Spine- Thoracolumbar I- Intro thru Stabilization

Question 1

What is the first part of a biomechanical exam?

Answer 1

scan or screen

Question 2

What describes normal ROM?

Answer 2

Smooth, coordinated and full

Question 3

Can impairments be present without symptoms?

Answer 3

YES

Question 4

What is the primary purpose of a biomechanical exam?

Answer 4

Assess for further detail in involved area

Question 5

What does limited ROM NOT indicate?

Answer 5

Lack of accessory motion

Question 6

What does pain with passive elbow extension and resisted elbow flexion indicate? (most likely)

Answer 6

musculotendinosis

Question 7

What can stiff areas do if NOT addressed?

Answer 7

Cause painful hypermobile compensations elsewhere

Question 8

Are stiff areas always painful?

Answer 8

No

Question 9

Where are hypermobile compensations often found?

Answer 9

• the past of LEAST resistance

Question 10

What can a stiff lower thoracic region and thoracolumbar junction lead to? (potentially?)

Answer 10

Hypermobile mid to lower lumbar spine

Question 11

What can a stiff SI joint and hip lead to? (potentially?)

Answer 11

Hypermobile lower lumbar spine

Question 12

What are our general Rx and purposes for hypomobility and hypermobility?

Answer 12

Mobility in hypomobile areas, stability in hypermobile areas

Question 13

Why are hypermobile areas usually painful?

Answer 13

Axis of motion is less controlled

Question 14

What can cause the axis of motion to be less controlled?

Answer 14

Trauma, injury, etc.
- damages tissue, creates a lax joint, and loss of stability to the ligaments and capsule, etc.

Question 15

What should we do with hypermobile areas?

Answer 15

Stabilize

Question 16

Should we treat adjacent joints/areas when addressing an injury/pain?

Answer 16

YES

Question 17

What does the orientation of facets determine?

Answer 17

Direction and amount of motion

Question 18

What plane are the thoracic spine facet joints in?

Answer 18

Mostly frontal plane but ribs limit greater SB

Question 19

What motion is greatest in the thoracic spine? How much?

Answer 19

Rotation: 25-30˚

Question 20

What motions are the most in the thoracic spine? Least?

Answer 20

Rotation, then SB, flexion, with the least amount in extension

Question 21

Where is there the MOST rotation in the thoracic spine?

Answer 21

T5 and T10

Question 22

Where is there the LEAST rotation in the thoracic spine?

Answer 22

T11 and T12

Question 23

Why is there less rotation in the lower most thoracic spine?

Answer 23

Facets transition to the shape of lumbar facets, start to look and act like lumbar vertebra

Question 24

What is the shape of the lumbar spine facet joints? What plane?

Answer 24

Slightly curved
- anterior more coronal, particularly at L5,S1
- Posterior more sagittal

Question 25

What motion is the MOST in the lumbar spine?

Answer 25

Flexion and extension

Question 26

What motion is the LEAST in the lumbar spine? how much in degrees?

Answer 26

Rotation, 5-7˚ total

Question 27

What is controlled mobility MORE than?

Answer 27

Just strength of superficial and big muscles

Question 28

What are the 4 variables for stabilization?

Answer 28

1. Joint Integrity (i.e cartilage) 2. Passive Stiffness (i.e. ligaments) 3. Neural Input 4. Muscle Function

Question 29

What are characteristics of local muscles?

Answer 29

- closer to axis of motion - often deeper - stabilization > rotary forces - postural - aerobic > anaerobic - MORE often type I fibers

Question 30

What are characteristics of global muscles?

Answer 30

- further away from axis of rotation - often superficial - rotary > stabilization forces - spurt muscles - anaerobic > aerobic - MORE often type II fibers

Question 31

What are some muscles we need for stabilization in the thoracolumbar region? (be able to find and label these)

Answer 31

- Quadratus Lumbourm - Psoas Major - Multifidus - Transverse Abdominus - Rotatores longus

Question 32

What other body part is critical for low back stabilization?

Answer 32

PELVIC FLOOR

Question 33

What does the Psoas muscle do for stabilization?

Answer 33

Frontal plane stabilizer

Question 34

What does the quadratus lumborum do for stabilization?

Answer 34

Frontal plane stabilizer

Question 35

What do the pelvic floor and transversus abdominus do for stabilization?

Answer 35

Increase contraction of multifidus

Question 36

What does the multifidi/rotatores do for stabilization?

Answer 36

If smaller = higher injury rates and LBP

Question 37

What muscles do pain, swelling, disuse, and joint laxity effect?

Answer 37

Decreased and delayed motor performance and control of local muscles such as transversus abdominus, multifidi, etc.

Question 38

What type of muscle is inhibition preferential to?

Answer 38

Type I muscles

Question 39

What declines with pain, swelling, disuse, and joint laxity?

Answer 39

strength declines with local muscle atrophy, specifically multifidus, along with every other muscle function

Question 40

What non-contractile tissues will have increased stress with lack of stabilization?

Answer 40

Cartilage, ligament and capsule become gradually more symptomatic

Question 41

What can pain, swelling, disuse, and joint laxity cause regarding global muscles?

Answer 41

Increased and inefficient motor activity of global muscles such as external abdominal obliques/erector spinae, etc.

Question 42

What does atrophy lead to?

Answer 42

FATTY INFILTRATION

Question 43

What percentage of muscle cross sectional area is fat in those over 60?

Answer 43

50%

Question 44

What happens to fiber type with pain, swelling, disuse and joint laxity?

Answer 44

Type I to type II, lose endurance stabilizing function

Question 45

Does muscle function normalize automatically once symptoms are improved?

Answer 45

NO

Question 46

What percentage of muscle activation is sufficient to keep stability and is suitable to improve muscular endurance?

Answer 46

30% - doesn't take a lot for improvement