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T3 CLINICAL ASSESSMENT > Lumbar Spine Part 1 > Flashcards

Lumbar Spine Part 1 Flashcards

1
Q

The ______ spine refers to the “low back” and is made up of ___ vertebrae and their intervertebral discs.

A

Lumbar Spine
5 Vertebrae

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2
Q

Beginning about ___ inches from the ________ angle of the scapula, the vertebrae of the lumbar spine create a ________ curve before finally attaching to the sacral spine.

A

6 Inches
Inferior Angle
Lordotic Curve

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3
Q

Based on the following image, label numbers 1-9 of the lumbar spine.

A

1) Intervertebral Foramen
2) Nucleus Pulposus
3) Annulus Fibrosis
4) Vertebral Body
5) Intervertebral Disc
6) Superior Articular Facet
7) Posterior Longitudinal Ligament
8) Ligamentum Flavum
9) Supraspinous Ligaments

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4
Q

In the lumbar spine, the _________ are commonly compared to hockey pucks interspaced with ______________ _____ known as jelly donuts.

A

Vertebrae
Intervertebral Discs

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5
Q

The _________ allow for attachments of muscles and ligaments that provide _________ and mobility of the lumbar spine.

A

Vertebrae
Stability

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6
Q

The ______________ _____ act to absorb and ________ axial loads and tensile stressed from one vertebra to another.

A

Intervertebral Discs
Transmit

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7
Q

The ____ lumbar vertebra is the largest and transmits forces from the _____ extremities to the sacrum and pelvis.

A

5th Lumbar Vertebra
Upper Extremities

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8
Q

T/F - The 5th lumbar vertebra is wedge shaped and forward orientated, therefore the above vertebra sits slightly anteriorly allowing for normal lordotic curve.

A

False - The 5th lumbar vertebra is wedge shaped and forward orientated, therefore the above vertebra sits slightly POSTERIORLY allowing for normal lordotic curve.

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9
Q

Which segment of the vertebral column is the most common segment for problems?

A

L5-S1 Segment

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10
Q

The lumbar facet joints sit in the ________ plane, therefore the available movements are _______ and _________.

A

Sagittal Plane
Flexion and Extension

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11
Q

T/F - Rotation and side bending are very limited at the lumbar spine

A

True

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12
Q

The role of the ______ are to stabilize the spine, allow limited movement and protect the IVDs from shear forces.

A

Facets

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13
Q

There are ___ pairs of facets in the lumbar spine, consisting of ________ (facing medial and backward) and ________ (facing lateral and forward).

A

5 Pairs
Superior
Inferior

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14
Q

Name the 3 spine conditions due to injury, degeneration and/or trauma.

A

1) Spondylosis
2) Spondylolysis
3) Spondylolythesis

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15
Q

A spine condition involving degeneration of the intervertebral disc.

A

Spondylosis

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16
Q

A spine condition where there is a defect in the pars interarticularis, involving a fracture between the lamina and pedicle.

A

Spondylolysis

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17
Q

What is displayed in the following image?

A

Scottie Dog X-Ray

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18
Q

A Scottie dog x-ray is used as a diagnostic sign for _____________ and occurs with over _________ pressing the SPs together.

A

Spondylolysis
Over Extension

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19
Q

A spine condition involving forward displacement of one vertebrae over another.

A

Spondylolythesis

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20
Q

T/F - Discs make up approximately 35% of the total length of the vertebral column and this will decrease with age due to overall degeneration.

A

False - Discs make up approximately 25% of the total length of the vertebral column and this will decrease with age due to overall degeneration.

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21
Q

What are the 2 parts of an intervertebral disc?

A

1) Annulus Fibrosis
2) Nucleus Pulposus

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22
Q

Part of the intervertebral disc consisting of approximately 20 rings of criss-crossing collagenous fibers.

A

Annulus Fibrosis

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23
Q

Part of the intervertebral disc that is incompressible fluid.

A

Nucleus Pulposus

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24
Q

A general term used to describe any change in the annulus shape of an intervertebral disc that will cause it to protrude beyond its normal perimeter.

A

Herniation

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25
Q

What are the 4 categories of disc herniation?

