Lumbar Spine Anatomy and Biomechanics

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Questions and Answers

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?

They primarily facilitate forward and backward bending Signup and view all the answers

What is the typical lumbar curve range in degrees?

40-60 degrees Signup and view all the answers

During lumbar flexion, which muscle initiates the movement?

Psoas Signup and view all the answers

Which ligament is primarily involved in limiting lumbar extension?

Anterior Longitudinal Ligament Signup and view all the answers

What happens to lumbar lordosis during an anterior pelvic tilt?

It increases Signup and view all the answers

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

Contralateral axial rotation Signup and view all the answers

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

Abdominals Signup and view all the answers

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

It is relaxed along with most other muscles Signup and view all the answers

How does lumbar flexion impact the pelvis after 60 degrees?

The pelvis starts to rotate additional degrees Signup and view all the answers

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

To improve kinetic chain function 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?

They should open up Signup and view all the answers

What is a key component when assessing lumbar lateral flexion?

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

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

Towards the testing side Signup and view all the answers

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

Towards the same side as the testing Signup and view all the answers

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

Slight mobility Signup and view all the answers

What common mistake might affect the lateral flexion assessment positioning?

Patient should slouch in the chair Signup and view all the answers

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

They should close Signup and view all the answers

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

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

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

Prone with lumbar spine in midrange Signup and view all the answers

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

The mobilizing/manipulating hand Signup and view all the answers

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

Bring the patient's knees toward the chest Signup and view all the answers

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

It decreases pain and enhances range of motion Signup and view all the answers

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

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

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

It optimizes the effectiveness of the mobilization techniques 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?

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

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

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

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

Prone on the treatment table. Signup and view all the answers

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

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

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

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

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

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

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

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

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

About 2 to 3 times for best results. Signup and view all the answers

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

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

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

Lateral flexion is associated with contralateral axial rotation. Signup and view all the answers

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

Ipsilateral lateral flexion coupled with ipsilateral axial rotation. Signup and view all the answers

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

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

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

Affects the contralateral Longissimus and Spinalis portions. Signup and view all the answers

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

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

Which approach is critical for improving kinetic chain function?

Eliminate compensatory mechanical stress on adjacent structures. Signup and view all the answers

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

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

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

Assessing the coupled axial rotation with palpation. Signup and view all the answers

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

Type 4 Signup and view all the answers

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

Decreased gap between interspinous spaces Signup and view all the answers

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

They are contralateral to the side of rotation assessment Signup and view all the answers

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

Both lateral flexion and contralateral rotation Signup and view all the answers

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

Sitting upright with arms crossed Signup and view all the answers

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

The spinous process moves towards the new testing contact Signup and view all the answers

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

Spinous processes moving ipsilaterally Signup and view all the answers

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

Type 4 requires a rotational component assessment Signup and view all the answers

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

Posterior rotation mal-fixation from L1-L5 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?

Abnormal lateral flexion Signup and view all the answers

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

Pelvis level with the affected segment Signup and view all the answers

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

Avoid any traction techniques Signup and view all the answers

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

SP moves into testing side but remains fixed Signup and view all the answers

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

To produce closure of the affected segment Signup and view all the answers

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

Spinous process 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?

Hypertonicity of the sacrospinalis muscle Signup and view all the answers

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

Medial to lateral Signup and view all the answers

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

On the patient’s shoulder during traction Signup and view all the answers

Which contraindication applies to all the described lumbar mobility techniques?

Spondylolisthesis Signup and view all the answers

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

To facilitate joint mobility Signup and view all the answers

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

SP moves away from the testing side Signup and view all the answers

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

Disc closure 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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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.