Lumbopelvic Anatomy, Kinematics, and Palpation PDF

Lumbopelvic Anatomy and Kinematics Adam Squires PT, DPT, Cert SMT, Cert DN Board Certified Specialist in Orthopedic Physical Therapy  Objectives Understand the normal anatomy of the lumbopelvic region. Understand the osteo and arthrokinematics of the lumbopel...

Lumbopelvic Anatomy and Kinematics Adam Squires PT, DPT, Cert SMT, Cert DN Board Certified Specialist in Orthopedic Physical Therapy  Objectives Understand the normal anatomy of the lumbopelvic region. Understand the osteo and arthrokinematics of the lumbopelvic region. Become familiar with Fryette’s laws of coupled motion in the spine. Demonstrate ability to palpate selected structures in the lumbopelvic region. Lumbar Spine  Lumbar Spine 5 lumbar vertebrae Anterior longitudinal ligament Posterior longitudinal ligament Ligamentum flavum Interspinal ligament  Lumbar Spine https://www.goodmancampbell.com/conditions/spine/spine-anatomy/ https://radiopaedia.org/articles/vertebra  Lumbar Spine Facet joints Orientation varies significantly Facet anomalies (tropisms) at L5–S1  Lumbar Spine Intervertebral Disc Endplate Lumbar Spine Muscles Sacrum/Pelvis  Sacrum 5 fused vertebrae Coccyx https://coreem.net/core/sacral-fractures/ https://medlineplus.gov/ency/imagepages/19464.htm Pelvis Anatomical Differences Pelvis Sacral/Pelvic Muscles Sacral/Pelvic Muscles Lumbopelvic Nerves https://teachmeanatomy.info/lo wer-limb/nerves/lumbar-plexus/ Lumbopelvic Nerves https://texstarchiropractic.com/what-is-your-sciatic-nerve-and-why-does-it-hurt-so-much/ Osteokinematics  Lumbopelvic Osteokinematics Flexion – 40-60 deg Extension – 20-35 deg Lateral flexion – 15-20 deg Rotation – 3-18 deg  Lumbopelvic Osteokinematics Rotation limited by facet joint orientation https://www.researchgate.net/figure/Rotation-of-the-lumbar-spine-The-inferior-articulate-process-of-upper-vertebra-marked_fig6_6428554  Lumbopelvic Osteokinematics Nutation vs Counternutation http://thepainnovationrevolution.com/wp-content/uploads/2019/09/nutationcounternutation.jpg  Innominate Dysfunctions Inflare/outflare Anterior/posterior rotation Upslip/downslip https://www.amboss.com/us/knowledge/pelvic-and-sacral-osteopathy  Innominate Dysfunctions https://phcn-online.com/2021/11/26/joint-mobilization-of-the-lumbopelvic-spine-part2/ https://www.osmosis.org/learn/Pelvis_muscle_energy_treatment  Sacral Torsions Left Oblique Axis Right Oblique Axis Superior Transverse Axis Middle Transverse Axis - posture here Inferior Transverse Axis http://www.kidport.com/reflib/science/humanbody/skeletalsystem/images/S acrum.jpg https://www.amboss.com/us/knowledge/pelvic-and-sacral-osteopathy Arthrokinematics  Lumbopelvic Arthrokinematics Facet joint slide without roll Intervertebral joints pivot and glide Ball bearing https://link.springer.com/chapter/10.1007/978-3-031-25322-5_9 https://www.youtube.com/watch?app=desktop&v=Nw4CFPar1H4  Lumbopelvic Arthrokinematics “Closing” of facet joints – extension, ipsilateral lateral flexion, contralateral rotation “Opening” of facet joints – flexion, contralateral lateral flexion, ipsilateral rotation https://www.wheelessonline.com/is sls/section-2-chapter-10-function- and-dysfunction-of-the-facet-joint/  Lumbopelvic Arthrokinematics When the sacrum nutates, its articular surface glides When the sacrum counternutates, its articular surface inferoposteriorly relative to the innominate bones. glides anterosuperiorly relative to the innominate bones. Fryette’s Laws  Fryette’s Laws Law #1 – Neutral Mechanics Spine is in neutral (not extended or flexed) Side bending and rotation occur in OPPOSITE directions Ex: left side-bending results in right rotation of the segment https://www.youtube.com/watch?app=desktop&v=OF2koDeFbRQ  Fryette’s Laws Law #2 – Non-neutral Mechanics Spine is either flexed or extended Side bending and rotation occur in the SAME direction Ex: right side-bending results in right rotation  Fryette’s Laws Law #3 Motion in one direction will decrease motion in all other directions Most relevant in high-velocity, low-amplitude manipulation More comfortable Potentially more safe – avoiding end-range motions Palpation  Palpation Bony Landmarks Spinous process Top of iliac crest = L4 spinous process PSIS Sacral base S2 Spinous process Inferior Lateral Angle of sacrum (ILA) Ischial tuberosity ASIS, AIIS Pubic Symphysis  Palpation Soft tissues Erector spinae Hip abductors Hip extensors/rotators Hip flexors Hip adductors  Objectives Understand the normal anatomy of the lumbopelvic region. Understand the osteo and arthrokinematics of the lumbopelvic region. Become familiar with Fryette’s laws of coupled motion in the spine. Demonstrate ability to palpate selected structures in the lumbopelvic region. Questions