Lumbar spine review and current concepts

IVD

-bean shaped

-more fluid in youth

-more fibrous with age

what is the area of theIVD that is most vulnerable to degeneration

-posterolateral

Anterior facet joint capsule is the

-ligamentum flavum

posterior facet joint capsule blends with

-multifidus

____________ are present in the capsule

-intra-articular meniscoids

what structure may play a role in preventing central disc bulge

-posterior longitudinal ligament (PLL)

_______________ may prevent joint capsular entrapment

-ligamentum flavum

Entrapment and hypertrophy of the ligamentum flavum may contribute to

-degenerative stenosis

iliolumbar ligament restrains

-all motions at L5-S1 (level with most shear forces)

-most frequently strained bc of multiple attachments

thoracolumbar fascia is _____________ (elastic/non-elastic)

-non-elastic

TLF envelopes

-musculature

hypertrophy of muscles ______________ (tensions/slackens) fascia

-tensions

working out and hypertrophy of larger muscles can

-create spinal stability

t/f TLF has multiple attachments to the spine and other ligaments

-T

TLF has attachments to

-lats

-TVA (TrA)

TLF facilitates work of core muscles because

-it communicates to several structures

what muscle must you address in someone w/ LBP

-multifidus

multifidus

-are major arthrokinematic controllers

-responsible for 2/3 of lumbar spine stiffness

-active during almost all antigravity activities

multifidi are __________ (increased/reduced) in size in pts w/ LBP

-reduced

-reduction persists after pain has resolved

-may be restored w/ specific strengthening

multifidi are innervated how

-segmentally

-medial branch of primary posterior rami

multifidi are impaired how

-segmentally

-one level doesn't work, but levels above and below do work

multifidi are the

-rotator cuff of the lumbar spine

-when one side is acting concentrically the other is acting eccentrically

TVA (TrA)

-thought to play vital role in stability by creating a rigid cylinder and enhancing lumbar stiffness via its attachments to the TLF

iliopsoas

-has extensive attachments to bodies, discs, and TVPs of lumbar spine

-can create compression, may increase lordosis and anterior shear

-may act as stabilizer

_______________ (flexion/extension) is the predominant motion available at the lumbar spine and most commonly used in everyday activities

-flexion

full flexion usually results in a _____________ (flattening/rounding) of the lordosis w/ a slight reversal of lordosis in some cases

-flattening

in flexion

-vertebral body rocks anteriorly, w/ slight anterior glide

-inferior facets of sup vertebrae glide superiorly and anteriorly

-anterior disc is compressed

-posterior disc is tensioned

in full flexion there is

-minimal facet joint contact

in flexion excessive anterior translation is prevented by

-facets and capsule

-multifidus

-erector spinae

-ligaments

-disc

in flexion intervertebral foraminal space and spinal canal space are

-increased

in extension

-vertebral body: rocks posteriorly

-facets: glide inferiorly

-posterior disc is: compressed

-anterior disc is: tensioned

in extension intervertebral foraminal space and spinal canal space are

-reduced

in extension the ligamentum flavum may ____________ if degenerated

-bunch

in extension facet joints are

-close packed

extension is limited by

-bony contact

-ability of disc to allow tension anteriorly and compression posteriorly

sidebending occurs with flexion kinematics on the

-contralateral side

sidebending occurs with extension kinematics on the

-ipsilateral side

in sidebending coupled motions of rotation to the ____________side may occur

-opposite

rotation compresses the _________facet

-contralateral

rotation decompresses the ________facet

-ipsilateral

rotation does what to the interverterbral foraminal space

-nothing

rotation coupled w/ ______________ (flexion/extension) allows increased rotation and may injure disc

-flexion

rotation is limited by _______________

-facet joint

excessive rotation in the case of trauma may injure

-the facet joint

excessive compression may result in

-loss of disc height and

-degenerative changes

with degeneration forces are transferred to the facet joints. Abnormal loading causes

-facet joint hypertrophy

-loss of intervertebral foraminal space

lumbar spine distraction

-rarely occurs in everyday life in symmetrical fashion

-primarily limited by annulus fibrosis

-allows increase in imbibition of fluids by the disc

-most often employed therapeutically

neutral zone is

-a region of laxity around neutral resting position of the spine

stability depends on what systems

-active

-passive

-CNS

role of ___________system is essential throughout ROM for stability to occur

-active

active system

-spinal muscles

passive system

-spinal column

CNS

-neural

active system 2

-trunk muscles classified as mobilizers and stabilizers

-mobilizers move trunk through space

-stabilizers maintain general trunk stiffness

-stabilizers classified as global and local stabilizers

local mobility

-speaks to pathokinesiolgy which considers how tissue dysfunction can lead to mvmt impairment

global stability

-means lumbar spine muscles and regions around it can generate isolated activation taht can be coordinated w/ various joint movements and incorporated into ADLs

-speaks to kinesiopathology which considers how mvmt impairment can lead to tissue dysfunction

spinal stability exercises should

-strengthen trunk muscles so they can produce sufficiently large forces and active stiffness

-increase endurance of trunk muscles so the force output of the muscles doesn't deteriorate

-incorporate sound motor learning principles to address impaired motor control strategies

-utilize manual therapy to address any impaired mobility of the nn, joints, and soft tissues to enhance mvmt control

global stabilizers

-rectus abdominis

-int and ext obliques

-lateral fibers of QL

-thoracic part of lumbar iliocostalis

global stabilizer functions

-increase general trunk stiffness

-have no segmental influence

-eccentrically decelerate momentum and control gross rotation of trunk

local stabilizers

-lumbar multifidus

-TVA (TrA)

-posterior fibers of internal oblique

-medial fibers of QL

-lumbar portions of iliocostalis and longissimus thoracis