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PTRS 845 Midterm > Lumbar Instabilities and Stabilization > Flashcards

Lumbar Instabilities and Stabilization Flashcards

1
Q

Term: controls normal loads and stressed placed on the spine

A

Stabilizing structures

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2
Q

System: Passive system/stabiliy of bones, joints, capsules, and ligaments

A

Osteoligamentous subsystem

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3
Q

System: Active system/dynamic stability

A

Muscle system

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4
Q

System: Guides the muscle system via timing, force control, etc.

A

Neural control subsystem

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5
Q

3 Components of a Stabilized Spine

A
  1. Osteoligamentous subsystem
  2. Muscle system
  3. Neural control subsystem
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6
Q

Describe the effect of dysfunction in one of the three subsystems

A

Added stress/demand to the other systems

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7
Q

Term: first few degress of motion

A

Neutral zone

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8
Q

Term: zone in which movement occurs in a free range against little resistance

A

Neutral zone

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9
Q

Zone: Grades 1 and 2

A

Neutral zone

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10
Q

Term: From the end of the neutral zone to the end of ROM

A

Elastic zone

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11
Q

Term: zone in which movemtn occurs with considerable internal resistance

A

Elastic zone

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12
Q

Zone: Grades 3 and 4

A

Elastic zone

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13
Q

Describe the relationship between load and displacement

A

Non-linear relationship

The stiffness of the spine varies with the load. At low load the spine is flexible (larger displacement) while at high load the spine is stiff (small displacement). At some point/high force there is a plateau in displacement.

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14
Q

Zone: Passive structures

A

Elastic zone

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15
Q

Describe the effect of laod on displacement when passive structures are injuried

A

When the elastic zone/passive structures are injuried there is more displacement at higher loads because stiffness from the elastic zone is compromised

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16
Q

Term: increase in neutral zone

A

Segmental instability

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17
Q

Term: Decrease in elastic zone

A

Segmental instability

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18
Q

Define segmental instability

A

Panjabi says: When the stability system is compromised and neutral zone is increased

Bogduc says: Decreased stiffness/elastic zone resulting in hypermobility

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19
Q

Term: dysfunction in one or more stabilizing components leading to an increase in the size of the neutral zone, loss of stiffness, and abnormal movement

A

Segmental instability

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20
Q

Term: Abnormal movement of one vertebra on another

A

Segmental instability

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21
Q

System: Osseous and ligamentous system that limited the neutral zone and stabilizes the elastic zone

A

Passive system

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22
Q

System: Muscle and facia system that control motion dynamically under load and controls both zones

A

Active system

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23
Q

System: Determines amount of stability needed, acts on muscles to produce force

A

Neural system

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24
Q

System: Adds stiffness by activating specific pattern of muscle activity

A

Neural system

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25
Q

3 ways to assess dysfunction in the PASSIVE subsystem

A
  1. PPVIMs (hypo/hyper)
  2. PAVIMs (central/unilateral PA)
  3. Instability test
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26
Q

5 ways to assess dyfunction in the ACTIVE subsystem

A
  1. US reveals decreased in CSA
  2. Decreased contraction with palpation
  3. Decreased feedback with pressure device
  4. Mm fatigue seen with EMG
  5. Unable to resist/accept load
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27
Q

3 ways to assess dysfunction in the NEURAL subsystem

A
  1. Delayed mm onset (EMG)
  2. Altered MUR (EMG)
  3. Change in proprioception
28
Q

Describe the effect of dysfunction in any one of the systems over time

A

Can lead to habitual changes in spinal movement and movement impairment

29
Q

Condition: defect in pars interarticularis

A

Sponylolysis/Spondylolisthesis

30
Q

Condition: Results in increased intervertebral segment motion

A

Spondylolysis/Spondylolisthesis

31
Q

Condition: Typically in teens due to trauma

A

Spondylolysis/Spondylolisthesis

32
Q

Condition: can be seen in adults due to repeated (occupational) stress

A

Spondylolysis/Spondylolisthesis

33
Q

Term: degenerative changes in pars interarticularis

A

Spondylosis

34
Q

Term: Defect of partial fx in pars interarticularis

A

Spondylolysis

35
Q

Term: “Collar on Scottie dog”

