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Active Care Exam Two > Lumbar Spine/Core > Flashcards

Lumbar Spine/Core Flashcards

(102 cards)

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1
Q

Which muscles are tight in the lower cross syndrome?

A

Erector spinae and iliopsoas

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2
Q

Which muscles are weak in the lower cross syndrome?

A

Abdominal muscles, gluteus maximus

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3
Q

What is the neutral zone in reference to the spine?

A

Region of laxity around the neutral resting position of a spinal segment (between flexion and extension, for example)

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4
Q

According to Panjabi, how can neutral zone impairment lead to pain and disability?

A

Decrease in the capacity of the stabilizing system of the spine to maintain the intervertebral neutral zones within physiological limits

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5
Q

How does high-speed trauma affect a spinal segment’s neutral zone?

A

Increases it

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6
Q

Biomechanically speaking, what is the most stable position for stress on the spine to be placed?

A

Within neutral zone

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7
Q

What things make up the passive system that influences the neutral zone?

A

Vertebrae, IVD, zygaphophyseal joints, ligaments

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8
Q

What things make up the active system that influences the neutral zone?

A

Muscles and tendons

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9
Q

What things make up the neural system that influences the neutral zone?

A

Central and peripheral nervous systems

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10
Q

What 3 large body concepts make up the overall stability of the spine?

A

Nervous system, spinal column, muscles

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11
Q

What muscles make up the core stabilizers?

A

Transversus abdominis, pelvic floor, diaphragm, multifidis

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12
Q

Which involves larger, torque-producing muscles that are anatomically more superficial: global system or local system of muscles?

A

Global: control spinal orientation and balance of external loads

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13
Q

Which involves anatomically deeper muscles that provide stability through increasing spinal segmental stiffness: global system or local system of muscles?

A

Local: play a role in anticipation of motion

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14
Q

When are the core stabilizers at work?

A

All times

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15
Q

When do the core stabilizers increase their action?

A

BEFORE any further loading or motion

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16
Q

Which pelvic tilt is utilized to find the neutral zone by drawing the belly up toward the rings and toward the floor while flattening the low back against the floor?

A

Posterior pelvic tilt

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17
Q

Which pelvic tilt is utilized to find the neutral zone by pushing the tail bone down and arching the low back up from the floor?

A

Anterior pelvic tilt

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18
Q

About how many muscle attachments make up the core area?

A

29

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19
Q

Which core muscles form the “core container”?

A

Pelvic floor, diaphragm, transversus abdomens

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20
Q

What additional muscles to the core function to stiffen the spine and stabilize the core?

A

Iliocostalis, longissimus, multifidi, rotators, intertransversarii (also ligaments and fascia, technically)

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21
Q

What are the extensors of the thoracolumbar spine?

A

Longissimus, iliocostalis, and multifidis

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22
Q

What is the thoracic portion of the erector spinae muscles that are extensors of the thoracolumbar spine?

A

Longissimus thoracis pars thoracics

Longissimus lumborum pars thoracis

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23
Q

What is the lumbar portion of the erector spinae muscles that are extensors of the thoracolumbar spine?

A

Longissimus thoracis pars lumborum

Longissimus lumborum pars lumborum

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24
Q

What is the origin of the pars thoracis?

