Spinal Stability and Fryette's Laws Quiz
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Questions and Answers

According to Fryette's laws, what happens when the spine is in a neutral position and side-bending occurs to one side?

  • Flexion occurs simultaneously.
  • Extension occurs simultaneously.
  • Horizontal rotation occurs to the same side.
  • Horizontal rotation occurs to the opposite side. (correct)

    • Which statement best describes Fryette's third law?

  • Side-bending and rotation always occur to the same side, regardless of spinal position.
  • Motion in one plane of the spine does not affect motion in other planes.
  • Introducing motion in one plane will modify motion in the other two planes. (correct)
  • Motion in one plane of the spine enhances motion in other planes.

    • In the context of spinal instability, how does the neural zone (NZ) behave relative to the pain-free zone (PFZ)?

  • The Neural Zone is thought to increase over the Pain Free Zone limits in an unstable spine. (correct)
  • The Neural Zone remains constant with changes to the Pain Free Zone in an unstable spine.
  • The Neural Zone decreases over the Pain Free Zone limits in an unstable spine.
  • The Neural Zone is unrelated to the Pain Free Zone.

    • Which of the following contributes to the passive stabilization of the spine?

    <p>Vertebral architecture and bone mineral density. (C)</p> Signup and view all the answers

    What is the role of mechanoreceptors in spinal stabilization?

    <p>Sending proprioceptive impulses to the central nervous system. (C)</p> Signup and view all the answers

    What key process defines neuromuscular control in maintaining joint stability?

    <p>The involuntary activation of dynamic restraints in anticipation of and reaction to joint motion and loading. (C)</p> Signup and view all the answers

    Which of the following is an example of feedforward neuromuscular control?

    <p>Activating core muscles before lifting a heavy object. (B)</p> Signup and view all the answers

    How does lumbar segmental instability primarily contribute to chronic low back pain?

    <p>It results in loosening of the motion segment due to injury and dysfunction. (D)</p> Signup and view all the answers

    What is the primary characteristic of spinal segmental instability?

    <p>A decreased capacity of the stabilizing systems to maintain intervertebral neutral zones within physiological limits. (D)</p> Signup and view all the answers

    Which factor is LEAST likely to be associated with lumbar segmental instability?

    <p>Strengthening of the local muscle system. (A)</p> Signup and view all the answers

    Which of the following best describes spinal stability, according to Vleeming et al. (2008)?

    <p>The effective accomodation of joints to specific load demands through tailored joint compression, coordinated muscle and ligament forces, to produce effective joint reaction forces under changing conditions. (B)</p> Signup and view all the answers

    Clinical stability of the spine is characterized by:

    <p>Limiting displacement patterns to avoid damage or irritation to the spinal cord and nerve roots, preventing deformity or pain. (A)</p> Signup and view all the answers

    The neutral zone (NZ) of intervertebral motion is best described as:

    <p>The initial range of motion where resistance is low and the spine exhibits high flexibility. (D)</p> Signup and view all the answers

    Which of the following is true of the elastic zone (EZ) in spinal motion?

    <p>It's a region where resistance to movement increases due to tension in ligaments and capsules, requiring more load per unit displacement. (A)</p> Signup and view all the answers

    The helical axis of motion (HAM) is useful because:

    <p>It precisely describes three-dimensional motion between irregularly shaped objects, like anatomic structures. (B)</p> Signup and view all the answers

    Coupled motion in the spine refers to:

    <p>The consistent association of one motion about an axis with another motion around a different axis. (C)</p> Signup and view all the answers

    Which motion typically exhibits coupled behavior in the spine?

    <p>Lateral flexion and rotation. (C)</p> Signup and view all the answers

    Why is it difficult for pure lateral flexion and pure rotation to occur in the spine?

    <p>Because of the coupling effect, for either motion to occur, at least some of the other must occur as well. (A)</p> Signup and view all the answers

    During the transition from a bipedal to unipedal stance, what compensation is likely observed in a patient with lumbar segmental instability?

    <p>Trunk compensation due to the inability to shift weight through the lumbar spine. (B)</p> Signup and view all the answers

    Which characteristic is most indicative of a multi-directional pattern of lumbar instability?

    <p>Pain in all weight-bearing postures with difficulty finding relief. (C)</p> Signup and view all the answers

    During a palpatory examination, what finding would suggest lumbar segmental instability at a symptomatic level?

