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KNSS 220 Athletic Therapy > Lumbar Spine, Sacrum, and Abdomen > Flashcards

Lumbar Spine, Sacrum, and Abdomen Flashcards

1
Q

Describe the anatomy of the lumbar spine.

A
  • 5​ ​lumbar​ ​vertebrae
  • Discs​ ​are​ ​like​ ​jelly​ ​donuts
  • Spinal​ ​nerves​ ​come​ ​off​ ​each​ ​side
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2
Q

How are discs like donuts?

A
  • Annulus​ ​fibrosus​ ​on​ ​outside

- Jelly​ ​=​ ​nucleus​ ​pulposus

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3
Q

Nerves = _____ pain

A

referred

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4
Q

What are we looking for when asking history for lumbar spine?

A
  • Where​ ​they​ ​have​ ​pain
  • When​ ​they​ ​have​ ​pain
  • nerve pain will have referred pain
  • Need​ ​to​ ​differentiate​ ​between​ ​leg​ ​injury​ ​and​ ​back​ ​injury​ ​etc.
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5
Q

What can we observe in lower back injuries?

A
  • Muscle​ ​spasm
  • Hard​ ​to​ ​see​ ​any​ ​bruising/inflammation
  • Bruising​ ​will​ ​generally​ ​only​ ​be​ ​from​ ​a​ ​contact​ ​injury
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6
Q

What type of movements occur in the lumbar spine?

A
  • flexion
  • extension
  • side/lateral flexion (tilting to left and right)
  • rotation
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7
Q

What is the biggest movement in the lower back?

A

flexion

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8
Q

What percent of flexion movement occurs in the lumbar spine?

A

75%

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9
Q

The majority of flexion takes place in which specific places?

A

Majority​ ​of​ ​this​ ​movement​ ​is​ ​in​ ​very​ ​bottom​ ​of​ ​spine​ ​(L5,​ ​S1,​ ​L4-5)

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10
Q

What part of the spine has the most movement during extension?

A

Equal​ ​amount​ ​of​ ​movement​ ​all​ ​the​ ​way​ ​up​ ​lumbar​ ​and​ ​thoracic​ ​vertebrae

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11
Q

What part of the spine has the most movement during side/lateral flexion?

A

Equal​ ​amount​ ​of​ ​movement​ ​all​ ​the​ ​way​ ​up​ ​lumbar​ ​and​ ​thoracic​ ​vertebrae

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12
Q

What part of the back has the most movement during rotation?

A
  • Most​ ​movement​ ​comes​ ​from​ ​torso

- Very​ ​little​ ​in​ ​low​ ​back

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13
Q

What is sciatica?

A

Inflammation​ ​or​ ​aggravation​ ​of​ ​the​ ​sciatic​ ​nerve

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14
Q

What are the 3 causes of sciatica?

A
  • Can​ ​happen​ ​because​ ​you​ ​have​ ​a​ ​disc​ ​injury
  • Can​ ​happen​ ​because​ ​you​ ​have​ ​a​ ​muscle​ ​(ext.​ ​Rotators​ ​or​ ​glutes)​ ​is​ ​squeezing sciatic​ ​nerve
  • Can​ ​be​ ​a​ ​structural​ ​abnormality​ ​where​ ​the​ ​nerve​ ​runs​ ​through​ ​their​ ​piriformis muscle
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15
Q

What is the most important thing that we do when assessing sciatica?

A

figure out why they have it

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16
Q

What are the signs and symptoms of sciatica?

A
  • burning pain down the back of leg
  • Tingling​ ​or​ ​numbness
  • Muscles​ ​by​ ​the​ ​sciatic​ ​nerve​ ​can​ ​stop​ ​working​ ​(long​ ​term)
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17
Q

Generally, what is the order that symptoms go in from mild to bad?

A
  • pain
  • tingling
  • numb
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18
Q

Describe the burning pain that people experience when they have sciatica.

A
  • Middle​ ​of​ ​sacrum​ ​to​ ​back​ ​of​ ​leg​ ​to​ ​knee,​ ​splits​ ​into​ ​2​ ​different​ ​sections
  • Can​ ​have​ ​pain​ ​anywhere​ ​along​ sciatic nerve
  • The​ ​farther​ ​it​ ​goes,​ ​the​ ​worse​ ​it​ ​is
  • Can​ ​be​ ​all​ ​the​ ​time,​ ​or​ ​sharp​ ​and​ ​sudden,​ ​depending​ ​on​ ​their​ ​movements
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19
Q

Describe the tingling or numbness that people with sciatica experience.

