S3_L1: Thoracolumbar Spine Flashcards
Determine the actions of the muscles below:
- Rectus Abdominis
- Erector Spinae
- Internal Oblique
- External Oblique
- Quadratus Lumborum
- Multifidus
A. Flexion
B. Extension
- A
- B
- A
- A
- B
- B
How many degrees does a normal thoracic kyphosis have?
40 degrees
Source: Thoracolumbar Spine (Quizlet)
How many degrees does a normal lumbar lordosis have?
45 degrees
Source: Thoracolumbar Spine (Quizlet)
In scoliosis, curves are named by the side of their ____.
convexity
Define lateral stenosis.
Narrowing of the intervertebral foramen affecting a nerve root
Case: A.B. a 16 y/o (-)Htn/DM, ® handed female was referred for PT eval and mx secondary to intermittent aching pain graded 2/10 pain on (B) upper and mid- back regions elicited by long hours of sitting and is relieved c rest and lying down. Condition started when the px was 10 years old and her mom noticed that px’s shoulders were not level. This prompted MD consultation, where Pt underwent an x-ray 2018. Results revealed a 50° thoracodextroscoliosis, with apex at T6 and a 15° lumbar levoscoliosis apex at L3. Pt is a high school student, sleeps on a firm mattress, and uses 3 1- inch pillows, two under her head and the other on her side when sleeping. Pt usually carries he bag using her ® shoulder.
Based on the case above, what is the convexity of the thoracic and lumbar segment?
Thoracic: Right
Lumbar: Left
Case: A.B. a 16 y/o (-)Htn/DM, ® handed female was referred for PT eval and mx secondary to intermittent aching pain graded 8/10 pain on (B) upper and mid- back regions elicited by long hours of sitting and is relieved c rest and lying down. Condition started when the px was 12 years old and her mom noticed that px’s shoulders were not level. This prompted MD consultation, where Pt underwent an x-ray that revealed a 50° thoracodextroscoliosis, with apex at T6 and a 15° lumbar levoscoliosis apex at L3. Pt is a high school student, sleeps on a firm mattress, and uses 3 1- inch pillows, two under her head and the other on her side when sleeping. Pt usually carries he bag using her ® shoulder.
Based on the case above, what kind of curve is expected to be seen at the X-Ray result?
S-Curve
Case: A.B. a 16 y/o (-)Htn/DM, ® handed female was referred for PT eval and mx secondary to intermittent aching pain graded 8/10 pain on (B) upper and mid- back regions elicited by long hours of sitting and is relieved c rest and lying down. Condition started when the px was 12 years old and her mom noticed that px’s shoulders were not level. This prompted MD consultation, where Pt underwent an x-ray that revealed a 50° thoracodextroscoliosis, with apex at T6 and a 15° lumbar levoscoliosis apex at L3. Pt is a high school student, sleeps on a firm mattress, and uses 3 1- inch pillows, two under her head and the other on her side when sleeping. Pt usually carries he bag using her ® shoulder.
Based on the case, what is the major curve?
thoracodextroscoliosis
Case: A.B. a 16 y/o (-)Htn/DM, ® handed female was referred for PT eval and mx secondary to intermittent aching pain graded 8/10 pain on (B) upper and mid- back regions elicited by long hours of sitting and is relieved c rest and lying down. Condition started when the px was 12 years old and her mom noticed that px’s shoulders were not level. This prompted MD consultation, where Pt underwent an x-ray that revealed a 50° thoracodextroscoliosis, with apex at T6 and a 15° lumbar levoscoliosis apex at L3. Pt is a high school student, sleeps on a firm mattress, and uses 3 1- inch pillows, two under her head and the other on her side when sleeping. Pt usually carries he bag using her ® shoulder.
Based on the case, in what severity is the thoracic and lumbar segment classified as?
Thoracic: Severe
Lumbar: Mild
TRUE OR FALSE: Mild scoliosis produces no symptoms.
True
Identify 4 modalities that may be used for patients with scoliosis.
- HMP
- US
- Traction
- NMES
TRUE OR FALSE: Idiopathic Structural Scoliosis has a male bias on infants.
True
Enumerate 2 causes for LBP
- Inflammation
- Mechanical
The _____ muscle is quick to atrophy in pts with LBP.
multifidus
This is also known as Strumpell-Marie Arthritis or Marie-Strumpell Arthritis
Ankylosing Spondylitis
This muscle is attached to the thoracolumbar fascia and acts as a corset that provides intersegmental stability
Transversus Abdominis
_____ is also known as neutral spine, and has no or minimum stress on inert structures
Neutral Zone
Most common spinal bracing
Milwaukee Brace
Enumerate the 2 measurement techniques for scoliosis. Which one of those is more commonly used?
