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Kines II > Exam 4: Lumbopelvic & Posture > Flashcards

Exam 4: Lumbopelvic & Posture Flashcards

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1
Q

Define

Spondylosis

A

age related degeneration (DDD - degenerative disc disease and DJD - degenerative joint disease)

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2
Q

Define

Spondylolysis

A

defect/fracture in the pars interarticularis or arch of the vertebra

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3
Q

Define

Spondylolisthesis

A

forward displacement of one vertebra on another; aka slippage

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4
Q

Define

Retrolisthesis

A

backward displacement of one vertebra on another

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5
Q

Define

Peripheralization

A

pain is being referred distally toward or into a limb

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6
Q

Define

Centralization

A

pain is moving toward the spine or source

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7
Q

Define, example

Mechanical Low Back Pain

A
  • general term for back pain that does not refer distally
  • ex. hypermobility and core weakness
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8
Q

What does LBP stand for?

A

low back pain

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9
Q

Define

Lesion

A

offending structure/unhealthy tissue or pain generator

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10
Q

What percentage of weight bearing are the disc responsible for?

A

80%

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11
Q

What percentage of the weight bearing are facets responsible for?

A

20%

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12
Q

If discs were to wear down, what would that do to the distribution of weight bearing?

A

more weight bearing load would be placed on the facets

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13
Q

What is a spinal motion segment made up of?

A
  • inferior facets of superior vertebrae
  • disc (intervertebral joint)
  • superior facets of inferior vertebrae
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14
Q

Spinal Motion Segment

There is more potential for … and … in the lumbar area/segments.

A

nerve root impingement and mechanical stress

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15
Q

Facet Joints

L1-L5 is mainly oriented in the … plane to allow …. and resist …..

A
  • sagittal
  • flex/ext
  • rotation
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16
Q

Facet Joints

L1-L5 facets are oriented nearly …

A

vertically

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17
Q

Facet Joints

L1-L5 facets are oriented about … degrees from the … plane.

A
  • 25
  • sagittal
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18
Q

Facet Joints

L1-L5 has strong … plane bias.

A

sagittal

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19
Q

Facets Joints

L5-S1 is more oriented in the ….. plane to allow for …

A
  • oblique/frontal
  • rotation
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20
Q

Facet Joints

Most of the rotation of the lumbar spine occurs at the … level.

A

L5-S1

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21
Q

Facets Joints

Anatomical … is the norm. Facets may be … and/or more oriented in a different plane.

A
  • variation
  • asymmetrical
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22
Q

Lumbar Anatomy

The thoracolumbar junction marks an abrupt change in the orientation of the facets from the … to the … plane.

A
  • frontal
  • sagittal
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23
Q

Lumbar Anatomy

Transitional Zone of TL junction Significance

A
  • increased likelihood of mechanical instability
  • similar to lower cervical spine, it is susceptible to degenerative changes (spondylosis)
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24
Q

Look at image on slide 6.

