Lumbar

Question 1

Lumbar movements in general

Answer 1

a lot of flex/ext
some LF
minimal rotation

Question 2

Ferguson’s angle is what

Answer 2

line parallel to superior aspect of sacrum and horizontal line
Greater in F than M - angle inc in pregnant women
Larger angle = more likely to have back pain

Question 3

IVD function

Answer 3

separate the vertebrae
absorb stress and shock
enable movement in 3 planes

Question 4

IVD made of what

Answer 4

fibrocartilage

NP and AF

Question 5

IVD with anterior bending (flex)

Answer 5

Tension, NP shifts towards region of compression

Question 6

IVD with posterior bending (ext)

Answer 6

Compression, AF bulges towards region of tension

Question 7

IVD - torsion

Answer 7

shear stress increased from center to periphery

denser on outside than in center

Question 8

Facet joint - orientation at cervical, thoracic, lumbar

Answer 8

cervical = 45
thoracic = 60
lumbar = 90
Hardly any rotation in lumbar

Question 9

External oblique action

Answer 9

if contract B will flex

unilateral contraction will do contralateral rot, ipsilateral SB

Question 10

Internal oblique action

Answer 10

Ipsilateral SB and Rot (unilaterally contracting)

Question 11

Flex/Relaxation phenomenon

Answer 11

Flex forward - gravity will take over, use the extensors to control flex ecc, ligaments will stretch out to suport weight

Question 12

Greater inclination of pelvis leads to what

Answer 12

increase shear, compression, and lordosis
makes abs looser
get ant pelvic tilt

Question 13

Smaller inclination of pelvis leads to what

Answer 13

increase compression, decrease shear and lordosis

Question 14

Shear forces are common where

Answer 14

L4-L5 because of superincumbent weight (HAT)

Question 15

Shear is largest with what pelvic position

Answer 15

anterior pelvic tilt

Question 16

Compression is largest with what pelvic position

Answer 16

posterior pelvic tilt

Question 17

Load based on posture

Answer 17

supine
standing straight
sitting
bending
slouching

Question 18

Cauda equina syndrome

Answer 18

B/B changes, saddle anesthesia, global or progressive weakness in LE, sensory deficits/weakness in L4-S1 dermatomes/myotomes

Question 19

Red flags

Answer 19

Constant/severe night pain
paralysis
unexplained weight loss
loss of appetite
unusual fatigue 
persistent root pain
pain worse after 1 month 
radicular pain with cough 
paresthesias 
visual disturbance
B nerve root s/s
SOB

Question 20

Spondylolysis is what

Answer 20

separation of vertebrae - sliding between structures
Defect in pars interarticularis “scotty dog fracture”
Most common at L5-S1, common in young women

Question 21

Spondylolysis s/s - pain with what movement

Answer 21

pain with ext

Question 22

Spondylolisthesis is what

Answer 22

forward movement of vertebral body, fracture on vertebrae

common at lumbosacral angle

Question 23

Spondylolisthesis s/s - pain with what movement

Answer 23

pain with ext/rot

Question 24

Disc herniation

Answer 24

Protrusion of NP from the AF

Question 25

Disc herniation - pain with what movemment

Answer 25

usually posterolateral herniation Pain with flexion repeated flex will peripheralize, ext will centralize

Question 26

Degenerative spinal stenosis - pain with what

Answer 26

extension

Question 27

Capsular pattern

Answer 27

lat flexion and rotation, then ext

Question 28

Facet joint dysfunction - aggravated with what movement

Answer 28

end range movements

Question 29

Lower crossed syndrome

Answer 29

Short ES, iliopsoas, gastroc, soleus, hip add | Long abductors, glut max

Question 30

SLR

Answer 30

pt supine, passively flex hip with knee ext until pt complains, slowly lower limb and then DF + if reproduction of sx with DF foot

Question 31

Quadrant test

Answer 31

Pt standing Intervertebral foramen - pt SB L, rot L, ext to max close L foramen Facet - pt SB L, rot R, ext to max compress L facet joint? + with pain or pares

Question 32

Stork standing test

Answer 32

identifies spondylolisthesis pt stand on one leg - cue pt into trunk ext + if pain in low back with ipsi leg on ground

Question 33

McKenzie slide glide test

Answer 33

differentiate btw scoliotic curvature vs/ neurologic dysfunction causing lateral shift Pt stand - stand on side that upper trunk is shifted towards, place shoulders into pt upper trunk, wrap arms around their pelvis, and pull pelvis to normal alignment while stabilizing trunk + if reproduction of neuro symptoms as alignment of trunk is corrected

Question 34

Femoral nerve traction test

Answer 34

pt lay on nonpainful side with trunk in neutral, head flexed slightly, lower limb and hip/knees flexed passively extend hip while knee of painful limb is in ext (flex knee if no s/s)

Question 35

Vasalva identifies what

Answer 35

space occupying lesion | + if inc LBP or neuro sx in LE

Question 36

Repeated lumbar flexion should dec pain of what

Answer 36

facet or stenosis

Question 37

Repeated lumbar extension should dec pain of what

Answer 37

disc problem

Question 38

Babinski - what is pos

Answer 38

extension of big toe and splaying (abd) of other toes

Question 39

Freyettes laws of biomechanics - in the neutral spine

Answer 39

LF and rot occur in opp directions at lumbar level

Question 40

Freyettes laws of biomechanics - in hyperextended/hyperflexed lumbar spine

Answer 40

LF and rot occur in same direction

Question 41

Coupled movement - type I

Answer 41

LF and rot in opp directions Neutral tends to occur in groups of segments (3+)

Question 42

Coupled movement - type II

Answer 42

LF and rot in same directions Non-neutral seen in one segment only

Question 43

Group dysfunction

Answer 43

3+ segments type 1 neutral Restrict in LF in one direction and Rot in other

Question 44

Single segment dysfunction

Answer 44

1 vertebral motion unit involved type II restriction of Flex/Ext, LF and Rot limited on same side

Question 45

Direction of motion is named by what

Answer 45

ant and sup vertebrae

Question 46

If S is first (before R) means what (or if N is first letter)

Answer 46

coupled opp

Question 47

If R is first (before S) means what (or if E/F is first letter)

Answer 47

coupled same

Question 48

Ex: NSR(L) Motion available Position Motion restriction

Answer 48

flex/ext R SB L rot Neutral, R SB, L rot L SB, R rot

Question 49

Ex: ERS(L) Motion available Position Motion restriction

Answer 49

ext L rot L SB extended, L rot, L SB flexion R rot, R SB

Question 50

Ex: FRS(R) Motion available Position Motion restriction

Answer 50

flexion R rot R SB flex, R rot, R SB extension L rot, L SB

Question 51

Example of ERS(R), what motion are restricted? | what happens with flex and ext

Answer 51

``` ERS(R) - they are extended, R rot, and R SB R facet does not open Flexion - R TP prominent Extension - TPS more equal Restriction - flex, L rot, L SB ```

Question 52

Example of FRS(R), what motion are restricted? | what happens with flex and ext

Answer 52

``` FRS(R) - they are flex, R rot, R SB L facet will not close Ext - R TP more prominent Flex - TPs equal Restriction - ext, L rot, L SB ```