Lumbopelvic Biomechanics and Prone Set-Ups
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Questions and Answers

What is the degree of rotation required for micro failure of annular fibers?

  • 2.5 degrees
  • 5 degrees
  • 10 degrees
  • 3 degrees (correct)

    • What is the purpose of the facets in the lumbar spine?

  • To protect the intervertebral discs from rotational stresses (correct)
  • To facilitate flexion in the lumbar spine
  • To provide additional support for the posterior annular fibers
  • To increase rotational range of motion

    • What is the typical degree of rotation allowed by the articular cartilage before compression occurs?

  • 3 degrees (correct)
  • 5 degrees
  • 1 degree
  • 2 degrees

    • What is the typical location of an intervertebral disc herniation that causes Cauda Equina Syndrome?

    <p>L3-L4 or L4-L5</p> Signup and view all the answers

    What is a red flag for Low Back Pain that requires surgical attention?

    <p>Numbness in the bladder or bowel area</p> Signup and view all the answers

    What is the degree of rotation that causes complete macro failure of annular fibers?

    <p>12 degrees</p> Signup and view all the answers

    What is a musculoskeletal cause of Low Back Pain?

    <p>Musculo-ligamentous strain</p> Signup and view all the answers

    What is the percentage of compression required for the articular cartilage to allow 3 degrees of rotation?

    <p>60%</p> Signup and view all the answers

    What is the most common cause of lumbar strain/sprain?

    <p>Faulty biomechanics of weak muscles</p> Signup and view all the answers

    What is the primary purpose of imaging in lumbar strain diagnosis?

    <p>To rule out fracture</p> Signup and view all the answers

    What is the effect of prolonged bedrest on recovery from lumbar strain?

    <p>It slows down recovery</p> Signup and view all the answers

    What is the characteristic of facet pain?

    <p>Refers to buttocks and posterior thigh</p> Signup and view all the answers

    What is the most common cause of lumbar radiculopathy?

    <p>Herniated disc</p> Signup and view all the answers

    What is the significance of dermatomes in lumbar radiculopathy?

    <p>They help diagnose nerve root irritation</p> Signup and view all the answers

    What is the characteristic of myotomes in lumbar radiculopathy?

    <p>They are muscles stimulated by a single spinal nerve</p> Signup and view all the answers

    What is the implication of HVLA in lumbar radiculopathy?

    <p>It is contraindicated in absolute conditions</p> Signup and view all the answers

    What is the effect of chemical changes on nerve root irritation?

    <p>It causes inflammation</p> Signup and view all the answers

    What is the relationship between herpes varicella and shingles?

    <p>You can only get shingles if you had chickenpox</p> Signup and view all the answers

    What is the position of the sacrum with less lordosis and facets spread apart?

    <p>Open-packed position</p> Signup and view all the answers

    Which of the following is a sign of a PI ilium?

    <p>Low crest and PSIS/ High ASIS</p> Signup and view all the answers

    What is the percentage of lower back pain caused by SI issues?

    <p>50%</p> Signup and view all the answers

    What is the effect of a compression test on a patient with PS-SB?

    <p>Relieves pain</p> Signup and view all the answers

    Which of the following is a palliative maneuver for SI Syndrome?

    <p>Laying down</p> Signup and view all the answers

    What is the effect of a compression test on a patient with AI-SB?

    <p>Increases pain</p> Signup and view all the answers

    Which of the following is a sign of a AS ilium?

    <p>High crest and PSIS/ low ASIS</p> Signup and view all the answers

    What is the position of the sacrum with more lordosis and facets approximate?

    <p>Closed-packed position</p> Signup and view all the answers

    What is the primary function of the muscles innervated by L3?

    <p>Hip flexion</p> Signup and view all the answers

    Which of the following is a visceral cause of low back pain?

    <p>All of the above</p> Signup and view all the answers

    What percentage of patients with malignant spinal neoplasms are over 50 years old?

    <p>80%</p> Signup and view all the answers

    Which of the following is a red flag for cancer?

    <p>Unexplained weight loss</p> Signup and view all the answers

    What is the most common source of spinal malignancy?

    <p>All of the above</p> Signup and view all the answers

    What is an absolute contraindication to HVLA?

    <p>All of the above</p> Signup and view all the answers

    What is the definition of a contraindication?

    <p>A problem identified before the procedure</p> Signup and view all the answers

    What is the definition of an adequate reaction?

    <p>A normal product of manual therapy</p> Signup and view all the answers

    What is the definition of an adverse reaction?

    <p>A significant increase in discomfort</p> Signup and view all the answers

    What is the most common compression fracture seen in patients with osteoporosis?

