Lumbar Spine Anatomy and Biomechanics
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Lumbar Spine Anatomy and Biomechanics

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What is the primary reason for the greater range of motion in the lumbar spine compared to the thoracic spine?

  • Presence of ribs limiting movement
  • A smaller size of the lumbar vertebrae
  • Lack of weight-bearing load on lumbar vertebrae
  • Alignment of facet joints with the sagittal plane (correct)
  • In the context of clinical application, what is a key factor in determining when to apply mobilization techniques?

  • Patient's age and previous injuries
  • Presence of common joint fixations (correct)
  • Practitioner's personal preference
  • Patient's level of physical fitness
  • What characteristic of lumbar vertebrae contributes to their ability to bear heavy loads?

  • Their significant alignment with the thoracic spine
  • Their extensive network of rib attachments
  • Their large size and structural integrity (correct)
  • Their limited range of motion
  • Which of the following best describes the role of facet joints in the lumbar spine?

    <p>They primarily facilitate forward and backward bending</p> Signup and view all the answers

    What is the typical lumbar curve range in degrees?

    <p>40-60 degrees</p> Signup and view all the answers

    During lumbar flexion, which muscle initiates the movement?

    <p>Psoas</p> Signup and view all the answers

    Which ligament is primarily involved in limiting lumbar extension?

    <p>Anterior Longitudinal Ligament</p> Signup and view all the answers

    What happens to lumbar lordosis during an anterior pelvic tilt?

    <p>It increases</p> Signup and view all the answers

    Which motion is naturally coupled with lateral flexion in the lumbar spine?

    <p>Contralateral axial rotation</p> Signup and view all the answers

    Which of the following muscles plays a significant role in lumbar extension after the initial movement?

    <p>Abdominals</p> Signup and view all the answers

    Which statement correctly describes the role of the Iliocostalis Thoracis during full lumbar flexion?

    <p>It is relaxed along with most other muscles</p> Signup and view all the answers

    How does lumbar flexion impact the pelvis after 60 degrees?

    <p>The pelvis starts to rotate additional degrees</p> Signup and view all the answers

    What is the primary purpose of performing a lumbar mobility scan?

    <p>To improve kinetic chain function</p> Signup and view all the answers

    During the sitting flexion assessment, what should happen to the interspinous spaces when the patient’s torso is flexed?

    <p>They should open up</p> Signup and view all the answers

    What is a key component when assessing lumbar lateral flexion?

    <p>The patient should have arms crossed in a bear hug</p> Signup and view all the answers

    When performing the rotation assessment, which direction should the practitioner rotate the patient’s torso for ipsilateral rotation?

    <p>Towards the testing side</p> Signup and view all the answers

    In the lateral flexion assessment, the spinous processes should move ipsilaterally. What does 'ipsilateral' mean in this context?

    <p>Towards the same side as the testing</p> Signup and view all the answers

    What does the practitioner need to check for during the lumbar lateral flexion by applying a force?

    <p>Slight mobility</p> Signup and view all the answers

    What common mistake might affect the lateral flexion assessment positioning?

    <p>Patient should slouch in the chair</p> Signup and view all the answers

    When assessing for extension restrictions in the lumbar spine, what should happen to the interspinous spaces?

    <p>They should close</p> Signup and view all the answers

    What is the primary purpose of performing a lateral glide using the spinous process as a lever?

    <p>To improve accessory motion into lumbar vertebral body rotation and facet joint distraction</p> Signup and view all the answers

    In which position should the patient be for the lateral glide technique?

    <p>Prone with lumbar spine in midrange</p> Signup and view all the answers

    Which hand is positioned on the medial surface of the pisiform during the lateral glide technique?

    <p>The mobilizing/manipulating hand</p> Signup and view all the answers

    What should the clinician do to prepare the patient for a rotation glide in the side lying position?

