Week 1 Flashcards
What type of joint is the sacro-coccygeal joint?
Fibro-cartilaginous joint
Movement at the sacro-coccygeal joint is noted with ___
Defacation, breathing, childbirth, and positional changes
The pelvic floor is supplied by the ____ nerve, which is at spinal root ____
The pelvic floor is supplied by the pudendal nerve, which is at spinal root S2-4
Layers 1-2 muscles of the pelvic floor is considered the external layer. It provides “squeeze” for ___ and “release” for ___
Layers 1-2 of the pelvic floor is considered the external layer. It provides *squeeze for continence and release for sexual penetration and elimination”
70% of layers muscles 1-2 pelvic floors are ____ and 30% are ____
70% of layers 1-2 pelvic floors are fast twitch fibers and 30% are slow twitch fibers
The front half of layers muscles 1-2 of the pelvic floor is called the ____
The front half of layers 1-2 of the pelvic floor is called the urogenital triangle
The second half of layers muscles 1-2 of the pelvic floor is called the ____
The second half of layers 1-2 of the pelvic floor is called the anorectal triangle
Layer 3 muscles of the pelvic floor is called the ____
Layer 3 muscles of the pelvic floor is called the floor of the core
Layer 3 muscles of the pelvic floor provides ___ and ____
Layer 3 muscles of the pelvic floor provides “ the lift and longer, lower load contraction”
70% of layers muscles 3 pelvic floors are ____ and 30% are ____
70% of layers muscles 3 pelvic floors are slow twitch fibers and 30% are fast twitch fibers
The pelvic floor play a role in _____ control
The pelvic floor play a role in *intra-abdominal pressure (IAP) control
What are the 3 inter-related subsystems of the spine?
- Control subsystem (Neural)
- Active subsystem (Spinal muscles)
- Passive subsystem (Spinal column, disc and ligaments)
Dysfunction in any one of the subsystems of the spine may lead to ____
Dysfunction in any one of the subsystems of the spine may lead to spinal instability
What are the functions of the vertebral column that are achieved through the spine rigidity (stability)?
- Protect the spinal cord
- Maintain upright posture
- Transmit body weight to lower members
What are the functions of the vertebral column that are achieved through the spine flexibility (mobility)?
- Acts as a shock absorber
- Provides motion for head and trunk
- Provides attachments for muscles and ligaments (stability and mobility)
What is consisted in the anterior portion of the vertebral motion segment?
- Vertebral bodies
- Intervertebral disc
- Longitudinal ligaments
What is consisted in the posterior portion of the vertebral motion segment?
- Vertebral arches
- Zygapophyseal (facet) joints
- Transverse and spinous processes
- Posterior ligaments
What are the 3 parts of the intervertebral disc?
- Annulus fibrosus
- Nucleus pulposus
- Vertebral endplate
What are the functions of intervertebral disc?
- Form intervertebral joints by joining the articulating surfaces of the adjacent vertebrae
- Allows motion
- Acts as a shock absorber (transmits body weight/axial loads)
What type of joint does the intervertebral disc make?
Fibro-cartilaginous “symphysis” joints
How does the intervertebral disc allow motion?
Two vertebrae move on each other around centers of motion that are in the intervertebral disc (mobility)
___ is 25% of the length of the vertebral column
IVD is 25% of the length of the vertebral column
The nucleus pulposes is made up of ____ and the dry components account for the ____ or ___
The nucleus pulposes is made up of 70-90% water and the dry components account for the thickness or viscosity
___ is how the disc connects with the adjacent vertebral body
Vertebral end plates is how the disc connects with the adjacent vertebral body
The vertebral endplate has a higher concentration of ____ near the vertebral bone and a higher concentration of ___ and ____ nearer to the nuucleus pulposes
The vertebral endplate has a higher concentration of collagen near the vertebral bone and a higher concentration of proteoglycans and water nearer to the nucleus pulposes
___ has 10-20 concentric lamellae, its collagen fibers run parallel, 65 degrees to vertical, and the fiber orientation alternates with each concentric layer
Anulus fibrosus has 10-20 concentric lamellae, its collagen fibers run parallel, 65 degrees to vertical, and the fiber orientation alternates with each concentric layer
The two layers of the anulus fibrosus assist with…?
The two layers of the anulus fibrosus assist with weight bearing and movement
The alternation of the anulus fibrosus fibers help provides..?
The alternation of the anulus fibrosus fibers help provides stability
What does the outer fibers of the intervertebral disc do?
