IAR Lumbar Workbook

Lumbar Ligaments

unites a superior lamina of one vertebra to that inferiorly adjacent. In its entirety, it travels from C1-2 to L4-5. The ligament is short in stature, and thickest in the lumbar spine.

Ligamentum flavum

the only "True elastic ligament in the body

Ligamentum flavum

Lumbar Ligaments

The Posterior longitudinal ligament occupies the anterior aspect of the spinal canal and transverses the posterior surface of the vertebral bodies

Posterior longitudinal ligament

Lumbar Ligaments

canvases the ventral surface of the vertebral body and discs. It widens as it travels inferiorly

Anterior Longitudinal Ligament

Where does the Iliolumbar ligament travel from?

L5 TP to iliac crest

Where is blood supply best in the IV Disc?

outer 1/3

Annulus Fibrosis:

The collagen fibers contained within each band run parallel to one another at approximately ___ degrees

30° from the horizontal plane,

Coupling in the lumbar spine will occur opposite in lumbar segments __-__

_____ at L3-4 will occur concomitantly with ___ _____ of L3 on L4

2-4; sidebending contralateral rotation

Partial articular patterns

Closing

Pain with?

extension, ipsilateral sidebending

Partial articular patterns

Opening

Pain with?

pain with flexion, contralateral sidebending

Partial articular patterns

Impingement

Pain with?

pain with extension, ipsilateral sidebending, contralateral rotation

L1 Dermatome

Inguinal Region

L2 Dermatome

Central-Anterior Thigh

L3 Dermatome

Medial Knee

L4 Dermatome

Medial Lower Leg & Ankle

L5 Dermatome

Between 1st and 2nd digits

S1 Dermatome

Lateral surgace of foot

S2 Dermatome

Popliteal Region

S3-4 Dermatome

Saddle/Perianal Zone

Lumbar Reflexes: L5

Medial Hamstring

Red flags that pertain to increased likelihood of metastatic cancer

Hx of cancer, night pain, unexplained weight loss, age >50/<17, failure to improve over predicted timer

Red flags suggesting an undiagnosed vertebral fracture

Prolonged corticosteriods, mild trauma >50, age >70, hx of osteoporosis, recent major trauma (MVA or fall from >5 feet)

Red flags that may indicate a dangerous abdominal aortic aneurysm

Pulsating mass in abdomen, age >60, throbbing back pain at rest, hx of atherosclerotic vascular disease

The most commonly accepted cause of lumbar instability is:

the lack of ligamentous support resulting from disc degeneration.

Spondylolisthesis Grade 1:

25% slippage

Spondylolisthesis Grade 2:

25-50% slippage

Spondylolisthesis Grade 3:

50-75% slippage

Spondylolisthesis Grade 4:

Greater than 75% slippage

Spondylolisthesis Grade 5

100% anterior slippage on subjacent

a defect or fracture of the pars interaarticularis on the vertebral arch

spondylolisthesis

Examples of "passive restraints" in the lumbar spine.

What type of loads do they help resist?

Bony and ligamentous structures; compressive

Examples of "active restraints" in the lumbar spine.

What type of loads do they help resist?

muscles; shear

Requirements for Lumbar Manipulation TBC:

4 or more

Duration of symptoms <16 days, 1 hip greater than 35 IR, lumbar hypomobility, no symptoms distal to knee, FABO work subscale <19

Requirements for Lumbar Stabilization TBC:

3 or more

Age <40, Average SLR <90, aberrant movement, positive PIT

Requirements for Lumbar Traction TBC:

All must be met

Positive SLR, deficits in reflexes, sensory, or strength, pain or numbness distal to buttock in previous 24 hours, pain peripheralizes with extension or crossed SLR

Femoral Nerve Slump Bias

knee flexion, hip extension

Lateral Femoral Cutaneous Nerve Biasing

: knee flexion, hip extension, hip ADD

Obturator Nerve Biasing

Knee flexion, hip extension, hip ABD

Saphenous Nerve Biasing

Knee flexion, hip extension, ankle DF/Ev

the 2 most frequent site of entrapment and injury for the Femoral Nerve

inguinal ligament, ilacus/psoas major