    <p>Bring the patient's knees toward the chest</p> Signup and view all the answers

    What is an effect of the lateral glide technique on the lumbar spine?

    <p>It decreases pain and enhances range of motion</p> Signup and view all the answers

    Which statement best describes the positioning of the clinician during the lateral glide technique?

    <p>The clinician is at the patient's side, facing the lumbar spine</p> Signup and view all the answers

    What is the significance of having the lumbar spine in midrange during these techniques?

    <p>It optimizes the effectiveness of the mobilization techniques</p> Signup and view all the answers

    During the rotation glide, where should the mobilizing end of the clinician's arm be positioned in relation to the patient's trunk?

    <p>On the lateral side of the trunk, resting on their arm</p> Signup and view all the answers

    What is a primary indication for using the backward bending glide mobilization technique?

    <p>The technique should lead to a reduction in pain or an increase in motion.</p> Signup and view all the answers

    During the backward bending glide mobilization, what position is the patient required to be in?

    <p>Prone on the treatment table.</p> Signup and view all the answers

    What is the role of the clinician's guiding hand during backward bending glide mobilization?

    <p>To provide stabilization by supporting the patient's anterior inferior ribs.</p> Signup and view all the answers

    What should be the clinician's focus while maintaining the joint mobilization force during the procedure?

    <p>To continuously adjust their position in relation to the treatment plane.</p> Signup and view all the answers

    How should the patient perform backward bending during the mobilization technique?

    <p>By bending backward as far as possible while keeping the pelvis on the treatment table.</p> Signup and view all the answers

    What immediate outcome should the clinician expect if the backward bending glide mobilization technique is effective?

    <p>An immediate increase in range of motion and/or a decrease in pain.</p> Signup and view all the answers

    How many times should the backward bending glide mobilization technique be repeated if successful?

    <p>About 2 to 3 times for best results.</p> Signup and view all the answers

    What is the primary purpose of the backward bending glide mobilization technique?

    <p>To decrease pain and increase the pain-free range of motion.</p> Signup and view all the answers

    What characteristic defines a Type 1 coupling pattern during lateral flexion?

    <p>Lateral flexion is associated with contralateral axial rotation.</p> Signup and view all the answers

    Which of the following best describes the coupling pattern observed in a Type 2 fixation?

    <p>Ipsilateral lateral flexion coupled with ipsilateral axial rotation.</p> Signup and view all the answers

    In assessing for Type 2 fixation, which statement is accurate?

    <p>Only lateral flexion assessment is abnormal while rotation remains normal.</p> Signup and view all the answers

    Which description correctly identifies the impact of muscular imbalances in a Type 2 fixation?

    <p>Affects the contralateral Longissimus and Spinalis portions.</p> Signup and view all the answers

    What should be expected when assessing lateral flexion with no movement in Type 3 fixations?

    <p>The spinous process maintains normal movement towards the ipsilateral side.</p> Signup and view all the answers

    Which approach is critical for improving kinetic chain function?

    <p>Eliminate compensatory mechanical stress on adjacent structures.</p> Signup and view all the answers

    During a lateral flexion assessment, which of the following actions is appropriate?

    <p>Challenge mobility by applying a lateral to medial force on the spinous process.</p> Signup and view all the answers

    What should clinicians focus on during the assessment phase for lateral flexion?

    <p>Assessing the coupled axial rotation with palpation.</p> Signup and view all the answers

    What condition is characterized by abnormal lateral flexion combined with abnormal rotation in the lumbar spine?

    <p>Type 4</p> Signup and view all the answers

    During the lumbar sitting flexion assessment, which change indicates a restriction in flexion?

    <p>Decreased gap between interspinous spaces</p> Signup and view all the answers

    In the context of muscular imbalance related to type 4 assessments, what is true about the Multifidus muscles?

    <p>They are contralateral to the side of rotation assessment</p> Signup and view all the answers

    Which of the following assessments must be completed in order to diagnose type 4?

