Exam 2 Flashcards
(201 cards)
1
Q
what is this test?
A
thomas test:
Positive when there is a contraction or contracture of the psoas muscle
- norm = extended leg should contact table
- space = iliopsoas spasm
Test both sides
2
Q
Tentorium Cerebelli
A
anterio borderr: clinoid processes - cradles pituitary wiht infundibulum piercing fascia
medial border: anterior clinoid
lateral border: posterior clinoid
cranial rhythmic impulse creates motion of “tent”
3
Q
how to differentiation b/w disc herniation and piriformis syndrome?
A
EMG
disc = N impinge prox to piriformis
piuriformis: abnorm distal to piriformis
4
Q
Articulations lumbar spine
A
Zygapophoseal joints: (synovial joint).
Intervertebral joints: (Fibrocartilagenous joints.)
5
Q
interstitial fluid pressure and lymph sys
A
approximately -6.3mmHg and flow at 120cc/hr
incrase in interstitial P –> increases absorption into cap
if P > 0 = collapse lymph caps
6
Q
IV disc components
A
- Fibrocartilaginous joint
- Annulus fibrosis
- thicker anteriorly and thinner posteriorly.
- Nucleus pulposus
- Interlocking crosshatch
- allows the disc to undergo rotary motions and shearing forces while still maintaining restrictive stability.
•Attachment to anterior & posterior longitudinal ligaments
7
Q
Extension of a vertebral unit causes what on the IV disc and ligaments
A
Increases pressure on the anterior annulus and ALL
8
Q
Functional Anatomy-Psoas Major
A
- Origin –TP/SP/IV discs T12-L5
- Insertion – lesser trochanter
- Innervations- L1-L3
- Actions-Flexes thigh, external rotation, flexes spine on pelvis
9
Q
taut band
A
hypercontracted extrafusal muscle fibers
pressed = referred pain, motor dysfunction, autonomic phenom
needling/rolling = local twitch response
10
Q
Pathophysiology – Psoas Syndrome
A
M is position of strain and then suddenly lengthens
CNS senses “overstretch” –> reflex contraction
- inc in alpha moto output = incr in gamma firing
pain-spasm feedback loop –> psoas syndrome
11
Q
Pelvic Diaphragm
A
levator ani - 3 M
Coccygeus - 3 M, posterior to levator ani
12
Q
Piriformis Syndrome
Physical Exam - motion testing, neuro, special tests
A
motion:
- hip pain with external rotation, passive internal rotation/flex/adduc
- lumbar spine restricted esp in ext
neuro:
- NORMAL!!
special tests:
- SLR (straight leg raising) - painful throughout
13
Q
gluteus medius: N and spinal lvl
A
sperior gluteal, L4-5, S1
14
Q
spondylolysis
A
stress fx b/w pars interarticularis b/w facets usu L4/L5
most common low back pain in adol athletes
angle & pull of M —> “slippery slope” spondylolisthesis
15
Q
diseases that increase interstitial P > 0 mmHg
A
sys htn
cirrhosis
hypoalbuminemia: starvation
toxins
16
Q
Spondylolisthesis: 80% will present with
A
hamstring hypertonia
17
Q
Piriformis Syndrome
OMT - indirect techniques
A
used more commonly
counterstain: TP at midpole sacrum, piriformis M, postermedial troch
facilitated positional release (FPR)
18
Q
thymus
A
loc: superior mediastinum
T-lymphocytes
involution in adulthood
19
Q
sibson’s fasica
A
prevert fascia + scalene fascia
thoracic duct txverses sibsons –> C7 and then turns around an emptys into L subclavian
20
Q
Quadratus Lumborum
Trigger Points and Referred Pain Patterns
A
21
Q
load on L3: in order of increasing load:
bending sideways, standing, twisting
A
standing (700) < twisting (900) < bending sideways (950)
22
Q
QL Spasm/Trigger Point: clinical characteristrics
A
–Unlevel pelvis
–Patient’s trunk leans to 1 side
–Very hypertonic muscles on the concave side
–Short leg on side of QL spasm
