Spine- Thoracolumbar I- Intro thru Stabilization Flashcards
What is the first part of a biomechanical exam?
scan or screen
What describes normal ROM?
Smooth, coordinated and full
Can impairments be present without symptoms?
YES
What is the primary purpose of a biomechanical exam?
Assess for further detail in involved area
What does limited ROM NOT indicate?
Lack of accessory motion
What does pain with passive elbow extension and resisted elbow flexion indicate? (most likely)
musculotendinosis
What can stiff areas do if NOT addressed?
Cause painful hypermobile compensations elsewhere
Are stiff areas always painful?
No
Where are hypermobile compensations often found?
- the past of LEAST resistance
What can a stiff lower thoracic region and thoracolumbar junction lead to? (potentially?)
Hypermobile mid to lower lumbar spine
What can a stiff SI joint and hip lead to? (potentially?)
Hypermobile lower lumbar spine
What are our general Rx and purposes for hypomobility and hypermobility?
Mobility in hypomobile areas, stability in hypermobile areas
Why are hypermobile areas usually painful?
Axis of motion is less controlled
What can cause the axis of motion to be less controlled?
Trauma, injury, etc.
- damages tissue, creates a lax joint, and loss of stability to the ligaments and capsule, etc.
What should we do with hypermobile areas?
Stabilize
Should we treat adjacent joints/areas when addressing an injury/pain?
YES
What does the orientation of facets determine?
Direction and amount of motion
What plane are the thoracic spine facet joints in?
Mostly frontal plane but ribs limit greater SB
What motion is greatest in the thoracic spine? How much?
Rotation: 25-30˚
What motions are the most in the thoracic spine? Least?
Rotation, then SB, flexion, with the least amount in extension
Where is there the MOST rotation in the thoracic spine?
T5 and T10
Where is there the LEAST rotation in the thoracic spine?
T11 and T12
Why is there less rotation in the lower most thoracic spine?
Facets transition to the shape of lumbar facets, start to look and act like lumbar vertebra
What is the shape of the lumbar spine facet joints? What plane?
Slightly curved
- anterior more coronal, particularly at L5,S1
- Posterior more sagittal
What motion is the MOST in the lumbar spine?
Flexion and extension
What motion is the LEAST in the lumbar spine? how much in degrees?
Rotation, 5-7˚ total
What is controlled mobility MORE than?
Just strength of superficial and big muscles
What are the 4 variables for stabilization?
- Joint Integrity (i.e cartilage)
- Passive Stiffness (i.e. ligaments)
- Neural Input
- Muscle Function
What are characteristics of local muscles?
- closer to axis of motion
- often deeper
- stabilization > rotary forces
- postural
- aerobic > anaerobic
- MORE often type I fibers
What are characteristics of global muscles?
- further away from axis of rotation
- often superficial
- rotary > stabilization forces
- spurt muscles
- anaerobic > aerobic
- MORE often type II fibers
What are some muscles we need for stabilization in the thoracolumbar region? (be able to find and label these)
- Quadratus Lumbourm
- Psoas Major
- Multifidus
- Transverse Abdominus
- Rotatores longus
What other body part is critical for low back stabilization?
PELVIC FLOOR
What does the Psoas muscle do for stabilization?
Frontal plane stabilizer
What does the quadratus lumborum do for stabilization?
Frontal plane stabilizer
What do the pelvic floor and transversus abdominus do for stabilization?
Increase contraction of multifidus
What does the multifidi/rotatores do for stabilization?
If smaller = higher injury rates and LBP
What muscles do pain, swelling, disuse, and joint laxity effect?
Decreased and delayed motor performance and control of local muscles such as transversus abdominus, multifidi, etc.
What type of muscle is inhibition preferential to?
Type I muscles
What declines with pain, swelling, disuse, and joint laxity?
strength declines with local muscle atrophy, specifically multifidus, along with every other muscle function
What non-contractile tissues will have increased stress with lack of stabilization?
Cartilage, ligament and capsule become gradually more symptomatic
What can pain, swelling, disuse, and joint laxity cause regarding global muscles?
Increased and inefficient motor activity of global muscles such as external abdominal obliques/erector spinae, etc.
What does atrophy lead to?
FATTY INFILTRATION
What percentage of muscle cross sectional area is fat in those over 60?
50%
What happens to fiber type with pain, swelling, disuse and joint laxity?
Type I to type II, lose endurance stabilizing function
Does muscle function normalize automatically once symptoms are improved?
NO
What percentage of muscle activation is sufficient to keep stability and is suitable to improve muscular endurance?
30% - doesn’t take a lot for improvement