    <p>Both lateral flexion and contralateral rotation</p> Signup and view all the answers

    What position should the patient be in during the sitting lateral flexion assessment?

    <p>Sitting upright with arms crossed</p> Signup and view all the answers

    What abnormal assessment finding occurs during contralateral rotational assessment related to type 4?

    <p>The spinous process moves towards the new testing contact</p> Signup and view all the answers

    During the lumbar mobility scan, what indicates normal lateral flexion movement in relation to the spinous processes?

    <p>Spinous processes moving ipsilaterally</p> Signup and view all the answers

    What is one key aspect that differentiates a type 3 fixation from a type 4 fixation?

    <p>Type 4 requires a rotational component assessment</p> Signup and view all the answers

    What is a specific indication for performing the spinous push technique?

    <p>Posterior rotation mal-fixation from L1-L5</p> Signup and view all the answers

    During a lateral flexion assessment, if the spinous process moves away from the testing side, what does this indicate?

    <p>Abnormal lateral flexion</p> Signup and view all the answers

    Which positioning is correct for the practitioner when performing a lumbar spinous hook?

    <p>Pelvis level with the affected segment</p> Signup and view all the answers

    What modification should be made to the traction technique if the patient has spondylolisthesis?

    <p>Avoid any traction techniques</p> Signup and view all the answers

    In the context of disc closure techniques, which assessment finding indicates a fixed lateral flexion?

    <p>SP moves into testing side but remains fixed</p> Signup and view all the answers

    What is the primary goal of the thrust applied during a lumbar spinous push?

    <p>To produce closure of the affected segment</p> Signup and view all the answers

    Which structure is specifically targeted when performing a lumbar traction technique?

    <p>Spinous process</p> Signup and view all the answers

    What kind of muscular imbalance is indicated by a lateral flexion that results in the SP moving toward the testing side?

    <p>Hypertonicity of the sacrospinalis muscle</p> Signup and view all the answers

    What is the appropriate line of drive when performing a lumbar spinous hook?

    <p>Medial to lateral</p> Signup and view all the answers

    When should the indifferent hand be positioned during the lumbar spine techniques?

    <p>On the patient’s shoulder during traction</p> Signup and view all the answers

    Which contraindication applies to all the described lumbar mobility techniques?

    <p>Spondylolisthesis</p> Signup and view all the answers

    What is the primary purpose of lumbar joint slack removal during these techniques?

    <p>To facilitate joint mobility</p> Signup and view all the answers

    When assessing the lumbar spine's rotational movement, which observation indicates a normal response?

    <p>SP moves away from the testing side</p> Signup and view all the answers

    Which technique is recommended for addressing faulty mechanics pertaining to the quadratus lumborum (QL)?

    <p>Disc closure</p> Signup and view all the answers

    Study Notes

    Lumbar Spine Anatomy and Biomechanics

    • The lumbar spine has more motion than the thoracic spine due to the absence of ribs.
    • The lumbar spine bears significant loads from body weight, lifting, and other movements.
    • The lumbar spine's movement is dictated by facet joints, which are aligned differently in the upper and lower regions, leading to varying degrees of flexion and extension.
    • The typical lumbar vertebrae are wide from side to side.
    • L5 is atypical due to its larger size, shorter transverse processes, and different facet orientation.
    • The lumbar curve should be 40-60 degrees.
    • Anterior pelvic tilt increases lumbar lordosis, placing more stress on facets.
    • Posterior pelvic tilt decreases lumbar lordosis, placing stress on intervertebral discs.

    Lumbar Spine Movements and Muscles

    • Flexion: Initiated by concentric contraction of the Psoas and abdominals, controlled by eccentric contraction of the erector spinae.
    • Extension: Initiated by concentric contraction of the sacrospinalis, controlled by eccentric contraction of the abdominals and gravity.