    <p>Multi-directional increased intersegmental motion. (B)</p> Signup and view all the answers

    In the context of lumbar movement control dysfunction, what is the primary focus of the initial stage of training?

    <p>Isolating co-contraction of the local muscle system without global muscle substitution. (D)</p> Signup and view all the answers

    What is the focus when training isometric co-contraction of the transversus abdominis and lumbar multifidus in the early stages of rehabilitation?

    <p>Low levels of maximal voluntary contraction with controlled respiration in a neutral lordosis. (A)</p> Signup and view all the answers

    What is a common symptom across all four clinical patterns of lumbar dysfunction?

    <p>Inability to initiate co-contraction of the local muscle system within the zone (B)</p> Signup and view all the answers

    A patient presents with central back pain, experiences an arc of pain during flexion, and requires the use of their hands to return to a neutral position. Which clinical pattern does this presentation align with?

    <p>Flexion pattern (C)</p> Signup and view all the answers

    Which of the following is a key characteristic of the extension pattern of lumbar dysfunction?

    <p>Increased lumbar lordosis with segmental hinging in extension (C)</p> Signup and view all the answers

    In the context of the lateral shift pattern, what is commonly observed when palpating the lumbar multifidus muscles?

    <p>Resting muscle tone on the side ipsilateral to the shift, and atrophy and low tone on the contra-lateral side (D)</p> Signup and view all the answers

    A patient with a lateral shift pattern exhibits a loss of lumbar lordosis and a lateral shift at the affected level. Which movement is most likely to exacerbate their symptoms?

    <p>Reaching or rotating in one direction associated with flexed postures (D)</p> Signup and view all the answers

    During assessment, a patient with a suspected extension pattern demonstrates a tendency to hold their lumbar spine in lordosis during flexion, followed by a sudden loss of lordosis in the midrange, along with an arc of pain. How would you expect them to return to a neutral position?

    <p>With the use of the hands to assist the movement with a tendency to hyperlordose the spine segmentally before the upright posture (D)</p> Signup and view all the answers

    A patient is diagnosed with lower cross syndrome. Based on this diagnosis, which of the following muscle imbalances is most likely?

    <p>Tight hip flexors and weak abdominal muscles (D)</p> Signup and view all the answers

    What common compensatory strategy might you observe in a person with a flexion pattern?

    <p>Movement strategies which stabilize the motion segment out of the neutral zone and towards an end-range position (B)</p> Signup and view all the answers

    What is the primary focus of the associative stage of motor learning?

    <p>Refining a particular movement pattern. (C)</p> Signup and view all the answers

    During the associative stage, what is the recommended approach for addressing faulty movement patterns?

    <p>Breaking down the patterns into component movements and practicing with high repetitions. (A)</p> Signup and view all the answers

    What type of exercise is encouraged during the associative stage to aid in automaticity of movement patterns?

    <p>Regular aerobic exercise with correct postural alignment. (B)</p> Signup and view all the answers

    In what situations are patients encouraged to perform co-contractions during the associative stage?

    <p>When they experience or anticipate pain or feel 'unstable'. (D)</p> Signup and view all the answers

    What is the typical duration of the associative stage of motor learning?

    <p>8 weeks to 4 months, depending on various factors. (A)</p> Signup and view all the answers

    What characterizes the autonomous stage of motor learning?

    <p>A low degree of attention is required for correct performance. (D)</p> Signup and view all the answers

    Why is pain control emphasized during the component movement practice in the associative stage?

    <p>To allow for controlled movement and progression. (B)</p> Signup and view all the answers

    Which of the following videos would be MOST helpful to examine lumbar segmental instability?

    <p>The Cluster of Rehorst | Lumbar Segmental Instability. (D)</p> Signup and view all the answers

    Flashcards

    Neuromuscular control

    Involuntary activation of muscles and nerves for joint stability during movement.

    Feedforward control

    Muscle preparation in advance of movement to maintain stability.

    Feedback control

    Muscle adjustments in response to actual movement or load changes.

    Lumbar segmental instability

    Loosening of the lumbar motion segment due to injuries and muscle dysfunction.

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    Spinal segmental instability

    Reduced ability of spinal stabilizing systems to maintain neutral zones safely.

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    Fryette's Law 1

    In neutral spine, side-bending one way causes opposite rotation.

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    Fryette's Law 2

    In flexed/extended spine, side-bending one way causes same-side rotation.

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    Fryette's Law 3

    Motion in one plane reduces motion in others; they are not coupled.