23
Q
Anterior Longitudinal Ligament
A
- broad
- Limits extension
24
Q
anterior cervical fascia
A
attachements: base of skull, mandible, hyoid, scapula, clavicle, sternum
25
X + 1 rule
hernation disc X = X + 1
nerve root X already exited
26
Gluteus Medius Trigger Points
along iliac spine starting posterior
can refer pain to greater troch
27
lumbar IV disks
large
heavy load bearing
named for vert above
28
Extrinsic Forces of lymph sys
○Osteopathic Manipulative Treatment
○Exercise
○Muscle Contraction
○Adjacent Artery Pulsation
○Increased negative intra-thoracic pressure with respiration
29
FUNCTIONAL ANATOMY Psoas Minor
•Absent in 40% of people
•
•Origin– bodies of T12 and L1 and their disc
•
* Insertion – tendon attached to pecten pubis, ilippectineal eminence, and iliac fascia
* Innervations-branch of L1
•
•Action-Weak flexor of thigh and trunk
•
30
Piriformis Syndrome
OMT - direct techniques
Muscle Energy-no absolute contraindication
HVLA-use to treat sacrum and iliac SD (caution with osteoporosis)
31
Goals of Lymphatic Treatment
Improve respiration and circulation
Improve lymphatic circulation and decrease edema/congestion
Improve drug delivery
32
FUNCTIONAL ANATOMY Iliacus
•Origin- superior 2/3 iliac fossa, inner lip of iliac crest, ASIS, and lumbosacral ligaments (sacroiliac , iliolumbar) lateral sacrum
•
* Insertion-common tendon with p. major to lesser trochanter
* Innervation-branches of femoral nerve, L1. L2
•
•Action-flexes thigh and moves trunk
33
what has a very intimate relationship with the lymph of head, neck, thorax, upper extremity?
anterior cerv fascia
34
Examples-Initial Positions of Flexion that result in psoas syndrome
* Sitting with pelvis “tucked under”
* Desk work
* Bending over from waist
* Weeding
* Repetitive sit-ups
35
Conditions Associated with TrPs/Myofascial Pain
* Vitamin deficiency/insufficiency (C, D, B12, folate)
* Hypo:
* thyroid
* glycemia
* Hyperuricemia
* Iron deficiency
* Candida albicans infection
36
Relationship of the Abdominal Diaphragm with the Pelvic Diaphragm
should work in synchrony -\> optimal mvmt interstitial fluids
* pump for lymp vess & venous sinuses in pelvis, rectum, perineum
pelvic floor must dissipate P of respiratory cycle
37
Where does majority of flexion occur
and degrees
38
Iliolumbar ligaments
* Iliac crest just above and lateral to PSIS to transverse process of fourth and fifth vertebra.
* First ligament to be strained in a lumbosacral imbalance.
39
Piriformis Anatomy/Action
* Straight lower ext.: External rotation of the thigh at the hip; may contribute to thigh extension
* Bent lower ext. 90°: Abduction of the thigh at the hip; may also internally rotate thigh
40
Piriformis Syndrome
peripheral neuritis of the sciatic nerve caused by an abnormal condition of the piriformis
can "masq" as other common SD
41
lymph sys consissts of:
Organized lymph tissue
○Spleen, thymus, tonsils, appendix, visceral lymphoid tissue in the GI and Pulmonary systems and the liver (each with a specific function).
Collecting ducts
○Beginning with blind endothelial tubes and terminating in the minor & major lymphatic ducts.
Lymph fluid
○Clear, containing proteins and salts.
42
Load characteristics on IV discs
* Reabsorption increases thickness
* Decreased thickness under load
* age decreases the ability to recover thickness
43
Functionally the thoracic inlet consists of...
T1-4 vertebrae, ribs 1 & 2 plus their costo-cartilages, the manubrium and clavicles
44
Causes of QL Trigger Points
* Passive- postures that shorten the muscle.