    Lumbar Mobilization Techniques

    Lateral Glide

    • Purpose: Assess for lumbar spine joint impairment, increase accessory motion, increase range of motion, decrease pain.
    • Positioning: Patient prone with lumbar in midrange, clinician at the patient's side, stabilizing hand on the inferior spinous process, mobilizing hand on the superior spinous process.
    • Procedure: Stabilize the inferior vertebra, glide the superior spinous process towards the contralateral side during exhalation.

    Rotation Glide (Side Lying)

    • Purpose: Increase accessory motion into lumbar vertebral body rotation, increase range of motion, decrease pain.
    • Positioning: Patient side lying on the untreated side, clinician at the side facing the anterior trunk, inferior vertebrae locked by bringing the patient's knees towards their chest.
    • Procedure: Continuously adjust the position to maintain the mobilization force, ensure the technique does not reproduce the patient's pain.

    Backward Bending Glide

    • Purpose: Increase pain-free range of motion into backward bending.
    • Positioning: Patient prone, clinician at the side, mobilizing hand on the spinous process, guiding hand on anterior inferior ribs.
    • Procedure: Apply a superior glide to the vertebra, instruct the patient to perform a backward bend while maintaining the glide, apply overpressure at the end of the range.

    General Notes on Mobilization Techniques

    • These techniques are only indicated if they can be performed without increasing the patient's pain.
    • They should result in an immediate increase in range of motion and/or decrease in pain.
    • If effective, the techniques should be repeated 2-3 times.

    Understanding Problematic Segmental Coupled Lateral Flexion/Rotation Fixation Types

    • Type 1 (Normal Coupling Pattern)
      • Lateral Flexion is coupled with Axial Rotation to the OPPOSITE side (Contralateral)
      • Posterior body rotation occurs towards the contralateral side of Lateral Flexion
      • Spinous Process (SP) rotates towards the ipsilateral side of Lateral Flexion
      • Apply a lateral to medial force on SP to test mobility
      • Normal motor control is achieved through ECCENTRIC unilateral contraction of the contralateral Quadratus Lumborum muscle

    Type 2 (Abnormal Coupling Pattern) - Rotary Type Fixation

    • Lateral Flexion is coupled with ABNORMAL Axial Rotation to the SAME side (Ipsilateral)
    • Posterior body rotation occurs towards the Ipsilateral (same) side of Lateral Flexion
    • SP rotates AWAY to the contralateral side of testing
    • Lateral Flexion assessment is ABNORMAL but Rotational assessment is NORMAL
    • Muscular imbalance of the Contralateral Sacrospinalis (especially Longissimus and Spinalis portions) exists.
    • Lesion is contralateral to testing side

    Type 3 (Diverging from Normal Coupling Pattern)

    • Lateral Flexion is associated with either NO movement or movement in the direction opposite to trunk bending
    • SP rotates normally towards the ipsilateral side of Lateral Flexion (Testing Side)
    • Apply a lateral to medial force on SP to test mobility.
      • Upper hand traction is applied superiorly
      • Contact hand pushes into the mamillary process towards the practitioner
      • Body weight is dropped down onto the thigh slowly
      • Body weight is dropped once traction has reached end stage
    • Contraindications:
      • Spondylolisthesis
      • Acute lumbar disc lesion (herniation)

    Type 4 (Abnormal Lateral Flexion combined with Abnormal Rotation)

    • Lateral Flexion is associated with abnormal coupled rotational movement
    • During Lateral Flexion, the SP moves to the contralateral side (OPPOSITE) of testing thumb (Abnormal)
    • A dysfunctional pattern exists where a proper rotational assessment needs to be done on the contralateral side of lateral flexion to see if the SP moves into the “new” testing contact during rotation.
    • Both Lateral Flexion and contralateral Rotational assessments must be ABNORMAL
    • Muscular imbalance of the contralateral Multifidus Muscles exists
    • Lesion is contralateral to testing side of Lateral Flexion and Ipsilateral side of Rotation Assessment

