ROM

Answer 19

local ligaments

facets; discs; neural

spinal

Question 20

The ___________ ________ consists of the bony structures, ligaments, joint capsules, discs, and passive portion of the musculotendinous units This system is thought to send feedback to the neural subsystem about joint positions and challenges to stability at the passive level

Answer 20

passive system

Question 21

The _______ _______ is composed of the muscles and tendons and is the subject of the core exercises later.

Answer 21

active system

Question 22

The _______ _______ receives and transmits information from and to the other two systems to manage spinal stability. Neuromuscular control can be compromised in patients with LBP and must be considered in a core stabilization program

Answer 22

neural subsystem

Question 23

Typically intervertebral joints- 3 functional components:

________/__________ ________
(mechanical levers that increase mechanical leverage of muscles and ligaments)

_________ __________ (guiding intervertebral motion)

_________ ( _____________) _____ (absorb and distribute load, >est adhesion between vertebrae, houses axes of rotation, is a spacer, provides passage for nerves)

Answer 23

transverse/spinous processes

apophyseal joints

interbody; intervertebral joint

Question 24

Osteokinematics of intervetebral joints Movement at any invertebral junction is _______ Added together- gives large _______ motion 3 _______ planes Axia for each near/at _______ joint Rotation reference point is _____ of the more ranial vertebrae

Answer 24

small angular cardinal reference anterior

Question 25

Arthrokinematics of intervertebral joints: Most facets are _____ Approximation _______/_________/________

Answer 25

flat seperation gapping sliding

Question 26

Question 27

Apophyseal joints _____ pairs ______ joints Lined with _______ cartilage Enclosed by ______ _____ innervated capsule Acts as _________ ___________- the orientation of the plane determines the kinematics: horizonal facet favors _____ rotation; vertical in either _____ or ______ planes block axial rotation Muscles help control______

Answer 27

24 synovial articular synovial; well mechanical barricades axial sagittal; frontal motion

Question 27

Apophyseal joints small and inconsistently formed _______ structures most frequent in upper _____ and ________ subscapular ____ ______ Role- ________ but can become ______, painful, and ____ facets

Answer 27

accessory cervical; ; lumbar fat pads unknown impinged lock

Question 28

Disc- NP _______ shock absorbing systen _______ and ______ loads across consecutive vetebra _____ like, _______ _______ (water binding) linked to _____ proteins; thin type ___ collagen fibers, elastin, other proteins small # of ___________ and ________ in the nucleus (synthesizes the ______ and ________ )

Answer 28

Hydraulic Dissipates; transfers fel; proteoglycan GAGs core II chondrocytes fibroblasts protein proteoglycans

Question 29

Annulus Fibrosis _____-_______ concentrics rings of ______ fibers, ______ degrees from vertical Prevent _______/_________/________ Due to angulation @ 90% of ______ force to stretch _______; in direction of forces ______/________ liquid-based nucleus ______-_______% collagen (___-_____% in nucleus) _______ intersped parralel to _____ of collagen (circumferential e_lastocity) Outer layer contains _____ only, ______ nerves, binds to ______ and _______ (outer more _______ and inner more ______)

Answer 29

15; 25 collagen 65 distx; shear; torsion torsion fibers entraps/encases 5; 60; 15; 20 Elastin; rings disc sensory ALL; PLL collagen water

Question 30

Vertebral endplates Relatively _______ (____% height of IV space) ________ caps cover most of sup/inf surface of ______ _______ Surface facing disc is _______ and binds directly and strongly to _______ in _________ Surface facing bone _______ cartilage- weakly _______ to bone Outer rings of with vascular supply- _____ ______ @ disc Diffusion of ______ and _______

Answer 30

thin 5 cartilaginous vertebral bodies fibrocartilage collagen; AF calcifies affixated limited healing O2; glucose

Question 31

__________ Normally compressive forces produce _______ _______ in disc and evenly distribute _____- protecting intervertebral and aophyseal joints Changes precede _______

Answer 31

Degeneration hydrostatic pressure load OA

Question 32

Degeneration Reduced _________- reduced inhibits ________ of proteoglycans Less proteoglycans- less ______ Less ability to ______ and ______ loads Not just with ______ but ______/_______ loads create these problems

Answer 32

permeability synthesis water absorb; transfer aging excessive/abnornal

Question 33

IVD as a hydrostatic pressure distributor ____% of load carried on _______ joint in standing at L/spine _____% posterior elements Disc designed for ______ _____ handle force of BW and muscle activation _______ _________ system: biomechanical interaction water-based NP & annular rings Compressive loads push ______ inward to _____ NP slowly ______ radially vs AF Stretched rings of _____ and ______ create tension to resist/balance force- uniformly transferred to vertebral _____- then return when ____ is off __________ - resists a fast/strongly applied load; less resistance to slow or light compression (flexible low loads/rigid at higher loads)

Answer 33

80 intervertebral 20 shock absorbers endplates; NP deforms collagen/elastin bodies; load viscoelastic

Question 34

Least to most Supine (LEAST- 1) Side-Lying (2) Standing (5) Standing bent over (8) Sitting in Chair (4) Sitting hunched over (6) Sitting reclined (3) Standing bent over with box (10) Standing with box between knees (9) Standing straight up with box (7)