- Cobb Method (more common)
- Risser-Ferguson Method
TRUE OR FALSE: In the spine, muscle performance only involves strength, power, and endurance.
False.
This also involves stability.
Source: Kisner & Colby 7th ed., page 495
Activation of the (1)_____ muscles as well as the (2)____ muscles of the neck and trunk are fundamental techniques for developing spinal stability.
- deep segmental
- superficial/global multisegmental
Source: Kisner & Colby 7th ed., page 495
Aerobic conditioning exercises are initiated as soon as the patient tolerates repetitive activity without exacerbating symptoms.
TRUE OR FALSE: Aerobic Training may be done in the maximum protection phase/ early training.
True.
This may be done as long as the patient can tolerate it in a position of comfort.
Source: Kisner & Colby 7th ed., page 494-495
How do you passively position a patient in supine when active movement and control is not possible. Enumerate 2 ways.
Passively position the pelvis in posterior tilt and lumbar flexion by placing the lower extremities in the hook-lying position
OR
Anterior tilt and lumbar spine extension c small pillow or folded towel under the lumbar spine.
Source: Kisner & Colby 7th ed., page 496
In general, movement of the extremities
away from the trunk (shoulder flexion and abduction, hip extension and abduction) causes (1)____; movement of the extremities toward the trunk (shoulder extension and adduction, hip flexion and adduction) causes (2)____.
- spinal extension
- spinal flexion
Source: Kisner & Colby 7th ed., page 496
TRUE OR FALSE: Stretching is contraindication in an acute nerve root irritation from bony spurs or lipping in an arthritic spine.
False.
This pain sx may actually be relieved through stretching.
ADDITIONAL NOTE: if there are postures that relieve symptoms but are difficult to assume because of tissue restriction or fluid stasis, stretching or repetitive movement into the restricted range may be appropriate.
Source: Kisner & Colby 7th ed., page 496
The primary functions of the muscles of the trunk are:
- to provide (1)____ so (2)____ can be maintained against a variety of forces that disturb balance
- to provide a (3)____ so the muscles of the extremities can execute their function efficiently and without undue (4)____ to the spinal structures
- to move and control trunk motions during (5)____.
- stability
- upright posture
- stable base
- stress
- functional activities
Source: Kisner & Colby 7th ed., page 513
TRUE OR FALSE: Activation of the deep segmental muscles of the trunk, specifically the transversus abdominis (TrA) and multifidus (Mf), is often delayed or absent in patients with back pain.
True
Source: Kisner & Colby 7th ed., page 514
This maneuver is used prior to all exercises and activities to develop the activation and stabilizing function and eventually automatic feedforward stabilization from the muscles
“drawing-in” maneuver
Source: Kisner & Colby 7th ed., page 515
What 3 positions may be done when performing drawing-in maneuver?
- quadruped
- prone/ seme-reclined
- hook-lying
Source: Kisner & Colby 7th ed., page 517
When a bulge is felt during drawing-in maneuver. What muscle is being contracted?
internal oblique
Source: Kisner & Colby 7th ed., page 517
If a patient has difficulty activating the TrA, what are the two feedback techniques that a PT may use?
- Pressure biofeedback using a stabilizer inflated to 70 mmHg
- Biofeedback using surface electrodes on RA and External Obliques
Source: Kisner & Colby 7th ed., page 518
Posterior pelvic tilt exercises principally activates the (1)_____ muscle, which is used primarily for (2)____ trunk flexion activity.
- Rectus Abdominis
- dynamic
Source: Kisner & Colby 7th ed., page 519
A PT asks his patient to perform side-planks. Based on your knowledge, what muscles does the PT want to activate in this position?
- Quadratus Lumborum
- External Obliques
Source: Kisner & Colby 7th ed., page 528
In performing isometric contractions and rhytmic stabilization to a pt, what the the positional progression?
supine - sitting - kneeling - standing
Source: Kisner & Colby 7th ed., page 530
TRUE OR FALSE: There is no clinically significant selective difference between the upper and lower RA function
True
Source: Kisner & Colby 7th ed., page 531
In cases that a pt has knee pain or weakness and unable to squat while lifting, what will the PT opt to teach?
Lifting c lunge technique
Source: Kisner & Colby 7th ed., page 541
TRUE OR FALSE: When lifting with a flexed lumbar spine, support for the spine is primarily from inert
structures
True
Source: Kisner & Colby 7th ed., page 541
A “golfer’s lift” is used for picking up light objects, such as keys, pencils, and small toys. How is this performed?
This is done by flexing the trunk forward over one hip while the other hip extends
Source: Kisner & Colby 7th ed., page 541
This position involves lifting and carrying objects as close to the center of gravity as possible.