* Active- trauma, such as MVA; bending over and reaching to one side to pull or lift something
45
sacralization
L5 fused with S1
46
degrees •of flexion at the L5-S1
what % does this contribute to total flexion
45 degrees
75%
47
Disc Herniation
•Posterio-lateral herniation
–narrow posterior longitudinal ligament
•Most common
–L4-L5 95% of herniations
–L5-S1
48
what does this test fix?
what is this technique calleD?
* Treatment of quadratus trigger points
* 12th rib technique and passive myofascial release of the quadratus lumborum (both useful during the acute stage).
49
Multifidus
Small Back Muscles
Deep to Erector Spinae
Postural
Bilateral Contraction Local Extension
Intertransversarii muscle Control individual vertebra
type II
50
•FRYETTE’S SECOND PRINCIPLE (TYPE 2 MECHANICS)
•When side bending is introduced into a region of the spine in a **non-neutral position**, rotation of at least one segment must preceed sidebending. Rotation and side bending occur to the same side.
51
•Osteoarthritis of the hip is characterized by:
–Pain at the actual hip joint anteriorly mid thigh @ level of inguinal ligament
–Decreased extension
–Decreased internal rotation
52
L4
medial side foot, walk on heel
pateller reflex
deep perioneal N: tib anterior
dorsiflex, inversion
53
Loss of lumbar lordosis due to...
what exercise to "fix"
* Spending time in forward flexion
* Lumbar kyphotic postures causing elongation of the posterior longitudinal ligamentous, fascial and muscular tissues.
* disc bulging and posterior herniation.
•Exercises: extension
54
Hip Drop Test principle
knee flexion of one leg result in 20-25 degree drop of the iliac crest on that side (side of non weight bearing) also produce an observed smooth side bending curve of the lumbar spine on the opposite side (side of weight bearing)
55
Piriformis Syndrome
Etiological Considerations
•Primary piriformis syndrome (\<15%)
* –Anatomical cause due to split piriformis, split sciatic n., anomalous sciatic n. path
•Secondary piriformis syndrome-more common
* – trauma, ischemic mass effect, local ischemia
* •Macrotrauma to buttocks inflammation and muscle spasm creating nerve compression
* •Microtrauma due to overuse as in running/walking or direct compression (“wallet neuritis”/sitting on hard surfaces)
56
right lymphatic duct drains
heart
lungs
R upper arm
57
Function of Lymphatic System
To transport proteins in the interstitium back to the circulatory system.
To present antigens to immune cells to facilitate immune system activation.
To drain off inflammatory mediators to allow orderly progression of inflammatory response.
58
Increase tone (Hypertonicity) of diaphragm =
flattens!
motion of lower ribs may stay down with inhalation
* inhal restriction = exhale SD
* decrease in transverse diameter of chest cav -- \> less efficient respir --\> decs in P gradient --\> less lymph flow and venous return
* accessory M use during inspiration: scalenes
59
Intrinsic Forces of lymphatic sys
smooth M contraction, interstitial fluid pressure
60
A 50-year-old male comes to your office with chronic low back pain. His back pain is a dull ache that radiates into the buttock and thighs bilaterally. The pain is made worse with standing or walking 20 minutes or more and maintaining extension. Pain is relieved completely with sitting. Range of motion of his lumbar spine is decreased. Sensation is decreased in both feet in a stocking like distribution. Percussion on the spinous processes produce no pain. There is no fever, no weight loss and undisturbed sleep. What is the most likely finding this patient will have on radiological studies?
A. A herniated nucleus pulposus on magnetic resonance imaging.
B.Spondylolisthesis of the L1 on L2
C.Spondylosis of the lumbar spine.
D.Loss of definition of a vertebral end-plate and elevation of the periosteum suggestive of vertebral osteomyelitis.
E.Lytic (punched-out lesions) spinal metastases involving the lumbar vertebrae.
.Spondylosis of the lumbar spine.