Question 35

Sustained and full lumbar EXT reduces _______ in discs and can allow water to be _______ into the disc

Answer 35

pressure reabsorbed

Question 36

Diurnal fluctuations Supine- ______ pressure- ______- water, swell slightly when _______ WB forces push _____ out of the _______ ____% of height change Related to age- as __________reduces, _______ retaining reduces Less ________ pressure Can have a dx of ______ _______ MR imaging: loss of _________ AF/NP , nuclear _______, loss of _____ space Not always _______ or loss of _______

Answer 36

low attract sleeping water disc 1 proteoglycan; water hyrdostatic degenerative disc distinction bulging disc aging; function

Question 37

____ degrees of thoracic flexion ______ degrees of lumbar flexion = 85 degrees total

Answer 37

35 50

Question 38

_____ degrees of thoracic extension ______ degrees of lumbar extension = 35 degrees total

Answer 38

20 15

Question 39

Rotation ____-_____ degrees _______ plane

Answer 39

25; 35 horizontal

Question 40

Lateral flexion to each side ___-____ degrees (ribs prohibit more) Lateral flexion similar to ___-____

Answer 40

25; 30 C2; C7

Question 41

Anterior tilt: contraction of hip ______/back ______ or hip _______ contracture Posterior tilt Contraction of the ____ extensors/_____

Answer 41

flexors; extensors; flexion hip; abs

Question 42

Question 43

Structures resisting shear at L5/S1 ______ _______ of facets _____ _____ and _____ facets (frontal plane) _______ ligaments: inf aspect __-___ and _____ _______ --> inf at the ilium/ant to the _____ and upper lat _____ is a firm anchor between ____ and ilium/sacrum These create a resistance force of _______ at L5/S1 facets

Answer 43

Discs capsule ALL wide; sturdy iliolumbar; L4-L5 SIJ; sacrum; L5 compression

Question 44

Question 44

What is this?

Answer 44

T1 weighted MR image anterior spondyliolosthesis of L5 on S1

Question 45

Flexion of the Lumbar Spine _______ plane Flexion is a reversal of _______

Answer 45

sagittal lordosis

Question 46

L3-L4 flexion: ________ articular facets of _____ slide sup/ant roughly 5mm relative to _____

Answer 46

Inferior; L3; L4

Question 47

With lumbar flexion, _________ forces shift away from ______ (normally 20% of load in ______)

Answer 47

compression facets standing

Question 48

Question 49

Flexion of Lumbar Spine Compression on _______ aspects of the discs and bodies Stretches _______ ligs ________ pressure (facets) increases ________ and canal change ______ Disc can change.... NP into _______ direction.

Answer 49

anterior posterior contact foramina; size posterior

Question 50

Extension of the lumbar spine L3-L4: inferior articular facets of L3 slide ___/____ relative to the ______ facets of L4 _______ contacts and _____ in facets Fulll extension causes tips of ________ articular facets slide _____ beyond the joint surface Hyperextension can cause the tips of the inf. articular processs to contact the _______ _______.... can cause damage and compress _______ ligaments

Answer 50

inf; post; sup Increased; load inf; inf adjacent lamina posterior lig

Question 50

Question 51

Extension of lumbar spine Size of ________ _______ is reduced and NP presses ______ Full lumbar extension has been shown to _____ pressure within the _____ and reduced contact pressure between disc _______ and _____ tissues (c ________ )

Answer 51

intervertebral foramina reduce disc materials neural centralization

Question 52

Lumbopelvic Rhythm during trunk flexion/extension The kinematic relationship between the ______ and ______ during sagittal plane motions Attention to the pattern and trunk ________ recruitment pattern can provide clues to addressing _______

Answer 52

spine; hips extensor dysfunctions

Question 53

Lumbopelvic Rhythm during trunk flexion/extension _____ degree lumbar/ _____ degree hip (_____ on ______) Usually 3 phases: ______ flexion; _______ flexion and ______ flexion; mostly _____ flexion Limited ____ flexion or limited ______ flexion

Answer 53

45 60 pelvic; femoral lumbar hip; lumbar hip hip lumbar

Question 54

A normal kinematic strategy used to flex the trunk from a standing position, incorportating a near simultaneous ____ degrees of a flexion of the lumbar spine and _______ degrees of hip (______ on _______ ) flexion

Answer 54

45 60 pelvic; femoral

Question 55

With limited flexion in the hips (tight hamstrings), greater ______ is required of the lumbar and lower thoracic spines

Answer 55

flexion

Question 56

With limited ______ mobility, greater flexion is required of _____ joints

Answer 56

lumbar hip

Question 57

Axial Rotation of the Lumbar Spine ___-_____ degreees to each side L1-L2: Rot to R- left _____ facet of L1 ________ vs ______ facet of L2; R inf _____/________ from _____ facet of L2 Bony ________ to rotation due to ________ of facets > ___ deg at any lumbar segment would damage _______ surface and tear ____

Answer 57

5-7 Inf; approximates; sup gaps/distracts sup resistance; facet; AF

Question 58

Lateral flexion of lumbar spine _____ degrees each side Slight ______ in disc

Answer 58

20 deformation