Lumbar Instabilities and Stabilization Flashcards Preview

PTRS 845 Midterm > Lumbar Instabilities and Stabilization > Flashcards

Flashcards in Lumbar Instabilities and Stabilization Deck (66):
1

Term: controls normal loads and stressed placed on the spine

Stabilizing structures

2

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

Osteoligamentous subsystem

3

System: Active system/dynamic stability

Muscle system

 

4

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

Neural control subsystem

5

3 Components of a Stabilized Spine

1. Osteoligamentous subsystem

2. Muscle system

3. Neural control subsystem

6

Describe the effect of dysfunction in one of the three subsystems

Added stress/demand to the other systems

7

Term: first few degress of motion

Neutral zone

8

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

Neutral zone

9

Zone: Grades 1 and 2

Neutral zone

10

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

Elastic zone

11

Term: zone in which movemtn occurs with considerable internal resistance

Elastic zone

12

Zone: Grades 3 and 4

Elastic zone

13

Describe the relationship between load and displacement

Non-linear relationship

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

14

Zone: Passive structures

Elastic zone

15

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

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

16

Term: increase in neutral zone

Segmental instability

17

Term: Decrease in elastic zone 

Segmental instability

18

Define segmental instability

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

Bogduc says: Decreased stiffness/elastic zone resulting in hypermobility

19

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

Segmental instability 

20

Term: Abnormal movement of one vertebra on another

Segmental instability

21

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

Passive system

22

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

Active system

23

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

Neural system

24

System: Adds stiffness by activating specific pattern of muscle activity

Neural system

25

3 ways to assess dysfunction in the PASSIVE subsystem

1. PPVIMs (hypo/hyper)

2. PAVIMs (central/unilateral PA)

3. Instability test

26

5 ways to assess dyfunction in the ACTIVE subsystem

1. US reveals decreased in CSA

2. Decreased contraction with palpation

3. Decreased feedback with pressure device

4. Mm fatigue seen with EMG

5. Unable to resist/accept load

27

3 ways to assess dysfunction in the NEURAL subsystem

1. Delayed mm onset (EMG)

2. Altered MUR (EMG)

3. Change in proprioception

28

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

Can lead to habitual changes in spinal movement and movement impairment

29

Condition: defect in pars interarticularis

Sponylolysis/Spondylolisthesis

30

Condition: Results in increased intervertebral segment motion

Spondylolysis/Spondylolisthesis

31

Condition: Typically in teens due to trauma

Spondylolysis/Spondylolisthesis

32

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

Spondylolysis/Spondylolisthesis

33

Term: degenerative changes in pars interarticularis

Spondylosis

34

Term: Defect of partial fx in pars interarticularis

Spondylolysis

35

Term: "Collar on Scottie dog"

Spondylolysis

36

Term: Complete fx of pars interarticularis with slippage

Sponydlolisthesis

37

Term: Decapitated Scottie dog

Sponydlolisthesis

38

Describe the types of anterior slippage

1. Normal

2. Stage 1

3. Stage 2

4. Stage 3

5. Stage 4

1. Vertebral bodies (L5-S1) aligned

2. 0-25% anterior translation (conscerv. tx)

3. 25-50% anterior translation (conscerv. tx)

4. 50-75% anterior translation (fusion)

5. 75+% anterior translation (fusion)

39

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

Functional instability

40

Term: Inability to maintain neutral zone, segmental hypermobility

Functional instability

41

Term: Instability related to either muscle or neural system changes

Functional instability

42

Condition: Subjective

- Young > Old

- Commonly L5-S1

- Fluctuating symptoms, rarely radiating

- Localized pain

Functional Instability

43

Condition: Subjective

- Constantly moving positions

- Pain decreased when new positions reached

- Hx of catching/locking

 

Functional Instability

44

Condition: Aggravating Factors

- s/p vigorous activity

- Static posture

Functional Instability

45

Condition: Easing factors

- Rest

- Changing to a new position

Functional Instability

 

46

Condition: Ojective

- Increased lumbar lordosis

- End ROM may provoke symptoms

- Hesitation in flexion at 30-40 degrees

- Hinging with extension

- Gowers +

 

Functional Instability

47

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

Will see more lumbar extension compared to hip extension

48

Condition: Objective

- Poor pelvic and abdominal control

- Central PA painful with altered end feel

- Leg load test + 

Functional Instability

49

End feel and Motion: Hypermoble Central PA

Increased neutral zone motion with a soft end feel

50

End feel and Motion: Hypomobile Central PA

Decreased neutral zone motion with a stiff end feel

51

Describe how hypomobility and instability/hypermobility can co-exist

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

52

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

Those who lack control in local muscles

53

Describe how global exercises impact the spine and stability

Global muscle exercises apply a compressive force

They provide nonspecific stability and can't control shear forces

54

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

Local muscles

55

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

Local muscles

56

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

Local muscles

57

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

TA

58

Muscle: Active during ipsilateral and contralateral trunk rotation

Multifidus

59

Muscle: Controls the neutral zone and lordosis

Multifidus

60

Muscle: Controls pelvic rotation

Multifidus

61

Describe how which exercises bias the internal and external obliques

Internal: crunches, sit up

External: side plank, SL hip ABD

 

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

62

Describe why it is difficult to activate hip musculature

- Has small cortical representation

- Is a redundant system making it easy to compensation with other muscles (thus they aren't activated)

63

Describe they it is difficult to activate postural muscles

- We don't typically think about activating activating them since they are "automatic" (it'll take some time to due it on command)

- Small cortical representation (with chronic LBP this small representation may be "shut down" making it even more diffiicult to find the pathways needed to activate these muscles)

64

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

Motor training 

65

4 Element of Motor Training

1. Proprioceptive and kinesthetic awareness

2. Dynamic stability

3. Preparatory and reactive muscle characteristics

4. Conscious and unconscious functional motor patterns

66

3 Phases of Motor Training

1. Phase 1 = static stabilization

2. Phase 2 = transitional stabilization

3. Phase 3 = dynamic stabilization