A
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25
# Describe Facet Joints
synovial joints with capsule around each facet pair
26
Facet joint Innervation?
multisegmental innervation by medial branch of dorsal ramus
27
Facet joints contain a ... that can get locked in younger patients.
"meniscus"
28
What is the main job of facet joints?
guide osteokinematics
29
See image on slide 7.
29
L5-S1 (oblique orientation) shear forces resisted by:
* disc * ZAJ * ZAJ capsule * ALL * iliolumbar ligaments ## Footnote think about osteophytes and hypertrophy
29
Sacral orientation? results in?
* post to ant, inclined ant/inf 40 degrees * shear force due to body weight
30
See images on slide 8.
31
Lordosis accentuates...
anterior shear forces
32
Normal Lordosis?
40-50 degrees
33
What helps contribute to lordosis?
disc shape
34
See images on slide 10.
35
# Consists of? Pelvis
* 2 innominates * sacrum * coccyx
36
# Movement? Why? Sacroiliac Joint
* very little movement due to inherent stability (coarse texture, ridges, and depressions of joint surfaces - anatomical variation is the norm) * Consider Wolfe's Law - bone adapts to mechanical stress placed on it, remodeling to become stronger - once we begin walking
37
Where is the iliac crest in relation to vertebral level?
* can be anywhere from L3-L5 depending on gender * L4 is typically the standard answer
38
Properties of the nucleus pulposus?
* hydrophilic * very reliant on water content * mainly type 2 collagen to resist compressive forces
39
Properties of the annulus fibrosis?
* mainly type 1 collagen to resist tension forces * oblique angle of fibers perpendicular to one another = 50/50 * inner annulus is monosegmentally innervated (early on in disease process, thumbprint, isolated pain) * outer annulus is polysegmentally innervated (diffuse pain, hand print pattern)
40
41
The outer annulus is ... innervated.
polysegmentally ## Footnote diffuse pain, handprint
42
The inner annulus is ... innervated.
monosegmentally ## Footnote isolated pain, thumb print
43
# Disc Define radial expansion.
dissipation of forces by the disc in a circumferential fashion
44
# Radial expansion When is the disc at an increased risk for damage?
with combined flexion and rotation/twisting
45
What is the main job of the disc?
resist compression and tension
46
Read Neumann's special focus 9.8.
includes nuclear material and fragments of the vertebral endplate
47
See image on slide 15.
48
Better prognosis is available with ... or ... due to potential for resorption by macrophages.
extrusion and sequestration
49
# Define, what does it resist Anterior Longitudinal Ligament
thick ligament that resists anterior migration of the disc and lumbar extension
50
# resists? thickness? recess? Posterior Longitudinal Ligament
* resists posterior migration of the disc centrally by provides very little support in lateral recess * very thin * posterolateral/lateral recess - problems with nerve roots
51
# o
51
What is the significance of the posterolateral/lateral recess?
common site of disc herniation
52
# resists? effect of hypertrophy? Ligamentum Flavum
* resists flexion * hypertrophy due to degeneration leads to compression in the lateral recess
53
Degenerated spines with loss of disc height will result in hypertrophy of these structures and lead to possible ...
spinal cord or nerve root impingement
54
See images on slide 19.
55
# Dura What does the dura do?
encapsulate the spinal cord and part of the exiting nerve
56
What may become adhered in foramen or on PLL?
dura
57
The dura has what type of innervation?
multisegmental with diffuse pain pattern
58
Root is ...sensitive.
chemo
59
Root is only mechanoreceptive when...
primed by chemical irritation
60
What does DRG stand for?
dorsal root ganglion
61
The DRG is ... and ... sensitive
mechanosensitive and chemosensitive
62
Roots follow...
dermatomal patterns
63
Spondylolisthesis is the condition in which one ... is slipped forward over another.
vertebral body
64
Spondylolisthesis is most likely caused by an underlying condition of ...
spondylolysis
65
What are the different kinds of spondylolisthesis?
* degenerative * isthmic * dysplastic * traumatic * pathologic
66
Which condition is associated with the scotty dog sign and worsened by hyperextension?
spondylolisthesis
67
Spondylolysis is a condition in which there is a defect in a portion of the spine called the ...
pars interarticularis
68
The pars interarticularis defect of spondylolysis leads to spondylolisthesis ... percent of the time.
15
69
Is lumbar myeloopathy a thing?
no; at that point it's typically called cauda equina syndrome; there is such thing as cervical myelopathy though
70
# Wiltse Classification for Spondylolisthesis Type I
* dysplastic/congenital * translation is secondary to an abnormal neural arch
71
# Wiltse Classification for Spondylolisthesis Type II
* isthmic * translation is secondary to a lesion involving the pars articularis * 3 subtypes: A (lytic), B (elongated pars), C (acute pars fx)
72
# Wiltse Classification for Spondylolisthesis Type III
* degenerative * result of chronic instability and intersegmental degenerative changes
73
# Wiltse Classification for Spondylolisthesis Type IV
* post traumatic * fracture in region other than pars leading to slippage
74
# Wiltse Classification for Spondylolisthesis Type V
* pathological * diffuse or local disease compromising the usual structural integrity that prevents slippage
75
# Wiltse Classification for Spondylolisthesis Type VI
* iatrogenic * related to illness caused by medical examination or treatment
76
See image on slide 23.
77
Facet movement with thoracolumbar flexion?
* facets move anterior/superior * superior vertebra (inferior articular facets) sits inside of inferior vertebrae (superior articular facets)
78
Lumbar flexion makes more room for ...
nerve roots
79
Lumbar flexion norm?
45-55 degrees
80
Lumbar flexion reverses ...
lordosis | see image on slide 26
81
Describe disc movement in lumbar flexion.
* nucleus moves posterior * annulus bulges anterior
82
During lumbar flexion, the facets/foramen ... to result in up to a ...% increase in foramen size.
* open up * 19% increase
83
Lumbar flexion is a relative .... translation of vertebrae.
superior/anterior
84
Lumbar flexion tightens which ligament?
PLL
85
Extreme lumbar flexion stresses ... and surrounding ligaments.
ZAJ capsule
86
During lumbar flexion the compressive load shifts from ... to ...
ZAJs to disc
87
Although the load is decreased on the ZAJ during lumbar flexion, the "..." may increase due to reduced surface area to distribute the load.
contact pressure
88
Know figure on slide 27.
89
What is a good treatment/exercise for disc rehydration? what condition is this typically treating?
