written test #2- lumbar, Hip, Knee Flashcards
Which direction do lumbar intervertebral discs deform and displace when a person performs right lateral flexion?
Left
If a patient has radiating symptoms that demonstrate motor weakness, the patient is given what type of radiating symptoms diagnosis?
Radiculopathy
Injury at sub failure load is most likely to occur when there is inadequate recovery (time) between exposures of load. T or F?
True
Limacon shaped lumbar vertebral discs demonstrate more diffuse nucleus deformation than ovid shaped discs. T or F?
False
Which of the following spinal motions are limited the greatest due to the orientation of the lumbar facet joints?
Rotation
What best describes the process of pain centralization?
Distal pain that slowly progresses towards the spine
Based on categorization of low back pain, what treatment is most ideal for addressing a facet mobility problem?
Joint manipulation
Lumbar ligaments are densely populated with mechanoreceptors providing feedback regarding position and motion. T or F?
True
What best describes the reason for the ilopsoas’s attachment to the lumbar spine?
Disperse hip flexion forces across the lumbar spine
Based on categorization of low back pain, what treatment is the most ideal for addressing a motor control problem?
Stabilization exercises
What position are the hip abductors capable of generating the greatest force (strongest)?
Adducted 10 degrees
In a seated position with hips flexed to 90 degrees, the piriform is positioned to efficiently perform which movement?
Internal Rotation
What combination of positions puts the hip in OPEN packed position?
Slight external rotation, hip flexion 30 degrees, abducted 30 degrees
What position is the right femur in relative to the pelvis when the pelvis left laterally tilts (left side drops)?
Adduction
When the pelvis rotates to the left, what direction does the left femur need to move relative to the pelvis to keep the left foot aligned in the sagittal plane?
Medial Rotation or Internal rotation
Which position will a person adopt posturally, if they have femoral retroversion?
Lateral rotation of the leg (toed-out)
What position is the femur in relative to the pelvis when the pelvis is tilted anteriorly
Flexion
In a standing position, posterior rotation of the pelvis is equivalent to closed kinetic chain hip extension. T or F?f
True
Which of the following is true regarding coxa vara?
It is associated with less risk of dislocation
Which of the normal variants of the femoral neck increases mobility of the iliofemoral joint, while sacrificing stability- Coxa valga or Coxa vara?
Coxa valga
Which meniscus demonstrates less mobility, possibly explaining why it more frequently injured?
Medial
Which area of the meniscus has the best potential to heal due to a better blood supply?
Outer 1/3
Any movement of the vastus medialis oblique will allow a greater amount of lateral glide of the patella due to the origin of the quadriceps muscles being orientated laterally to their insertion point. T or F
True
What motions create the “screw home” mechanism of the knee during terminal knee extension? You need to know what a terminal knee extension is to understand this question…
The femur internally rotates and the tibia externally rotates
Which meniscus is deeper?
Lateral
Which directions does the femur move relative to the tibia during knee extension?
Rolls anterior and slides posterior
The posterior Cruciate ligament functions to prevent what motions at the knee?
posterior translation of the tibia and anterior translation of the femur
The lateral femoral condyle rotates which direction on the tibia during knee flexion?
posterior
what position is considered the open packed position of the knee?
30 degrees of flexion
Which direction do the menisci move during knee extension?
Anterior
What are the 3 common occurrences for patient that reported low back pain compared to those who do not?
Reduced lumbar ROM
Move more slowly
Have reduced proprioception
LBP has a high rate of reoccurrence. T or F?
True
Treatment of LBP focused on the intervertebral disc should focus on what treatment?
Direction Specific exercise
Treatment of LBP focused on the Facet or SI joint should focus on what treatment?
Joint manipulation
Treatment of LBP focused on motor control should focus on what treatment?
Stability & motor control exercises
Treatment of LBP focused on central sensitization should focus on what treatment?
cognitive behavior therapy
IVD deform opposite to _________
Load
The nucleus pulposus deforms in the direction opposite to the ________
motion
If the spine flexes the nucleus pulposus moves ?
posterior
IF the spine extends what direction does the nucleus pulposus move?
Anterior
If you laterally flex your spine does the nucleus pulposus move contralateral or ipsilateral?
Contralateral
The IVD store energy from rotation and releases that energy to help drive what?