61
terminal lymph drainage
angle!
internal jugular and subclavian
62
lumbar spine ferguson's angle
affected by?
line paralleling the top of the sacrum and a line drawn horizontally.
Rotational changes in the pelvis and lumbar spine will effect the lumbosacral angle.
35
normal = 35-55
63
Initiation of Quadratus Problems:
Posture: low back pain.
dmg by overload or prolonged malposition
constant state of stretch
(a) weakness,
(b) pain
(c) sometimes spasm.
64
do disc herniations need sx usu?
no. most will resolve with conventional tx
65
how are the lumbar bones oriented?
what type of mvmt is greatest ROM? least?
sagittal plane orientation of facents
flex/extend = greatest ROM
rotation = least ROM
SB = inb/w
66
piriformis anatomy: origin, insertion, innervation
Origin: sacrum @ level of S2-S4, sacrotuberous ligament
Insertion: greater trochanter
Innvervation: S1,S2, occasionally L5
67
conservative tx spinal stenosis
elong spine
unkink enclosed cauda equina
pelvic tilt/OMT
corset
68
releiving factors of spinal stenosis
20-3min rest
sitting/flexed/leaning over (shopping cart)
side-lay with knees to chest
69
ultimate goal of lymph OMT
decrease work of breathing
increase lymph drainage
70
Abdominal Diaphragm
Dome shaped muscle with two lateral hemi-diaphragms.
Its shape is influenced by the viscera below.
The primary function is respiration.
Secondary functions include; circulation of blood, lymphatic pumping, speech, micturition, defecation and parturition.
71
tentorium cerebelli is formed by
intracranial meningeal dura
sella turcica "saddle shaped" sphenoid region b/w clinoid processes (houses pituitary)
* covered by diaphragma sella (dura mater) - continuation of tentorium cerebelli
72
Diseased vs. healthy disc under load
* diseased or aging disc can be more compressible & annulus tears.
* Decreased disc thickness causes an increased weight load on the facet joint
decreased flex!!!
73
meralagia paresthetica
P on lateral fem cut N - through inguinal lig
upper ant-lat thigh pain
74
Typical Posture of psoas syhndrome
–Flexion at hip and sidebending of lumbar spine to side of most hypertrophied psoas
75
Referred Pain Patterns from Trigger Points of what M?
psoas
76
this is showing what test?
standing side bending test
77
Kernig’s sign
supine, hip flexed to 90, then try to extend leg
pain in hamstring = meningeal irritation
78
spondylolisthesis
forward "slippage" - "spotty dog"
"palpable shelf" - gap
able to be asymp in physically active pt
can be retro
79
rectus abdominus TrP
lower ipsi = mimic appendincitis
lower bilat = menstrual
80
•Sciatic Nerve
–Formed by the ventral rami of L4-S3
–Converge on the anterior surface of the piriformis muscle
–Largest nerve in the body (2 cm in width)
81
SCM TrPs
82
Where do the nerves of the diaphragm exit?
C3-5
83
The lymphoid tissue is the ________ is the most organized
GI tract: peyers patches, lacteals
controlled by ENS
proximity of the ENS (Auerbach & Messiner’s plexi) and Peyer’s Patches and Lacteals suggest the potential benefit of lymphatic treatment for functional bowels disorders.
84
Posterior Longitudinal Ligament
* Narrow
* Limits flexion
85
position of body and load
## Footnote
1. laying supine
2. laying lateral
3. standing
4. flex (slumping) while standing
5. sitting in chair
6. slumped over while sitting in chair
86
To achieve full flexion ....
•proportionate rotation of the pelvis about the hip joint will occur.