* supine 90/90 (supine w/ feet on chair) * stenosis
90
What is the typical directional preference in stenosis?
flexion
91
Facet movement with thoracolumbar extension?
* facets slide posterior/inferior * translate on the inferior vertebra/its superior articular facets
92
Thoracolumbar extension tends to ...
close things down
93
Normal lumbar extension?
15-25 degrees
94
Lumbar extension increases...
lordosis
95
Lumbar extension involves a relative ... tilt of the pelvis.
anterior
96
Disc material movement during lumbar extension?
* nucleus moves anterior * annulus bulges posterior
97
During lumbar extension, facets/foramen .... resulting in up to a ...% decrease in foramen size
* close down * 11% decrease
98
During lumbar extension, it can close down on a nerve root; however, this is ok unless it is already .... in which case the mechanical stress can cause pain.
chemically irritated
99
Lumbar extension involves the relative ... translation of vertebrae.
inferior/posterior
100
Lumbar extension tightens which ligament?
ALL
101
Relatively sharp tips of the facets contact the adjacent ... in hyperextension.
lamina
102
Hyperlordosis has the potential to cause ...
long-term degenerative changes and result in pain
103
What athlete population tends to have hyperlordosis?
gymnasts; they adapt but often have back pain
104
Full sustained lumbar extension can reduce... How can this be reduced?
* pressure on the disc * centralize sypmtoms, repeated motions, McKenzie exercises
105
What are McKenzie exercises?
use directional preference and repeated movement to improve symptoms | see slide 32 image
106
Differential diagnosis is key - Most pain with sagittal plane motions is likely from the ...
disc
107
T or F: Discs can slip.
false
108
...ing water content can relieve pressure with pain in lumbar extension.
decreasing
109
Disc dehydration exercises?
* prone press ups * double knee to chest (lumbar flexion stretch)
110
During lumbar SB, one side ... and the other side ...
* closes down * opens up
111
If you SB to the R, the R facet... and the L facet... What ligament tightens?
* R closes * L opens * L intertransverse ligament
112
If you SB left what happens at the facets? which ligament tightens?
* L facet closes * R facet opens * R intertransverse ligament
113
What happens with the disc material during lumbar right SB?
* Nucleus moves L * Annulus bulges R
114
What ligament tightens/resists motion with lumbar SB?
intertransverse ligament
115
See images on slides 34-35
116
Normal lumbar SB ROM?
20 degrees
117
See image on slide 36.
118
Norm lumbar rotation ROM?
5-7 degrees
119
What is the norm for combined thoracolumbar rotation?
about 40 degrees
120
When rotating to the R, what happens with facets and what ligament tightens?
* L facet closes * R facet opens * interspinous ligament tightens
121
During lumbar rotation, disc movement is dependent on ...
coupling
122
During L lumbar rotation, what happens at facets, what ligament is tightened?
* R closes * L opens * interspinous ligament
123
See image on slide 37.
124
Lumbar rotation is limited by the ... and its ... fiber orientation.
* annulus * oblique
125
"In theory, an axial rotation of ... degrees at any lumbar vertebral junction would damage the ... and tear the ... fibers in the annulus fibrosis". -Neumann | (normal motion does not reach these levels)
* 3 degrees * articular facet surfaces * collagen
126
Differential diagnosis is key - Most pain with 3D motions is likely from the ...
facets
127
# Lumbar Rotation Extension and SB is possible (in context of 3D motions) with ....
joint approximation
128
# Example L4 ... articular facets sit inside of L5 ... articular facets
* inferior * superior
129
# Differential Dx of Mechanical LBP Muscle strain: age, pain pattern (location, onset, standing, sitting, bending stress), SLR test, plain x-ray?
* 20-40 years old * unilateral back * acute * increased stress standing * decreased stress sitting * increased stress bending * negative SLR and xray
130
# Differential Dx of Mechanical LBP Herniated nucleus pulposus: age, pain pattern (location, onset, standing, sitting, bending stress), SLR test, plain x-ray?
* 30-50 years old * unilateral back, leg * acute (prior episodes) * decreased stress standing * increased stress sitting * increased stress bending * positive SLR * negative xray
131
# Differential Dx of Mechanical LBP Osteoarthritis: age, pain pattern (location, onset, standing, sitting, bending stress), SLR test, plain x-ray?
* >50 years old * unilateral back * insidious * increased stress standing * decreased stress sitting * decreased stress bending * negative SLR * positive xray
132
# Differential Dx of Mechanical LBP Spinal Stenosis: age, pain pattern (location, onset, standing, sitting, bending stress), SLR test, plain x-ray?
* >60 years old * bilateral leg * insidious * increased stress standing * decreased stress sitting * decreased stress bending * positive SLR (stress) and xray
133
# Differential Dx of Mechanical LBP Spondylolisthesis: age, pain pattern (location, onset, standing, sitting, bending stress), SLR test, plain x-ray?
* 20 years old * back * insidious * increased stress standing * decreased stress sitting * increased stress bending * negative SLR * positive xray
134
# Differential Dx of Mechanical LBP Scoliosis: age, pain pattern (location, onset, standing, sitting, bending stress), SLR test, plain x-ray?
* 30 years old * back * insidious * increased stress standing * decreased stress sitting * increased stress bending * negative SLR * positive xray
135
Positive Kemp Test
* radicular pain w/ the kemp/quadrant standing test * nerve root impingement
136
# where pain, type, potential cause Positive Quadrant Test
* local pain w/ the kemp/quadrant standing test * non-radicular pain * may be disc or facet
137
Kemp/Quadrant Test Positioning
* standing * hip block * extension, ipsi SB and ipsi rot
138
# Fryette's Laws Fryette's Laws definition.
naturally occurring kinematic motion
139
Freyette's Law: type 2
* ipsilateral coupling * SB and rot occur in same direction * occurs while in flexion * ex. R SB associated w/ R rot
140
# Coupling Reliability is Poor Anatomical factors?
* curvature of the spine * influence of the disc * orientation of the ZAJs
141
Fryette's Law: type 1
* contralateral coupling * SB and rot occur in opposite directions * ex. R SB associated w/ L rot * likely occurs in extension and neutral lordosis
142
# Coupling Reliability is Poor Impact of age and degeneration?
* increased age = greater change in coupling patterns * DDD = stiffness * instability = altered coupling patterns
143
144
# Takeaway on Coupling There is minimal ... plane motion so our main emphasis is movement in the ... and ... planes.
* horizontal * sagittal * frontal