A

Spondylolysis

36
Q

Term: Complete fx of pars interarticularis with slippage

A

Sponydlolisthesis

37
Q

Term: Decapitated Scottie dog

A

Sponydlolisthesis

38
Q

Describe the types of anterior slippage

  1. Normal
  2. Stage 1
  3. Stage 2
  4. Stage 3
  5. Stage 4
A
  1. Vertebral bodies (L5-S1) aligned
  2. 0-25% anterior translation (conscerv. tx)
  3. 25-50% anterior translation (conscerv. tx)
  4. 50-75% anterior translation (fusion)
  5. 75+% anterior translation (fusion)
39
Q

Term: Segmental instability due to degeneration of discs, ligament/muscle injury, or poor motor control

A

Functional instability

40
Q

Term: Inability to maintain neutral zone, segmental hypermobility

A

Functional instability

41
Q

Term: Instability related to either muscle or neural system changes

A

Functional instability

42
Q

Condition: Subjective

  • Young > Old
  • Commonly L5-S1
  • Fluctuating symptoms, rarely radiating
  • Localized pain
A

Functional Instability

43
Q

Condition: Subjective

  • Constantly moving positions
  • Pain decreased when new positions reached
  • Hx of catching/locking
A

Functional Instability

44
Q

Condition: Aggravating Factors

  • s/p vigorous activity
  • Static posture
A

Functional Instability

45
Q

Condition: Easing factors

  • Rest
  • Changing to a new position
A

Functional Instability

46
Q

Condition: Ojective

  • Increased lumbar lordosis
  • End ROM may provoke symptoms
  • Hesitation in flexion at 30-40 degrees
  • Hinging with extension
  • Gowers +
A

Functional Instability

47
Q

Decreased the amount of lumbar vs. hip extension in those with functional instability.

A

Will see more lumbar extension compared to hip extension

48
Q

Condition: Objective

  • Poor pelvic and abdominal control
  • Central PA painful with altered end feel
  • Leg load test +
A

Functional Instability

49
Q

End feel and Motion: Hypermoble Central PA

A

Increased neutral zone motion with a soft end feel

50
Q

End feel and Motion: Hypomobile Central PA

A

Decreased neutral zone motion with a stiff end feel

51
Q

Describe how hypomobility and instability/hypermobility can co-exist

A

They can co-exist but not at the same segment, must be at different segments

52
Q

Describe who would benefit most from a stabilization/TA exercise regiment.

A

Those who lack control in local muscles

53
Q

Describe how global exercises impact the spine and stability

A

Global muscle exercises apply a compressive force

They provide nonspecific stability and can’t control shear forces

54
Q

Muscle type: Provide stiffness, control translation, adjust segments to reduce shear

A

Local muscles

55
Q

Muscle Type: anticipate load/movement and respond to WB exercises

A

Local muscles

56
Q

Muscle Type: Provide proprioception, support, and protection to the joint

A

Local muscles

57
Q

Muscle: First to register activity on EMG irrespective of direction of movement of limb or direction of forces acting on spine

A

TA

58
Q

Muscle: Active during ipsilateral and contralateral trunk rotation

A

Multifidus

59
Q

Muscle: Controls the neutral zone and lordosis

A

Multifidus

60
Q

Muscle: Controls pelvic rotation

A

Multifidus

61
Q

Describe how which exercises bias the internal and external obliques

A

Internal: crunches, sit up

External: side plank, SL hip ABD

**Focus on external because most people are generally inernal dominant

62
Q

Describe why it is difficult to activate hip musculature

A
  • Has small cortical representation
  • Is a redundant system making it easy to compensation with other muscles (thus they aren’t activated)
63
Q

Describe they it is difficult to activate postural muscles

A
  • We don’t typically think about activating activating them since they are “automatic” (it’ll take some time to due it on command)
  • Small cortical representation (with chronic LBP this small representation may be “shut down” making it even more diffiicult to find the pathways needed to activate these muscles)
64
Q

Term: Mind’s attempt to teach the body conscious control of a specific movement

A

Motor training

65
Q

4 Element of Motor Training

A
  1. Proprioceptive and kinesthetic awareness
  2. Dynamic stability
  3. Preparatory and reactive muscle characteristics
  4. Conscious and unconscious functional motor patterns
66
Q

3 Phases of Motor Training

A
  1. Phase 1 = static stabilization
  2. Phase 2 = transitional stabilization
  3. Phase 3 = dynamic stabilization

PTRS 845 Midterm (13 decks)

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