A
  • Nerves​ ​control​ ​sensation
  • Pins​ ​and​ ​needles
  • Completely​ ​numb
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20
Q

How do we manage sciatica?

A
  • Due​ ​to​ ​disc​ ​injury​ ​=​ ​treat​ ​disc
  • Due​ ​to​ ​tight​ ​muscle​ ​=​ ​find​ ​it,​ ​release​ ​muscle
  • Due​ ​to​ ​structural​ ​abnormality​ ​=​ ​relax​ ​piriformis
  • Rest (Need to make sure rest is helping)
  • Usually​ ​in​ ​pain​ ​all​ ​the​ ​time,​ ​typically​ ​will​ ​rest
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21
Q

What is the special test for sciatica? What does it aim to do?

A
  • slump test
  • Increase​ ​neural​ ​tension​ ​in​ ​the​ ​back​ ​of​ ​the​ ​body
  • Stretch​ ​out​ ​nerves​ ​as​ ​long​ ​as​ ​they​ ​can
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22
Q

What are the 4 stages of the slump test?

A
  • Stage​ ​1:​ ​slump,​ ​making​ ​spine​ ​as​ ​long​ ​as​ ​possible
  • Stage​ ​2:​ ​extend​ ​one​ ​leg​ ​out​ ​forward,​ ​stretch​ ​out​ ​nerves​ ​in​ ​leg
  • Stage​ ​3:​ ​flex​ ​neck:​ ​stretch​ ​out​ ​nerves​ ​in​ ​neck
  • Stage​ ​4:​ ​dorsi​ ​flex​ ​foot
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23
Q

What is the positive test for the slump test?

A
  • Positive​ ​test​ ​is​ ​NOT​ ​tension
  • Positive​ ​test:​ ​burning​ ​sensation,​ ​tingling,​ ​down​ ​sciatic​ ​nerve
  • Wherever​ ​there​ ​is​ ​a​ ​burning​ ​pain,​ ​they​ ​should​ ​be​ ​able​ ​to​ ​go​ ​back​ ​a stage​ ​and​ ​it​ ​should​ ​go​ ​away
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24
Q

Where are the most commonly injured discs? Why?

A
  • bottom of spine
  • Between​ ​L5-S1
  • Between​ ​L4-5
  • Due​ ​to​ ​the​ ​amount​ ​of​ ​movement​ ​there
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25
Q

What is the MOI of disc injuries?

A

Most​ ​are​ ​damaged​ ​by​ ​flexion,​ ​or​ ​flexion​ ​with​ ​a​ ​rotation

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26
Q

Most​ ​discs​ ​are​ ​damaged​ ​on​ ​the​ ​______ ​surface​ ​of​ ​the​ ​disc. Why is this?

A
  • posterior
  • during​ ​flexion,​ ​we compress​ ​front​ ​side,​ ​stretch​ ​back​ ​side,​ ​centre​ ​part​ ​of​ ​disc​ ​can​ ​bulge​ ​out​ ​the​ ​back
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27
Q

What is a herniated disc?

A
  • ​nucleus​ ​pulposus​ ​leaks,​ ​not​ ​contained​ ​in​ ​annulus​ ​fibrosus
  • leaking pushing​ ​back​ ​on​ ​spine​ ​will​ ​cause​ ​referred​ ​pain
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28
Q

What is prolapse?

A
  • ​pushing​ ​out​ ​back​ ​on​ ​the​ ​nerve

- will have symptoms that come and go

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29
Q

What is a extruded disc?

A
  • ​2​ ​segments,​ ​small​ ​channel​ ​between​ ​them

- will have constant symptoms

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30
Q

What is a sequestrated disc?

A

​- no​ ​longer​ ​contained,​ ​leaking​ ​down

- will have constant symptoms

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31
Q

What kind of trauma causes disc injuries?

A

can be caused by micro traumas or 1 big trauma

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32
Q

What is the difference between the symptoms of sciatica and the symptoms of disc injuries?

A

Same but​ ​in disc injuries they​ ​can​ ​go​ ​past​ ​their​ ​knee​ ​into​ ​toes

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33
Q

What does coughing and sneezing affect discs?

A
  • increases pressure in discs
  • Can​ ​be​ ​painful
  • Can​ ​lose​ ​feeling​ ​in​ ​legs
  • Often​ ​comes​ ​with​ ​flexion​ ​action
34
Q

How do we manage disc injuries?