145
# Takeaway on Coupling Unfortunately, due to individual ... and ... processes, no one model is completely ...
* variations * degenerative * reliable
146
# what does it stand for, what is it assessing PPIVMs
* Passive Physiological Intervertebral Movement * mobility testing: good at localizing hyper/hypo segments * can be performed with flexion, extension, SB, rotation
147
# stands for, primary goal, better reliability in identifying, ex.? PAIVMs
* Passive Accessory Intervertebral Movement * mobility testing * primary goal is to gain appreciation of the relationship between mobility and the onset of symptoms within each spinal segment * better reliability for identifying pain generator than degree of mobility * ex. spring test, P/As on spinous processes and the unilateral P/A of transverse process
148
# PPIVM Takeaway PPIVM is used for assessing the ... and example?
* degree of motion * ex. chronic LBP w/ hypermobile L4-5 segment and hypomobile surrounding segments will demo more movement in flexion than other surrounding segments
149
# PAIVM Takeaway PAIVMs used for assessing ... and example?
* degree of motion and ID pain generator * ex. chronic LBP w/ hypermobility/pain at L4-5 segment and hypomobile surrounding segments with spring testing
150
# PAIVM Takeaway PAIVMs assess ... (quality/quantity) and ...
* mobility * provocation
151
# PAIVM Takeaway Most PAIVMs can be used as...
mobilizations
152
Lumbopelvic rhythm is analogous to ... rhythm.
scapulohumeral
153
Define lumbopelvic rhythm/what is it?
close relationship between lumbar spine, pelvis, and hips to allow sagittal plane motion
154
When considering the lumbopelvic rhythm into flexion, how many degrees of lumbar vs. hip flexion?
* 45 degrees of lumbar flexion * 60 degrees of hip flexion
155
# muscle group and whether it's concentric or eccentric, main movement When considering the lumbopelvic rhythm into flexion, what is the 1st 25% of motion coming from?
* more lumbar flexion * eccentric load of lumbar extensors
156
# muscle group and whether it's concentric or eccentric, main movement When considering the lumbopelvic rhythm into flexion, what is the last 25% of motion coming from?
* more hip flexion * eccentric load of hip extensors
157
# main movement When considering the lumbopelvic rhythm into flexion, what is the middle 50% of motion coming from?
combo of lumbar and hip flexion
158
When considering lumbopelvic rhythm RETURN from flexion, it's ROM is...
* the same as lumbopelvic rhythm into flexion * 45 lumbar flexion * 60 hip flexion
159
When considering lumbopelvic rhythm RETURN from flexion, the early phase of motion is more ... and may be a ... for lumbar spine.
* hip extension/strong hip extensor activation * may be protective mechanism for lumbar spine
160
When considering lumbopelvic rhythm RETURN from flexion, the middle phase of motion is more ... and ... equal work from the ...
* combo hip/lumbar extension * equal work from the hip/lumbar extension
161
When considering lumbopelvic rhythm RETURN from flexion, at completion, there is relative ... of muscles.
inactivity
162
Study slides 55-58 images.
163
# Variations in Lumbopelvic Rhythms Describe what movement is limited and what movement is excessive with lumbar dominant lumbopelvic rhythm.
* limited hip flexion * excessive lumbar flexion
164
# Variations in Lumbopelvic Rhythms Describe what movement is limited and what movement is excessive with hip dominant lumbopelvic rhythm.
* limited lumbar flexion * excessive hip flexion
165
The pelvis consists of...
2 innominates, sacrum, coccyx | see image on slide 61
166
Define lumbarization.
movement between S1-S2
167
Define sacralization.
fusion of L5-S1
168
The sacroiliac (SI) joint has very little movement due to...
inherent stability (coarse texture, ridges, and depressions of joint surfaces)
169
In the SI joint, anatomical variation is the...
norm
170
How is SI joint movement described?
* "innominate rotation" * "sacral torsion"
171
How is SI joint movement measured?
in millimeters
172
... is responsible for up to ... percent of chronic low back pain.
* SI Joint * 25%
173
The pubic symphysis is connected by a ....
fibrocartilaginous disc
174
Which ligament helps maintain the stability of the pubic symphysis?
arcuate ligament
175
The pubic symphysis is an insertion site for which muscles?
* rectus abdominus * adductor longus
176
With pubic symphysis mobility, it will follow the ...
innominate
177
For example, when you have a L posteriorly rotated innominate, the L pubic ramus is ...
elevated and posteriorly rotated
178
How much movement does the pubic symphysis have?
less than 0.5 cm
179
The pubic symphysis will have more mobility in pregnancy due to ...
the hormone relaxin
180
# SI Joint With a form closure in vertical, the wedge shape creates a ....
bony closure
181
# SI Joint With force closure in horizontal, .... and ... create closure. name some?
* ligaments and muscles * interosseus, long dorsal, sacrotuberous, sacrospinous ligaments
182
What does the long dorsal ligament resist?
counternutation
183
What does the sacrotuberous ligament resist?
rotation
184
What do the sacrospinous ligaments resist?
nutation
185
# SI Joint What occurs at age 50 for men more than women?
fusion
186
Even with fusion of SI joint, ... can be maintained long after that
mobility
187
...% of people over the age of 60 have degenerative changes on imaging but no ...
* 85% * no pain
188
See image on slide 63
189
Define iliosacral motion.
movement of ilum on fixed sacrum
190
Define sacroiliac motion.
movement of sacrum on fixed ilium
191
Iliosacral and sacroiliac motion both mainly occur in the ... plane
sagittal
192
The SI joint transitions from a ... joint in childhood to a modified ... joint and articular surfaces move from ... to ...
* synovial * synarthroidal * smooth * rough
193
Due to inherent stability, the SI joint is often injured as a result of... and give examples.
* trauma * falls, MVA, childbirth
194
In addition to trauma, SI joint injury can also be related to ...... and examples.
* repeated stress * running, martial arts
195
A ...cm leg length asymmetry can result in ... times the ... load, generally felt on longer limb side.
* 1 cm * 5X * compressive
196
Pain and dysfunction in the SI joint can also be related to ....
malalignment/asymmetry
197
The ... is challenging to differentially diagnosis.
SI joint
198
Often, an ... is used to confirm SI joint pathology.
intra-articular injection of anesthetic
199
What does the pelvic ring do?
transfers body weight bi-directionally between the trunk and femurs | see image on slide 65
200
# Iliosacral Mobility Describe what the ASIS and PSIS do during anterior rotation of the innominate.
* ASIS moves anterior and inferior * PSIS moves anterior and cranially (superior)
