Lumbo pelvic region

Question 1

I. Pelvic Girdle

Answer 1

a. Pelvis movement relative to the femur
i. In weight-bearing, femur is fixed (closed chain)
ii. Reversal of motion
1. Pelvis on femur vs. femur on pelvis
iii. Change primary action for mm
1. Reversal of origin & insertion
2. Ex: Glut med: lateral tilt of pelvis vs. hip abduction
a. Rec fem: anterior tilt of pelvis vs. hip flexion

Question 2

i. Unilateral stance on R: frontal plane

Answer 2

1. Primary mm
   a. Right hip abductors acting on pelvis to pull into right lateral tilt
   b. Left lumbar erector spinae acting on pelvis to pull into right lateral tilt

Question 3

i. Rotation: horizontal plane

Answer 3

1. Rotation of pelvis produces medial/lateral rotation at hip joints
2. Pelvis rotates right
   a. Right femur externally rotates
   b. Left femur internally rotates
   c. Right hip internally rotates
   d. Left hip externally rotates

Question 4

i. Tilts: sagittal plane

1. Anterior pelvic tilt:

Answer 4

a. Hip flexion
b. Lumbosacral extension
c. Mm: erector spinae, ilipsoas, rectus femoris

Question 5

1. Posterior pelvic tilt:

Answer 5

a. Hip extension
b. Lumbosacral flexion
c. Mm: hamstrings, rectus abdominis

Question 6

Pelvis:

Fxn

Answer 6

○ Bear weight
○ Transfer loads from axial skeleton → appendicular
○ stable/limited mobility → more efficient transfer of loads
○ Serves as strong attachment point for mm.

Question 7

Gender differences

Male

Answer 7

● Prominent bony features

● narrow/

Question 8

Female

Answer 8

●	Less prominent bony features 
●	wide/oval pelvic inlet 
●	Wide distance b/n ASIS & ischial tubs. 
●	Ant. facing acetabulum
Wide pubic arch = 90-100 degrees

Question 9

● Implications:

of gender diff.

Answer 9

○ Different mechanics in gait - acetabulum orientation
○ Smaller BoS for males in sitting
○ Different MA, length-tension relationships for mm.

Question 10

● M. attachments

Answer 10

○ Pelvis has large influence on trunk, hip + knee
○ Transmission of loads
○ Position influences length-tension relationships of mm.
○ Unilateral stance: frontal plane
■ R hip abductors: glut med
● Acts on pelvis to pull into R lateral tilt
○ L lumbar ES:
■ Acts on pelvis to pull into R lateral tilt

Question 11

Lumbopelvic rhythm:

Answer 11

● Coupled motion b/n pelvis + LS
● Can increase overall trunk motion for fxn
● Study by McClure: kinematic analysis of lumbar & hip motion while rising from fwd flexed position in pts w/ & w/o history of LBP

Question 12

Contributions during fwd flex

Answer 12

○	Lumbar angle/hip rangle ratios during fwd bending: 
■	0-30 degrees = 1.9
■	30-60 degrees = .9
■	60-90 degrees = .4 
○	LS dominates early flex.
○	Hip dominates late flex.

Question 13

● Muscle recruitment strategies: McGorry et all

Answer 13

○ Conclusions:
■ NPD/PD demonstrated opp. Recruitment strategies
● Bottom-up vs top-down
■ Evidence for altered mvmt b4 pain devo
■ Potential for altered loading @ vertebral jt. Level w/ early activation of LES

Question 14

● Dynamic postures & mvmt

Answer 14

○ Quantity: ROM in all planes
○ Quality & willingness to move:
■ Aberrant mvmt patterns: sagittal plane

Question 15

Lumbopelvic rhythm reversal

Answer 15

Trunk moves 1st in flexion → last in extension

Pelvis moves last in flexion → 1st in extension

Question 16

Gower’s sign

Answer 16

Thigh climbing to get back to standing

Question 17

Instability catch

Answer 17

Can’t return to standing b/n of sudden painful “catch” in LB

Indicates spinal instab.

Question 18

Sacrum

● Osteology:

Answer 18

○ Triangular shaped wedged b/n 2 ½ of pelvis

Question 19

Base

Answer 19

Formed by 1st sacral vert.

