lumbar therex

what spinal ligaments are stressed in end range flexion?

posterior longitudinal ligament (PLL)

ligamentum flavum

interspinous ligament

supraspinous ligament

what spinal ligaments are stressed at end range extension?

anterior longitudinal ligament (ALL)

L2-L4 nerves converge to make what?

femoral nerve

list the intrinsic muscles of the lumbar spine

external oblique

internal oblique

latissimus dorsi

rectus abdominis

major/minor rhomboids

trapezius

lumbar anatomy

5 vertebrae

10 nerve roots

10 facet joints

6 main ligaments

5 intervertebral discs

facet joints

superior articular processes face anterolaterally

inferior articular processes face posteromedially

oriented in sagittal plane

intervertebral discs

nucleus pulpous (center)

annulus fibrous (middle)

endplates (outer)

what causes lumbar disc bulging and herniation?

excessive or repeated flexion and compression at end ranges

what population tends ot have more disc herniations?

younger population; their spines have a higher water content

what motion does the anterior longitudinal ligament restrict

extension

what motion foes the posterior longitudinal ligament restrict?

flexion

what motion does the ligamentum flavum restrict?

rotation

what motion does the intertransverse ligament restrict?

side bending/ rotation

what motion does the interspinous ligament restrict?

flexion

what motion does the interspinous ligament restrict?

flexion

what are the main motions of the lumbar spine?

flexion and extension

coupled motion

relationship between side bending and rotation of the spine

• lumbar rotation an side bending occur in OPPOSITE directions when spine starts in a NEUTRAL OR FLEXED position

• lumbar rotation and side bending occur in SAME directions when spine starts in EXTENDED position

lumbar flexibility

increased lumbar flexibility may predispose the athlete to injury

hip, knee, and ankle flexibility is more important in preventing lumbar injury

lumbar strength

more important in sports performance than injury prevention

lumbar endurance

consist of lighter weights, higher reps, and longer duration exercises

posture

the position in which a person holds themself in an upright or seated position

what is required for maintaining correct posture?

muscular endurance

muscular strength

flexibility

the ability for the spine to adapt to its surroundings

what does correct posture help reduce?

stress on muscles, discs, facet joints, and ligaments

how does lumbar spine maintain ideal posture?

small contractions of the abdominal wall

sway back

aka lumbar lordosis

present with an anterior pelvic tilt

flat back

loss or decrease in the lordotic curve of the lumbar spine

present with thigh and groin pain and increased hip and knee flexion

lateral shift

lateral displacement of the trunk in relation to the pelvis

the direction of the shift is described in relation to the movement of the shoulder and trunk relative to the pelvis

pelvic neutral position

neither anterior (flexed) or posterior (extended) tilted position

places the lumbar spine in optimal position for exercises, activity, and performance

lumbar exercise guidelines and progression

1. identify problems

2. create a stable body and spine

3. increase endurance of lumbar muscles

4. build strength

5. develop speed, power and agility

williams exercises

flexion exercises

1. pelvic tilt

2. single knee to chest

3. double knee to chest

4. hamstring stretch

5. partial sit up

6. hip flexor stretch

7. squat

McKenzie exercises

extension exercises

1. prone lying

2. progressive passive extension

3. prone on elbows

4. prone push up

5. standing backward bending

goal is to centralize pain in the lumbar spine

sprains/strains

most common injuries of the low back

improper lifting posture, trauma, long term overuse/misuse

muscle sprain: ligaments are torn from their attachment

muscle strain: stretching, tearing, or rupture of muscle fibers

treatment: modalities to reduce pain and inflammation, and exercises should focus on stability of the lumbar spine

lumbar fracture

younger patients: compression fractures (trauma, falls, car accidents)

older patients: nontraumatic or minor falls (underlying osteoperosis)

spondylothesis: fracture of one or both pars with no anterior movemennt

spondylolisthesis: bilateral parts fracture with resultant anterior slippage

commonly seen in gymnasts, football lineman, golfers, volleyball players, and cheerleaders

treatment: modalities to control pain and msucle spasm, stabilization exercises early on in rehab, but no hyperextension exercises

open restriction

limitation in flexion

closed restriction

limitation in extension

muscle energy

1. patient must actively contract the muscles

2. controlled joint position

3. muscle contraction in a specific direction

4. clinician applies a distinct counterforce

5. intensity of contraction is controlled

manipulation

always occur at the end range of joint movement

small amplitude, quick thrust

used to alter joint relationships, break soft tissue adhesions, or stimulate joint receptor activity

lumbar disc injuries

bulge→ herniation→ prolapse→ sequestration

occurs with some form of flexion involved

most commonly occurs posterior or posterolateral

piriformis syndrome

AKA gluteal syndrome or deep buttock pain

referred to as sciatica pain

treatment: anti-inflammatory modalities, ITB, piriformis, and hamstring stretching, D2 flexion/extension patterns

if conservative treatment doesn’t work: marcaine injection or surgery