201
# Iliosacral Mobility Describe what the ASIS and PSIS do during posterior rotation of the innominate.
* ASIS moves posterior and cranial (superiorly) * PSIS moves posterior and caudal (inferiorly)
202
# Iliosacral Mobility Describe what the ASIS do during innominate inflare and outflare.
ASIS moves medial or lateral
203
# Sacroiliac Mobility Describe what the ASIS and PSIS do during innominate upslip and downslip.
* Both ASIS and PSIS move superior or inferior together * this is considered normal during gait
204
Study images on slides 68, 70-71
205
# Iliosacral Special Test Brief, general description.
supine to sit (functional) leg length ## Footnote have pt bridge to "reset" pelvis, traction both legs to ensure neutral position
206
# Iliosacral Special Test What is the acronym for the supine position?
ALPS
207
# Iliosacral Special Test If the pt was supine short and sitting long, how would you describe the position of the innominate?
posterior rotation
208
# Iliosacral Special Test If the pt was supine long and sitting short, how would you describe the position of the innominate?
anterior rotation
209
# Iliosacral Special Test If the pt was supine short and sitting short, how would you describe the position of the innominate?
up slip
210
# Iliosacral Special Test If the pt was supine long and sitting long, how would you describe the position of the innominate?
down slip
211
With the iliosacral special test, the diagnosis is often based on ...
previous provocative tests - what side is symptomatic?
212
Study slides 73-76. ## Footnote check out video on slide 73
213
# Sacroilial Mobility ... motion around 2 axes.
triplanar
214
# Sacroilial Mobility What are the 2 axes that triplanar motion occurs around?
* L oblique axis * R oblique axis
215
# Sacroilial Mobility Position is defined as to what .... the ... side of the sacrum is facing.
* direction * anterior
216
# Sacroilial Mobility Forward Torsion Options?
* R on R forward sacral torsion * L on L forward sacral torsion
217
# Sacroilial Mobility What do we mean when we say R on R forward sacral torsion?
the anterior sacrum is facing right and moving on R oblique axis (ROA)
218
# Sacroilial Mobility Backward torsion options?
* R on L backward sacral torsion * L on R backward sacral torsion
219
# Sacroilial Mobility: deep vs. prominent What is happening with a sacroilial R on R oblique axis (ROA) forward torsion?
* L sacral base is deep * R ILA is prominent
220
# Sacroilial Mobility: deep vs. prominent What is happening with a sacroilial L on L oblique axis (LOA) forward torsion?
* R sacral base is deep * L ILA is prominent
221
# Sacroilial Mobility: deep vs. prominent What is happening with a sacroilial L on R oblique axis (ROA) backward torsion?
* L sacral base is prominent * R ILA is deep
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# Sacroilial Mobility: deep vs. prominent What is happening with a sacroilial R on L oblique axis (LOA) backward torsion?
* R sacral base is prominent * L ILA is deep
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Define nutation. ## Footnote not completely clear on this topic, see slide 77
In kinesiology, "nutation" refers to the anterior-inferior movement of the sacrum (while the coccyx moves posteriorly) relative to the ilium, often occurring during weight absorption at the sacroiliac joint.
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Define counternutation. ## Footnote not completely clear on this topic, see slide 77
The opposite movement, where the sacrum moves posteriorly and superiorly while the coccyx moves anteriorly, is called counternutation.
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Nutation can be considered... while counternutation can be considered... ## Footnote not completely clear on this topic, see slide 77
* flex * ext
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# Sacral Mobility ... is considered closed packed position ## Footnote not completely clear on this topic, see slide 77
full nutation
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What muscles are: part of the transversospinal group, thickest in the lumbosacral region, designed for the stability of the base of the spine, extend spine bilaterally, ipsilaterally SB, contralaterally rotate?
* Multifidi * Rotatores
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What muscles are responsible for fine motor control and have a high density of muscle spindles provide sensory feedback?
* interspinalis * intertransversarius
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See image of pelvic floor muscles slide 84.
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Which muscle's fibers are oriented diagonally like sticking your hands in your pockets, its most superficial, and does contralateral rotation?
exernal oblique
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Which muscle's fibers are oriented opposite like crossing arms, 2nd layer, and attaches to thoracolumbar fascia?
internal oblique
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Which muscle has the largest cross-sectional area of all the abs?
internal oblique
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What muscle has a very large force production, making it a stabilizer?
internal oblique
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Function of internal obliques?
ipsilateral rotation
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What is known as your corset muscle and attaches to thoracolumbar fascia?
transverse abdominis
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Look at box analogy slide 87.
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... are made up of muscles, fascia, and ligaments all working together to create ...
* myofascial slings * stability
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# muscles/structures involved, how/where stability created, exercise ex. Describe the anterior oblique sling.
* exernal oblique and internal oblique, connecting with contralateral adductor muscles via the adductor abdominal fascia * crosses pubic symphysis and provides pelvic stability * exercise examples: walking, running
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# muscles/structures involved, how/where stability created, exercise ex. Describe the posterior oblique sling.
* glute max, opposite latissimus dorsi and thoracolumbar fascia * through the thoracolumbar fascia, this sling stabilizes the SIJ and creates stability at the back of the pelvis, especially during single-leg propulsion * exercise examples: swimming, squats, lunges, etc.
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# muscles/structures involved, how/where stability created, exercise ex. Describe the deep longitudinal sling.