Connect to ring apophysis to serve as ligaments to restrain motion
The zygapophyseal joints are formed by…?
The zygapophyseal joints are formed by inferior articular facet of superior vertebra and the superior articular facet of the inferior vertebra
What does the zygapophysial joints do?
Help guide and limit movement as the spine moves
What are the functions zygapophyseal joints
- Moderate and guide the direction and extent of segmental motion
- Protection against excessive shear of torsional forces
- Load bearing, transmit axial loads
____ is greatest in the lumbar region due to lordosis and line of gravity
Load bearing, transmit axial loads is greatest in the lumbar region due to lordosis and line of gravity
The lumbosacral angle is anterior and inferior inclination of ___. It is usually 30 degrees from _____
The lumbosacral angle is anterior and inferior inclination of sacral base. It is usually 30 degrees from horizontal
What are the factors that may increase the lumbosacral angle?
Pregnancy, obesity, postural habits
Abrupt change in facet orientation –
oblique to frontal plane
What does the lumbosacral joint limit?
Lateral flexion and rotation
What happens to the vertebrae when a person likes to stand with an anterior pelvic tilt?
L5 will move further from the horizontal and more vertically, which means that there will be greater shear forces at L5-S1, which can lead to low back pain
Motion in the vertebrae is described by ___
Motion is described by the superior segment moving on the inferior segment.
Vertebral motion is described in terms of the ____
Vertebral motion is described in terms of the
movement direction of the anterior surface of the `vertebral body.
In Fryette’s laws of vertebral motion, what is type 1 mechanics (neutral mechanics)?
- Coupled motion in OPPOSITE directions
* LF to one side is accompanied by ROT to the opposite side (L LF and R ROT)
In Fryette’s laws of vertebral motion, what is type 2 mechanics (non-neutral mechanics)?
- Coupled motion in SAME directions
* LF to one side is accompanied by ROT to the same side (L LF and L ROT)
In Fryette’s laws of vertebral motion, what is type 3 mechanics?
• Motion in one plane reduces motion in all remaining planes
What happens in vertebral flexion?
The superior vertebra rotates anteriorly around the transverse or horizontal (x) axis and translates (tilts and glides) anteriorly along the sagittal or AP (z) axis
What happens anteriorly in vertebral flexion?
- Compression of anterior disk (annulus fibrosus)
* Laxity within anterior longitudinal ligament
What happens posteriorly in vertebral flexion?
- Inferior articular process of superior vertebra moves superiorly in relation to superior articular process of the interior vertebra
- Separation of spinous processes, facet joints “open”, widening of IV facet
- Tension in the posterior disk (annulus fibrosus), facet joint capsules, PLL, etc
What happens in vertebral extension?
The superior vertebra rotates posteriorly around the transverse or horizontal (x) axis and translates (tilts and glides) posteriorly
along the sagittal or AP (z) axis
What happens anteriorly in vertebral extension?
• Tension in the anterior disk (annulus fibrosus), ALL, and anterior trunk musculature
What happens posteriorly in vertebral extension?
• Inferior articular process of superior vertebra moves inferiorly in relation to superior articular process of the interior vertebra
• Approximation of spinous processes,
narrowing of IVF, facets “close”
• Laxity in the posterior disk (annulus fibrosus), facet joint capsules, LF, PLL, IS and SS
What is the lumbar-pelvis rhythm?
Coordinated movement of the lumbar spine and pelvis during flexion – extension
What happens in the lumbar pelvic rhythm during flexion?
Lumbar flexion followed by anterior pelvic tilt
What happens in the lumbar pelvic rhythm during extension?
Posterior pelvic tilt followed by lumbar extension
Pelvic motion at the hips ____ overall ROM and ____ the amount of flexibility
needed in the spine.
Pelvic motion at the hips increases overall ROM and reduces the amount of flexibility
needed in the spine.
What happens in vertebral lateral flexion?
The superior vertebra rotates around the anteroposterior (z) axis and translates (tilts and glides) laterally along the horizontal (x) axis
What is the coupled motion of lateral flexion?
Contralateral axial rotation in upper lumbar and ipsilateral rotation at L5-S1
What happens in vertebral rotation?
The superior vertebra rotates around the vertical (y) axis and translatory movement is dependent on vertebral segment involved
Axial rotation tends to couple with _____
Axial rotation tends to couple with contralateral LF in upper lumbar and ipsilateral LF at L5-S1
Axial rotation may couple with___ or ____
Axial rotation may couple with flexion or extension
What happens to the facet joint of the ipsilateral side during rotation?