A

1) Protrusion
2) Prolapse
3) Extrusion
4) Sequestration

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26
Q

Based on the following image, label letters A-D with their associated type of disc herniation.

A

A) Protrusion
B) Prolapse
C) Extrusion
D) Sequestration

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27
Q

A type of disc herniation when the nucleus pulposus is only contained by the outer fibres of the annulus and supporting ligamentous structures.

A

Protrusion

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28
Q

A type of disc herniation involving rupture of the nuclear material into the vertebral canal.

A

Prolapse

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29
Q

A type of disc herniation involving extension of nuclear material beyond the confines of the posterior longitudinal ligament or above and below the disc space, but still in contact with the disc.

A

Extrusion

30
Q

A type of disc herniation in which the extruded nucleus has separated from the disc and moved away from the prolapsed area.

A

Sequestration

31
Q

The following actions increase pressure in the ___ intervertebral disc:
- Walking (15%)
- Small jumps (40%)
- Laughing (40-50%)
- Bending forward (150%)
- Lifting 2kg with back straight (73%)
- Lifting 2kg with back bent (169%)

A

L3 Intervertebral Disc

32
Q

T/F - It is highly recommended to avoid laughing while taking a small jump with your back bent.

A

True

33
Q

The resting position of the lumbar spine is midway between _______ and _________.

A

Flexion and Extension

34
Q

The close packed position of the lumbar spine is _________.

A

Extension

35
Q

Some common questions to ask when getting a patient’s history include their primary _________, general health and mechanism of ______.

A

Primary Complaint
Mechanism of Injury

36
Q

If a patient is experiencing a past injury or complaint, you want to ask about prior ___________ and how they were treated.

A

Prior Occurrences

37
Q

The following lumbar spine injuries are examples of _____ pain:
- Facet joint irritation
- Paravertebral muscle spasm
- Ligament Sprain

A

Local Pain

38
Q

A type of pain that travels down the involved limb due to spinal nerve and/or root irritation, such as with sciatica.

A

Radiating Pain

39
Q

The following impairments are examples of ________ pain:
- Trigger points
- Visceral organs (e.g. prostrate cancer)
- Systemic conditions (e.g. ankylosing spondylitis)

A

Referred Pain

40
Q

Match the following behaviour/symptoms with the associated impairment area.

1) Popping/Tearing
2) Numbness
3) Catching
4) Tingling/Warmth/Coldness

A) Nerve Root/Circulation
B) Muscle
C) Peripheral Nerve/Nerve Root Irritation
D) Muscle Spasm/Facet Joint

A

1) Popping/Tearing - B) Muscle
2) Numbness - C) Peripheral Nerve/Nerve Root Irritation
3) Catching - D) Muscle Spasm/Facet Joint
4) Tingling/Warmth/Coldness A) Nerve Root/Circulation

41
Q

When doing our ____________ of the patient’s lumbar spine, we want to look at:
- Regular landmarks (e.g. alignments of SPs)
- Spinal posture
- Upper and lower extremity landmarks (e.g. acromion process, patellae, malleoli)
- Lordotic curve

A

Observations

42
Q

When creating our testing __________, we must consider if the MOI was traumatic or non-traumatic.

A

Testing Hypothesis

43
Q

Which 3 areas need to be ruled out prior to functional testing for the lumbar spine?

A

1) Hip
2) Pelvis
3) Cervical Spine

44
Q

T/F - When ruling out the hip, we want to do active free flexion and external rotation with overpressure.

A

False - When ruling out the hip, we want to do active free flexion and MEDIAL rotation with overpressure.

45
Q

Which 3 tests are used to rule out the pelvis?

A

1) Rocking
2) Gapping
3) Approximation

46
Q

When ruling out the cervical spine, we want to do active free flexion, extension, side bend and rotation with overpressure, expect _________.

A

Extension

47
Q

Active flexion range is usually ___ to ___ degrees in the lumbar spine.

A

40 to 60 degrees

48
Q

With active _______ of the lumbar spine, the patient is standing and tucks their chin to their chest and forward bends as far as possible.

A

Flexion

49
Q

T/F - Active flexion of the lumbar spine is initiated by a concentric contraction of the sacrospinal and multifidi muscles, and controlled eccentrically by the psoas and abdominal muscles.