* the great communicator as it assists the lower body to know where the upper body is in space * creates stability around the pelvis during forwards and backwards movements * erector spinae, multifidus, thoracolumbar fascia, sacrotuberous ligament, and biceps femoris on same side of body * create stability during any standing activity * exercise examples: single leg bridge and the roll down exercises
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# muscles/structures involved, exercise ex. Describe the lateral sling.
* gluteus medius, gluteus minimus, tensor fascia latae, iliotibial band, and opposite adductors * pelvis rotatory control especially in single leg stance * exercise examples: sidelying glute exercises such as leg lifts and side planks
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# Spinal Stabilization What does VPAC stand for?
volitional pre-emptive abdominal contraction | aka enganging core/core stabilization
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# Spinal Stabilization During a lifting task, VPAC is associated with increased trunk and hip extensor ... , increased internal oblique ... , and increased intra--abdominal ...
* force * thickness * pressure ## Footnote All factors are associated with increased power during hip and trunk extension movements.
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VPAC has been associated with reducing...
LBP recurrence
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Inability to perform a VPAC may place an individual at a higher risk for...
injury
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VPAC has been shown to improve performance during several dynamic activities, such as...
* active forward reach * unipodal lower extremity balance test * stair descent * drop landing
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What are the 2 most common VPAC strategies described in literature?
* drawing-in maneuver * abdominal bracing maneuver (ABM)
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# describe, cue Describe the drawing-in maneuver VPAC strategy.
* volitional transverse abdominis contraction intended to pull umbilicus toward spine * cue to draw belly button up and in toward spine * thanksgiving dinner trick and remember to breathe
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# describe, cue Describe the abdominal bracing maneuver VPAC strategy.
* involves concurrent muscle contraction around entire trunk (including TA contraction) * cue to "gently inhale, then exhale, now stiffen your trunk as though you will be hit in the belly. hold this contraction." * ABM is most commonly used method in the health and fitness industry and is very effective in providing spinal stability
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See image on slide 94 on TA recruitment and pelvic floor/breathing exercises.
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Pelvic tilts have ... TA activation compared to draw-in.
less
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# based on... When may pelvic tilts be appropriate for TA activation?
based on directional preference
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# pt dx Which patient population are pelvic tilts commonly used with?
stenotic patients
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Key to pelvic tilt is to train in ... posture and then adjust "tilt" as needed for the individual.
neutral
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Define static posture.
body and its segments are aligned and maintained in certain positions ## Footnote standing, sitting, lying, kneeling
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Define dynamic posture.
body and/or its segments are moving ## Footnote walking, running, jumping, throwing, lifting
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Erect bipedal stance increases the work of the ... and places increased stress on vertebral column, pelvis, and extremities and reduces ...
* heart * stability
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Posture has a strong relationship with...
* base of support (BOS) * center of gravity/mass (COG/COM)
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Define postural control.
a person's ability to maintain stability of the body and its segments in response to forces that threaten its equilibrium
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Postural control can be static or ...
dynamic
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Describe and give an example of reactive/compensatory postural control.
* responses occur as reactions to external forces that displace COM * ex. being pushed
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Describe and give an example of proactive/anticipatory postural control.
* responses occur in anticipation of internally generated forces * ex. volitional preemptive abdominal contraction (VPAC)
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basic elements of postural control?
* control body's orientation in space * maintain COM over BOS * stabilize head in regard to vertical to optimize vision * need for accurate ROM * muscles have ability to respond w/ appropriate speeds and forces
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Postural control is dependent on recepters in and around .... as well as ... in the soles of the feet. The ... must process and react to all this information.
* joints (capsule, tendons, ligaments) * sensation * CNS
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What is another name for kinesthetic awareness?
proprioception
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Define proprioception.
The unconscious perception of movement and spatial orientation arising from stimuli within the body itself. In humans, these stimuli are detected by nerves within the body itself, as well as by the semicircular canals of the inner ear.
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# & Example Kinesthetic awareness is the key to...
* dynamic postural control * ex. lateral ankle sprain -> laxity in lateral ligaments --> receptors are slow to signal CNS --> delayed reaction --> recurrent lateral ankle sprain * similar process happens in other injuries as well as cases of chronic pain
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Define perturbation.
any sudden change in conditions that displaces body posture away from equilibrium
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What causes a sensory perturbation?
altered vision
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What causes a mechanical perturbation?