Load Position
Source: Kisner & Colby 7th ed., page 541
What are the 3 subtypes of spinal stability?
- passive (inert structures/bones and ligaments)
- active (muscles)
- neural control
NOTE: Instability of a spinal segment is often a combination of inert tissue damage, insufficient muscular strength or endurance, and poor neuromuscular control. If any one of the legs is not providing support, it affects the stability of the whole structure.
Source: Kisner & Colby 7th ed., page 422
TRUE OR FALSE: The thoracic spine is prone to hypomobility impairments
True
Source: Kisner & Colby 7th ed., page 479
Determine whether the descriptions below refer to a structural or non-structural scoliosis.
- curve disappears in supine or prone
- seen among patients with cerebral palsy
- presence of tumor in the spine
- caused by leg length discrepancy
- irreversible lateral curvature of the spine
- caused by nerve root irritation
A. Structural
B. Non-Structural
- B
- A
- A
- B
- A
- B
Determine whether the descriptions below refer to a structural or non-structural scoliosis.
- idiopathic scoliosis
- patient has neurofibromatosis
- functional or positional scoliosis
- patient has hip contractures
- presence of hemivertebra
- correction of the lateral curvature with forward bending or side bending
A. Structural
B. Non-Structural
- A
- A
- B
- B
- A
- B
Determine the kind of intervention for the following type of conditions.
- Hypomobility
- Spinal instability
- Directional Preference
- Nerve Root Compression
A. Traction
B. Direction Specific Exercise
C. Manipulation
D. Stabilization
- C
- D
- B
- A
TRUE OR FALSE: Scoliosis may be d/t more contraction on one side of the trunk than the other.
True.
This may be possible for non-structural scoliosis
TRUE OR FALSE: The diaphragm is considered a core muscle.
True
Determine if the muscles listed are global or local.
- Iliopsoas
- Internal Oblique
- Multifidus
- Medial Fibers of Quadratus Lumborum
- Lateral Fibers of Quadratus Lumborum
A. Global/ Superficial
B. Local/ Core
- A
- A
- B
- B
- A
The (1)______ exercises is used for patients with extension bias, while the (2)_____ exercises is used for patients with flexion bias.
- McKenzie Extension
- William’s Flexion
In treating Scheuermann’s Disease, a PT would promote (1)____ and (2)____ lying programs to prevent further (3)___ contractures.
- extension
- prone
- flexion
This conditions results from an anterior slippage of a vertebra on the one directly below it
Spondylolisthesis
Enumerate the 6 exercises in McKenzie Extension Exercise in correct order.
- prone lying
- prone on elbows
- prone on hands
- double knee to chest
- back hyperextension in standing
- seated floor reach
In the thoracolumbar area, we must first strengthen the (1)_____ muscles, before strengthening the (2)_____ muscles
- core
- global
What are the muscles that protect the spine from injuries?
- Superiorly: Diaphragm
- Inferiorly: Pelvic floor muscles
- Laterally: Obliques / abdominals
- Anteriorly: Transversus abdominis (TrA)
- Posteriorly: Multifidus (Mf)
In the cobb method, the lowest vertebra has the disk above it wider on the (1)____ side, while the disk below it wider on the (2)___ side.
- convex
- concave
This is the vertebra that is in the greatest distance (farthest) from the midline of the spine
Apex of the curve / Apical vertebra
This is the kind of exercise program that involves an interdisciplinary team which includes psychologists and even guidance counselors to help treat the mental hurdles brought by the condition
Integrated Scoliosis Rehabilitation (ISR)
This is the kind of exercise program that entails the patient to shift the trunk laterally to concave side and to lift heel on convex side
Side-shift Exercise and Hitch Exercise
This is the kind of exercise program is an active self correction technique that emphasizes conscious proprioception
Scientific Exercises Approach to Scoliosis (SEAS) Program
In KLAPP’s Exercise, a PT decides to let her pt do it in a quadruped position, what spine segment did he wanted to target?
thoracolumbar spine
In KLAPP’s Exercise, a PT decides to let her pt do it in a heel sitting position, what spine segment did he wanted to target?
thoracic spine
Determine whether the spinal changes are seen on the concave or convex side in a structural scoliosis.
- Rib hump
- Distortion of vertebral body
- Thinner lamina
- Rib prominence
- Narrower vertebral canal
A. Concave
B. Convex
- B
- B
- B
- A
- B
In scoliosis, muscles are (1)____ on the concave side and (2)____ on the convex side.
- Tight
- Stretched
If core muscles are postural muscles, then they muscle be abundant with what kind of muscle fibers?
type I
TRUE OR FALSE: In ankylosing spondylitis, some of the pt education must be:
- Ample rest
- Firm mattress
- Rest with one pillow on head
False
No pillows are recommended to prevent FHP.