Gapping of facet joint on ipsilateral side
What happens to the facet joint of the contralateral side during rotation?
Impaction of facet joint on contralateral side
What are the factors that influence spinal stability and mobility?
- Thickness, elasticity, and compressibility of the IVDs
- Shape and orientation of the spinous processes and facet joints
- Tension of the facet joint capsules
- Resistance of the back muscles and ligaments
- Attachment of the thoracic rib cage
- Bulk of surrounding tissue
How does the “thickness, elasticity, and compressibility of the IVDs” influence spinal stability and mobility?
Thicker discs or discs with greater elasticity and compressibility will allow greater movement
How does the “shape and orientation of the spinous processes and facet joints” influence spinal stability and mobility?
Sagittal facet orientation limits rotation in the lumbar spine
How does the “tension of the facet joint capsules” influence spinal stability and mobility?
Thicker joint capsules limit mobility
How does the “resistance of the back muscles and ligaments” influence spinal stability and mobility?
Thicker, stronger ligaments increase stability and limit mobility
How does the “attachment of the thoracic rib cage” influence spinal stability and mobility?
Limits lateral flexion in the thoracic spine
What are the deep muscles(inner unit) of the spine?
- Deep fibers of the lumbar multifidus posteriorly and the transverse abdominis anteriorly
- The pelvic floor muscles and the diaphragm
What are anterior oblique muscles of the spine?
- Internal and external oblique
- Contralateral hip adductors
What are posterior oblique muscles of the spine?
- Lat dorsi, glut max, TFL
What are deep longitudinal muscles of the spine?
Hamstrings and erector spinae
What are lateral muscles of the spine?
Glut med, glut min, and contralateral hip adductors
The brain receives input from the _____ to determine the specific requirements for maintaining stability.
The brain receives input from the passive and active subsystems to determine the specific requirements for maintaining stability.
When may the effectiveness of the neuromuscular control system be compromised?
Following injury.
What is range of motion?
The entire range of the physiological intervertebral motion, measured from the neutral position
What is the neutral zone?
Range of physiological intervertebral motion, measured from the neutral position, within which the spinal motion is produced with minimal internal resistance by passive structures
What is the elastic zone?
Range of physiological intervertebral motion, measured from the end of the neutral zone up to the physiological limit within which motion is produced against significant resistance from passive tissues.
What controls the neutral zone?
The active system and the neural control system
____ is the most common site of metastases of cancer
Skeleton is the most common site of metastases of cancer
Common metastatic cancer that cause lumbar spinal pain is from ____
Common metastatic cancer that cause lumbar spinal pain is from prostate
What are the features to look for when considering if the cause of a person’s low back pain is rom cancer/back-related tumor?
- Prior history of cancer
- Over 50
- Unexplained weight loss
- Failure to improve over 1 month
What are the things to look for to determine if a person is suffering from cauda equina syndrome?
- Urine retention
- Saddle anesthesia
- Sensory or motor deficits in the feet (L4-S1)
What are the things to look for to determine if a person is suffering from spinal compression fracture?
- Females over 50
- Major trauma, pain and tenderness
What are the clinical manifestations of Abdominal Aortic Aneurysm (AAA)
- Palpable pulsating abdominal mass
- Throbbing, pulsating pain
- Patient unable to find comfortable position
- History of cigarette smoking, HTN
- Positive family history
- History of AAA, vascular atherosclerotic disorder
What is ankylosing spondylitis and who does it happen more often in?
Inflammatory arthropathy, systemic rheumatic disorder that happens more in males with an history of inflammatory conditons
What are the key factors of ankylosing spondylitis?
- Morning stiffness of more than 30 mins
- Improvement of LBP with exercise, but not with rest
- Night pain during 2nd half of night only
- Alternating buttock pain
What are the questions in cluster 1 of determining if abdominal pain is of musculoskeletal origin?
- Does coughing, sneezing, or taking a deep breath make pan feel worse? (yes)
- Do activities such as bending, sitting, lifting, twisting, or turning over in bed make pain feel worse? (yes)
- Has there been any changes in bowel habit since the start of symptoms? (no)
Answers listed results in moderate probability that complaints are of musculoskeletal origin
What are the questions in cluster 2 of determining if abdominal pain is of musculoskeletal origin?
- Does eating certain food make the pain feel worse? (yes)
- Has weight changed since symptoms started? (no)
Answers listed increases probability to strong of musculoskeletal origin
What are the questions to ask to help rule out renal/urinary disorders?