direct change in relationship bt COM and BOS, movement of entire body or just body segments
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What are some fixed-support synergies?
* ankle synergy * hip synergy
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Describe the ankle synergy.
* distal to proximal * reaction to movement of support platform
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Describe the hip synergy.
* proximal to distal * reaction to movement of support platform
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# Just an Info Card from Muscle Synergies Slide Change in support strategies: * stepping - forward, backward, sideways * grasping - use of hands to grab other fixed support (ex. railing)
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# Ankle, Hip Strategies - Perturbations If you have a forward translation of the support surface, what motion is the body having?
backward motion
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# Ankle Strategies - Perturbations What muscles **distal to proximal** response are in use with a forward translation of support surface/backward motion of body?
* tibialis anterior * quadriceps femoris * abdominals * neck flexors
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# Ankle, Hip Strategies - Perturbations If you have a backward translation of the support surface, what motion is the body having?
forward motion
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# Ankle Strategies - Perturbations What muscles **distal to proximal** response are in use with a backward translation of support surface/forward motion of body?
* gastrocnemius * hamstrings * paraspinals * neck extensors
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# Hip Strategies - Perturbations What muscles **proximal to distal** response are in use with a backward translation of support surface/forward motion of body?
* paraspinals * hamstrings * gastrocnemius
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# Hip Strategies - Perturbations What muscles **proximal to distal** response are in use with a forward translation of support surface/backward motion of body?
* abdominals * quadriceps femoris * tibialis anterior
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See images on posture ppt slides 9-11.
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When the line of gravity (LOG) passes directly through the joint axis no ... gravitational torque/.... is created.
* external * moment
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# Line of Gravity When the LOG passes outside of this ideal alignment, ... will act upon the joint = .... moment.
* gravity * flexion/extension moment
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# Line of Gravity The surrounding muscles will respond to the external moment with an .... and example?
* internal moment * ex. external hip flexion moment will result in hip extensors reacting
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# Sagittal Plane Alignment in Standing Posture Atlanto-occipital joint: Line of gravity, external moment, passive opposing forces, active opposing forces?
* LOG: anterior, anterior to transverse axis for flexion and extension * external moment: flexion * passive opps: ligamentum nuchae, alar ligament, tectorial, atlantoaxial, and posterior atlanto-occipital membranes * active opps: rectus capitus posterior major and minor, semispinalis capitus and cervicis, splenius capitis and cervicis, inferior and superior oblique muscles
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# Sagittal Plane Alignment in Standing Posture Cervical: Line of gravity, external moment, passive opposing forces, active opposing forces?
* LOG: posterior * external moment: extension * passive opps: ALL, anterior annulus fibrosus fibers, ZAJ capsules * anterior scalene, longus capitis and colli
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# Sagittal Plane Alignment in Standing Posture Thoracic: Line of gravity, external moment, passive opposing forces, active opposing forces?
* LOG: anterior * external moment: flexion * passive opps: posterior longitudinal, supraspinous, and interspinous ligaments * active opps: ligamentum flavum, longissimus thoracis, spinalis thoracis, semispinalis thoracis
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# Sagittal Plane Alignment in Standing Posture Lumbar: Line of gravity, external moment, passive opposing forces, active opposing forces?
* LOG: posterior * external moment: extension * passive opps: ALL, iliolumbar ligament, anterior fibers of the annulus fibrosus, ZAJ joint capsules * active opps: rectus abdominis, external and internal oblique muscles
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# Sagittal Plane Alignment in Standing Posture Sacroiliac Joint: Line of gravity, external moment, passive opposing forces, active opposing forces?
* LOG: anterior * external moment: nutation * passive opps: sacrotuberous, sacrospinous, iliolumbar, and anterior sacroiliac ligaments * active opps: transverse abdominis
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# Sagittal Plane Alignment in Standing Posture Knee Joint: Line of gravity, external moment, passive opposing forces, active opposing forces?
* LOG: anterior * external moment: extension * passive opps: posterior joint capsule * active opps: hamstrings, gastrocnemius
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# Sagittal Plane Alignment in Standing Posture Hip Joint: Line of gravity, external moment, passive opposing forces, active opposing forces?
* LOG: posterior * external moment: extension * passive opps: iliofemoral ligament * active opps: iliopsoas
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# Sagittal Plane Alignment in Standing Posture Ankle Joint: Line of gravity, external moment, passive opposing forces, active opposing forces?
* LOG: anterior * external moment: dorsiflexion * passive opps: n/a * active opps: soleus, gastrocnemius
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# Coronal Plane Alignment in Standing Posture Head: LOG location, observation?
* LOG: passes through middle of the forehead, nose, and chin * observation: eyes and ears should be level and symmetrical
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# Coronal Plane Alignment in Standing Posture Neck/Shoulders: LOG location, observation?
* LOG: n/a * observation: right and left angles between shoulders and neck should be symmetrical. clavicles should also be symmetrical
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# Coronal Plane Alignment in Standing Posture Chest: LOG location, observation?
* LOG: passes through the middle of the xiphoid process * observation: ribs on each side should be symmetrical