A
  • Centralization:​ ​try​ ​to​ ​pull​ ​all​ ​of​ ​symptoms​ ​in​ ​legs​ ​or​ ​hip​ ​so​ ​that​ ​they​ ​only​ ​have pain​ ​in​ ​back
  • Back​ ​extension​ ​exercises​ ​(posture)
  • Strong​ ​core​ ​exercises
35
Q

Describe back extension exercises for disc injuries.

A
  • Mechanism​ ​is​ ​flexing​ ​forward
  • Extension​ ​would​ ​squish​ ​back,​ ​pushing​ ​all​ ​material​ ​forward
  • Flexion​ ​would​ ​just​ ​push​ ​fluid​ ​to​ ​back,​ ​making​ ​all​ ​symptoms​ ​worse
36
Q

Describe core exercises for disc injuries.

A
  • Lots​ ​of​ ​spasm​ ​in​ ​low​ ​back,​ ​don’t​ ​want​ ​to​ ​move
  • Shuts​ ​down​ ​abdominal​ ​muscles
  • Core​ ​stabilizes​ ​everything​ ​as​ ​you​ ​move
  • Less​ ​spasms
37
Q

What are the special tests for disc injuries?

A

Valsalva maneuver

38
Q

Describe the Valsalva maneuver.

A
  • sneezing/coughing
  • Hold​ ​breath,​ ​push​ ​yourself​ ​down​ ​into​ ​seat
  • Will​ ​not​ ​have​ ​positive​ ​test​ ​with​ ​anything​ ​but​ ​disc​ ​injury
39
Q

Describe the straight leg test.

A
  • Patient​ ​flat​ ​on​ ​back
  • Passive​ ​test
  • Raise​ ​their​ ​leg
  • See​ ​if​ ​they​ ​get​ ​symptoms​ ​and​ ​where​ ​they​ ​get​ ​symptoms
40
Q

What is the positive test for the straight leg test?

A
  • Positive​ ​test:​ ​pain,​ ​burning​ ​pain​ ​along​ ​nerve
  • Pain​ ​at​ ​30​ ​degrees​ ​(pain​ ​in​ ​hip​ ​or​ ​back)​ ​=​ ​inflammation​ ​in​ ​nerve​ ​(​sciatic nerve),​ ​or​ ​disc​​ ​pushing​ ​on​ ​a​ ​nerve​ ​at​ ​back
  • Pain​ ​gets​ ​worse,​ ​travels​ ​down​ ​leg​ ​at​ ​60​ ​degrees​ ​=​ sciatic​ ​nerve
  • Anything​ ​from​ ​60-90​ ​degrees:​ ​very​ ​specific​ ​pain​ ​at​ S​​I joint​​ ​(test​ ​for​ ​SI​ ​joint sprain)
41
Q

The sacroiliac joint is between the ______ (____) and ______.

A
  • pelvis (ilium)

- sacrum

42
Q

Describe the sacroiliac joint.

A
  • Not​ ​a​ ​fused​ ​joint
  • Has​ ​a​ ​little​ ​bit​ ​of​ ​movement
  • Very​ ​important​ ​for​ ​walking
43
Q

Describe the ligaments of the sacroiliac joint.

A
  • Ligaments​ ​on​ ​front​ ​and​ ​back​ ​side​ ​(inside​ ​abdomen)
  • Can​ ​sprain​ ​one​ ​set​ ​or​ ​both
  • 2​ ​SI​ ​joints,​ ​rare​ ​to​ ​do​ ​both​ ​at​ ​same​ ​time
44
Q

What is the MOI of a SI joint sprain?

A
  • Feet​ ​planted,​ ​twisting

- Lying​ ​down,​ ​leg​ ​forcibly​ ​twisted​ ​across​ ​body

45
Q

What are the signs and symptoms of a SI joint sprain?

A
  • No​ ​referred​ ​pain
  • Local​ ​pain​ ​to​ ​SI​ ​joint
  • Pain​ ​with​ ​walking​ ​anytime​ ​that​ ​leg​ ​is​ ​in​ ​contact​ ​with​ ​ground​ ​(planting,​ ​walking through)
  • Likely​ ​try​ ​to​ ​lean​ ​on​ ​things​ ​to​ ​take​ ​pressure​ ​off​ ​if​ ​they’re​ ​standing
  • No​ ​visible​ ​inflammation
  • Muscle​ ​spasm​ ​in​ ​muscles​ ​of​ ​low​ ​back​ ​and​ ​hip
46
Q

Spraining posterior ligaments means…

A

​it​ ​is​ ​easier​ ​to​ ​point​ ​out​ ​where

47
Q

Spraining anterior ligaments means…

A

deep​ ​pain​ ​in​ ​hip,​ ​hard​ ​to​ ​point​ ​out​ ​where

48
Q

How do we manage SI joint sprains?