A

Posterior sacrum and medial iliac crest

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25
To where do the pars thoracis attach?
Ribs and vertebral components (run parallel to spine)
26
Is the pars thoracics mostly slow or fast twitch fibers?
Slow (type 1) (75%)
27
Is the pars thoracis a global/superficial muscle or local/deep?
Global/superficial
28
What is the function of the pars thoracics?
Produce greatest amount of lumbar extension with minimal compression of the spine
29
What is the origin of the pars lumborum?
Posterior sacrum and medial aspect of iliac crest
30
To where do the pars lumborum attach?
Mammillary and transverse processes of lumbar vertebrae
31
What is the action of the pars lumborum?
Generates posterior sheer with extension on the superior vertebrae
32
Is the pars lumborum made of mostly type 1 or type 2 fibers?
Even mix of both
33
To what does the multifidus attach to?
Spinous processes
34
Do the multifidi provide global or local muscle action?
Local
35
Multifidi have a high concentration of which muscle fiber type?
Type I (endurance) with extensive capillary system
36
How can a low back injury affect the multifidi?
Asymmetric atrophy
37
Which motions are the rotators and intertransversarii usually described as causing?
Twisting and lateral flexion (minimal contribution, however)
38
Which have more muscle spindles: rotators/intertransverarii or multifidi and why?
Rotators/intertransversarii: function as length transducers and position sensors at every lumbar and thoracic joint
39
An EMG study by McGill found that rotator muscles were silent upon which movement and active upon which?
Silent on side of trunk rotation, active on side of stretch
40
What is the action of the internal and external oblique abs?
Twisting and lateral flexion (also accessory muscles for respiration)
41
What fascia is seen anterior to the internal and external oblique abs? Posterior to?
``` Anterior = abdominal fascia Posterior = thoracodorsal fascia ```
42
The rectus abdominis is contained within what structure?
Abdominal fascia
43
The rectus abdominis also connects to what muscle superiorly?
Pec major
44
What is the action of rectus abdominis?
Trunk flexion
45
Why is the rectus abdomininis sectioned off?
Prevents bulking upon shortening and allows greater trunk flexibility when contracted
46
Why would it make sense for the rectus abdominis to not be sectioned off?
All section have the same nerve supply; one long muscle would create more force
47
The psoas muscle attaches to what part of the spine?
T12-L5
48
What is the action of the psoas?
Hip flexion (causes some substantial spinal compression)
49
How does the lower cross system affect the psoas muscle?
Facilitated (tight) and therefore puts chronic compression on the spine
50
What is the quadratus lumborum attached to?
Each lumbar vertebrae, pelvis, and rib cage
51
What is the strongest muscular stabilizer of the spine?
Quadratus lumborum
52
What type of contraction is seen with the QL?
Isometric (hardly changes length during any spine motion)
53
What is the deepest muscle of the abdominals?
Transversus abdominis
54
From where does the transversus abdominis arise?
From thoracolumbar fascia between the iliac crest and 12th rib
55
To what does the transversus abdominis attach?
Inguinal ligament, iliac crest, and lower 6 ribs (anteriorly to abdominal aponeurosis)
56
Contraction of the transversus abdominis has what effects on the body?
1 increased intra-abdominal pressure 2 core and lumbar spine stiffening 3 provides compression to SI joints
57
During movement of the upper and lower extremities, which muscle is recruited first before any limb movement occurs?
Transversus abdominis
58
Does the compression of the SI joints by the transversus abdominis cause force closure or form closure of the SI joint?
Force closure
59
What is "form closure"?
Shape of the joint compresses or closes the joint (think form = shape)
60
What is "force closure"?
Force from contraction of transversus abdominis compresses/closes SI joint space
61
What are the exercises used to strengthen the pelvic floor?
Kegel exercises
62
What muscles make up the pelvic floor?
Coccygeus, levator ani, iliococcygeus, pubococcygeus
63
What else are the muscles involved with kegel exercises used for?
Stop flow of urine
64
How many times per day should kegel exercises be done by a patient?
200X
65
What does the diaphragm attach to?
Lower 6 ribs, xiphoid, L1-L4, central tendon
66
What structure forms the top of the abdominal core?
Diaphragm
67
What role does compression play when it comes to core stability?
Equal dispersion of compression and tension forces are necessary for optimal stabilization
68
What is tensegrity?
A force pulling in one direction is equally opposed by a force pulling in the opposite direction (leading to stability overall)
69
What is the cause of compression with the concept of tensegrity?
Gravity
70
What structures of the human body allow for tension to be absorbed and provided via tensegrity?
Muscle, tendon, bone, ligament
71
Should a patient be instructed to suck in or "hollow" the abdominal wall?
NO - always try to keep the spine in NEUTRAL during exercises
72
What muscles cause lumbar hyperlordosis?
Shortened erector spinae
73
What muscles cause anterior pelvic tilt?
Weakness in gluteals, tight quads
74
What muscles cause a protruding abdomen?
Weak abdominals (duh)
75
What muscles are responsible for foot flare?
Tightness in external hip rotators
76
What muscle could be responsible for pain over the lateral knee or lateral SI area?
Shortened TFL
77
What is the area of concern with an active straight leg raiser test?
Ability to perform test on a graded scale (not focused on pain like in NMS testing)
78
What muscle is being tested during an active straight leg test when compressing the ASIS? Trochanters? PSISs up and medial?
``` ASIS = transverse abdominis Trochanters = pelvic floor PSIS = multifidis ```
79
What is a positive sign for the prone instability test?
Reduce pain when lifting legs of floor
80
What does it mean if a patient has a positive sign for the prone instability test?
Means they're likely to benefit from stabilization exercises
81
What is the hip extension motion pattern order?
1 ipsilateral hamstring 2 ipsilateral gluteals 3 contralateral spinal extensors 4 ipsilateral spinal extensors
82
When a patient has weak glutes, which muscles must be recruited further for hip extension?
Paraspinals
83
What muscles are weak and tight if the patient expresses an inability to hold knee extension?
Facilitated hamstrings; inhibited glutes
84
What muscles are weak and tight if the patient exhibits forced lumbar extension?
Facilitated thoracolumbar extensors; inhibited glutes
85
What muscle should be evaluated when upper back/thoracic spine activation is seen to occur first with trap activation?
Contralateral lattisimus dorsi
86
According to the George Constanza Method of rehab, how would you treat altered hip extension?
Stretch the tight muscles (psoas, quads, and hamstrings), strengthen the weak ones (gluten, abdominals) and also adjust thoracics, lumbars, SI
87
What could be a muscular cause of decreased ROM with an altered hip abduction pattern?
Adductor tightness
88
What could be a muscular cause of forward drift and hip flexion during an altered hip abduction pattern?
TFL substitution
89
What could be a muscular cause of foot flare and hip external rotation during an altered hip abduction pattern?
Piriformis substitution
90
What could be a muscular cause of hip hiking (aka bending at the waist) during altered hip abduction pattern?
QL substitution
91
What would be the retraining treatment for an altered hip abduction motor pattern?
Stretch adductors (TFL, QL, piriformis), strengthen glutes, adjust
92
What is a failed test for the glute activation screen?
Cramping of down leg hamstring or if hip drops/elevates as a compensation for glute weakness
93
What muscles are overactive or inhibited with a failed flute activation screen?
Overactive hamstring inhibited glutes
94
Monster walks help strengthen what muscle?
Glutes (med/min)
95
What is another name for the stratification syndrome?
Layer syndrome
96
What syndrome is a combination of both upper and lower cross?
Stratification syndrome (aka layer syndrome)
97
Which erector spinae are tight and which are weak with the stratification syndrome?
``` Tight = thoracolumbar Weak = lumbosacral (think just like glutes) ```
98
The lumbar spine should never be fully placed into what motion?
Flexion
99
What is a good way to pre-stress the lumbar system for stability during lifting?
Abdominal brace
100
The saddle toss maneuver for lifting involves what body part?
Knee
101
The direct force during a big lift should be directed through what part of the body?
Naval (keeps forces through low back)
102
What organization is responsible for the development of proper lifting recommendations?
National Institute for Occupational Safety and Health (NIOSH)

Active Care Exam Two (4 decks)

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