2 articular facets face post.

Facets articulate w/ inf. Facets of L5

Question 20

Apex

Answer 20

Formed by 5th sacral vert.

Articulates w/ coccyx

Question 21

Lateral region = ala

Answer 21

Ear shaped articular surface

Articulates w/ ilium

Question 22

SIJ

characteristics

Answer 22

Rigid articulation = boomerang shape

Auricular surface of sacram = lateral region + auricular surface of ilium

Question 23

SIJ

fxn

Answer 23

Weight bearing
Relieve stress in pelvis
Load transfer
Stab.

Question 24

SIJ

Ligaments

Answer 24

Primary: ant. SI, iliolumbar, interosseous, post. SI

Secondary: sacrotuberous, sacrospinous

Question 25

SIJ | Kinematics

Answer 25

``` ■ Motion = poorly defined ● Mobility studies: ○ Support limited motion of 2 degrees in all 3 planes ■ 1-4 degrees rotation ■ 1-2mm translation ```

Question 26

■ Nutation vs. counternutation

Answer 26

● Ex: bilateral hip extension in prone ○ Sacrum moves in counternutated position relative to pelvis ○ Pelvis moves in ant. Pelvic tilt = relative to sacrum ● Fxn: Increases congruence b/n joint surfaces ○ > articular stab. ○ Optimizes transference of load ○ Ligs get support from muscles

Question 27

Nutation = fwd nod of sacrum

Answer 27

● Sacrum moves relative to pelvis ● Base moves ant/inf ● Apex moves post/sup Pelvis moves in opp motion = post. Pelvic tilt

Question 28

Counternutation = bkwd nod of sacrum

Answer 28

● Mvmt of sacrum relative to pelvis ● Base moves post/sup ● Apex moves ant Pelvis moves in opp motion = ant. Pelvic tilt

Question 29

Panjabi's stability model

Answer 29

passive stabilizers active stabilizers motor control.

Question 30

spinal instability:

Answer 30

decrease in capacity of stab system of spine to maintain IV neutral zones w/n physiological limits so there’s no neurological dysfxn, no major deformity, & no incapacitating pain

Question 31

passive instability

Answer 31

Vertebrae IVDs Jt capsule Passive component of m.

Question 32

Active instability

Answer 32

Muscles | Tendons

Question 33

Stability exercises | Extrinsic = global stab

Answer 33

Long mm. Attach to structures outside vert. Column ``` Abs Hip mm. ES QL Psoas maj. Lats Scap. mm. ```

Question 34

Stability exercises | Intrinsic = segmental stab

Answer 34

Short, deep mm. Attach to structures w/n vert. Column ``` Transversospinal group ● Semispinalis ● Multifidus ● Rotatores Short segmental group ● Interspinalis Intertransversarii ```

Question 35

Supine heel slide w/ SLR

Answer 35

``` Extrinsic: Abs Psoas major Iliacus Rectus femoris ``` Intrinsic Multifidus Rotatores

Question 36

Bird dog = quadruped

Answer 36

``` ExtrinsicAbs Lats Traps Hips: glut max ES QL psoas ``` ``` Intrinsic Rotatores Multifidus Interspinalis All ```

Question 37

Relationship b/n posture & dysfxn: | Seated:

Answer 37

``` Issue: Prolonged flexion forces > flexor MA on spine > pressure on ant. IVD → weakened annulus fibrosus ```

Question 38

Standing

Answer 38

``` Issue:Prolonged hyperextension Forces: Compression of facets > ant. Shear @ lumbosacral jxn → spondylolisthesis: 1 vert. Slides fwd on the other Graded: 4 = complete separation ```

Question 39

research

Answer 39

○ 40-64% asymptomatic ppl → LBP during prolonged standing ○ prolonged standing = consistent predictor of LBP ○ sitting upright: ■ > compression compared to standing @ L3-4 & L4-5 ■ > compression when sitting cross-legged/slumped ○ improved health outcomes: ■ > standing doesn’t prevent onset of obesity or diabetes ○ what’s better: ■ standing: frequent postural cycling ■ sitting: dynamic = no effect ■ conditioning = important