87
S1
superficial peroneal N: peroneus longus and brevis
plantar flex, eversion
achilles
lat/sole of foot
88
Functional leg length discrepancy
hypertonic QL (shorter M length) = appears like short ipsi leg = sidebending to ipsi side
89
tensor fascia lata: N and spinal lvl
superior gluteal, L4-5
90
Function of the Iliopsoas
* Walking
* Flexion of femur, pelvis, and lumbar spine
* Maintains erect posture at the hip joints
* Maintain postural balance with the pelvis in the midline
•
91
Lordosis develops during
childhood
forms as result of spine extending
restricted by iliopsoas
92
What is a Trigger Point (TrP)?
a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band
93
seq of lymph txp
single layer "leaky" --\> lymph vessel \*lymphangion) --\> trunk --\> ducts --\> R/L angles
94
trigger points and ATP
ATP usually inhib Ach release and powers Ca+ pump
deplted = cycle increased Ach release and impaired Ca2{ uptake --\> inc contractile activity of M
95
ethyl chloride vapocoolant spray
(spray and stretch)
just a distraction - over Trp and referral area
stops pain cycle --\> allows strech of M and Trp
96
babinski test
heel and curve up towards big toe
should cause plantar flex
dorsiflex in babies and neuro problems in adults
97
trunks of the abdomen, pelvis and lower extremities drain in to
cysterna chyli
anterior and R of L1/L2, posterior to crus
98
appendix
medial surface of the cecum
99
During side bending to the right the nucleus moves toward the concavity or convexity?
convexity
100
popliteal diaphragm
potential space - hinders mvmt of fluids distally
lymph caps can be croweded by soleus arch and adductor canal
101
aggrevating factors of spinal stenosis
walking, extension
102
Flexion of a vertebral unit does what to the annulus and ligaments?
Increases pressure on posterior annulus and posterior longitudinal ligament
103
How Many Diaphragms does the body have?
1. Tentorium Cerebelli (diaphragma sella)
2. Cervical –Thoracic or Thoracic inlet
3. Abdominal – Respiratory diaphragm: largest
4. Pelvic diaphragm
5. Popliteal
* Controversial
* Palm of the Hand (aponeurosis)
* Plantar of the Foot (aponeurosis)
104
•strongest flexor of the thigh?
Iliopsoas
105
tonsils
a ring of lymphoid tissue at the posterior oropharynx
palatine, lingual, phryngeal
produces immune cells
106
this is an xray showing...
OA of lumbar spine
107
Active TrPs:
Symptoms
clinical pain complaint
always tender - prevent full elngth of M: weakens M --\> pt-recog pain patter with direct compression
referred motor/autnomic pain & tenderness
108
Piriformis Syndrome-
Physical Exam - observation
–Altered painful gait
–Leg externally rotated
–Increased flexion spine
109
Colles’ fascia
fascia of the urogenital diaphragm
110
Chronic Diseases associated with restricted thoracic cage mechanics
Chronic obstructive pulmonary disease (COPD)
Asthma
Obesity
Kyphosis
* ○Ankylosing spondylitis
* ○Osteoporosis
111
lymph channels traverse all tissues of the body except
CNS, epidermis & endomysium
These areas are perfused by small interstitial conduits
112
which fascia surrounds the trachea and esophagus
anterior cerv
113
lymph cap and SNS tone
acute: contraction & peristalsis
prolonged = decreased! - hyper SNS
114
formation of a trigger point involves
contraction of sacromere that does not norm relax --\> forms contraction knot
group dev near each other = palpable nodule
115
Embryologic development of the lymphatic and immune systems begins at
20 weeks
116
How to treat not based on a technique specifically directed at the muscle with the trigger point?
Treat the origin and insertion of the muscle with the TrP
117
Lumbar Structural Screening
* Standing Sidebending Test
* Looking for presence of a smooth lateral curve
* Feet shoulder width-apart; ask patient to slide his hand down the lateral aspect of thigh while keeping feet on ground
Normal = 20-25 degrees
118
Scarpa’s fascia
subcutaneous abdominal fascia
119
psoas attaches to what part of the diaphragm?
medial arcuate lig
120
special tests of psoas syndrome
thomas
straight leg
well leg
121
recurrent nerve of Luschka
innerv ALL, PLL, nerve sheath dura
122
Latent TrPs:
Symptoms
more common that active TrPs
clinically quiescent with spont pain
painful ONLY when palp - may not recog pain as familiar
taut band in M --\> incr M tensions/ restricts ROM --\> stiffness
has all features of active TrPs -- pain referral, motor dysfunc, auton phenom
123
S2 S3 S4
•Intrinsic musculature of the foot
bullseye around anus
bladder
124
Trunk Rotation test
determine the rotational ability and its range in the thoracolumbar spine.