Our gait
Put these in order from least force on the IVDs to the most-
Coughing
Lifting 22.5 lbs
Forward bending 40 degrees
Holding 1lbs at arms length
Lying supine
Standing erect
Sitting in an unsupported position
Sitting in a supported position
lying supine- 250 N
Sitting supported- 400 N
Standing erect- 500 N
Sitting unsupported- 700 N
Coughing- 700 N
Forward bending 40 degrees- 1000 N
Lifting 22.5 lbs- 1700 N
Holding 11lbs at arms length- 1900 N
What are the lumbar disc shapes?
Ovoid Disc- Circular, thinner spines, more diffuse nucleus deformation
Limacon- bean shaped, thicker spines, more focal deformation
3 ways the IVD can cause symptoms are?
Direct injur to annulus fibrosis
Mechanical pressure & Chemical irritation affecting IVFs
Loss of disc height
Define radiculitis
Radicular or Radiating pain. Sensory changes due to ectopic discharges from a nerve due to inflammation
Define Radiculopathy
compression or a nerve that results in motor weakness
Pain originating from the spine that refers distally is called what?
Peripheralization
Symptoms moving back towards the midline of the spine is what?
Centralization
The bigger the herniation the more likely it will ________ ____________
spontaneously resorb
Repeated movement testing is performed and if centralization or a direction preference is identified, they are placed into this category. What treatment category is this?
DIRECTION SPECIFIC EXERCISE
What is unique about the lumbar facets superior to inferior?
Primarily lie in a sagittal plane in the upper lumbar and changes to a coronal plane in the lower lumbar
Anterior rotation + Anterior translation = What in the spine
Flexion
Anterior translation of vertebrae is limited by what?
bony facet joints
anterior rotation is limited by ??
Posterior annulus fibrosus & posterior ligament
Posterior Rotation + Posterior Translation= what is the spine
Extension
Lumbar extension is limited by the approximation of the __________ and __________
articular processes
spinous processes
What limits side bending in the lumbar spine
Intertransverse ligament
Capsule of the contralateral facet joint
Approximation of the ipsilateral facet joint
In a neutral position- rotation is limited by 2 things. What are they?
Approximation of the facet joint surfaces
limited by tension in the joint capsule, annulus
fibrosus, & PLL.
If the vertebral body rotates to the left, what happens that limits the rotation?
joint surfaces of the right facet approximate
joint capsule of the left facet is stretched/under tension
What is the open packed position for the lumbar spine?
Flexion & rotation toward the same side
What is the closed packed position for the lumbar spine?
extension & rotation toward the same side
What is the degrees of ROM seen in rotation for the scarum?
Between 1-8 degrees, avg of 2 to 3 degrees
What are the 3 types of SI joint motion?
Symmetrical motion
Asymmetrical motion
Lumbopelvic motion
Antagonistic movement of each innominate relative to the sacrum, which includes movement at the symphysis pubis. What motion is this describing?
Asymmetrical motion
Movement of both innominates relative to the sacrum. What motion is this describing?
Symmetrical motion
Combined movement of the innominates and the spine as a unit around the femoral heads. What motion is this describing?
Lumbopelvic Motion
What are the two movements associated with the SI joint and symmetrical motion?
Nutation
Counter-nutation
Forces from above and below pass through the body in what direction relative to the sacrum?
Anterior
How do the superior and inferior forces act on the sacrum?
Upper body weight tries to tip the sacrum forward
Ground forces tend to rotate the innominate bones backward
Extension of the trunk from standing combines extension of the lumbar vertebrae with ________ rotation of the pelvis on the fixed femurs.
posterior
Flexion of the trunk from standing combines flexion of the lumbar vertebrae with _______ rotation of the pelvis on the fixed femurs.
forward
What factors can limited lumbopelvic flexion?
Hamstring stiffness (limits anterior pelvic rotation)
Excessive lumbar flexion (increased load on discs/ligs)
Weakness in hip flexors (lack of anterior pelvic rotaiton)
What factors can limit lumbopelvic extension?
Tension in iliolumbar ligaments
“tightness” in the hip flexors (anterior tilt of the pelvis)
What are the two self locking mechanisms of the SI joint?
Form closure
Force closure
The sacrum acting as a “keystone”, locks the innominates in place providing bony structural stability. What is this?
Form closure