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    Spinal Instability

    Loss of spinal stability can lead to abnormal movement and back pain.

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    Active Stabilization

    Muscles and tendons provide stability under nervous system control.

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    Clinical Stability

    The spine's ability to limit displacement under loads to protect the spinal cord and prevent pain.

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    Physiologic Range of Motion (ROM)

    The range of motion of a vertebra involving a neutral zone and elastic zone.

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    Neutral Zone (NZ)

    The initial part of intervertebral movement with low resistance and high flexibility.

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    Elastic Zone (EZ)

    The area where resistance increases when ligaments and tendons are under tension.

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    Helical Axis of Motion (HAM)

    A unique axis defining motion in three-dimensional space between irregularly shaped objects.

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    Coupled Motions

    The consistent association of one motion about an axis with another motion around a different axis.

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    Lateral Flexion and Rotation

    Predominant motions in the spine that occur together and cannot exist in isolation.

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    Bipedal to Unipedal Stance

    Transition from two-legged to one-legged stance affecting trunk compensation.

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    Multi-directional Pattern

    A debilitating condition often due to traumatic injury, causing pain in all weight-bearing postures.

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    Symptomatic Hypermobile Motion Segment

    Identify unstable areas in the spine correlating with pain and dysfunction.

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    Dynamic Stability in Lumbar Rehabilitation

    Involves transversus abdominis, diaphragm, and lumbar multifidus in controlling spine stability.

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    Cognitive Stage of Training

    Initial phase focusing on awareness and co-contraction of local muscles without global substitution.

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    Associative stage of motor learning

    The stage focused on refining movement patterns through practice.

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    Movement component repetition

    Performing specific parts of a movement multiple times to enhance skills.

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    Pain control during training

    Managing pain while practicing movement components to enhance learning.

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    Increase in speed and complexity

    Gradually performing movements faster and in more complex ways as skills improve.

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    Aerobic exercise in training

    Engaging in activities like walking to improve overall health and muscle tone.

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    Co-contraction during instability

    Engaging specific muscles together to stabilize during uncertain movements.

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    Duration of the associative stage

    This stage can last from 8 weeks to 4 months depending on various factors.

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    Autonomous stage of motor learning

    The final stage where tasks can be performed with minimal attention required.

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    Clinical Patterns

    Framework of assessing injuries based on direction and symptoms.

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    Four Clinical Patterns

    The main types of clinical presentations: flexion, extension, lateral-shift, multidirectional.

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    Flexion Pattern

    Common pattern characterized by central back pain and loss of lumbar lordosis.

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    Extension Pattern

    Pattern involving repeated extension injuries and increased lumbar lordosis.

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    Lateral Shift Pattern

    Pattern where there's a side shift in posture with lumbar lordosis loss.

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    Symptoms of Clinical Patterns

    Common issues include lack of movement control and inability to initiate core contraction.

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    Lower Cross Syndrome

    Condition where tight lumbar extensors and hip flexors and weak glutes and abs are present.

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    Movement Control Issues

    Inability to stabilize the spine may lead to compensatory strategies during movement.