    <p>Vertebral fracture</p> Signup and view all the answers

    Study Notes

    Lumbopelvic Biomechanics

    • The sacrum has two positions: open-packed and closed-packed
    • Open-packed position:
      • Less lordosis
      • Facets spread apart
      • Disc more vulnerable to damage
      • MC disc herniation occurs when in flexion + rotation
    • Closed-packed position:
      • More lordosis
      • At risk for facet syndrome
    • Sacral compression test:
      • Gentle pressure on SB: P->A
      • Relieves pain if PS-SB
      • Increases pain if AI-SB
    • PI ilium:
      • More common
      • Signs:
        • Low crest & PSIS/ High ASIS
        • Short leg
        • Decreased prone thigh extension
        • Prominent PSIS
    • AS ilium:
      • Signs:
        • High crest & PSIS/ low ASIS
        • Long leg
        • Increased prone thigh extension
        • Less prominent PSIS

    SI Syndrome

    • Provocative (increases pain):
      • Weight-bearing
      • Sit -> stand
      • Walking
    • Palliative (decreases pain):
      • Laying down
    • Findings:
      • Pain from SI joint
      • Local tenderness
      • Leg-length inequality
      • Lig. laxity
      • Hypomobility
      • Guarded gait, compensatory mechanisms

    Lumbar Joints and Pathology

    • Rotational ROM:
      • 10-15 degrees
      • 2.5 degrees per joint
      • Articular cartilage must compress 60% to allow 3 degrees of rotation
      • >3 degrees of rotation -> micro failure of annular fibers
      • 12 degrees of rotation -> complete macro failure of annular fibers
    • Facets:
      • Protect IVD from rotational stresses
      • In flexion, facets spread out
      • Disrupts posterior annular fibers
      • Disruption greater with rotation
    • Cauda Equina Syndrome (CES):
      • Caused by midline IVD herniation @ L3, L4, or L5
      • Signs:
        • Bilateral radiculopathies
        • Distal paralysis of lower limbs
        • Sacral sensory loss
        • Sphincter paralysis

    Causes of LBP

    • Red flags for LBP:
      • Unsteady when standing/ walking
      • Difficulty passing or controlling bladder/ bowels
      • Previous cancer or osteoporosis
      • LBP with unexplained weight loss/ fever
    • Musculoskeletal:
      • Musculo-lig. injuries
        • MC cause = lumbar strain/ sprain
        • Chronic strain/ sprain MC caused by faulty biomechanics of weak muscles
      • IVD/ facet degeneration
        • Degeneration can lead to root impingement through IVF
        • Facet hypertrophy
        • Herniated disc into IVF
      • Nerve root irritation
        • Causes:
          • Direct mechanical pressure
          • Chemical changes
          • Spinal stenosis (narrowing)
          • Viral infection
    • Visceral:
      • Can refer LBP from abdominal & pelvic organs
      • e.g. gallstones, kidney stones, aorta, lymph nodes
    • Systemic:
      • Cancer
        • MC systemic disease affecting spine
        • Only accounts for 50 y/o
        • History of cancer
        • Red flags:
          • Unexplained weight loss
          • Pain > 1 month w/o improvement to conservative therapy
          • Pain not better w/ rest
      • Spinal infection
        • Absolute contraindication to HVLA
        • Osteomyelitis
        • Septic discitis
        • Spinal TB
        • Red flags:
          • History of UTI, catheters, skin infections, injection sites, IV drug users
          • Fever
      • Compression fractures
        • MC in pt w/ osteoporosis
        • Red flags:
          • Osteoporosis
          • Corticosteroid usage
          • >50 or >70 y/o
          • Hx of trauma

    Contraindications

    • Definitions:
      • Contraindication:
        • Problem identified before the procedure
        • Absolute contraindication
          • Contraindicative to ANY form of thrust manipulation
        • Relative contraindication
          • Potential contraindication depending on severity/ stage
      • Complications:
        • Problem that occurs after procedure performed
        • Reversible complication
          • Pathological condition that is reversible
          • Onset within 2 days
          • Tissue damage but can be reversed
        • Irreversible complication
          • Onset within 2 days
          • Permanent tissue damage
      • Reaction:
        • Episodes of increased symptoms that resolve spontaneously
        • Normal reaction
          • Minor increase in discomfort
          • MC in pt w/ successful treatment
        • Adverse reaction
          • Significant discomfort
          • Least common
        • Adequate reaction
          • Normal product of manual therapy
          • Onset 6-12 hours
          • Local soreness, tiredness, headache
          • No decrease in work, ADL's
          • Duration

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    Description

    Test your knowledge of lumbopelvic biomechanics, including prone set-ups, mobilizations, and postures, as well as sacrum anatomy and mechanics.

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