    Lumbar Spinous Hook

    • Indications:
      • Superior fibers of the Sacrospinalis muscle L1-L5 in spasm
      • Coupled Rotary type fixation
      • Posterior rotation mal-fixation (Type II fixation) from L1-L5
      • Can also be done on T11-T12
    • Assessment:
      • Lumbar Assessment (Rotation and Lateral Flexion)
        • Lateral Flexion - SP moves away from testing side (Abnormal)
        • Rotation - SP moves away from testing side (Normal)
    • Patient Position:
      • Side posture (Lesion side DOWN)
      • Head piece elevated or pillow used to elevate head
      • Lower arm is pulled and folded over the top shoulder, stabilized with the indifferent hand and provide traction superiorly
      • Lower leg is slightly bent at the knee
      • Upper leg is flexed with upper foot place in the popliteal space (behind knee of lower leg) to provide rotational traction
      • Pelvis must remain at 90 degrees to the table
    • Practitioner Position:
      • Fencer (lunge stance)
      • Pelvis is level with the affected spinal segment
      • Bent upper leg of the patient is placed between the Practitioner’s thighs
      • Practitioner performs a thigh to knee contact with patient
      • Practitioner’s torso should not rotate and spine should be straight
    • Contact Point:
      • Contact Hand:
        • Middle finger on the contralateral side of the involved spinous process
        • Hand and forearm rest on the superior ileum of the patient
        • Practitioner’s elbow is kept close to the torso
      • Indifferent Hand:
        • On superior shoulder holding patient’s lower arm and providing superior traction while holding them in posterior rotation
    • Joint Slack:
      • Remove joint slack by pressing against the SP with the contact hand and adding enough hip flexion and upper body traction/rotation
    • Line of Drive:
      • Medial to Lateral
    • Thrust:
      • Leg and body drop on the patient while the contact hand hooks the SP from medial to lateral
    • Contraindications:
      • Spondylolisthesis
      • Acute lumbar disc lesion (herniation)

    Disc Closure

    • Indications:
      • Disc closure issue, faulty mechanics, or overactive QL
      • Type 3 fixation from L1-L5
      • Can also be done on T10-T12
    • Assessment:
      • Lumbar Assessment (Lateral Flexion)
        • Lateral Flexion - SP moves into testing side but is challenged and remains fixed (Abnormal)
    • Patient Position:
      • Side posture (Lesion side DOWN)
      • Side lying (lesion open disc wedge side up) with NO torso rotation
      • Maximal elevation of the head and knee pieces of the table
      • Arms folded on chest or shoulders and stabilized by indifferent hand
    • Practitioner Position:
      • Fencer (lunge) stance
      • Pelvis is level with the lesion on the patient
      • Lower leg slightly bent at the knee
      • Upper leg flexed with upper foot place in the popliteal space (behind knee of lower leg) to provide rotational traction
      • Locate the lesion and monitor interspinous movement above and below the lesion while flexing the patient’s leg
      • Practitioner’s torso should not rotate and spine should be straight
    • Contact Point:
      • Contact Hand:
        • Reinforced second finger in the interspinous space
        • Forearm wraps around the pelvis and is resting on patient’s ileum
      • Indifferent Hand:
        • Forearm and hand are placed over the patients shoulder
    • Joint Slack:
      • Remove joint slack with contact hand by pressing in against the interspinous space and adding enough hip flexion and upper body traction
    • Line of Drive:
      • Forearm contacts accentuate a C curve in the patient’s spine
      • Line of drive is directly downward on to the lesion site
    • Thrust:
      • Inferior to produce a closure of the non-functioning disc space
    • Contraindications:
      • Spondylolisthesis and Acute lumbar disc lesion (herniation)