125
What is the sequence of lymph transport
What is the sequence of lymph transport?
Single layer “leaky” epithelial
Arterial lymphatic capillaries
Peripheral lymphatic capillaries
Trunks
The Right Lymphatic Duct or Left (Thoracic) Lymphatic Duct.
The ducts then drain into major veins.
○RLD-Brachiocephalic or jct of Right Internal Jugular and Right Subclavian veins.
○LLD- jct of the Left Internal Jugular and Left Subclavian veins.
126
Short leg syndrome on diaphragm
can cause lateral spinal cuves --\> asymm pull on diaphragm --\> impinge thoracic duct
127
locations of superficial and deep lymph nodes
superficial = subcut connective tissue accompanies veins
deep = beneath fascia and M
128
•Superior + Inferior Articular Processes of lumbar spine
–Superior articular facets
* concave
* face medially and backward
* rotated 45 degrees from the sagittal plane.
–Inferior articular facets
* convex
* face laterally and forward
129
Structural Integrity of spine depends on:
## Footnote
Anterior Longitudinal Ligament
Posterior Longitudinal Ligament
Intraspinal Ligament
Supraspinous ligaments
130
the QL attaches to what part of the diaphragm
lateral arcuate lig
131
Gluteus Maximus/Hamstrings on lordosis
•pull pelvis posteriorly, reduced lordosis Hypolordotic.
132
Iliolumbar Ligament Syndrome
palp of lig --\> referred pain into groin on ipsilateral side
SD on same side
133
•FRYETTE THIRD PRINCIPLE
-\>
* When motion occurs in any one plane within a joint or region, **motion in all other planes of that joint will be influenced.**
* Example: If a vertebral unit was flexed, its range of sidebending and rotation would be reduced.
134
kemp's test
what does this test?
lumbar extension with rotation
30 sec --\> pain radiates below butt
spinal stenosis
135
Abdominal Diaphragm
Attachments
Sternum/xiphoid
Ribs 6-12, the internal surface circumferentially
T12
Crura
L1/L2 LEFT
L1-L3 RIGHT
fibers converge to common central tendon = NO BONY ATTACHMENTS
136
Psoas Syndrome-Etiology
1. chronic shortening of psoas (flex stress) followed by sudden lengthening
2. ppt by overuse
3. neuro imbal due to hypertrophy
can be avoided with slow txition from shortened position
137
fascia of psoas, QL, and arcuate lig are attached to....
tip of 12th rib
138
Psoas Syndrome
Full-Blown Left
Where to begin the OMT treatment?
Key somatic dysfunction L1-L2
139
Fixation of the central tendon causes
elevation of the lower ribs.
140
Dysfunctional motor end-plates causes
excess Ach release
sustained depol of postjx memb --\> continued release of Ca2+ from SR
sustained shortening of sacromere
compresssed local sens N --\> reducing inhib of Ach release
compressed local bv --\> reduced O2 supply
result: depletes ATP, fav anaerobic metab
141
90% of back pain =
mechanical
142
Abdominal muscles on lordosis
Flatten
143
sensory N for the diaphragm are from what nerves?
Sensory of central portion-phrenic
Sensory of peripheral-intercostals T5-T11 and subcostals T12
144
When a person with a shortened psoas muscle stands....