A
  • Always​ ​painful
  • Modalities​ ​to​ ​calm​ ​down​ ​swelling​ ​and​ ​muscle​ ​spasms
  • Generally​ ​like​ ​to​ ​be​ ​braced
  • SI​ ​belt:​ ​belt​ ​that​ ​comes​ ​around​ ​and​ ​push​ ​SI​ ​joints together
  • Will​ ​rest
  • Longer​ ​heal,​ ​hard​ ​to​ ​make​ ​joint​ ​inactive
49
Q

What are the special tests for SI joint sprains?

A
  • SI shear test

- SI approximation test

50
Q

Describe the SI shear test.

A
  • Pushing​ ​front​ ​of​ ​ASIS​ ​apart,​ ​stresses​ ​ligaments​ ​on​ ​​anterior​ ​​SI​ ​joint
  • Positive​ ​test​ ​is​ ​pain,​ ​will​ ​not​ ​see​ ​laxity
51
Q

Describe the SI approximation test.

A
  • Pushing​ ​ASIS​ ​together,​ ​stresses​ ​ligaments​ ​on​ ​​posterior​ ​​SI​ ​joint
  • Positive​ ​test​ ​is​ ​pain​ ​at​ ​SI​ ​joint
52
Q

What is the organ of concern in the right upper quadrant?

A

liver

53
Q

What is the organ of concern in the left upper quadrant?

A

spleen

54
Q

What is the organ of concern in the right lower quadrant?

A

appendix

55
Q

What is the organ of concern in the left lower quadrant?

A

nothing

56
Q

What is the fancy word for getting winded?

A

blow to the solar plexus

57
Q

What is the MOI of a blow to the solar plexus?

A
  • Can​ ​be​ ​blow​ ​from​ ​any​ ​side,​ ​but​ ​generally​ ​happens​ ​at​ ​front
  • Blow​ ​is​ ​hard​ ​enough​ ​that​ ​it​ ​sends​ ​diaphragm​ ​into​ ​spasm
  • Not​ ​contract/relax​ ​=​ ​not​ ​breathing
58
Q

What happens during a blow to the solar plexus?

A
  • Contusion​ ​to​ ​diaphragm

- Diaphragm​ ​sits​ ​on​ ​inside​ ​of​ ​rib​ ​cage,​ ​attaches​ ​on​ ​all​ ​sides

59
Q

What is a complication that can come with a blow to the solar plexus?

A

rib fractures

60
Q

How do we find rib fractures?

A
  • Need​ ​to​ ​make​ ​sure​ ​whole​ ​rib​ ​cage​ ​has​ ​no​ ​point​ ​tenderness​ ​(more​ ​than just​ ​from​ ​the​ ​contusion)
  • Pain​ ​every​ ​time​ ​you​ ​breathe
61
Q

How do we manage a blow to the solar plexus?

A
  • Can’t​ ​do​ ​anything​ ​to​ ​help​ ​them
  • Can’t​ ​breathe​ ​for​ ​a​ ​bit,​ ​go​ ​unconscious,​ ​then​ ​diaphragm​ ​will​ ​relax,​ ​then​ ​they​ ​will breathe
  • Comfort​ ​them,​ ​calm​ ​them​ ​down,​ ​help​ ​them​ ​relax
62
Q

What is a hernia?

A
  • Tear​ ​in​ ​fascia​ ​that​ ​covers​ ​intestines
  • Intestine​ ​by​ ​it​ ​will​ ​stick​ ​through​ ​hole
  • Creates​ ​pressure​ ​=​ ​pain
63
Q

What happens with your intestine during activity if you have a hernia?

A

Intestine​ ​gets​ ​sucked​ ​back​ ​in​ ​during​ ​activity​ ​because​ ​abdominal​ ​muscles​ ​are​ ​tight

64
Q

Where do hernias usually happen?

A

usually closer to pelvis

65
Q

What happens if the intestine is sticking out for too long?

A

If​ ​intestine​ ​is​ ​there​ ​for​ ​too​ ​long​ ​without​ ​normal​ ​blood​ ​flow,​ ​that​ ​part​ ​of​ ​the​ ​intestine can​ ​die

66
Q

What are the signs and symptoms of a hernia?