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# Coronal Plane Alignment in Standing Posture Abdomen/hips: LOG location, observation?
* LOG: passes through the umbilicus. * observation: right and left waist angles should be symmetrical
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# Coronal Plane Alignment in Standing Posture Hips/pelvis: LOG location, observation?
* LOG: passes on a line equidistant from the right and left ASISs. passes through pubic symphysis. * observation: ASISs should be level
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# Coronal Plane Alignment in Standing Posture Knees: LOG location, observation?
* LOG: passes between knees equidistant from medial femoral condyles * observation: patella should be symmetrical and facing strait ahead
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# Coronal Plane Alignment in Standing Posture Ankles/feet: LOG location, observation?
* LOG: passes between ankles equidistant from the medial malleoli * observation: malleoli should be symmetrical, and feet should be parallel. toes should not be curled, overlapping, or deviated to one side
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Genu varum?
bowed legs
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Genu valgum?
knock knees
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Genu recurvatum?
back knee
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Pes cavus?
high arch
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Pes planus?
flat foot
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# Possible Effects of Malalignment on Body Structures Excessive anterior tilt of pelvis: compression, distraction, stretching, shortening?
* compression: posterior aspect of vertebral bodies, interdiscal pressure at L5-S1 increased * distraction: lumbosacral angle increased, shearing forces at L5-S1, likelihood of forward slippage of L5 on S1 increased * stretching: abdominal muscles * shortening: iliopsoas, lumbar extensors
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# Possible Effects of Malalignment on Body Structures Excessive lumbar lordosis: compression, distraction, stretching, shortening?
* compression: posterior vertebral bodies and facet joints, interdiscal pressures increased, intervertebral foramina narrowed * distraction: anterior annulus fibers * stretching: ALL * shortening: PLL, interspinous ligaments, ligamentum flavum, lumbar extensors
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# Possible Effects of Malalignment on Body Structures Excessive dorsal kyphosis: compression, distraction, stretching, shortening?
* compression: anterior vertebral bodies, intradiscal pressures increased * distraction: facet joint capsules and posterior annulus fibers * stretching: dorsal back extensors, posterior ligaments, scapular muscles * shortening: ALL, upper abdominal muscles, anterior shoulder girdle musculature
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# Possible Effects of Malalignment on Body Structures Excessive cervical lordosis: compression, distraction, stretching, shortening?
* compression: posterior vertebral bodies and facet joints, interdiscal pressure increased, intervertebral foramina * distraction: anterior annulus fibers * stretching: ALL * shortening: posterior ligaments, neck extensors
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# Forward head posture Forward head: structural components, long-term effects on structural function?
structural components: * anterior location of LOG causes increase in the flexion moment, which requires constant isometric muscle tension to support head * stretch of suprahyoid muscles pulls mandible posteriorly into retrusion long-term effects: * muscle ischemia, pain, and fatigue and possible protrusion of nucleus pulposus * retruded mandible position causes compression and irritation of retrodiscal pad and may result in inflammation and pain * reduction in ROM
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# Forward head posture Increase in cervical lordosis: structural components, long-term effects on structural function?
structural components: * narrowing of intervertebral foramen and compression of nerve roots * compression of ZAJ surfaces and increase in weight-bearing * compression of posterior annulus fibrosus * adaptive shortening of the posterior ligaments * adaptive lengthening of the anterior ligaments * increase in compression on posterior vertebral bodies at apex of cervical curve long-term effects: * damage to SC and/or nerve roots leading to paralysis * damage to cartilage and increased possibility of arthritic changes; adaptive shortening and possible formation of adhesions of joint capsules w/ subsequent loss of ROM * changes in collagen and early disc degeneration; diminished ROM at intervertebral joints * decrease in cervical flexion ROM * decrease in cervical extension ROM and decrease in anterior stability * osteophyte formation
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# Forward head posture Medial rotation of scapula: structural components, long-term effects on structural function?
structural components: * adaptive lengthening of upper posterior back muscles * adaptive shortening of anterior shoulder muscles long-term effects: * increase in dorsal kyphosis and loss of height * decrease in vital capacity and ROM of shoulder and arm
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What is the name of the scoliosis test?
Adam's forward bend test
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What are we looking for with the Adam's forward bend test?
* rib hump * Cobb angle
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What Cobb angle indicates scoliosis?
10 degrees
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What Cobb angle indicates a surgical intervention for scoliosis?
>40 degrees
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# Sitting Posture & Disc Pressure by Position STUDY posture ppt slides 20-21.
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Describe the basics of Janda Upper Crossed Syndrome.
Inhibited: * deep cervical flexors * lower trap, serratus anterior Facilitated: * SCM, pectoralis * upper trap, levator scapulae
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Describe the basics of Janda Lower Crossed Syndrome. ## Footnote See posture ppt, slide 23 for more detail
Inhibited: * abdominals * glute med/min/max Facilitated: * rectus femoris, iliopsoas * thoraco-lumbar extensors
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Describe how to set up active sitting.
PTs are Nice: * Set pelvis * Set torso * Set scapulae/shoulders * Set cervical spine/neck

Kines II (2 decks)

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