- Do you have any trouble with urination?
- Changes in urine color, initiation of stream, incontinence, flow changes (frequency, urgency, output volume, retention, pain with urination)
What are the questions to ask to help rule out reproductive system disorders in males?
- Urethral discharge
- Sexual dysfunction
- Pain during intercourse, ejaculation
What are the questions to ask to help rule out reproductive system disorders in females?
- Vaginal discharge
- Pain with intercourse
- Menstruation
- Frequency
- Length of cycle
- Dysmenorrhea
- Number of pregnancies and deliveries
- Menopause
What are the questions to ask to determine if a patient is suffering from depression?
- Over the past 2 weeks, have you felt down, depressed or hopeless?
- Over the past 2 weeks, have you felt little interest or pleasure in doing things?
One yes is bad
Why is a lower quarter screening exam performed?
To help narrow down and identify the area of concern. To reproduce symptoms.
What part of the screening is hypothesis refinement done?
- Regional screen
- Specific testing
What are the test included in the standing clearing lumbar test?
- Forward flexion
- Extension
- Quadrant motion which includes rotation, extension, and side bending
What are the test included in the seating clearing hip test?
- FABER: Flexion, Abduction, & External rotation
- F/ADD: Flexion, Adduction
A neurological examination is required for all patients who exhibit lumbar or lower quarter pain with symptoms ____ or for any patient with lower quarter symptoms of questionable origin
A neurological examination is required for all patients who exhibit lumbar or lower quarter pain with symptoms extending below the gluteal fold or for any patient with lower quarter symptoms of questionable origin
What does a positive supine clearing test: straight leg raise of less than 45 degrees indicate?
A lumbar radiculopathy
What does a positive supine clearing test: straight leg raise of more than 45 degrees indicate?
Adverse neuro-dynamics: sensitized nerves
What are the 2 things we do in a prone clearing: lumbar spring testing test?
- Central posterior to anterior (CPA) forces at each segment of the lumbar spine, into the lower thoracic region
- Unilateral posterior to anterior (UPA) motion
Statistical significance ____ clinical significance
Statistical significance does not equal clinical significance
What are the things that are assessed on the modified oswestry LBP disability questionnaire(ODI)?
- 8 items that assess activities of daily living and 2 items that assess pain
How is ODI scored?
- On a scale of 0-5
- Express as percent
- The higher the score, the worse the disability
What does the Fear-avoidance beliefs questionnaire (FABQ) assess?
It assesses the patient’s beliefs about work and physical activity
What does the Fear-avoidance beliefs questionnaire (FABQ) aid in?
Aids in identification or patients with fear avoidance who are at risk for prolonged disability
What are the items on the FABQ?
- 5 items for physical activity
- 11 items for work
How is the FABQ scores?
- Scored 0-6
- The physical activity items uses 2-5
- The work itms uses 6,7,9-12, 15
What is a high score for physical activity on the FABQ?
Higher than 15
What is a high score for work on the FABQ?
Higher than 34
____ is an excellent tool to track symptom location and quality
The body chart
____ assesses overall response to care and need to specifically ask “is the amount of change important to the patient?
Global Rating Change Scale (GROC)
How is GROC scored?
- From -7 to 7.
- A 0 indicated no change at all
- A 1-3 change is small
- A 4-5 change is moderate
- A 5-7 change is large
What are asterisk signs?
Subjective/objective measures collected that produce or aggravate patient’s symptoms
When can asterisk signs be used?
Within the test-retest process
What are the things to do in a test-retest?
- Be consistent in examination: make your self reliable in how your perform exam movements.
- Reestablish baseline symptoms and with asterisk retest after specific treatment and at beginning of follow-up visits.
- Helps determine next steps in care.
Where does appendix refers pain to?
Right upper thigh, and stomach
Where does the liver refer pain to?
Right shoulder and Mid to upper back
Where does the gallbladder refer pain to?
Right shoulder and Mid to upper back
Where does the common bile duct refer pain to?
Right shoulder, Mid to upper back,
Where does the pancreas refer pain to?
Mid abdominal region, left shoulder, right upper back
Where does the esophagus refer pain to?
Mid to upper back
Where does the stomach refer pain to?
Right posterior shoulder, right under armpit area in the back, and right mid-lower back
Where does the duodenum refer pain to?
Right posterior shoulder, right under armpit area in the back, and right mid-lower back
Where does the small intestine refer pain to?
Lower back (lumbo-sacral region)
Where does the large intestine and colon refer pain to?
Sacro-coccygeal region
