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Flashcards in lumbar Deck (57):
1

Mercer, Bogduk: lumbar lordosis

-Angle of Sacrum (45deg)
-L5/S1 disc = wedge
-L5 vert = wedge
-Inclination of l/s

2

Lordosis results in

-Inc compression posterior on discs and z-joints
-Stretch annulus and ALL anterior
-Verts tend to move forward in WBing (stopped by z-joints and discs, then ligs)

3

Pars Interarticularis

-Resist bending forces
-Prone to stress fracture.

4

Motion segment

Lower half of the top vert, disc, and upper half of bottom vert.

5

Most stabilizing structure in motion segment

z-joint:
-40% = 2 z-joints
-29% = disc
-31% = lymphatic, vascular, ligs

6

Mercer/Dogduk: stabilization

Mulrifidi (posterior capsule) and ligamentum flavum (anterior capsule) support z-joints.

7

Z-Joint orientation

Oriented posterior/medial.
-Resist flexion and rotation
-concave/convex - NOT planar

8

Z-joint capsule

Fibrous capsule around joint: 2 intra-articular structures (fat pad and meniscoid).
-transmit loads, protect joint during flexion

9

Disc make up

-Nucleous pulposus (70-90% water)
-annulus fibrosis: concentric rings, thicker ant and lat
-vertebral end plant: cartilage layer 1mm thick

10

Disc function

Allow movement and transmit force

11

Panjabi/Wilkes: stability

Stability of spine related to muscular rather than ligamentous factors.
-Breakdown of intrinsic muscles leads to LBP

12

Panjabi/Wilkes: 3 subsystems of stability

1. Passive (ligs, bones, discs)
2. Active (muscles and tendons)
3. Nervous system

13

Ligamentum flavum

medial and lateral portions connect to lamina. elastic and allows return from flexion to extension.
connected to ant capsule of z-joints.
Associated with causing stenosis.

14

ALL

-runs from c/s to sacrum
-covers disc ant and part of annulus
-crura of diaphragm attached to ALL (tendon)
-Resists extension

15

PLL

-Resists separation of vert in flexion

16

Supraspinous lig

often absent at L5-S1

17

Iliolumbar ligament

from TP L5 to inner edge of ilium in 5 bands.
-Age 30 = more fibrous vs muscular
-Prevents ant trans of L5
-Attached to QL
-Resists all motions at L5-S1

18

Meninges and nerve roots

Anterior root = motor
Posterior root = sensory

19

Psoas Major

Fascial attachments up to T5 (longus colli fascial attachments down to T5)
-T12-L5: attaches to TP, discs, bodies

20

Bogduk: Psoas

-Upper fibers tend to extend spine
-Lower fibers flex spine

21

Basmajian/Janda: Psoas

deep fibers of psoas stabilize the spine

22

QL

-covers lateral 2/3 of ant surface of L1-4 TPs.
-Extends latterally - may have iliolumbar lig connection

23

Multifidi

-controls flexion
-compressor of spine
-increases lordosis

24

Jull, Hodges, Hides: Multifidi

multifidi are stabilizers

25

Bogduk: Multifidi

Innervation = medial branch of dorsal ramus

26

Hides: multifidi

Trauma/back pain will inhibit multifidi from stabilizing

27

Vleeming/Lee: Thoracolumbar fascia

supports breathing and force closure

28

Force closure

Done by erector spinae, glute max, lats, biceps femoris

29

Arthrokinematics with flexion: l/s

Facets slide anterior/superior
-opening

30

Arthrokinematics with extension: l/s

facets slide posterior/inferior
-closing

31

Arthrokinematics with SB right: l/s

R post/inf, L ant/sup

32

Anomaly of L5-S1

35% rate of anomaly of articular processes

33

Fryette's Law 1

In neutral, SB and rotation are contralateral in lumbar spine

34

Fryette's Law 2

In flexion/extension, SB and rotation are ipsilateral in lumbar spine

35

Fryette's Law 3

Movement in lumber spine in any direction will decrease amount of movement available in other directions

36

Type 2 non-neutral dysfunctions

-Closing: loss of post/inf glide (worse in ext)
-Opening: loss of ant/sup glide (worse in flex)
-Single segment = primary dysfunction (worse in 1 direction, corrects in other direction)

37

Hypermobility

Angular/osteokinematic
-Consistent loss of motion
-can be "normal"

38

Instability

Linear/arthrokinematics
-Inconsistent loss of motion
-Not stopped by ligs/capsule

39

Panjabi/Dogudk: Neutral Zone

Movement in neutral posture
Minimal resistance to movement is offered by passive vertebral column

40

Panjabi: clinical instability

significant decreased in capacity of stabilizing systems of the spine to maintain intervetebral neutral zones within physiological limits
-results in pain and disability

41

Bergmark: local stabilization

Local muscular stabilizing system: TA, multifidus, diaphragm, pelvic floor
-controls neutral zone
-controls intersegmental motion
-"stiffness" of spine

42

Bermark: global stabilization

-superficial muscles
-primary movers of spine
-transfers load between t/s, ribs, l/s, pelvis
-transmits load to local stabilizers

43

Form Closure: Vlemming/Snijders

Congruencey of joints - osseous.
"Puzzle"

44

Force Closure: Vleeming/Snijders

Muscular synergistic stability
"lock and key"

45

Compression-Vibration test

screen for:
-potential fx (compression/vib sensitive)
-discogenic (comp sens)
T12 most common fx at TP
Perform: pt supine, hit IT with heel of hand

46

Kidney/Flank pain test

dull or sharp pain, could be several areas.
-11/10 pain
-Blood in urine, weight loss, hard to move
Perform: percussion over kidney

47

Aorta Test

Feel for pulse width and length:
-lack of normal "lub-dub"
-larger than 3 finger width
Hx: 50+ y.o male, heart disease, HBP, family hx, LBP with movement sometimes into leg, pain in solar plexus, boring pain in back.

48

Slump test

lumbrosacral neutral - screen for nerve

49

Position/motion testing

sitting flexion/extension feel for segment positions
-Can be done in prone, sitting back on knees, prone extension.

50

PIVMT

Looking at hyper or hypo mobility: ROM
NOT instability

51

PAIVMT

Combined motion looking at motion segment, not cardinal plane
gliding motion tested at end range, opening/closing, 3D lockup

52

PEMT

PAIVMT blocking at same vert

53

CBT

PAIVMT opposite side level below

54

Spring testing

use heel of hand or thumbs, go slowly
some instabilities are velocity dependent.
Done in prone.

55

Anterior stress test

P->A test
sidelying - hips at 70deg, 90deg
block segment you want to test, push knees back

56

Posterior stress test

A->P test
sitting, block inf vert - gives and A>P of sup vert

57

Rotational stress test

prone (general) or sidelying (specific)