•femur is fixed and the psoas pulls the lumbar spine into extension (increased lordosis)
can pull secral base foward
anterior rotate pelvis
145
Thoracic Inlet
bordered by:
* 1st rib
* T1
* manubrium
* clavicle
traverses sibson's fascia to C7 --\> turns around and empties to L subclavian vein
146
spleen
largest mass of lymphoid tissue
deep to ribs 9-11 on left, inferior to ab diaphragm
func: destroys dmg RBC, synth immunoglobins, clearing encap bac
147
lumbar spine gets ________ as it descends
why?
larger
accomodate stab/mobility
L5 = largest in height and circumference
148
what hsould be considered before specific TrP treatment.
•Consider common innervation levels and check for SD at these levels
149
Stages of TrP Development
1. hyperirritability: local tenderness
2. increased metab/reduced circ: local pain, possible twitch response
3. taut band: referred pain pattern, satellite trigger pts in func related M
150
What is the innervation of the diaphragm
Phrenic
151
•The quadratus lumborum is the key M in stabilizing the spine in a _______ direction.
side-to-side
152
Spasm of the quadratus lumborum on one side causes
trunk imbalance
innominate (un-named) compensation: superior on side of QL spasm
153
psoas synd ROM
Increased hip flexion
decreased extension
154
back pain time length
acute, subactue, chronic
6 weeks
6-12 weeks
3 months
155
Milgram Test
intratheal P - hold up for 30 s
space occupying lesions: disc/tumor
156
Thoraco - abdominal Diaphragm
Mechanics
During inspiration, the diaphragm descends as it contracts.
Motion is limited by the mediastinal contents and resistance of the abdominal organs.
This descent & contraction decreases intrathoracic pressure and increases the volume of the thoracic cavity.
The pressure gradients improve movement of lymph and blood toward the heart creating efficient respiration and circulation.
157
Factors that increase interstitial pressure \>0mmHg
Systemic hypertension
Cirrhosis (decreased plasma protein synthesis)
Hypoalbuminemia as seen with starvation
Toxins
158
absolute contraindications to lymph techniques
DVT
splenic pump for mono
local fx
anuria in pts not on dialysis
159
what M is this stretching
Gluteus Medius Stretch
160
visceral lymphoid tissue found in the
Respiratory and GI tracts
161
Psoas Syndrome Stages
Clinical Progression
1.Initial somatic dysfunction – B/L Psoas Spasm
•
2. Unilaterally Dominant Spasm/Sacral Torsion
•
3. Contralateral Piriformis Spasm
•
4. Sciatica Dysfunction
•
162
Typical Pain Pattern of psaos syndrome
Low back pain with pain on lateral/anterior aspect of the lower extremity no further than knee
163
Definition of diaphragm
thin partition separating adjacent regions
164
Gluteus Medius OMT-
Counter strain
location: upper outer portion of gluteus medius
tx pos: hip ext, abd, lat rotation
165
Buck’s fascia
deep fascia of the penis, continuous with Colles & Scarpa’s
166
•FRYETTE’S FIRST PRINCIPLE (TYPE 1 MECHANICS)
* When motion is introduced into the spine from a **neutral position**, sidebending preceeds rotation, with rotation occuring to the side opposite sidebending.
* Example: L1-4 NSlRr
167
gluteus max: N and spinal lvl?
inferior gluteal: L5, S1-2
168
ROM lumbar spine
–Flexion: 40-50°
–Extension: 20-30°
–SB: 30°
169
funtional lumbar spine
T11-L5
170
Trapezius TrPs
upper: temple, posterior neck
lower: neck, interscap/suprascap regions
171
•Typical Associated Somatic Dysfunctions : Psoas Syndrome-
–Upper lumbar flexion dysfunctions (L1, L2)
–L5 extended
–Variable sacral and innominate dysfunctions
–Contralateral piriformis tenderpoints
172
One of the major causes of increased lumbar lordosis
hypertonicity of the psoas muscle
173
Femoral Cutaneous Nerve
dermatome
174
lumbarization
S1 independent of rest of sacrum
175
what location do Most back problems occur
Multifidus Triangle
176
Hip Drop Test how to
* This is a screening test to determine lumbar and lumbothoracic side bending ability.