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    Study Notes

    Lumbar Segmental Instability

    • Lumbar segmental instability is a significant cause of chronic low back pain.
    • Spinal stability is the effective accommodation of joints to specific load demands.
    • This involves joint compression, muscle and ligament forces, and adapting to changing conditions.
    • Physiological range of motion (ROM) includes the neutral zone (NZ) and elastic zone (EZ).
    • The neutral zone exhibits low resistance and high flexibility due to laxity in ligaments, capsules, and tendons.
    • Resistance increases in the elastic zone due to increased tension on tissues.
    • Three-dimensional motion involves a helical axis of motion (HAM), or screw axis of motion.
    • Coupled motions, like lateral flexion and rotation, are common. Pure flexion and pure rotation do not occur in the spine.
    • Fryette's laws describe the relationship between sidebending and rotation in the spine. In neutral position sidebending to one side is accompanied by horizontal rotation to the opposite side.
    • In positions other than neutral, sidebending to one side is accompanied by rotation to the same side.
    • Lumbar spine in resting (lordosis) position - Sidebending often couples with rotation to the opposite side.
    • Lumbar spine in marked flexion (kyphosis) position - Sidebending usually couples with rotation to the same side.
    • Damage to any spinal structure results in some level of instability.
    • Instability can lead to abnormal movement quality and/or quantity (increased motion).
    • In asymptomatic individuals, neural zone (NZ) and ROM are normal and contained within pain-free zone (PFZ).
    • In an unstable spine, NZ is thought to increase beyond PFZ limits.
    • Muscular training and surgical fusion can improve spinal stiffness, reducing NZ.
    • Three subsystems, the spinal column, muscles, and central nervous system (CNS), work synergistically to maintain stability.
    • Passive stabilization depends on vertebral architecture, bone density, disc joints, facets, ligaments, and curvature.
    • Mechanoreceptors in bones, disks and ligaments send proprioceptive impulses to the CNS, coordinating muscle tone, movement, and reflexes.
    • Active stabilization involves muscles and tendons under CNS control, ensuring stability mainly in the NZ.
    • Neuromuscular control is the involuntary activation of dynamic restraints that maintains and restores joint stability under function demand via feedforward and feedback control.
    • Damage to mechanoreceptors results in pain, inflammation, and overstress to joints & muscles.
    • Lumbar segmental instability is the weakening of the motion segment secondary to injury and dysfunction in local muscles and intervertebral discs.
    • Spinal segmental instability results in less capacity of stabilizing systems to maintain the intervertebral zones within physiological parameters.
    • Clinical patterns of instability include injury directionality, patient symptoms, and motor dysfunction, manifested in flexion, extension, lateral shift, and multidirectional patterns.
    • Symptoms shared across patterns include vulnerability, lack of movement control, inability to initiate co-contraction within the neutral zone, and compensatory movement outside the neutral zone to end-range positions

    Flexion Pattern

    • This is the most common type.
    • Central back pain and single or repeated flexion-rotation type injuries/movements are typical.
    • Loss of segmental lumbar lordosis is observed.
    • Patients experience pain while bending and struggle to return to a neutral position without aid.

    Extension Pattern

    • Characterized by an increase in segmental lumbar lordosis in the affected segment, with a loss of lordosis in segments above.
    • Individuals experiencing this pattern may have a tendency to hold the lumbar spine in lordosis leading to a sudden loss of lordosis in the mid-range flexion coupled with pain.
    • Returning to neutral often requires hand assistance, accompanied by a tendency to exaggerate lumbar lordosis before upright posture.

    Lateral Shift Pattern

    • Often involves reaching or rotating in one direction associated with flexion postures.
    • Individuals present in standing with a loss of segmental lumbar lordosis and a lateral shift.
    • Palpation tends to show high muscle tone ipsilateral to the shift and low tone on the contrlateral side.
    • Lateral shifts accompanied by movement during mid-range flexion and an arc of pain, along with bracing of the abdominal wall. Loss of breathing control frequently accompanies this pattern.

    Multi-Directional Pattern

    • Often described as serious and debilitating.
    • Associated with trauma and high pain levels.
    • All posture related to weight bearing is painful.
    • Difficulty in achieving pain-relieving weight-bearing positions.
    • Characterized by locks in the spine after sustained flexion, rotation, and extension postures.
    • Often accompanied by jabbing pain and back muscle spasms.
    • Examination reveals increased inter-segmental motion at symptomatic levels

    Physical Examination Aims

    • Identify the affected, hypermobile segment and correlate it with radiographic findings.
    • Determine clinical patterns.
    • Analyze the strategy of neuromuscular and dynamic stabilization.
    • Observe and document any loss of dynamic trunk stabilization during functional movements.
    • Observe local muscle system dysfunction, and patterns of global muscle substitution or compensatory strategies.
    • Determine the relationship between symptoms and local muscle system control.

    Lumbar Movement Control Dysfunction Screening

    • Information on the topic is accessible through links provided in the presentation.

    Management of Lumbar Segmental Instability

    • Providing dynamic stability and segmental control to the spine. Strategies include targeted exercises for the transversus abdominis, diaphragm, and lumbar multifidus muscles.
    • Focuses on deficits in motor control of these muscles.

    Stages of Rehabilitation

    • Stage 1 focuses on cognitive awareness to isolate co-contraction, without global muscle substitution.
    • Stage 2 involves refining movement patterns through repetitive components and activities, like increasing walking speed and complexity.
    • Stage 3 transitions into autonomous control with decreased attention required for the task.

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    Lumbar Segmental Instability Spring 2024-2025 PDF

    Description

    Test your knowledge on spinal stability principles and Fryette's laws. This quiz covers the role of mechanoreceptors, neuromuscular control, and the characteristics of segmental instability. Prepare to explore the complexities of spinal biomechanics and their implications for chronic pain.

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