    Spinous Push

    • Indications:
      • Superior fibers of the sacrospinalis muscle L1-L5 in spasm
      • Rotational Fixation (Type 4 fixation) from L1-L5 (Type IV Push to help remember)
      • Can also be done on T11-T12
    • Assessment:
      • Lumbar Assessment (Rotation and Lateral Flexion)
        • Lateral Flexion - SP moves away from testing side (Abnormal)
        • Rotation - SP moves toward testing side (Abnormal)
    • Patient Position:
      • Side posture (Lesion side UP)
      • Side lying with minimal torso rotation
      • Maintain spine and pelvis at 90 degrees to the table
      • Pull on the lower arm and fold over the top shoulder stabilizing with the indifferent hand and provide traction superiorly
      • Lower leg slightly bent at the knee
      • Upper leg flexed with upper foot place in the popliteal space (behind knee of lower leg) done to provide rotational traction
      • Pelvis must remain at 90 degrees to the table
    • Practitioner Position:
      • Fencer (lunge stance)
      • Pelvis is level with the affected spinal segment
      • Bent upper leg of the patient between the Practitioner’s thighs
      • Practitioner performs a thigh to knee contact with patient
      • Practitioner’s torso should not rotate and spine should be straight
    • Contact Point:
      • Contact Hand:
        • Forearm resting on patient’s ileum and gluteal muscles pulling ileum towards the practitioner
        • Fully flex and ulnar deviate wrist with Index and Middle Finger contact against affected SP with a fully enforced arch (L1-3)
        • OR
        • Fully flex the wrist with Index and Middle Finger or Middle Finger and Ring Finger contact against affected SP with a fully enforced arch (L4-5)
      • Indifferent Hand:
        • On superior shoulder holding patient’s lower arm and providing superior traction
    • Joint Slack:
      • Remove joint slack with contact hand by pressing against the SP and adding enough hip flexion and upper body traction
    • Line of Drive:
      • (L1-L3) Inferior to Superior (45 Degree angle)
      • (L4-L5) Lateral to Medial (Perpendicular to table)
    • Thrust:
      • Leg and body drop on the patient while the contact hand is on the affected SP:
        • L1-L3 Thrust: Thrust is inferior to superior (45 degree angle) on the spinous process
        • L4-L5 Thrust: Thrust is perpendicular to the spinous process
    • Contraindications:
      • Spondylolisthesis and Acute lumbar disc lesion (herniation)

    Hand Positioning

    • If the SP doesn’t move or is stiff, this is a Type 3 fixation
    • Type 3 fixations are rare and manipulation techniques for them are not covered.
    • Type 3 fixations are theorized to result from faulty disc mechanics/closure or over dominance of the QL.

    Lumbar Mobility Scan: Sitting

    • Flexion/Extension Assessment:
      • Patient is sitting with arms crossed (bear hug)
      • Practitioner sits or stands behind the patient
      • Place the non-palpating forearm across top of the patients posterior shoulder
      • To test for flexion restrictions, place 3 fingers into the interspinous spaces and passively flex the patient’s torso forward, the spaces should open up (GAP increases).
      • To test for extension restrictions, place 3 fingers into the interspinous spaces and passively extend the patient’s torso backwards, the spaces should close (GAP decreases).
    • Lateral Flexion Assessment:
      • Patient is sitting UPRIGHT (no slouching) with arms crossed (bear hug)
      • Practitioner sits or stands behind the patient
      • Contact patient’s ipsilateral shoulder with forearm
      • Place your thumb (contact) on the lateral surface of the SP’s on the side of INDUCED lateral flexion (Ipsilateral side)
      • Take the patient’s torso and Laterally Flex them Ipsilateral (towards your testing side)
      • The SP should move Ipsilateral (Into testing side)
      • “Lumbar Lateral Flexion Loves you”
      • Now challenge.

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    Description

    Explore the complex anatomy and biomechanics of the lumbar spine in this quiz. Understand its unique movements, load-bearing capabilities, and the role of various muscles in flexion and extension. Perfect for students and professionals in the medical and physical therapy fields.

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