A

False - Active flexion of the lumbar spine is initiated by a concentric contraction of the PSOAS and ABDOMINAL muscles, and controlled eccentrically by the SACROSPINAL and MULTIFIDI muscles.

50
Q

T/F - If active flexion of the lumbar spine is full and pain free, over pressure may be applied.

A

True

51
Q

With active flexion, the lumbar lordosis should flatten but not produce a ________. If it does not fully flatten, consider whether the lumbar spine is _____________ in postural assessment.

A

Kyphosis
Hyperlordotic

52
Q

With active flexion, the therapist may wish to measure from ____ to ___ as the patient bends forward. The tape should ________ in length by about 7-8 cm.

A

T12 to S1
Increase

53
Q

Pain with movement during active_______ of the lumbar spine may be caused by:
- Spasm or tightness of the back muscles
- Local facet capsular restriction
- Advanced ankylosing spondylitis
- Sacrospinalis muscle spasm (common in degenerative diseases)

A

Flexion

54
Q

Pain at end range during active _______ of the lumbar spine may be caused by:
- Dura mater stretch
- Lumbar nerve root irritation or nerve compression
- Thoracolumbar fascial injury
- Centralized pain may indicate a sprain of the posterior capsular ligament of the facet joint, the supraspinous ligament or ligamentum flavum

A

Flexion

55
Q

Radiating pain in the lower limb felt distal to the knee may indicate ____ __________ with nerve root irritation.

A

Disc Herniation

56
Q

Pain that does not travel past the knee is likely to be ________ pain from trigger points in local guarding muscles, or compression on the peripheral _______ nerve.

A

Referred Pain
Sciatic Nerve

57
Q

Active extension range is usually ___ to ___ degrees in the lumbar spine.

A

20 to 35 degrees

58
Q

Active _________ will often be the last range tested for the lumbar spine, as the muscles involved are often injured or guarding.

A

Extension

59
Q

The safest position for active lumbar extension is the ______ position. The lumbar area is observed during movement for an increase in ________, which should be evenly distributed.

A

Sphinx Position
Lordosis

60
Q

Only if the patient is able (physically and emotionally), can the patient be ________ to do active lumbar extension, while the therapist stabilizes the ______ and possibly the small of the back.

A

Standing
Pelvis

61
Q

T/F - Active extension of the lumbar spine is initiated by a concentric contraction of the long back extensors and controlled eccentrically by the abdominal muscles.

A

True

62
Q

With active _________ of the lumbar spine, note any segmental vertebral hypo or hypermobility by looking for any ____________ movements for the above or below segments.

A

Extension
Compensatory

63
Q

Pain with movement during active _________ of the lumbar spine may be caused by:
- SI dysfunction
- Gluteal or hamstring strain or sprain
- Ankylosing spondylitis
- Articular derangement in a joint
- Abdominal muscle spasm

A

Extension

64
Q

Pain at the end or limited range during active _________ may be caused by:
- Posterior facet joint problem
- Osteophyte formation
- SI joint dysfunction
- Spondylolithesis

A

Extension

65
Q

Active side bending range is usually ___ to ___ degrees in the lumbar spine.

A

15 to 20 degrees

66
Q

The safest position for active lumbar side bending is ____ ______. If the patient is capable of ________ for this motion, they may side bend by reaching down the side of their leg attempting to touch their knee.

A

High Seated
Standing

67
Q

T/F - Active side bending of the lumbar spine should be done with some flexion or extension.

A

False - Active side bending of the lumbar spine should be done WITHOUT ANY flexion or extension.

68
Q

The lumbar spine should have a smooth even curve with active side bending. A sharp bend or angulations may indicate _____________ at that particular segment.

A

Hypermobility

69
Q

Pain on the side being ____ with active lumbar side bending may be caused by:
- Ipsilateral muscles that initiate the movement (e.g. external/internal obliques, quadratus lumborum, transverse abdominus)

A

Bent

70
Q

Pain on the side bending _________ with active lumbar side bending may be cause by:
- Eccentric contraction of muscles used to initiate the movement (e.g. external/internal obliques, quadratus lumborum, transverse abdominus), but on the contralateral side

A

Stretched

T3 CLINICAL ASSESSMENT (9 decks)

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