Podcast
Questions and Answers
What is the nature of the coupling described by Fryette in neutral versus flexed or extended postures?
What is the nature of the coupling described by Fryette in neutral versus flexed or extended postures?
It is contralateral in neutral and ipsilateral in flexed or extended postures.
During lumbar flexion, what changes occur to the anterior and posterior annulus fibrosus?
During lumbar flexion, what changes occur to the anterior and posterior annulus fibrosus?
The anterior annulus fibrosus experiences compression and bulging, while the posterior annulus fibrosus is stretched.
Which lumbar segment exhibits the largest range of motion for lateral flexion and axial rotation?
Which lumbar segment exhibits the largest range of motion for lateral flexion and axial rotation?
The largest range of motion occurs between the L2 and L3 vertebrae.
How does the movement of the nucleus pulposus differ between lumbar flexion and extension?
How does the movement of the nucleus pulposus differ between lumbar flexion and extension?
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What occurs to the inferior facet of the superior lumbar vertebra during lumbar flexion?
What occurs to the inferior facet of the superior lumbar vertebra during lumbar flexion?
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What is the effect of lumbar extension on the intervertebral foramen on the right side?
What is the effect of lumbar extension on the intervertebral foramen on the right side?
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Describe how positional distraction differs from traditional lumbar traction.
Describe how positional distraction differs from traditional lumbar traction.
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Explain the movement of the inferior facet of the superior vertebra during lumbar extension.
Explain the movement of the inferior facet of the superior vertebra during lumbar extension.
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What is the recommended frequency for performing positional distraction at home?
What is the recommended frequency for performing positional distraction at home?
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In the context of spinal movements, what does 'coupled with contralateral rotation and side bending' imply?
In the context of spinal movements, what does 'coupled with contralateral rotation and side bending' imply?
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What role do the supraspinous and interspinous ligaments play in spinal movement?
What role do the supraspinous and interspinous ligaments play in spinal movement?
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How do the intertransverse ligaments affect lateral spinal motion?
How do the intertransverse ligaments affect lateral spinal motion?
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What is the primary function of the anterior longitudinal ligament?
What is the primary function of the anterior longitudinal ligament?
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What does the posterior longitudinal ligament reinforce?
What does the posterior longitudinal ligament reinforce?
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What is the significance of the orientation of lumbar facet joints?
What is the significance of the orientation of lumbar facet joints?
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What occurs to load distribution in the lumbar region during intervertebral disc degeneration?
What occurs to load distribution in the lumbar region during intervertebral disc degeneration?
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Describe the resting position of the lumbar spine.
Describe the resting position of the lumbar spine.
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How does lateral flexion couple with rotation in the lumbar spine?
How does lateral flexion couple with rotation in the lumbar spine?
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What are the primary functions of the vertebral column?
What are the primary functions of the vertebral column?
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Define low back pain syndrome (LBP).
Define low back pain syndrome (LBP).
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Identify one common pathological condition associated with low back pain.
Identify one common pathological condition associated with low back pain.
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What role do the facet joints play in lumbar spine motions?
What role do the facet joints play in lumbar spine motions?
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Describe the structural composition of an intervertebral disc.
Describe the structural composition of an intervertebral disc.
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What does the term 'red flags' refer to in the context of lumbar spine assessment?
What does the term 'red flags' refer to in the context of lumbar spine assessment?
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How does poor posture affect discal pressure in the lumbar region?
How does poor posture affect discal pressure in the lumbar region?
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Name the ligaments associated with lumbar stability and their function.
Name the ligaments associated with lumbar stability and their function.
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Study Notes
Lumbar Spine Problems
- Lumbar spine structure: Composed of vertebrae (T12, L1-L5, sacrum, coccyx) and facet joints
- Objectives: Students should memorize related clinical anatomy and biomechanics, define low back pain syndrome, describe pathological classifications of LBP and common conditions, and identify red flags
- Facet joint orientation direction of lumbar spine motions
- Common pain types
- Common lumbar pathological conditions
- Vertebral column function: Transmits upper body weight to lower limbs, protects spinal cord, aids in gait and trunk movement; provides stability, flexibility, and protection
- Vertebral column structure: 33 vertebrae divided into cervical, thoracic, lumbar, sacral, and coccygeal categories; 23 intervertebral discs
- Spinal curves: Two primary curves (kyphotic) present at birth; two secondary curves (lordotic) develop later in a person's life
- Normal lumbar vertebra structure: Components include vertebral body, neural arch (with pedicles and posterior elements), transverse processes, spinous processes, articular processes, and intervertebral disc
- Normal lumbar disc structure: A tough fibrous shock-absorbing pad located between lumbar vertebrae; 20-25% of the vertebral column length
- Cartilaginous endplates hold individual discs in place
- Annulus fibrosus (outer band) encases the nucleus pulposus (gel-like substance)
- Intervertebral disk function: Allows vertebra to tilt, increasing range of motion at the interbody joint
- Posture effect on pressure: Sleeping, sitting, and leaning forward/hunched over significantly increases disc pressure compared to standing
- Lumbar nerve roots: Exit spinal canal through small passageways between vertebrae and discs; can cause radiculopathy when a damaged disc presses on nerve roots
- Lumbar ligaments: Function to limit vertebral movement. Specific examples include: ligamentum flavum, supraspinous/interspinous ligaments, intertransverse ligaments, anterior longitudinal ligament, posterior longitudinal ligament, apophyseal joint capsule (facet joint), iliolumbar ligament
Facet Joints
- Function: Plays a crucial role in load transmission, provides posterior load-bearing, stabilizes segmental motion in flexion and extension, and shares in lumbar load-bearing (20-25% which can reach up to 70% with degeneration of the intervertebral disc).
- Sagittal plane orientation of lumbar facets favors flexion and extension
- With increased extension/lordosis and with degeneration of the intervertebral disc the facet joints assume more of the compressive load.
- The facet joints' sagittal plane orientation allows for a wide range of flexion and extension movement and resists rotation.
- Superior facets are concave; inferior facets are convex
- Facet joint direction during lumbar motions: Relationship with flexion, extension, rotation, and side bending movements
Lumbar Movements
- Motions occur in three planes (sagittal, coronal, transverse)
- Specific movements of the lumbar spine cause compression and bulging of the anterior annulus fibrosus and stretching of the posterior annulus fibrosus and nucleus pulposus will migrate posteriorly. In extension, the superior vertebra tilts and glides posteriorly over the vertebra below, stretching the anterior annulus fibrosus and the bulging posterior portion of the disc causing the nucleus pulposus to migrate anteriorly
- The greatest lateral flexion and axial rotation happen between L2 and L3, while flexion and extension primarily occur on lower levels (L4-S1)
- Coupled motions of side bending and rotation:
- Contralateral in neutral spine
- Ipsilateral in flexed/extended spine
Treatment
- Positional distraction: Alternative to lumbar traction, allowing for isolation of affected spinal level and maximally opening neuroforamen, can be done at home
- Advantages include being localized, able to be done at home, and under patient control
- Typically lasts 10-20 minutes with possible performance several times per day
Lumbar Musculature
- Muscles involved in supporting and influencing lumbar movement: Includes, but is not limited to, erector spinae, quadratus lumborum, psoas major, and abdominal muscles.
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Description
This quiz assesses your understanding of the anatomy and biomechanics of the lumbar spine. You will explore key concepts such as low back pain syndrome, pathological classifications, and common conditions related to lumbar spine issues. Test your knowledge on structure, function, and spinal curves to reinforce your learning.