* To do this: Operator’s finger on superior and lateral aspect of iliac crest act as indicators of levelness of the iliac plane. The patient is told to bear all the weight on one leg by flexing at the knee and let the opposite drop inferiorly to its full extent.
177
Multifidus Triangle
: spine L4 to iliac crest and tip of the sacrum
contains:
* multifidus
* L4/L5 : most completely ruptured lumbar disc
* intertxverse lig
* iliolumbar lig
* facet syndromes
* sacroiliac jt
178
OMT to the cervical fascia helps
decrease intrathoracic congestion and facilitate lymphatic drainage from the head and neck
179
which fascia has an intimate relationship with the lymphatics of the head, neck, thorax and upper extremity.
anterior cervical fascia
surrounds: larynx, pharynx, thyroid, carotid, trachea, esophagus (last 2 through prevert fascia)
180
pretracheal fascia
suspended from hyoid
contin with percardial fascia and daphragm
attaches at T2
181
flu epidemic
1918
182
Consider “referred pain” in the absence of
significant tissue texture changes at the site of pain.
183
Where does the diaphragm insert
Diaphragm-attaches to lower ribs and sternum
Crura anchors at L1, L2, L3
184
L5
deep peroneal N: EHL
no refelx
lat leg, dorsum foot
185
Psoas muscles affect on lordosis
•pull on upper vert.-Inc. Lordosis ( think arching back )
186
Apertures of the Diaphragm
8: vena cava
10: esophagus
12: aorta, thoracic duct
187
Characteristics of a Muscle with a Trigger Point:
* Pain in the muscle & referred
* Decreased contractility (weakness) of the muscle
* Decreased flexibility of the muscle (hypertonic)
secondarily: restricted ROM --\> reflex reduced firing thresholds of M within referral zone
188
Quadratus Lumborum
* Origin-12th rib and TP’s of L1-L4
* Insertion-ilioolumbar ligament and posterior iliac crest
* Actions-stabilizes 12th rib, lateral flexion of lumbar unilateral) and extension of lumbar(b/l)
189
exercises to help with Lordotic Low Back Pain
* Pelvis tilt –supine method
* Active resistive Lsp in flexion exercise.
* Extension inducing for loss of lumbar lordosis.
* We will discuss in the lecture groups
190
referred pain patterns
191
Subscapularis TrPs activated by:
1. forceable internal roation of upper extremity: pitching, crawl stroke
2. flumped forward-head posture
3. prolonged immob of shoulder in adducted and internal rotated position
192
cerv fascia moves _______ with exhalation and __________ with inhalation
anterior, posterior
193
hx and risk fac of low back pain
age: \<20, \>55
activities: drugs, manual labor, trauma
smoker
h0ormone replacement
sys corticosteriods use
ca hx
194
Psoas Somatic Dysfunction
ureter courses over the psoas muscle - affected by psoas spasm
passing of kidney stone = cause psoas dysfunc
others: I C(see) UFOs
* irritable bowel
* crohns
* ulcerative colitis
* fibroid tumors
* ovarian disease
195
lymph sys flow
m layer & 1 way valves: UNIDIRECTIONAL
each seg contracts onafter other prox --\> distal
once lymph enters main txp vessels = propellby by lymph vessel itself
196
cauda equina syndrome
altered sens b/w legs
anal/urinary sphincter weakness
most = secondary to disc hern
197
Psoas Syndrome
A painful low back condition characterized by hypertonicity of psoas musculature
198
batwing deformity
unilateral sacralization/lumbarization
199
Sciatica
pain or discomfort associated with the sciatic nerve
•sharp or burning pain that radiates from the lower back or hip, possibly following the path of the sciatic nerve to the foot.
**set of symptoms**
200
relative contraindications to lymph techniques
unstaged ca
coaguopathies/anticoagulants
abscess
201
Piriformis Syndrome
Treatment
•Early conservative treatment effective in 79% patients
–NSAIDS
–ICE
–Rest
–Muscles relaxants