A
  • The​ ​longer​ ​they​ ​have​ ​it,​ ​the​ ​longer​ ​they​ ​start​ ​to​ ​feel​ ​they​ ​have​ ​the​ ​flu
  • Painful​ ​in​ ​a​ ​very​ ​specific​ ​location
  • Local​ ​pain
  • Can​ ​sometimes​ ​feel​ ​bubble​ ​where​ ​intestine​ ​is​ ​sticking​ ​out,​ ​tender
67
Q

How do you manage a hernia?

A
  • Day​ ​surgery:​ ​Push​ ​it​ ​back​ ​in,​ ​stitch​ ​it​ ​back
  • Can​ ​wait​ ​with​ ​most
68
Q

What is the test for the hernia?

A
  • Cough
  • Sit​ ​up
  • Pain​ ​in​ ​one​ ​location
69
Q

What abdominal muscles can you strain?

A
  • tend to have it more in rectus abdominis

- can also happen in obliques

70
Q

Describe the 3 grades of abdominal strains.

A
  • Grade​ ​1:​ ​stretch,​ ​no​ ​tearing
  • Grade​ ​2:​ ​some​ ​tearing,​ ​very​ ​common
  • Grade​ ​3:​ ​rupture,​ ​very​ ​rare
71
Q

What is the MOI of abdominal strains?

A
  • less​ ​likely​ ​to​ ​stretch​ ​too​ ​far
  • Likely​ ​in​ ​extension​ ​position,​ ​then​ ​forcibly​ ​contracting​ ​forward
  • Ex.​ ​volleyball​ ​strike,​ ​hockey​ ​slap​ ​shot
72
Q

What are the signs and symptoms of abdominal strains?

A
  • Bigger​ ​area​ ​of​ ​pain

- Can​ ​palpate​ ​it​ ​feeling​ ​very​ ​hard​ ​where​ ​it​ ​is​ ​painful

73
Q

How do we manage abdominal strains?

A
  • Abdominal​ ​muscles​ ​don’t​ ​get​ ​rest
  • Can​ ​have​ ​constant​ ​pain​ ​at​ ​the​ ​site​ ​of​ ​injury
  • Decrease​ ​muscle​ ​spasm
  • Decrease​ ​pain
  • Longer​ ​healing​ ​time​ ​because​ ​of​ ​how​ ​active​ ​the​ ​muscle​ is
  • Cross​ ​fibre​ ​friction
  • Limit​ ​their​ ​ability​ ​to​ ​do​ ​sit​ ​ups,​ ​crunches​ ​etc.​ ​for​ ​approx.​ ​1​ ​month (can do plank instead)
74
Q

Describe cross fibre friction.

A
  • Designed​ ​to​ ​help​ ​make​ ​the​ ​tissue​ ​stronger​ ​and​ ​break​ ​up​ ​scar​ ​tissue
  • Break​ ​up​ ​all​ ​tissue​ ​that​ ​isn’t​ ​in​ ​line​ ​with​ ​where​ ​we​ ​need​ ​strength
  • Work​ ​across​ ​fibres - Painful
  • 30​ ​seconds,​ ​any​ ​more​ ​would​ ​cause​ ​body​ ​to​ ​treat​ ​it​ ​as​ ​another​ ​injury
  • Very​ ​deep​ ​pressure​ ​going​ ​back​ ​and​ ​forth
75
Q

How do you test for internal abdomen injuries?

A
  • palpation

- looking for rigidity

76
Q

Why do we look for rigidity in internal injuries?

A
  • Any​ ​injury​ ​means​ ​all​ ​muscles​ ​in​ ​area​ ​will​ ​contract​ ​to​ ​protect
  • Muscles​ ​will​ ​also​ ​contract​ ​with​ ​blood​ ​or​ ​fluid​ ​rushing​ ​into​ ​area
  • Can​ ​be​ ​specific​ ​or​ ​in​ ​entire​ ​area
77
Q

What do we look for in assessing a strain?

A

palpation​ ​of​ ​muscle​ ​to​ ​feel​ ​for​ ​pain,​ ​or​ ​find​ ​tender​ ​hard​ ​area

78
Q

What do we look for in assessing a hernia?

A

no​ ​spasm,​ ​will​ ​have​ ​bubble​ ​feeling​ ​when​ ​you​ ​palpate​ ​it,​ ​less​ ​painful​ ​when​ ​you push​ ​it​ ​back​ ​in

79
Q

What do you do if they have a internal organ injury?

A
  • ambulance

- emergency

80
Q

What do you do if they have a hernia?

A
  • ​not​ ​emergency

- ​go​ ​see​ ​family​ ​doctor

KNSS 220 Athletic Therapy (14 decks)

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